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1.
Rev Bras Enferm ; 75(1): e20210118, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34614087

RESUMEN

OBJECTIVE: To estimate the incidence and degree of acute radiodermatitis at the end and after the end of treatment in women with breast cancer undergoing hypofractionated radiotherapy. METHODS: Observational, prospective, and longitudinal study, conducted between March 2019 and January 2020, in a radiotherapy outpatient clinic. RESULTS: Thirty-two women participated in the study, among whom, in the last session of hypofractionated radiotherapy, 15 (46.9%) had radiodermatitis, erythema in 13 (40.6%), and wet peeling in 2 (6.3%). In the post-treatment evaluation, 27 (84.4%) had radiodermatitis, erythema in 17 (53.1%), dry peeling in 8 (25%), and wet peeling in 2 (6.3%). CONCLUSION: The general incidence of radiodermatitis after hypofractionated radiotherapy in women with breast cancer was 37.5%, erythema, 12.5%, and dry peeling, 25%. The development of care protocols for the management of radiodermatitis after treatment is of paramount importance.


Asunto(s)
Neoplasias de la Mama , Radiodermatitis , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Incidencia , Estudios Longitudinales , Estudios Prospectivos , Radiodermatitis/epidemiología , Radiodermatitis/etiología
2.
Rozhl Chir ; 100(6): 278-283, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34465117

RESUMEN

INTRODUCTION: The exact location of the original tumor should be known for a targeted increase in the dose to the tumor bed after breast cancer surgery. Therefore, at our site, we perform CT examinations of patients in the radiation position before breast cancer surgery. METHODS: Preoperative native CT scans were performed in the patients in the planning position for radiotherapy; these data were fused with standard planning CT for boost irradiation. We evaluated whether the tumor was accurately identifiable in preoperative CT scans. We also contoured one irradiation volume in the standard planning CT scans and the other in the fusion CT scans with preoperative examination, and compared these volumes. RESULTS: Out of the total number of 554 patients, we were able to identify the exact location of the breast tumor in 463 cases (83.6 %). In a group of 50 randomly selected patients, the clinical target volume for the boost dose to the postlumpectomy cavity was changed in 20 patients (40%) - decreased in 9 cases (18%) and increased in 11 cases (22%). CONCLUSION: As shown by the results of our study, preoperative CT in the planning position can be used in patients with confirmed breast cancer. This method allows us to more accurately locate the tumor bed and thus more accurately draw the target volume for boost irradiation. We confirmed that preoperative CT had an impact on the size of the target volume.


Asunto(s)
Neoplasias de la Mama , Mama , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía Segmentaria , Tomografía Computarizada por Rayos X
3.
Diving Hyperb Med ; 51(3): 288-294, 2021 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-34547780

RESUMEN

INTRODUCTION: Radiotherapy reduces the risk of locoregional recurrence of breast cancer. As a side-effect, tissue can become hypocellular, hypovascular, and hypoxic and late radiation tissue injury can develop months or years later. Radiotherapy increases the risk of complications following secondary breast reconstruction. Hyperbaric oxygen treatment (HBOT) improves oxygenation of irradiated tissue and induces neovascularisation. This study evaluated whether the incidence of complications following secondary breast reconstruction after radiotherapy is decreased with perioperative HBOT. METHODS: In this retrospective case-control chart review study, patients who underwent perioperative HBOT (n = 15) were compared to lifestyle-matched (n = 15) and radiation damage-matched (n = 15) patients who underwent secondary breast reconstruction without HBOT. RESULTS: The HBOT group had significantly more severe radiation damage of the breast than the lifestyle- and radiation-damage-matched control groups (scoring grade 1-4, mean 3.55 versus 1.75 and 2.89 respectively, P = 0.001). Patients underwent on average 33 sessions of HBOT (18 sessions preoperatively and 15 sessions postoperatively). There was no significant difference in the incidence of postoperative complications between the HBOT group, lifestyle-matched group and radiation damage-matched group. Logistic regression analysis showed a lower risk of postoperative complications in patients who underwent HBOT. CONCLUSIONS: Although the HBOT group had more radiation damage than the control groups, the incidence of postoperative complications was not significantly different. This implied a beneficial effect of HBOT, which was supported by the logistic regression analysis. Definitive conclusions cannot be drawn due to the small sample size. Future research is justified, preferably a large randomised controlled trial.


