RESUMO
PURPOSE: We aim to report our results in terms of chronic toxicities and cosmetic outcomes after intraoperative radiotherapy (IORT) using kV X-rays in women treated for early breast cancer at our institution. METHODS: Patients with early breast carcinoma were recruited between April 2011 and November 2014. After breast-conserving surgery, patients were treated with IORT using the Intrabeam® device. IORT was completed by whole-breast radiotherapy (WBRT) at a dose of 46-50.4 Gy in 23-28 fractions in case of adverse pathologic criteria on the final specimen examination. Skin toxicity was graded using the Late Effects in Normal Tissues-Subjective, Objective, Management and Analytic (LENT-SOMA) scale every 6 months, and cosmetic outcomes were evaluated at 36 months by patient self-evaluation and by two radiation oncologists, on a 1-10 scale. RESULTS: Forty-one women received IORT only and 30 patients received IORT followed by WBRT (IORT + WBRT group). After a median follow-up of 38.9 months, no locoregional or distant recurrence occurred. After IORT only, 2.4% of grade 2 or higher breast fibrosis, and no other grade 2 or higher disease, was observed. In the IORT + WBRT group, grade 2 or higher fibrosis and grade 2 or higher breast retraction were observed in 43.3 and 23.3% of patients, respectively. Objective cosmetic outcomes were very good and significantly better in the IORT-only group compared with the IORT + WBRT group (8.87 vs. 6.96) (p < 0.001). CONCLUSION: IORT using the Intrabeam® is well-tolerated, with very little chronic toxicity and good cosmetic outcome. However, a high rate of grade 2 or higher chronic breast toxicity was observed when IORT had to be completed by WBRT.
Assuntos
Neoplasias da Mama/radioterapia , Mama/patologia , Recidiva Local de Neoplasia , Radiodermite/etiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Fracionamento da Dose de Radiação , Eritema/etiologia , Estética , Feminino , Fibrose , Seguimentos , Humanos , Período Intraoperatório , Mastectomia Segmentar , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos , Radioterapia Adjuvante/instrumentação , Taxa de Sobrevida , Cicatrização/efeitos da radiaçãoAssuntos
Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal/diagnóstico , Carcinoma Ductal/patologia , Células Gigantes/patologia , Osteoclastos/patologia , Idoso , Biópsia por Agulha Fina/métodos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , HumanosRESUMO
Nonpuerperal uterine inversion is a very rare event. We reported on the first ever case of nonpuerperal uterine inversion due to adenomyosis. Magnetic resonance imaging is recommended in cases with an unusual vaginal mass, so that this possible uterine etiology can be taken into consideration.