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Marques-Antunes J, Cardoso F, Santos T, Nora M, Scigliano H. Invasive Lobular Carcinoma Arising in Ectopic Breast Tissue: A Case Report. Cureus 2022; 14:e24055. [PMID: 35573574 PMCID: PMC9097936 DOI: 10.7759/cureus.24055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Incomplete regression of the embryonic mammary line occurs in 0.3-6% of the population. Ectopic breast tissue is mostly asymptomatic and can undergo malignant transformation. Ectopic breast cancer accounts for 0.2-0.6% of all breast cancers. Screening breast examinations can miss these lesions due to their location making the diagnosis more challenging. We describe a case of a primary invasive lobular carcinoma in an ectopic breast on the left axilla detected in a 49-year-old woman. Firstly diagnosed as a sebaceous cyst, the lesion was excised under local anesthesia. Histopathology showed breast tissue widely infiltrated by an invasive carcinoma. Excision of the remnant tissue with axillary lymph node dissection was performed. Ectopic breast carcinoma is a rare diagnosis and there is a general lack of awareness. The presence of an abnormal mass along the mammary ridge should raise clinicians’ attention. Management of primary ectopic breast carcinoma should be based on a multidisciplinary approach under the same principles as breast cancer. Furthermore, it does not appear to bring a worse prognosis when diagnosed at similar disease stages.
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Fargier-Bochaton O, Wang X, Dipasquale G, Laouiti M, Kountouri M, Gorobets O, Nguyen NP, Miralbell R, Vinh-Hung V. Prone versus supine free-breathing for right-sided whole breast radiotherapy. Sci Rep 2022; 12:525. [PMID: 35017568 PMCID: PMC8752750 DOI: 10.1038/s41598-021-04385-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/24/2021] [Indexed: 01/29/2023] Open
Abstract
Prone setup has been advocated to improve organ sparing in whole breast radiotherapy without impairing breast coverage. We evaluate the dosimetric advantage of prone setup for the right breast and look for predictors of the gain. Right breast cancer patients treated in 2010-2013 who had a dual supine and prone planning were retrospectively identified. A penalty score was computed from the mean absolute dose deviation to heart, lungs, breasts, and tumor bed for each patient's supine and prone plan. Dosimetric advantage of prone was assessed by the reduction of penalty score from supine to prone. The effect of patients' characteristics on the reduction of penalty was analyzed using robust linear regression. A total of 146 patients with right breast dual plans were identified. Prone compared to supine reduced the penalty score in 119 patients (81.5%). Lung doses were reduced by 70.8%, from 4.8 Gy supine to 1.4 Gy prone. Among patient's characteristics, the only significant predictors were the breast volumes, but no cutoff could identify when prone would be less advantageous than supine. Prone was associated with a dosimetric advantage in most patients. It sets a benchmark of achievable lung dose reduction.Trial registration: ClinicalTrials.gov NCT02237469, HUGProne, September 11, 2014, retrospectively registered.
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Affiliation(s)
| | - Xinzhuo Wang
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
- Radiation Oncology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Giovanna Dipasquale
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Mohamed Laouiti
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
- Service de Radio-Oncologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Melpomeni Kountouri
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
| | | | - Nam P Nguyen
- Radiation Oncology, Howard University, Washington, DC, USA
| | - Raymond Miralbell
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland.
- Université de Genève, Geneva, Switzerland.
- Centro de Protonterapia Quirónsalud, Pozuelo de Alarcón, 28223, Madrid, Spain.
- Servei de Radiooncologia, Institut Oncològic Teknon, Quironsalud, Vilana 12, 08022, Barcelona, Spain.