Asunto(s)
Neoplasias de la Mama , Oxigenación Hiperbárica , Mamoplastia , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Estudios de Casos y Controles , Femenino , Humanos , Oxígeno , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos
4.
BMJ Case Rep ; 14(9)2021 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-34548298

RESUMEN

In this case report, radiation therapy was performed for bilateral hydronephrosis developed during multiple bone metastases of breast cancer and ileus due to peritoneal dissemination. The patient's preirradiation creatinine level was 8.2 mg/dL, which decreased by the fourth day after starting irradiation therapy. Creatinine level ultimately decreased to 0.6 mg/dL. Pain due to lumbar spine metastasis alleviated and ileus was resolved, allowing the patient to live at home for approximately 5 weeks. The effect of radiotherapy for bilateral hydronephrosis and gastrointestinal obstruction was rapid and good. Palliative radiation treatment can be used for multiple purposes, and in the present patient, we were able to prolong the vital prognosis.


Asunto(s)
Neoplasias Óseas , Neoplasias de la Mama , Neoplasias Óseas/radioterapia , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Dolor , Cuidados Paliativos , Dosificación Radioterapéutica
5.
J Appl Clin Med Phys ; 22(10): 152-160, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34543500

RESUMEN

PURPOSE: The goal of this study was to investigate how the choice of the region of interest (ROI) affects the registration results of surface imaging for daily positioning of breast cancer patients. METHODS: The AlignRT system (VisionRT, London) and the XVI Cone beam CT (CBCT; Elekta, Stockholm) installed on two Versa HD linacs (Elekta) were used in this study, which included 28 patients (160 fractions). In the clinical workflow, patients were prepositioned with AlignRT and then shifted in 6 degrees of freedom (DOF) according to the CBCT. A new reference capture was taken immediately afterward. Retrospectively, the surface capture resulting from prepositioning was registered to the latest reference capture. By varying the ROI used for registration, the surface-based results were optimized in terms of minimizing the deviation to the clinically applied CBCT shifts. Two sets of ROIs were used: one obtained by applying a variable margin to the breast surface, another by combining ROIs of anatomical structures, including the sternum and contralateral breast. RESULTS: Registration results showed significant differences from one ROI to another. Generally, the results improved with increasing ROI size, especially for rotational DOFs. ROIs, including the axilla or supraclavicular lymph drainage region, did not yield an improved registration result. On the other hand, an ROI comprising the breast surface, sternum, and a belt caudal to the breasts decreased the average magnitude of the translational and rotational deviations by 6.6% and 30.8% (p < 0.01), respectively, compared to the breast surface only results. CONCLUSION: The influence of the ROI choice on surface imaging registration results was analyzed and the surface-based shifts were compared to clinically applied CBCT shifts. An optimal ROI for the treatment of breast cancer patients, consisting of the breast surface, sternum, and a belt, was identified.


Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/radioterapia , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Planificación de la Radioterapia Asistida por Computador , Estudios Retrospectivos
6.
J Appl Clin Med Phys ; 22(10): 232-238, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34554605

RESUMEN

PURPOSE: This study compared the quality of treatment plans for early-stage, left-sided breast cancer, as planned for and delivered by the HalcyonTM and VitalBeam® . MATERIALS AND METHODS: Fifteen patients diagnosed with early-stage left-sided breast cancer, who had received VMAT with hypofractionated SIB, were recruited. All cases were planned using HalcyonTM comprising a dual-layer MLC (DL-MLC) and VitalBeam® with a Millennium 120 MLC (VB-MLC). For the PTVs, the quality of coverage (QC), conformity index (CI), and homogeneity index (HI) were calculated for each plan. The dosimetric differences between the two treatment plans were statistically compared using the Wilcoxon signed-rank test (p < 0.05). To evaluate delivery efficiency, the average delivery time for each patient's treatment plan was recorded and compared. RESULTS: For the PTVs, the two plans (DL-MLC and VB-MLC) were comparable in terms of the QC, CI, and HI. However, V30Gy and Dmean for the heart in the DL-MLC plan were significantly reduced by 0.49% and 14.6%, respectively, compared with those in the VB-MLC plan (p < 0.05). The Dmean value for the ipsilateral lung in the DL-MLC plan significantly decreased by 5.5%, compared with that in the VB-MLC plan (p < 0.05). In addition, the delivery times for the DL-MLC and VB-MLC plans were 79 ± 10 and 101 ± 11 s, respectively. CONCLUSIONS: DL-MLC plans were found to improve OAR sparing. In particular, when treating left-sided breast cancer via DL-MLC plans, the risk of heart toxicity is expected to be reduced.


