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1.
Anticancer Res ; 40(11): 6505-6511, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109590

RESUMO

BACKGROUND/AIM: This study aimed to investigate the bolus practice among Italian radiation oncologists. PATIENTS AND METHODS: In 2018, a survey on bolus application was sent to all members of the Italian Association of Radiotherapy and Clinical Oncology. RESULTS: The survey was joined by 102 radiation oncologists. Not all respondents answered to every question. A 69.5% of 82 respondents used bolus in case of skin infiltration and 52 of 68 respondents (76.5%) applied it every day. Skin was included as part of chest wall Clinical Target Volume both in the absence or the presence of breast reconstruction. Five mm bolus was the most used. 3D Conformal radiotherapy was the most used technique, in 73.5% of cases. Acute RTOG G2-G3 skin toxicity was recorded by 93.9% physicians. CONCLUSION: There was heterogeneity in the use of bolus, though an agreement was found in some topics. The achievement of a National Consensus may represent an interesting future goal.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/radioterapia , Radioterapia Adjuvante/métodos , Pele/efeitos da radiação , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada , Relação Dose-Resposta à Radiação , Feminino , Humanos , Itália/epidemiologia , Mamoplastia , Mastectomia , Oncologia/tendências , Pessoa de Meia-Idade , Padrões de Prática Médica , Radio-Oncologistas , Radioterapia Conformacional , Pele/patologia , Parede Torácica/patologia , Parede Torácica/efeitos da radiação
2.
Rev Lat Am Enfermagem ; 28: e3384, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-33084780

RESUMO

OBJECTIVE: to validate the content and appearance of an educational manual for breast cancer patients undergoing radiation therapy. METHOD: methodological research, which had the Theory of Psychometry as a theoretical-methodological reference. The minimum 80% Concordance Index was considered to ensure the adequacy of the material. The sample consisted of 17 experts in the subject area of the educational manual and 12 patients previously submitted to radiotherapy due to the diagnosis of breast cancer. RESULTS: two items of the expert evaluation tool were found to have a concordance index <80%. The other items were considered adequate and/or totally adequate in the three blocks of analysis proposed for the experts: objectives - 89.07%, structure and presentation - 92.94%, and relevance - 93.13%; and good and/or very good in the five blocks of analysis proposed for the patients: objectives, organization, writing style, appearance, and motivation, all with 100% agreement rate. CONCLUSION: the educational manual, after having been perfected based on the suggestions of the sample and the scientific literature, was considered valid according to its content and appearance, suggesting its contribution to the clinical practice of nursing and to the understanding of the treatment to which patients with breast cancer are submitted.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/radioterapia , Humanos , Motivação , Psicometria , Projetos de Pesquisa
3.
Rev Assoc Med Bras (1992) ; 66(9): 1301-1306, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027462

RESUMO

INTRODUCTION: Radiation therapy is widely used as adjuvant treatment in breast cancer patients. In the last decades, several studies have been designed to evaluate the safety and efficacy of hypofractionated breast radiation therapy. More recently, even shorter regimens with doses above 4 Gy (hyper-hypofractionation) have also been proposed. This study aims to present a narrative review of the various hypofractionation protocols used to treat breast cancer patients with a focus on clinical application. RESULTS: Long-term results from several phase III randomized controlled trials demonstrated the safety and efficacy of hypofractionated breast radiation therapy using 15 or 16 fractions for early and locally advanced disease. The results of the initial clinical trials of hyper-hypofractionation are also encouraging and it is believed that these regimens may become routine in the indication of adjuvant radiation therapy treatment after the ongoing studies on this subject have matured. CONCLUSIONS: The idea that normal tissues could present high toxicity at doses above 2 Gy was opposed by clinical trials that demonstrated that moderate hypofractionation had similar results regarding oncological and cosmetic outcomes compared to conventional fractionation. Cosmetic and toxicity results from hyper-fractionation studies are in principle favorable. However, the long-term oncological results of studies that used hyper-hypofractionation for the treatment of breast cancer patients are still awaited.