| | - Vincent Vinh-Hung
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
- CHU de Martinique, Fort-de-France, Martinique, France
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Hsieh MT, Aherne NJ, Ross W, Salindera S, Westhuyzen J, Winkley L, Shakespeare TP. Evaluation of apical clips placed during axillary dissection demonstrates potential under-coverage of axillary radiation therapy target volumes during breast cancer regional nodal irradiation. J Med Imaging Radiat Oncol 2021; 66:158-164. [PMID: 34821471 DOI: 10.1111/1754-9485.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Evidence-based Australian guidelines (eviQ) recommend adjuvant supraclavicular fossa irradiation after axillary lymph node dissection (ALND) in node-positive breast cancer patients. Disparity between surgically determined versus computed tomography (CT) determined nodal volumes may result in discontiguous nodal volumes and untreated nodal tissue. We examine the extent of untreated nodal tissue in women with breast cancer post-level II or III ALND and adjuvant radiation therapy (RT) using ESTRO contouring guidelines. METHODS Female breast cancer patients who underwent level II and III ALND with apical clip placement from 2016 to 2020 and CT simulated in supine position were included. CT-defined axillary level II-IV volumes were contoured using ESTRO guidelines. The distance between the apical clip and RT nodal volumes was measured to indicate extent of untreated tissue. RESULTS Of 34 eligible patients treated by 7 surgeons, 76% had level II ALND and 24% level III ALND. Only 5.9% of clips entirely encompassed the corresponding RT nodal volumes. 55.9% of clips fell within and 44.1% fell inferolaterally outside the corresponding RT nodal volumes. A median 3.6 cm (range 0-7.5 cm) of undissected nodal tissue would not be included within standard RT target volumes following eviQ recommendations. CONCLUSION There is a disparity between surgically determined versus CT determined axillary nodal volumes, leading to discontiguous nodal volumes and untreated axillary nodal tissue, despite following standard radiation contouring guidelines. Intraoperatively placed apical axillary clips may assist radiation oncologists to accurately delineate undissected nodal tissues at risk.
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Affiliation(s)
- Michael Ti Hsieh
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia.,RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - William Ross
- RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia.,Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Shehnarz Salindera
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Lauren Winkley
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia
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Introducing operator characteristic curves to define appropriate frequency of quality control tests: A case study involving whole breast radiotherapy image guidance. Phys Med 2020; 69:275-280. [DOI: 10.1016/j.ejmp.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022] Open
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Arenas M, Fernández-Arroyo S, Rodríguez-Tomàs E, Sabater S, Murria Y, Gascón M, Amillano K, Melé M, Camps J, Joven J. Effects of radiotherapy on plasma energy metabolites in patients with breast cancer who received neoadjuvant chemotherapy. Clin Transl Oncol 2019; 22:1078-1085. [PMID: 31679126 DOI: 10.1007/s12094-019-02232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy (NACT) is employed in patients with breast cancer (BC) with the aim of reducing tumor burden and improving surgical outcomes. We evaluated the levels of energy metabolites pre- and post-radiotherapy (RT) in breast cancer (BC) patients who previously received NACT and investigated the alterations of these metabolites in relation to the patient achieving a pathologic complete response to NACT. MATERIALS AND METHODS We included 37 BC patients who were treated with NACT following surgery and analyzed the concentrations of energy balance-related metabolites using targeted metabolomics before and one month after the end of RT. The control group was composed of 44 healthy women. RESULTS Pre-radiotherapy, patients had significant decreases in the plasma levels of 12 metabolites. RT corrected these alterations and the improvement was superior in patients with a pathologic complete response. CONCLUSION Our results highlight the importance of metabolism in the outcomes of patients with BC.