Asunto(s)
Neoplasias de la Mama , Radioterapia de Intensidad Modulada , Neoplasias de Mama Unilaterales , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Órganos en Riesgo , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Neoplasias de Mama Unilaterales/radioterapia
7.
BMC Cancer ; 21(1): 981, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34470602

RESUMEN

BACKGROUND: Paclitaxel (Taxol) is a microtubule-stabilizing drug used to treat several solid tumors, including ovarian, breast, non-small cell lung, and pancreatic cancers. The current treatment of ovarian cancer is chemotherapy using paclitaxel in combination with carboplatin as a frontline agent, and paclitaxel is also used in salvage treatment as a second line drug with a dose intensive regimen following recurrence. More recently, a dose dense approach for paclitaxel has been used to treat metastatic breast cancer with success. Paclitaxel binds to beta tubulin with high affinity and stabilizes microtubule bundles. As a consequence of targeting microtubules, paclitaxel kills cancer cells through inhibition of mitosis, causing mitotic catastrophes, and by additional, not yet well defined non-mitotic mechanism(s). RESULTS: In exploring methods to modulate activity of paclitaxel in causing cancer cell death, we unexpectedly found that a brief exposure of paclitaxel-treated cells in culture to low intensity ultrasound waves prevented the paclitaxel-induced cytotoxicity and death of the cancer cells. The treatment with ultrasound shock waves was found to transiently disrupt the microtubule cytoskeleton and to eliminate paclitaxel-induced rigid microtubule bundles. When cellular microtubules were labelled with a fluorescent paclitaxel analog, exposure to ultrasound waves led to the disassembly of the labeled microtubules and localization of the signals to perinuclear compartments, which were determined to be lysosomes. CONCLUSIONS: We suggest that ultrasound disrupts the paclitaxel-induced rigid microtubule cytoskeleton, generating paclitaxel bound fragments that undergo degradation. A new microtubule network forms from tubulins that are not bound by paclitaxel. Hence, ultrasound shock waves are able to abolish paclitaxel impact on microtubules. Thus, our results demonstrate that a brief exposure to low intensity ultrasound can reduce and/or eliminate cytotoxicity associated with paclitaxel treatment of cancer cells in cultures.


Asunto(s)
Neoplasias de la Mama/patología , Microtúbulos/patología , Mitosis , Neoplasias Ováricas/patología , Paclitaxel/farmacología , Ondas Ultrasónicas , Antineoplásicos Fitogénicos/farmacología , Apoptosis , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/radioterapia , Proliferación Celular , Citoesqueleto/metabolismo , Femenino , Humanos , Microtúbulos/efectos de los fármacos , Microtúbulos/efectos de la radiación , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/radioterapia , Tubulina (Proteína)/metabolismo , Células Tumorales Cultivadas
8.
Acta Oncol ; 60(11): 1425-1431, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34586930

RESUMEN

BACKGROUND: The standard in Denmark for treating breast cancer patients receiving loco-regional irradiation is tangential 3D Conformal RadioTherapy (3DCRT), treated in deep inspiration breath-hold (DIBH). Treating with Volumetric Modulated Arc Therapy (VMAT) may reduce the treatment time, which is particularly important for DIBH treatments. The VMAT should be performed without increased dose to the heart, lung, and contralateral breast. This study compares VMAT and 3DCRT for left-sided breast cancer patients with intramammary lymph node involvement. MATERIAL AND METHODS: Twenty left-sided breast cancer patients were included. VMAT and tangential plans were created for all patients, with a prescription dose of 50 Gy. The tangential plans used 6 MV and for larger breast combined with 18 MV. The VMAT plans utilised two 6 MV fields in a butterfly configuration. Dose planning was done in Pinnacle3 16.0 using the Auto-Planning module for the VMAT plans. Comparison of the plans was based on: mean doses, metrics provided by DBCG guidelines, dose-volume histograms and required number of breath-holds for treatment delivery in DIBH. RESULTS: For most OAR, the doses were similar for VMAT and 3DCRT. The target coverage was comparable, with VMAT having a statistically significant improved dose homogeneity of the target volumes. Less than half the number of breath-hold was required for VMAT compared to 3DCRT. Mean gamma pass rates (3 mm and 3%) from ArcCHECK of the VMAT plans was 98.4% (range 96.6-99.8%). CONCLUSION: Automatic VMAT planning of left-sided breast cancer patients with lymph node involvement can produce dose distributions comparable to those of tangential 3DCRT, while reducing the number of breath-holds in DIBH by more than a factor of two. The reduction in breath-holds is beneficial for patient comfort and reduces the risk of intra-fraction patient motion.


