Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging.

Background: Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC). Methods and Results: Retrospective three-dimensional surface imaging (3D-SI) of 100 breasts taken before or after breast conserving surgery for breast cancer were retrieved for reliability analysis. Three assessors followed a standardized measurement technique using two software programs, Vectra® 3D Analysis Module (VAM) and Breast Sculptor®. Mean breast volume was 489.9 ± 206 cc using VAM and 480.1 ± 229.1 cc using Breast Sculptor. Lin's concordance showed poor agreement between programs (0.81-0.88). Measurements using VAM had excellent intra- and inter-rater reliability with SEM = 4.1% for one assessor and 8.7% for multiple assessors. Breast Sculptor also had excellent intra-rater and substantial inter-rater reliability but the SEM was much larger at 14.5% (intra-rater) and 19.1% (inter-rater). The SDC value was lowest for VAM and a single rater with 56 cc indicating a meaningful change beyond measurement error. Conclusion: Breast volume measurements captured with 3D-SI using VECTRA-XT are highly reliable, but the volumes, SEM, and SDC varied between the two software programs. Measurement error was lowest with VAM software. Although the usefulness of VECTRA-XT and VAM software to detect change in breast volume is promising, further solutions to reduce measurement error are required to improve clinical utility to measure breast lymphedema.

Improving medical student education in radiation oncology: Integrating and evaluating an experiential interdisciplinary workshop into the medical student curriculum.

INTRODUCTION: To evaluate a novel interactive educational workshop designed to improve medical student knowledge and awareness of radiation oncology (RO). METHOD: A 2.5-h pilot workshop in RO was introduced in 2018 for one teaching hospital cohort of postgraduate medical students. Students participated in a voluntary interactive programme of learning 'stations' situated in the RO department, introducing students to practical aspects of RO planning, delivery and patient care. Students were surveyed before and immediately after the workshop to assess their perceptions of its educational value and the impact on RO knowledge and awareness. RESULTS: Forty-four of 51 students participated in the RO workshop with 44 students (100%) completing the preworkshop survey and 38 students completing postworkshop survey (86%). Twenty-three of 44 students had prior RO teaching, and 11/23 students (48%) had received between 30 and 60 min of teaching with only 4/44 (9%) confident in their knowledge of RO. Following the workshop, 22/38 (58%) felt their knowledge now met expectations for their level of training. Preworkshop, objective RO knowledge was low, regarding optimal use of RT (25%) and bone pain response (41%) and improved to 100% and 86% respectively. Overall, feedback around workshop value was highly positive with regard to enjoyment (97%) and students commented on the enthusiasm and multidisciplinarity of teachers. CONCLUSION: There remain large gaps in medical student knowledge and confidence in RO, and intervention is necessary to address these discrepancies. A novel interactive RO workshop for medical students has demonstrated improved awareness and knowledge with high levels of self-reported learner satisfaction.

Can adjuvant pelvic radiation therapy after local excision or polypectomy for T1 and T2 rectal cancer offer an alternative option to radical surgery?

PURPOSE: To determine outcomes after adjuvant pelvic local radiation therapy (RT) +/- concurrent chemotherapy for T1 and T2 rectal carcinomas treated with local excision or polypectomy. METHODS: We retrospectively identified adult patients with histologically proven T1 and T2 rectal adenocarcinoma, diagnosed incidentally at time of local excision or polypectomy between 01 January 2007 and 31 December 2019, and appropriately staged to confirm N0 M0 status. Patients were excluded if they had recurrent cancer or had received total mesorectal excision (TME): anterior resection (AR) or abdominoperineal resection (APR). Patient, tumour and treatment factors, together with disease and toxicity outcomes were collected from institutional medical records, correspondence and investigation reports. Descriptive statistical analyses were employed. The primary endpoint was loco-regional control and secondary endpoints were treatment-related toxicity, disease free survival, overall survival and rate of surgical salvage for pelvic recurrence. RESULTS: The median age of the 15 eligible patients was 73 (range 49-82 years). There were 9 men (60%) and 6 women (40%). The majority had T1 disease (80%) and most had received endomucosal resection (80%). All patients received 43-52Gy (EQD2) to the primary and 43-48Gy (EQD2) to the pelvis with 46.6% receiving concurrent chemotherapy (infusional 5-FU or oral capecitabine). At median follow up of 51 months, there were no local or regional recurrences. One patient experienced an isolated distant relapse at 48 months without any locoregional recurrence. CONCLUSION: Our findings demonstrate good locoregional disease control with the use of adjuvant pelvic RT for T1 and T2 rectal adenocarcinoma initially treated with polypectomy or local (non-oncological) excision. These findings indicate that adjuvant pelvic RT may provide an alternative to TME surgery in patients with incidentally detected early rectal cancers.