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Affiliation(s)
- M Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
| | - S Fernández-Arroyo
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - E Rodríguez-Tomàs
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - S Sabater
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Y Murria
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - M Gascón
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - K Amillano
- Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - M Melé
- Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - J Camps
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - J Joven
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
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Park HJ, Oh DH, Shin KH, Kim JH, Choi DH, Park W, Suh CO, Kim YB, Ahn SD, Kim SS. Patterns of Practice in Radiotherapy for Breast Cancer in Korea. J Breast Cancer 2018; 21:244-250. [PMID: 30275852 PMCID: PMC6158163 DOI: 10.4048/jbc.2018.21.e37] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/06/2018] [Indexed: 11/30/2022] Open
Abstract
Adjuvant radiotherapy (RT) is a well-established treatment for breast cancer. However, there is a large degree of variation and controversy in practice patterns. A nationwide survey on the patterns of practice in breast RT was designed by the Division for Breast Cancer of the Korean Radiation Oncology Group. All board-certified members of the Korean Society for Radiation Oncology were sent a questionnaire comprising 39 questions on six domains: hypofractionated whole breast RT, accelerated partial breast RT, postmastectomy RT (PMRT), regional nodal RT, RT for ductal carcinoma in situ, and RT toxicity. Sixty-four radiation oncologists from 54 of 86 (62.8%) hospitals responded. Twenty-three respondents (35.9%) used hypofractionated whole breast RT, and the most common schedule was 43.2 Gy in 16 fractions. Only three (4.7%) used accelerated partial breast RT. Five (7.8%) used hypofractionated PMRT, and 40 (62.5%) had never used boost RT after chest wall irradiation. Indications for regional nodal RT varied; ≥pN2 (n=7) versus ≥pN1 (n=17) versus ≥pN1 with pathologic risk factors (n=40). Selection criteria for internal mammary lymph node (IMN) irradiation also varied; only four (6.3%) always treated IMN when regional nodal RT was administered and 30 (46.9%) treated IMN only if IMN involvement was identified through imaging. Thirty-one (48.4%) considered omission of whole breast RT after breast-conserving surgery for ductal carcinoma in situ based on clinical and pathologic risk factors. Fifty-two (81.3%) used heart-sparing techniques. Overall, there were wide variations in the patterns of practice in breast RT in Korea. Standard guidelines are needed, especially for regional nodal RT and omission of RT for ductal carcinoma in situ.
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Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Myongji Hospital, Goyang, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Aghili M, Barzegartahamtan M, Alikhassi A, Mohammadpour R. Investigation of electron boost radiotherapy in patients with breast cancer: Is a direct electron field optimal? Cancer Radiother 2018; 22:52-56. [PMID: 29398305 DOI: 10.1016/j.canrad.2017.08.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/07/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Historically, electron boost dose mainly was delivered by a direct field in adjuvant radiotherapy of breast cancer. In this prospective study, we investigated direct electron field, in terms of optimal coverage of tumour bed volume following localization using ultrasound and surgical clips. MATERIAL AND METHODS First, for all 24 patients, a breast sonographer drew perimeter of tumour bed on the breast skin. Then an electron boost field was outlined on the demarcated territory, and a lead wire marker compatible with CT scan was placed on the field borders by a 2cm margin. After CT scan simulation, all patients underwent adjuvant whole breast irradiation with 3D-conformal radiotherapy to 50Gy in 25 fractions. Then for boost radiotherapy, lead wire in CT images was countoured as electron boost field. Also, the tumour bed was contoured based on surgical clips (true clinical target volume and true planning target volume). Electron treatment planning was done for electron boost field. Finally isodose coverages for true planning target volume investigated. RESULTS On average, 16.68% of clips planning target volume (true planning target volume; range: 0.00 to 95%) received 90% oor more of the prescribed dose when the electron treatment plan was made. Isodose curves does not provide adequate coverage on the tumour bed (clips planning target volume) when electron boost treatment planning was generated for electron boost field (en face electron field). In fact, a part of target (planning target volume-c) is missed and more doses is absorbed in normal tissue. CONCLUSIONS Electron boost treatment planning (an en face electron field) following tumour bed localization using ultrasonography does not provide an optimized coverage of tumour bed volume.