Asunto(s)
Neoplasias de la Mama , Radioterapia de Intensidad Modulada , Neoplasias de Mama Unilaterales , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Ganglios Linfáticos , Órganos en Riesgo , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Neoplasias de Mama Unilaterales/radioterapia
9.
Ann Surg Oncol ; 28(10): 5716-5722, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34333704

RESUMEN

BACKGROUND: In 2016, the Society of Surgical Oncology released a Choosing Wisely guideline recommending sentinel lymph node biopsy (SLNB) omission in females ≥70 years of age with early-stage, hormone-positive, clinically node-negative invasive breast cancer. This study investigated the impact of this guideline on SLNB and radiotherapy rates, in addition to assessing temporal trends of nodal biopsy and factors associated with recurrence. METHODS: The study involved a retrospective review of women who met the guideline criteria and underwent partial mastectomy at a single institution between 2009 and 2018. Using the same inclusion criteria, the National Cancer Database was queried to obtain a separate dataset. Statistical analyses included univariate comparisons, and multivariate logistic regression modeling to predict radiotherapy delivery. RESULTS: In our institutional series, 487 patients were included, 274 (56.3%) of whom received radiotherapy. There were 414 patients (85.0%) who underwent SLNB, with a nodal positivity rate of 11%. SLNB correlated with higher rates of radiotherapy (63.5% vs. 15.1%, p < 0.001). Age <80 years was an independent predictor of radiotherapy receipt (odds ratio 3.0, 95% confidence interval 0.22-0.52). SLNB performance decreased after 2016 (88.4% vs. 78.4%, p = 0.003). Median follow-up was 4.8 years, with 19 (3.9%) documented recurrences. SLNB performance was not associated with recurrence (2.9% vs. 5.5%, p = 0.279), whereas radiotherapy resulted in reduced recurrence (1.1% vs. 6.1%, p = 0.002). One (0.2%) disease-related mortality was observed. CONCLUSION: Recurrence rates and disease-related mortality remain low in this demographic regardless of treatment rendered. Omission of SLNB and radiotherapy should remain a consideration, and efforts in both patient and physician education should continue.


Asunto(s)
Neoplasias de la Mama , Ganglio Linfático Centinela , Anciano , Anciano de 80 o más Años , Axila , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Femenino , Hormonas , Humanos , Escisión del Ganglio Linfático , Mastectomía , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela
11.
J Pak Med Assoc ; 71(7): 1736-1739, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34410237

RESUMEN

OBJECTIVE: To investigate the utility of quantitative lung perfusion scintigraphy and pulmonary function tests in the assessment of radiation-induced lung injury. METHODS: The prospective study was conducted at Zonguldak Bulent Ecevit University Hospital, Turkey, from May 2012 to October 2016, and comprised female breast cancer patients having undergone lung perfusion scintigraphy with Tc-99m macroaggregated albumin before and after radiotherapy. Pulmonary function tests and carbon monoxide diffusing capacity tests were also carried out on all the patients, and the relationship between treatment-related changes and its association with radiotherapy doses was analysed. Data was analysed using SPSS 19. RESULTS: There were 43 patients with a median age of 49 (interquartile range: 32-71 years). Carbon monoxide diffusing capacity values at baseline showed a significant decrease at 6 and 12 months post- radiotherapy (p<0.05), while none of the parameters of the pulmonary function tests showed a significant difference (p>0.05). Also, the median percentage of perfusion studies in the irradiated lung decreased significantly (p<0.001) at 12 months post-treatment. There was significant reduction in perfusion studies of irradiated lungs (p<0.05). CONCLUSIONS: Carbon monoxide diffusing capacity and quantitative lung perfusion scintigraphy were found to be useful tools for the early diagnosis and monitoring of radiation-induced lung injury.