Assuntos
Neoplasias da Mama , Hipofracionamento da Dose de Radiação , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Fracionamento da Dose de Radiação , Humanos , Período Pós-Operatório , Radioterapia Adjuvante
4.
Crit Rev Oncol Hematol ; 156: 103121, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33038628

RESUMO

Radiation therapy has a prime importance for breast cancer management. However, first-generation techniques delivered significant radiation dose to the heart, which substantially increased cardiac mortality. Breast radiation therapy has fortunately evolved, and state-of-the-art radiation therapy techniques currently efficiently spare the heart without altering local control or overall survival. However, at the present time, potential cardiotoxicity risk is still a matter of concern and controversies exist concerning how to precisely evaluate cardiac radiation exposure, how to predict radiation-induced cardiac adverse events and which dosimetric constraints are clinically relevant. Based on current literature, this paper aims to review the present understanding of cardiotoxicity associated with breast cancer irradiation and to discuss controversies and perspectives about cardiac sparing improvement.


Assuntos
Neoplasias da Mama , Cardiotoxicidade , Neoplasias da Mama/radioterapia , Cardiotoxicidade/etiologia , Coração , Humanos , Radiometria , Dosagem Radioterapêutica
5.
Crit Rev Oncol Hematol ; 156: 103090, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33091800

RESUMO

Post-operative radiation therapy (RT) reduces loco-regional recurrence rates and mortality in most patients with non-metastatic breast cancer. The aim of this critical review is to provide an overview of the applicability of moderately hypofractionated RT for breast cancer patients, focusing on factors influencing clinical decision-making. An international group of radiation oncologists agreed to assess, integrate, and interpret the existing evidence into a practical report to guide clinicians in their daily management of breast cancer patients. We conclude that moderately hypofractionated RT to the breast, chest wall (with/without breast reconstruction), and regional lymph nodes is at least as safe and effective as conventionally fractionated regimens and could be considered as the treatment option for the vast majority of the patients.For those who are still concerned about its generalised application, we recommend participating in ongoing trials comparing moderately hypofractionated RT to conventionally fractionated RT for breast cancer patients in some clinical circumstances.


Assuntos
Neoplasias da Mama , Mama , Neoplasias da Mama/radioterapia , Humanos , Recidiva Local de Neoplasia/radioterapia , Hipofracionamento da Dose de Radiação , Radioterapia Adjuvante
7.
Diving Hyperb Med ; 50(3)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32957121

RESUMO

INTRODUCTION: Late radiation tissue injury (LRTI) after breast cancer may benefit from hyperbaric oxygen treatment (HBOT). This study aimed to report the LRTI symptom scores up to 12 months after HBOT and identify risk factors for poor scores. METHODS: A case-series of 67 patients who underwent a mean of 44 sessions of HBOT was analysed. LRTI symptoms were scored at four time points using the LENT-SOMA scale (Late Effects in Normal Tissues - Subjective, Objective, Management, and Analytic), a visual analog scale for pain, and the range of shoulder motion. RESULTS: Between starting HBOT and 12 months after HBOT 57 patients (85%) reported at least one point improvement in their LENT-SOMA score. Median pain and fibrosis scores improved significantly between the start and end of HBOT (P < 0.001), and remained stable three and 12 months after HBOT. The median breast oedema score improved significantly 12 months after HBOT (P = 0.003). Median shoulder abduction increased significantly from 90 to 165 degrees (P = 0.001) and median shoulder anteflexion increased significantly from 115 to 150 degrees (P = 0.004). Various risk factors were identified for poor scores despite HBOT; the most common risk factor was a poor score at start of HBOT. CONCLUSIONS: In this case-series, patients who underwent HBOT for LRTI after breast cancer reported significant improvement in pain, fibrosis, oedema, and shoulder movement. The improvement persisted up to 12 months after HBOT. A poor score at the start of HBOT was predictive for a poor score 12 months after HBOT.