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Affiliation(s)
- M Aghili
- Radiation Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - M Barzegartahamtan
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - A Alikhassi
- Department of Radiology, Imam Hospital, Tehran University of Medical Sciences, Tehran,Iran
| | - R Mohammadpour
- Department of Biostatistics, Health Sciences Research Centre, Mazandaran University of Medical Sciences, Sari, Iran
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Influence of body habitus on dose parameters of nodal levels III to IV irradiation for breast cancer: comparison of 3 techniques. Med Dosim 2017; 43:328-333. [PMID: 29223303 DOI: 10.1016/j.meddos.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/25/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to investigate the effect of body habitus on supraclavicular (SC) dose-volume histogram (DVH) parameters among breast cancer patients according to 3 different techniques. Three SC irradiation plans were generated for 24 postoperative breast cancer patients: (1) direct antero-posterior field only (1fieldP), with dose prescribed to a 3-cm depth; (2) 3-cm depth plan (3cmP) using an antero-posterior field plus a posterior boost with the dose prescription defined to 3 cm; and (3) optimized plan (OptP) similar to 3cmP, with dose prescribed depending on the anatomy. The OptP plans had the least variation in DVH parameters with body habitus; 3cmP plans were the most varied. Conformity index among normal weight patients were 0.73, 0.78, and 0.87 (p = 0.02) and 0.61, 0.6, and 0.82 among overweight-obese patients for 1fieldP, 3cmP, and OptP, respectively (p < 0.001). V95% of the planning target volume among normal weight patients were 72.63%, 78.03%, and 87.18% for 1fieldP, 3cmP, and OptP, respectively (p = 0.02). The corresponding values among overweight-obese patients were 60.5%, 59.62%, and 81.62%, respectively (p = 0.001). Fixed depth dose prescriptions caused greater SC under dose than plans optimized according to patient's anatomy.
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Dundas K, Pogson EM, Batumalai V, Delaney GP, Boxer MM, Yap ML, Ahern V, Chan C, David S, Dimigen M, Harvey JA, Koh ES, Lim K, Papadatos G, Lazarus E, Descellar J, Metcalfe P, Holloway L. The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning. Pract Radiat Oncol 2017; 8:e87-e97. [PMID: 28993138 DOI: 10.1016/j.prro.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of magnetic resonance imaging (MRI) versus computed tomography (CT)-derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiation therapy. METHODS AND MATERIALS Four WB radiation therapy plans were generated for 28 patients in which PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6-MV tangential intensity modulated radiation therapy technique was used, with plans designated as ideal, acceptable, or noncompliant. Dose metrics for PTVs and organs at risk were compared to analyze any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone). RESULTS With respect to imaging modality 2/11 whole breast planning target volume (WB_PTV) dose metrics (percentage of PTV receiving 90% and 110% of prescribed dose) displayed statistically significant differences; however, these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan versus a noncompliant plan were higher for the supine position compared with the prone position (P = .026). The minimum distance between the seroma cavity planning target volume (SC_PTV) and the chest wall was increased with prone positioning (P < .001, supine and prone values 1.1 mm and 8.7 mm, respectively). Heart volume was greater in the supine position (P = .005). Heart doses were lower in the supine position than prone (P < .01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone, respectively). Mean lung doses met ideal dose constraints in both positions, but were best spared in the prone position. The contralateral breast maximum dose to 1cc (D1cc) showed significantly lower doses in the supine position (P < .001, 4.64 Gy vs 9.51 Gy). CONCLUSIONS Planning with PTVs generated from MRI data showed no clinically significant differences from planning with PTVs generated from CT with respect to PTV and doses to organs at risk. Prone positioning within this study reduced mean lung dose and whole heart volumes but increased mean heart and contralateral breast doses compared with supine.
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Affiliation(s)
- Kylie Dundas
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia.