Asunto(s)
Neoplasias de la Mama , Neoplasias Pulmonares , Adulto , Anciano , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/radioterapia , Persona de Mediana Edad , Perfusión , Imagen de Perfusión , Estudios Prospectivos , Pruebas de Función Respiratoria
12.
S D Med ; 74(6): 260-263, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34449165

RESUMEN

Angiosarcoma is a rare, highly malignant endothelial cell carcinoma. Radiotherapy on breast cancer increases the risk of developing an angiosarcoma. We report an extremely rare case of bilateral breast radiation-associated angiosarcoma (RAA). Patient had a strong breast cancer family history, and genetic testing identified KRAS, PIK3CA, RPTOR, and VHL mutation, along with MYC amplification. The overall prognosis of RAA is poor as RAA is characterized by early metastasis, frequent local recurrence, and short overall survival time. The patient eventually passed away because of breast cancer metastasis to the lung and liver.


Asunto(s)
Adenocarcinoma , Neoplasias de la Mama , Hemangiosarcoma , Neoplasias de la Mama/radioterapia , Femenino , Hemangiosarcoma/etiología , Humanos , Pronóstico
13.
Rev Esc Enferm USP ; 55: e20200476, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34464432

RESUMEN

OBJECTIVE: To verify whether there is an association between spirituality/religiosity and quality of life of women with breast cancer undergoing radiotherapy. METHOD: Cross-sectional, quantitative study performed between May and July 2019 in an Oncology Hospital of Porto Alegre state, Brazil. A sociodemographic questionnaire and the instruments EORTC-QLQ-C30 and WHOQOL-SRPB were applied. The data were verified through Shapiro-Wilk test, Pearson correlation coefficient, and Spearman. RESULTS: The sample comprised 108 women with a mean age of 56, predominantly white, married, and with incomplete primary education. A positive correlation between "Overall quality of life score" with all facets of spirituality, as well as a negative correlation for the symptoms "Fatigue", "Insomnia", and "Diarrhea" with some aspects of spirituality, such as "Faith", were observed. CONCLUSION: The statistical significance of the correlation has positively associated spirituality/religiosity and quality of life in women with breast cancer undergoing radiotherapy. Understanding spirituality as a preponderant factor in quality of life contributes to positive nursing care interference, with individualized orientation and care to each woman.


Asunto(s)
Neoplasias de la Mama , Calidad de Vida , Neoplasias de la Mama/radioterapia , Estudios Transversales , Femenino , Humanos , Espiritualidad , Encuestas y Cuestionarios
14.
Int J Mol Sci ; 22(16)2021 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-34445424

RESUMEN

Biomarkers for predicting individual response to radiation and for dose verification are needed to improve radiotherapy. A biomarker should optimally show signal fidelity, meaning that its level is stable and proportional to the absorbed dose. miRNA levels in human blood serum were suggested as promising biomarkers. The aim of the present investigation was to test the miRNA biomarker in leukocytes of breast cancer patients undergoing external beam radiotherapy. Leukocytes were isolated from blood samples collected prior to exposure (control); on the day when a total dose of 2 Gy, 10 Gy, or 20 Gy was reached; and one month after therapy ended (46-50 Gy in total). RNA sequencing was performed and univariate analysis was used to analyse the effect of the radiation dose on the expression of single miRNAs. To check if combinations of miRNAs can predict absorbed dose, a multinomial logistic regression model was built using a training set from eight patients (representing 40 samples) and a validation set with samples from the remaining eight patients (15 samples). Finally, Broadside, an explorative interaction mining tool, was used to extract sets of interacting miRNAs. The most prominently increased miRNA was miR-744-5p, followed by miR-4461, miR-34a-5p, miR-6513-5p, miR-1246, and miR-454-3p. Decreased miRNAs were miR-3065-3p, miR-103a-2-5p, miR-30b-3p, and miR-5690. Generally, most miRNAs showed a relatively strong inter-individual variability and different temporal patterns over the course of radiotherapy. In conclusion, miR-744-5p shows promise as a stable miRNA marker, but most tested miRNAs displayed individual signal variability which, at least in this setting, may exclude them as sensitive biomarkers of radiation response.