Assuntos
Neoplasias da Mama , Oxigenação Hiperbárica , Lesões por Radiação , Neoplasias da Mama/radioterapia , Humanos , Oxigênio , Lesões por Radiação/terapia , Projetos de Pesquisa
8.
Khirurgiia (Mosk) ; (8): 29-34, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869612

RESUMO

OBJECTIVE: To report our own experience of one-stage surgical treatment of irradiation-induced osteomyelitis as a complication of radiotherapy for breast cancer (BC). MATERIAL AND METHODS: The study included 25 patients with irradiation-induced chest osteomyelitis after previous radiotherapy for breast cancer. All patients were examined according to the same protocol. One-stage surgery with full-thickness resection of affected tissues and plastic closure of the wound was performed depending on localization of lesion and availability of plastic material. RESULTS: Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were assessed according to Clavien-Dindo classification. Complications followed by antibacterial therapy and/or local treatment were observed in 8 (32%) out of 25 patients (95% CI 11.5-43.4). Marginal necrosis of musculoskeletal flap was registered in 4 (16%) patients. One (4%) patient required redo thoracomyoplasty after excision of necrotic tissues of musculocutaneous flap due to extensive tissue defect. Total necrosis of musculocutaneous flap was not noted. There were no fatal outcomes. Mean length of hospital-stay was 13 (10; 27) days in the group of musculocutaneous flap from latissimus dorsi muscle and 11 days (7; 24) in the group of rectus abdominis muscle. Good and satisfactory treatment outcomes after one-stage surgical treatment were achieved in 24 (96%) out of 25 patients (95% CI: 75-97.8). CONCLUSION: Irradiation-induced chest osteomyelitis is still actual problem despite an improvement of modern medical equipment and accumulation of experience in radiotherapy. Surgery is preferable method of treatment. Comprehensive examination including contrast-enhanced chest CT with 3D reconstruction and Doppler ultrasound of vascular pedicle is valuable to determine type of resection and plastic technique. Simultaneous approach with resection and plastic closure of the wound is preferred for irradiation-induced chest osteomyelitis if sufficient amount of plastic material is available and contraindications for reconstructive surgery are absent.


Assuntos
Neoplasias da Mama/radioterapia , Retalho Miocutâneo , Osteomielite/cirurgia , Radioterapia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Parede Torácica/cirurgia , Humanos , Músculo Esquelético/transplante , Retalho Miocutâneo/efeitos adversos , Osteomielite/etiologia , Reoperação , Parede Torácica/efeitos da radiação , Toracoplastia/métodos , Resultado do Tratamento
9.
Cancer Radiother ; 24(6-7): 645-648, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32883627

RESUMO

Immediate breast reconstruction versus delayed breast reconstruction improves quality of life of breast cancer patients undergoing total mastectomy without impacting oncologic outcomes. Two types of immediate reconstruction are possible, implant-based reconstruction or autologous reconstruction. These reconstructions interpose a tissue in the operating bed, which modifies target volume definition compared to a wall without reconstruction Post mastectomy radiotherapy increases the rate of postoperative complications for both surgical procedures. Recent guidelines were published about target volume definition in the post mastectomy setting after implant-based reconstruction. Guidelines about target volume definition after autologous reconstruction are still awaited. The aim of our work is to present the different surgical procedures for immediate breast reconstruction, their complications, and the definition of the postmastectomy target volume.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mamoplastia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Radioterapia Adjuvante/efeitos adversos , Fatores de Tempo
11.
Adv Exp Med Biol ; 1252: 95-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816267