| | - Elise M Pogson
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Miriam M Boxer
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, NSW, Australia
| | - Christine Chan
- Department of Radiology, Liverpool Hospital, NSW, Australia
| | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Marion Dimigen
- Department of Radiology, Liverpool Hospital, NSW, Australia
| | - Jennifer A Harvey
- School of Medicine, University of Queensland, QLD, Australia; Princess Alexandra Hospital, QLD, Australia
| | - Eng-Siew Koh
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Lim
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - George Papadatos
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia
| | | | - Joseph Descellar
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia
| | - Lois Holloway
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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Nguyen K, Mackenzie P, Allen A, Dreosti M, Morgia M, Zissiadis Y, Lamoury G, Windsor A. Breast interest group faculty of radiation oncology: Australian and New Zealand patterns of practice survey on breast radiotherapy. J Med Imaging Radiat Oncol 2016; 61:508-516. [PMID: 27987274 DOI: 10.1111/1754-9485.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This patterns of practice study was conducted on behalf of the RANZCR Breast Interest Group in order to document current radiotherapy practices for breast cancer in Australia and New Zealand. The survey identifies variations and highlights potential contentious aspects of radiotherapy management of breast cancer. METHODS A fifty-eight question survey was disseminated via the Survey Monkey digital platform to 388 Radiation Oncologists in Australia and New Zealand. RESULTS In total, 156 responses were received and collated. Areas of notable consensus among respondents included hypofractionation (77.3% of respondents would 'always' or 'sometimes' consider hypofractionation in the management of ductal carcinoma in-situ and 99.3% in early invasive breast cancer); margin status in early breast cancer (73.8% believe a clear inked margin is sufficient and does not require further surgery) and use of bolus in post-mastectomy radiotherapy (PMRT) (91.1% of participants use bolus in PMRT). Areas with a wider degree of variability amongst respondents included regional nodal irradiation and components of radiotherapy planning and delivery (examples include the technique used for delivery of boost and frequency of bolus application for PMRT). CONCLUSION The results of these patterns of practice survey informs radiation oncologists in Australia and New Zealand of the current clinical practices being implemented by their peers. The survey identifies areas of consensus and contention, the latter of which may lead to a development of research trials and/or educational activities to address these areas of uncertainty.
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Affiliation(s)
- Kimberley Nguyen
- Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia.,South Western Sydney Local Health District, Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Penny Mackenzie
- St George Hospital Cancer Care, St George Hospital, Kogarah, New South Wales, Australia
| | - Angela Allen
- Waikato Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand
| | - Marcus Dreosti
- Genesis Cancer Care: Adelaide Radiotherapy Centre, Adelaide, South Australia, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Yvonne Zissiadis
- Genesis Cancer Care: Wembley Radiotherapy Centre, Wembley, Western Australia, Australia
| | - Gilian Lamoury
- Northern Sydney Cancer Centre Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Apsara Windsor
- Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia.,University of New South Wales, Randwick, New South Wales, Australia
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Khalil Arjmandi M, Moslemi D, Sadati Zarrini A, Ebrahimnezhad Gorji M, Mosapour A, Haghhaghighi A, Halalkhor S, Bijani A, Parsian H. Pre and post radiotherapy serum oxidant/antioxidant status in breast cancer patients: Impact of age, BMI and clinical stage of the disease. Rep Pract Oncol Radiother 2016; 21:141-8. [PMID: 27601942 DOI: 10.1016/j.rpor.2015.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 11/04/2015] [Accepted: 12/23/2015] [Indexed: 01/15/2023] Open
Abstract
AIM In this study the effects of radiation therapy (RT) on serum oxidant/antioxidant status in breast cancer patients and the impact of age, BMI and clinical stage of the disease on the aforementioned variables were investigated. BACKGROUND RT that is used for cancer treatment is dependent on the production of reactive oxygen species. MATERIALS AND METHODS Eighty patients with breast cancer participated in this study and received RT at a dose of 50 Gy for 5 weeks. Blood samples were obtained in one day before and after the end of RT. Serum status of malondialdehyde (MDA), total antioxidant status (TAS), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were analyzed by spectrophotometry or ELISA and selenium (Se) level were analyzed by atomic absorption spectrometry. Paired t-test was used for comparing pre and post radiotherapy data. RESULTS Before and after the radiotherapy, a significant increase in MDA level was observed, while a significant decrease in GPx activity, SOD, TAS and Se levels were found (p < 0.05). The level of the CAT enzyme had no significant changes (p = 0.568). The results showed some changes in the status of TAS, SOD and GPx which are associated with age, BMI and clinical stage of the disease. CONCLUSION It seems that RT would have the potential to cause variations in the status of antioxidant/oxidant system. Although, some changes in variables were observed by sub-classification of the age, BMI and the disease stage, but it seems that these changes are not necessarily dependent to them.