Asunto(s)
Biomarcadores de Tumor/genética , Neoplasias de la Mama/radioterapia , Perfilación de la Expresión Génica/métodos , Regulación Neoplásica de la Expresión Génica/efectos de la radiación , MicroARNs/genética , Anciano , Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Neoplasias de la Mama/genética , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Persona de Mediana Edad , Análisis de Secuencia de ARN , Resultado del Tratamiento , Regulación hacia Arriba
15.
JCO Glob Oncol ; 7: 1212-1219, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34343013

RESUMEN

PURPOSE: In sub-Saharan Africa, radiotherapy (RT) utilization and delivery patterns have not been extensively studied in patients with metastatic breast cancer. METHODS: A retrospective cohort study of female patients with metastatic breast cancer seen at Parirenyatwa Radiotherapy Centre in Zimbabwe from 2014 to 2018 was conducted. Demographics, pathology, staging, and treatment data were abstracted through chart review. Fisher's exact test and chi-squared test of independence were used to compare proportions, and independent two-sample t-tests were used to compare means. RESULTS: Of 351 patients with breast cancer, 152 (43%) had metastatic disease, median age 51 years (interquartile range: 43-61 years). Of those with metastatic disease, 30 patients (20%) received radiation to various metastatic sites: 16 spine; three nonspine bone metastases; six whole brain; and five chest wall or supraclavicular. Patients who received radiation were younger (46 v 52 years; P = .019), but did not differ significantly by performance status than those who did not. The most common dose prescription was 30 Gy in 10 fractions (33%). Five (17%) patients had treatment interruption and two (7%) had treatment noncompletion. Province of origin and clinical tumor stage were significant predictors of RT receipt (P = .002; and P = .018, respectively). CONCLUSION: A minority of patients with metastatic breast cancer received RT (20%), and these were likely to be younger, with advanced tumor stage, and resided in provinces where RT is available. Conventional courses were generally prescribed. There is a need to strongly consider palliative RT as an option for patients with metastatic breast cancer and use of hypofractionated courses (e.g. 8 Gy in one fraction) may support this goal.


Asunto(s)
Neoplasias de la Mama , Oncología por Radiación , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Persona de Mediana Edad , Cuidados Paliativos , Estudios Retrospectivos , Zimbabwe
17.
Cancer Radiother ; 25(6-7): 679-683, 2021 Oct.
Artículo en Francés | MEDLINE | ID: mdl-34452822

RESUMEN

Due to the continuously increasing number of newly diagnosed breast cancer and limited health resources hypofractionated radiotherapy is a major topic. Recent results from randomized clinical trials assessing extreme hypofractionated radiotherapy for whole or partial breast radiotherapy are practice changing. Here we report toxicity and oncological outcomes from major recent trials of extreme hypofractionated breast irradiation and present an ongoing prospective implementation program. For whole breast irradiation, with a 10 years follow up, the UK-FAST trial demonstrated no significant difference in toxicity between a once weekly 5 fractions (5,7Gy/fr) regimen and a conventional 50Gy/25fr regimen. With a 5 years follow up, the FAST-Forward trial showed non inferiority on local control for a 5 fractions over 1 week (5,2Gy/fr) regimen versus standard 40Gy/15fr over 3 weeks with safe toxicity profile. For accelerated partial breast irradiation, in low-risk breast cancers patients, several phase III randomized trials confirmed that extreme hypofractionation is a valid option. With our "One Week Breast Radiotherapy" program, we propose the implementation of a one-week full workflow preparing and delivering 5 fractions over 1 week (26Gy) in selected patients with prospective follow-up. Several extreme hypofractionated breast radiotherapy regimens are validated and can be routinely discussed with patients in a share decision-making process following patient selection criteria and dosimetric constraints.