RESUMO

Surgery in the form of both mastectomy and breast conservation is the main step in the treatment of breast cancer. Numerous studies have shown an equivalent long-term survival for breast conserving surgery (BCS) and mastectomy . Patients desire and tumor characteristics, especially size and multicentricity, are the key factors that affect the decision between these two types of surgery . Patients with any contraindication for radiotherapy or previous history of radiation to the breast field are not suitable for BCS . There are few absolute contraindications for BCS , and early pregnancy is listed among them; mastectomy is preferred in the first trimester of pregnancy to avoid the impact of delaying radiation therapy on outcome of the cancer.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia , Complicações Neoplásicas na Gravidez/cirurgia , Mama/cirurgia , Neoplasias da Mama/radioterapia , Feminino , Humanos , Mastectomia Segmentar , Gravidez , Complicações Neoplásicas na Gravidez/radioterapia , Resultado do Tratamento
12.
Adv Exp Med Biol ; 1252: 125-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816271

RESUMO

Breast radiotherapy during pregnancy is a matter of debate as both the efficacy of treatment and the safety of the developing fetus should be considered. Currently there is not enough data to support the safety of in-utero exposure to radiation even with modern radiotherapy techniques. So it is highly recommended that breast radiotherapy is postponed to after delivery, though it might be considered in very selected patients according to risk-benefit assessment.


Assuntos
Neoplasias da Mama/radioterapia , Complicações Neoplásicas na Gravidez/radioterapia , Mama/efeitos da radiação , Feminino , Humanos , Gravidez , Medição de Risco
13.
BMJ ; 370: m2836, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32816842

RESUMO

OBJECTIVE: To determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer. DESIGN: Prospective, open label, randomised controlled clinical trial. SETTING: 32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada. PARTICIPANTS: 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT). INTERVENTIONS: Random allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients). MAIN OUTCOME MEASURES: Non-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes. RESULTS: Between 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005). CONCLUSION: For patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned. TRIAL REGISTRATION: ISRCTN34086741, NCT00983684.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirurgia , Idoso , Neoplasias da Mama/mortalidade , Carcinoma Ductal de Mama/mortalidade , Terapia Combinada , Feminino , Humanos , Cuidados Intraoperatórios , Mastectomia Segmentar , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estudos Prospectivos , Dosagem Radioterapêutica , Taxa de Sobrevida
14.
Cancer Radiother ; 24(6-7): 567-575, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32814669

RESUMO

Synchronous metastatic breast cancer accounts for 5 to 6% of all breast cancers in Western countries, which corresponds to nearly 2500 new cases per year in France. Irradiation of the primary tumour in cases of metastatic disease at diagnosis was historically reserved for palliative indications. However, progress in systemic treatments, a better understanding of the biological basis of metastatic dissemination, the genesis of the concept of oligometastatic disease and ablative treatments directed towards metastases are revolutionizing the management of patients with de novo stage IV breast cancer. Survival of these patients has improved markedly over the years, and several studies have investigated the carcinological benefit of local treatment of the breast tumour in patients with advanced diseases at diagnosis. This article provides an update on the role of irradiation of the primary tumour in breast cancer with synchronous metastases, and discusses its interest through published or ongoing trials.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/patologia , Feminino , Humanos , Metástase Neoplásica/radioterapia , Estudos Prospectivos , Estudos Retrospectivos
15.
Cancer Radiother ; 24(6-7): 576-585, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32830054

RESUMO

Cancer and cardiovascular disease (CVD) are the leading cause of mortality worldwide, and breast cancer (BC) the most common malignancy affecting women worldwide. Radiotherapy is an important component of BC treatment and participates in CVD occurrence. It seems, therefore, crucial to gather both radiation oncology and cardiology medical fields to improve the follow-up quality of our BC patients. This review aims at updating our knowledge regarding cardiotoxicities risk factors, and consequently, doses constraints in case of 3D-conformal and IMRT treatment planning. Then we will develop how to reduce cardiac exposure and what kind of cardiac follow-up we could recommend to our breast cancer patients.