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Affiliation(s)
| | - Dariush Moslemi
- Department of Radiation Oncology, Babol University of Medical Sciences, Babol, Iran
| | - Azadeh Sadati Zarrini
- Department of Biology, Science and Research Branch, Islamic Azad University, Fars, Iran
| | | | - Abbas Mosapour
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Asefeh Haghhaghighi
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Sohrab Halalkhor
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinant of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Hadi Parsian
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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12
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Dundas KL, Pogson EM, Batumalai V, Boxer MM, Yap ML, Delaney GP, Metcalfe P, Holloway L. Australian survey on current practices for breast radiotherapy. J Med Imaging Radiat Oncol 2015; 59:736-42. [PMID: 26269376 DOI: 10.1111/1754-9485.12348] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/21/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. METHOD An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. RESULTS Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. CONCLUSION This survey provides insight into the current radiotherapy practice for breast cancer in Australia.
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Affiliation(s)
- Kylie L Dundas
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elise M Pogson
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Miriam M Boxer
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lois Holloway
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
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13
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Seppälä J, Heikkilä J, Myllyoja K, Koskela K. Volumetric modulated arc therapy for synchronous bilateral whole breast irradiation - A case study. Rep Pract Oncol Radiother 2015; 20:398-402. [PMID: 26549999 DOI: 10.1016/j.rpor.2015.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/13/2015] [Accepted: 05/24/2015] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The treatment planning of bilateral breast irradiation (BBI) is a challenging task. The overlapping of tangential fields is usually unavoidable without compromising the target coverage. The purpose of this study was to investigate the technical feasibility and benefits of a single isocentre volumetric modulated arc therapy (VMAT) in BBI. METHODS AND MATERIALS Two women with bilateral breast cancer were included in this case study. The first patient (Pat#1) underwent a bilateral breast-conserving surgery and sentinel lymph node biopsy. The second patient (Pat#2) underwent a bilateral ablation and axillary lymph node dissection. Planning target volumes (PTV) and organs at risk were delineated on CT images. VMAT plans were created with four (two for both sides, Pat#1) or two (one for each breast, Pat#2) separate VMAT fields. Subsequently, traditional tangential field plans were generated for each patient and the dosimetric parameters were compared. RESULTS The treatment times of the patients with VMAT were less than 15 min with daily CBCT imaging. When compared to the standard tangential field technique, the VMAT plans improved the PTV dose coverage and dose homogeneity with improved sparing of lungs and heart. With traditional field arrangement, the overlapping of the tangential fields was inevitable without significantly compromising the target coverage, whereas with VMAT the hotspots were avoided. The patients were treated with the VMAT technique and no acute skin toxicity was observed with either of the patients. CONCLUSIONS A single isocentre VMAT technique has been implemented clinically for BBI. With the VMAT techniques, the dose delivery was quick and the hotspots in the field overlapping areas were avoided. The PTV dose coverage was superior in VMAT plans when compared with conventional tangential technique plans.
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Affiliation(s)
- Jan Seppälä
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Janne Heikkilä
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Kimmo Myllyoja
- Cancer Center, Kuopio University Hospital, Kuopio, Finland
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14
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Lara P, Calvo FA, Guedea F, Bilbao P, Biete A. Undergraduate cancer education in Spain: The debate, the opportunities and the initiatives of the University Forum of the Spanish Society of Radiation Oncology (SEOR). Rep Pract Oncol Radiother 2013; 18:405-13. [PMID: 24416587 DOI: 10.1016/j.rpor.2013.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/27/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022] Open
Abstract
Most medical schools in Spain (80%) offer undergraduate training in oncology. This education is highly variable in terms of content (theory and practical training), number of credits, and the medical specialty and departmental affiliation of the professors. Much of this variability is due to university traditions in the configuration of credits and programmes, and also to the structure of the hospital-based practical training. Undergraduate medical students deserve a more coherent and modern approach to education with a strong emphasis on clinical practice. Oncology is an interdisciplinary science that requires the input of professors from multiple specialties to provide the primary body of knowledge and skills needed to obtain both a theoretical and clinical understanding of cancer. Clinical skills should be a key focus due to their importance in the current model of integrated medical management and care. Clinical radiation oncology is a traditional and comprehensive hospital-based platform for undergraduate education in oncology. In Spain, a significant number (n = 80) of radiation oncology specialists have a contractual relationship to teach university courses. Most Spanish universities (80%) have a radiation oncologist on staff, some of whom are department chairs and many others are full professors who have been hired and promoted under competitive conditions of evaluation as established by the National Agency for Quality Evaluation. The Spanish Society of Radiation Oncology (SEOR) has identified new opportunities to improve undergraduate education in oncology. In this article, we discuss proposals related to theoretical (20 items) and practical clinical training (9 items). We also describe the SEOR University Forum, which is an initiative to develop a strategic plan to implement and organize cancer education at the undergraduate level in an interdisciplinary teaching spirit and with a strong contribution from radiation oncologists.