Asunto(s)
Neoplasias de la Mama/radioterapia , Hipofraccionamiento de la Dosis de Radiación , Ensayos Clínicos Fase III como Asunto , Estudios de Equivalencia como Asunto , Femenino , Estudios de Seguimiento , Humanos , Estudios Multicéntricos como Asunto , Selección de Paciente , Evaluación de Programas y Proyectos de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento
18.
In Vivo ; 35(5): 2655-2659, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34410953

RESUMEN

BACKGROUND/AIM: To evaluate the robustness of radiotherapy treatment planning optimization for respiratory-moving breast cancer using fixed-angle beams planning TomoDirect™ intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: A minimax optimisation algorithm was applied to 10 breast cancer patients. Two sets of treatment plans with or without robust techniques were prepared considering anterior-posterior and head-tail movements due to respiration. Parameters were compared between treatment plans: 95% planned target volume (PTV) dose, conformal index and homogeneity index (HI), and organs at risk (OAR) parameters including the lung volume receiving 20 Gy or more (V20) and 5 Gy (V5). RESULTS: Robust planning significantly improved parameters of 95% PTV dose and HI, without deteriorating V20 or V5 in the anterior-posterior movement, while it slightly improved 95% PTV and slightly deteriorated V20 in the head-tail movement. CONCLUSION: Robust treatment planning improves coverage of targets moving because of respiration in the treatment of breast cancer using TomoDirect; however, normal lung doses should be cautiously evaluated on a case-by-case basis.


Asunto(s)
Neoplasias de la Mama , Radioterapia de Intensidad Modulada , Neoplasias de la Mama/radioterapia , Femenino , Humanos , Órganos en Riesgo , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador
19.
In Vivo ; 35(5): 2763-2770, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34410966

RESUMEN

BACKGROUND/AIM: Being scheduled for radiotherapy can cause emotional distress. This study aimed to identify risk factors in 338 patients assigned to radiotherapy for breast cancer. PATIENTS AND METHODS: Nineteen potential risk factors including the COVID-19 pandemic were investigated for associations with the six emotional problems included in the National Comprehensive Cancer Network Distress Thermometer. RESULTS: Worry and fears were significantly associated with age ≤60 years; sadness with age and Karnofsky performance score (KPS) <90; depression with KPS and Charlson Comorbidity Index ≥3; loss of interest with KPS. Trends were found for associations between sadness and additional breast cancer/DCIS, Charlson Index and chemotherapy; between depression and additional breast cancer/DCIS, treatment volume and nodal stage N1-3; between nervousness and additional breast cancer/DCIS, mastectomy and triple-negativity; between loss of interest and Charlson Index, family history of breast cancer/DCIS, invasive cancer, chemotherapy, and treatment volume. The COVID-19 pandemic did not increase emotional problems. CONCLUSION: Several risk factors for emotional problems were identified. Patients with such factors should receive psychological support well before radiotherapy.


Asunto(s)
Neoplasias de la Mama , COVID-19 , Carcinoma Intraductal no Infiltrante , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Femenino , Humanos , Mastectomía , Mastectomía Segmentaria , Persona de Mediana Edad , Pandemias , Radioterapia Ayuvante/efectos adversos , SARS-CoV-2
20.
In Vivo ; 35(5): 2875-2880, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34410981

RESUMEN

BACKGROUND/AIM: To report the feasibility and oncological outcomes in breast cancer patients treated with a short hypofractionated radiotherapy schedule. PATIENTS AND METHODS: We evaluated 380 breast cancer patients treated with ten daily fractions of radiotherapy up to 39 Gy on tumor bed. Primary endpoint was local relapse rate (LRR). Secondary endpoints were overall survival (OS) and metastasis-free survival (MFS). RESULTS: The median follow up was 5.0 years. Two- and 5-year LRR rates were 0.2 and 2%, respectively. Two- and 5-year MFS rates were 96.1% and 90.5%, respectively. Two and 5-year OS rates were 97.4% and 95%, respectively. CONCLUSION: This short schedule may represent an alternative option to standard mild hypofractionated radiotherapy in breast cancer patients due to its excellent feasibility and very low recurrence rate.


Asunto(s)
Neoplasias de la Mama , Mastectomía Segmentaria , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Fraccionamiento de la Dosis de Radiación , Femenino , Estudios de Seguimiento , Humanos , Recurrencia Local de Neoplasia/radioterapia , Radioterapia Ayuvante
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