Assuntos
Neoplasias da Mama/radioterapia , Cardiotoxicidade/etiologia , Cardiotoxicidade/fisiopatologia , Assistência ao Convalescente , Feminino , Humanos , Planejamento de Assistência ao Paciente , Guias de Prática Clínica como Assunto , Doses de Radiação , Radioterapia Conformacional , Fatores de Risco
16.
Cancer Radiother ; 24(6-7): 612-622, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32839104

RESUMO

PURPOSE: This article aims to describe and list the clinical trials that have changed our practices in breast cancer, urological cancer, gynecological cancer, cancer of the upper aerodigestive tract and digestive cancer in the last ten years. MATERIAL AND METHODS: We listed and selected the studies published between 2010 and 2020. The articles were identified on the basis of a Medline search with PubMed and knowledge of the authors. RESULTS: Five to six trials were selected in breast cancer, urological cancers, gynecological cancers, cancers of the upper aerodigestive tract and digestive cancers asking the different fundamental questions in radiotherapy. CONCLUSION: Depending on the pathologies, the questions raised over the past 10 years remain fundamental questions such as the place of neoadjuvant treatment, the place of hypofractionation or the type of chemotherapy concomitant with radiotherapy.


Assuntos
Ensaios Clínicos como Assunto , Neoplasias/radioterapia , Padrões de Prática Médica/tendências , Neoplasias da Mama/radioterapia , Feminino , Neoplasias Gastrointestinais/radioterapia , Neoplasias dos Genitais Femininos/radioterapia , Humanos , Masculino , Neoplasias do Sistema Respiratório/radioterapia , Fatores de Tempo , Neoplasias Urológicas/radioterapia
17.
Cancer Radiother ; 24(6-7): 482-492, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32839105

RESUMO

Radiation therapy has benefited from many developments over the past 20 years. These developments are mainly linked to the technology, imaging and informatics evolutions which allow better targets definitions, ensure better organs-at-risk sparing and excellent reproducibility of treatments, with a perfect control of patient positioning. In breast cancer radiotherapy, the evolution was marked by the possibility of reducing the duration of treatments from 6-7 to 3-4 weeks by using hypofractionated regimens, or by further reducing the irradiation to one week when treatment is solely focalised to the tumour bed. This concept of accelerated partial breast irradiation has challenged the paradigm of the obligation to irradiate the whole breast after conservative surgery in all patients. In addition, the technical mastery of accelerated partial breast irradiation and the development of stereotactic radiotherapy techniques are currently contributing to the development of research projects in neoadjuvant settings. Thus, numerous ongoing studies are evaluating the impact of high-dose preoperative tumour irradiation, alone or in combination with systemic treatments, on biological tumor changes, on anti-tumour immunity, and on the pathologic complete response, which is considered as predictive of better long-term survival in some molecular breast cancer subtypes. In this review, we discuss all these developments which allow breast radiation therapy to enter the era of personalisation of treatments in oncology.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Terapia Neoadjuvante , Doses de Radiação , Radioterapia Adjuvante
19.
Clin Nucl Med ; 45(9): e403-e405, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32657871

RESUMO

Radiation pneumonitis (RP) can be an adverse complication of radiotherapy and usually occurs as an acute reaction from 6 to 12 weeks after radiotherapy. FDG PET is described as an early and adequate barometer for RP diagnosis. Only 1 case of fluoroestradiol uptake contemporary of metabolic FDG changes attributed to RP is reported. We report a case of a breast cancer patient with asymptomatic RP, who at 1 year later, at sequelar stage on CT, showed long-term memory of RP by F-fluoroestradiol PET imaging with nonmetabolic FDG PET.


Assuntos
Estradiol/análogos & derivados , Radioisótopos de Flúor , Tomografia por Emissão de Pósitrons , Pneumonite por Radiação/diagnóstico por imagem , Doenças Assintomáticas , Neoplasias da Mama/radioterapia , Feminino , Humanos
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