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Affiliation(s)
- Pedro Lara
- Universidad de Las Palmas, Canary Islands, Spain
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15
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Evidence based radiation oncology with existing technology. Rep Pract Oncol Radiother 2013; 19:259-66. [PMID: 25061519 DOI: 10.1016/j.rpor.2013.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 08/12/2013] [Accepted: 09/11/2013] [Indexed: 12/20/2022] Open
Abstract
AIM To assess the real contribution of modern radiation therapy (RT) technology in the more common tumoral types in Central America, Caribbean and South America. BACKGROUND RT is an essential tool in the management of cancer. RT can be either palliative or of curative intent. In general, for palliative radiotherapy, major technologies are not needed. MATERIALS AND METHODS We analyzed the contribution of RT technology based on published evidence for breast, lung, gastric, gallbladder, colorectal, prostate and cervix cancer in terms of disease control, survival or toxicity with especial focus on Latin America. RESULTS Findings indicate that three dimensional conformal radiation therapy (3D RT) is the gold standard in most common type of cancer in the studied regions. Prostate cancer is probably the pathology that has more benefits when using new RT technology such as intensity modulated radiation therapy (IMRT) versus 3DRT in terms of toxicity and biochemical progression-free survival. CONCLUSIONS In light of the changes in technology, the ever-increasing access of developing countries to such technology, and its current coverage in Latin America, any efforts in this area should be aimed at improving the quality of the radiotherapy departments and centers that are already in place.
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16
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Poortmans P, Marsiglia H, De Las Heras M, Algara M. Clinical and technological transition in breast cancer. Rep Pract Oncol Radiother 2013; 18:345-52. [PMID: 24416578 DOI: 10.1016/j.rpor.2013.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/08/2013] [Accepted: 08/05/2013] [Indexed: 12/01/2022] Open
Abstract
This article is a summary of the conference "Clinical and technological transition in breast cancer" that took place in the Congress of the Spanish Society of Radiation Oncology, placed in Vigo (Spain) on June 21, 2013. Hugo Marsiglia and Philip Poortmanns were the speakers, the first discussed about "Clinical and technological transition" and the second about "EORTC clinical trials and protocols".
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Affiliation(s)
- Philip Poortmans
- Radiotherapy Department, Institute Verbeeten, Tilburg, The Netherlands
| | - Hugo Marsiglia
- Radiotherapy Department, Instituve Gustave Roussy, Villejuif, France
| | | | - Manuel Algara
- Radiotherapy Department, Parc de Salut Mar, Barcelona, Spain
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17
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Usability application of multiplex polymerase chain reaction in the diagnosis of microorganisms isolated from urine of patients treated in cancer hospital. Radiol Oncol 2013; 47:296-303. [PMID: 24133395 PMCID: PMC3794886 DOI: 10.2478/raon-2013-0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/11/2013] [Indexed: 11/21/2022] Open
Abstract
Background The objective of this study was: i) to compare the results of urine culture with polymerase chain reaction (PCR) -based detection of microorganisms using two commercially available kits, ii) to assess antimicrobial susceptibility of urine isolates from cancer patients to chosen antimicrobial drugs and, if necessary, to update the recommendation of empirical therapy. Materials and methods. A one-year hospital-based prospective study has been conducted in Greater Poland Cancer Centre and Genetic Medicine Laboratory CBDNA Research Centre in 2011. Urine cultures and urine PCR assay from 72 patients were examined Results Urine cultures and urine PCR assay from 72 patients were examined. Urine samples were positive for 128 strains from which 95 (74%) were identical in both tests. The most frequently isolated bacteria in both culture and PCR assay were coliform organisms and Enterococcus spp. The Gram negative bacilli were most resistant to cotrimoxazol. 77.2% of these bacilli and 100% of E. faecalis and S. agalactiae were sensitive to amoxicillin-clavulanic acid. 4.7% of Gram positive cocci were resistant to nitrofurantoin. Conclusions The PCR method quickly finds the causative agent of urinary tract infection (UTI) and, therefore, it can help with making the choice of the proper antimicrobial therapy at an early stage. It appears to be a viable alternative to the recommendations made in general treatment guidelines, in cases where diversified sensitivity patterns of microorganisms have been found.
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18
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Soares A, Gonçalves J, Azevedo I, Pereira HG. Lobular ectopic breast carcinoma: A case-report. Rep Pract Oncol Radiother 2013; 18:189-91. [PMID: 24416552 DOI: 10.1016/j.rpor.2013.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 11/30/2012] [Accepted: 03/17/2013] [Indexed: 11/17/2022] Open
Abstract
In about 1-2% of the population an incomplete regression of the embryonic mammary line occurs, which may result in the presence of ectopic breast tissue. An ectopic breast tissue carcinoma is a rare entity. The authors present a case-report of a 51-year-old female patient, with a lobular carcinoma in an axillary ectopic breast tissue submitted to surgery and adjuvant radiotherapy.
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Affiliation(s)
- André Soares
- Radiotherapy Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Portugal
| | - Joana Gonçalves
- Radiotherapy Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Portugal
| | - Isabel Azevedo
- Radiotherapy Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Portugal
| | - Helena G Pereira
- Radiotherapy Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Portugal
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Khanfir A, Lahiani F, Bouzguenda R, Ayedi I, Daoud J, Frikha M. Prognostic factors and survival in metastatic breast cancer: A single institution experience. Rep Pract Oncol Radiother 2013; 18:127-32. [PMID: 24416543 DOI: 10.1016/j.rpor.2013.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/08/2013] [Accepted: 01/13/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The current retrospective study aims to identify some determinants of survival in metastatic breast cancer. METHODS The study concerned 332 patients with synchronous (SM) or metachronous (MM) metastatic breast cancer treated between January 2000 and December 2007. Statistical comparison between subgroups of patients concerning survival was carried out employing log-rank test for the invariable analysis and Cox model for the multivariable analysis. Factors included: age group (≤50 years vs. >50; ≤70 years vs. >70; ≤35 years vs. >35), menopausal status, presentation of metastatic disease (SM vs. MM), disease free interval (DFI) (≤24 months vs. >24 months; ≤60 months vs. >60 months), performance status at diagnosis of metastatic disease (PS) (0-1 vs. >1), hormone receptors (HR), number of metastatic sites (1 site vs. >1), nature of the metastatic site (visceral vs. non visceral), first line therapy, surgery of the primary tumor (SPT), locoregional radiotherapy (LRRT) and use or not of bisphosphonates. RESULTS Overall survival at 5 years was 12%. Positive prognostic factors in univariate analysis were: age ≤ 70 years, hormono-dependence of the tumor, good PS (PS 0-1), less than two metastatic sites, no visceral metastases, DFI ≥ 24 months, SPT or LRRT. In multivariate analysis, favorable independent prognostic factors included: good PS (PS 0-1), absence of visceral metastases (liver, lung, brain) and age ≤ 70 years. CONCLUSION Many of the prognostic factors in metastatic breast cancer found in our study are known in the literature but some of them, like the application of locoregional treatment (radiotherapy or surgery) and the use of bisphosphonates, need to be further investigated in randomized clinical trials.
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Affiliation(s)
- Afef Khanfir
- Department of Medical Oncology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Faiez Lahiani
- Department of Medical Oncology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Racem Bouzguenda
- Department of Medical Oncology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Ines Ayedi
- Department of Medical Oncology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Jamel Daoud
- Department of Radiotherapy, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
| | - Mounir Frikha
- Department of Medical Oncology, Habib Bourguiba University Hospital, 3029 Sfax, Tunisia
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Affiliation(s)
- Jiří Petera
- Department of Oncology and Radiotherapy, University Hospital Hradec Králové, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
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