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Haldar S, Sarkar B, Dixit A. Dose to Organ at Risk and its Characteristic Variation with the Clinically Used Different Prescription Levels for Early-stage Left-sided Breast Cancer. Clin Oncol (R Coll Radiol) 2024; 36:21-29. [PMID: 38040550 DOI: 10.1016/j.clon.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/27/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
AIMS To evaluate the organ at risk (OAR) dose and its characteristic variation with different clinically usable prescription doses (RxD) for breast and chest wall radiotherapy in patients with early-stage left-sided breast cancer. MATERIALS AND METHODS In total, 145 patients with early-stage breast cancers (T1N0M0-T2N0M0) on the left side were treated with radiotherapy after a modified radical mastectomy or breast conservation surgery, with a mean age of 45.1 ± 21.6 years. The patient received 4050 cGy of field-in-field (three-dimensional conformal radiotherapy) treatment limited to the breast or chest wall, excluding the supraclavicular node, axillary node and internal mammary chain, over 15 fractions. Additional plans of 5000 cGy/25 fractions, 4500 cGy/20 fractions and 2600 cGy/5 fractions were created with no or minor changes to the original plan. Mathematical modelling was used to study the distinctive change in the dose-volume characteristics for various OARs as a function of the RxD. OAR dosages, both absolute and normalised, were expressed in terms of the RxD. The mathematical (functional) relationship between OAR doses and different prescription levels was deduced by the least squares fit method. RESULT The left lung mean dose, V5Gy (%), V10Gy (%) and V20Gy (%) and the heart mean dose, V10Gy (%) and V20Gy (%) were evaluated. The dose-volume parameters showed a parabolic variation (x2) with the RxD. Prescription normalised OAR doses showed a linear relationship with the RxD; relative dose increased with diminishing RxD. Normalised lung and heart mean doses exhibited saturation (linear relationship) with RxD variation. Paired sample t-test results between RxD versus all evaluated parameters were found to be statistically significant (P = 0.004). The Pearson correlation coefficient between different prescription levels for left lung mean dose (range 0.942-1.0), heart mean dose (range 1.0-1.0), left lung V5Gy (%) (range 0.987-1.0), left lung V10Gy (%) (range 0.991-0.999), heart V10Gy (%) (range 0.998-1.0). CONCLUSION The functional form of absolute OAR dose-volume parameters versus RxD is parabolic and the RxD normalised OAR dose-volume parameter versus RxD is a straight line with a negative slope as RxD increases. This indicates an increase in the relative OAR dose-volume parameters if the RxD is reduced. This study is the first of its kind to compare the OAR doses as a function of clinically used degenerate prescription levels. These data will help to comprehend the OAR doses while adopting a new dose fractionation regimen and reviewing the radiotherapy treatment plans.
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Affiliation(s)
- S Haldar
- Department of Radiation Oncology, Saroj Gupta Cancer Centre and Research Institute, Kolkata, India; Department of Physics, Institute of Applied Science and Humanities, GLA University, Mathura, India
| | - B Sarkar
- Department of Radiation Oncology, Apollo Multispeciality Hospital, Kolkata, India.
| | - A Dixit
- Department of Mathematics, Institute of Applied Science and Humanities, GLA University, Mathura, India
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Wang J, Chen H, Koenig J, Wu Y, Bedrosian I, Arun B, Ding Q, Khazai L, Resetkova E, Huo L, Sneige N, Albarracin C. Discordance of Oncotype DX scores in synchronous bilateral and unilateral multifocal breast cancers. Breast Cancer Res Treat 2024; 203:73-83. [PMID: 37751078 DOI: 10.1007/s10549-023-07119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Oncotype DX, a 21-gene expression profiling test, has become standard of care in the management of estrogen receptor (ER)-positive breast cancer. In multifocal tumors, it is unclear whether testing of the different foci is necessary. We evaluated the concordance of Oncotype DX recurrence scores (RS) between 2 tumor foci in synchronous bilateral or unilateral multifocal tumors and characterized pathological predictors of discordance. METHODS We reviewed 713 ER+, HER2- primary invasive breast cancer patients with Oncotype RS and identified 17 bilateral synchronous patients (34 tumors) and 13 unilateral multifocal patients (26 tumors) with available Oncotype RS on all foci. Discordance in Oncotype RS between synchronous tumors was recorded and associations with clinicopathologic features including tumor size, histology, Nottingham histologic grade, progesterone receptor staining, and Ki67 index were analyzed. RESULTS Bilateral synchronous tumors were present in older patients (median age 59 years) and had larger tumor (median size 17 mm) and more discordant histology (10/17, 59%) as compared to unilateral multifocal tumors (median age 49 years, p < 0.01; median tumor size 12 mm, p = 0.01; discordant histology 2/13, 15%, p = 0.03). Oncotype RS were discordant in 47% (8/17) of bilateral and 54% (7/13) of unilateral multifocal tumors. Concordant Oncotype RS was associated with similar histologic grade and Ki67 index in 78% (7/9) of bilateral and 100% (6/6) of multifocal tumors. In contrast, only 25% (2/8) of bilateral (p = 0.06) and 14% (1/7) of unilateral multifocal (p < 0.01) cases with discordant Oncotype RS had concordant histology grades and Ki67 levels. In synchronous tumors with discordant Oncotype RS and Ki67 index, all (4/4) foci with higher RS had higher Ki67 index. CONCLUSION Discordance of Oncotype RS is common in both bilateral and unilateral multifocal breast cancer and is likely associated with discordant histologic grade or Ki67.
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Affiliation(s)
- Jing Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, G1.3617B, Houston, TX, 77030, USA.
| | - Jenna Koenig
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isabelle Bedrosian
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laila Khazai
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erika Resetkova
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nour Sneige
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Constance Albarracin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 085, G1.3617A, Houston, TX, 77030, USA.
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Griffin C, Fairhurst K, Stables I, Brunsden S, Potter S. ASO Visual Abstract: Outcomes in Women Undergoing Mastectomy for Unilateral Breast Cancer Who Elect to Undergo Contralateral Mastectomy for Symmetry-A Systematic Review. Ann Surg Oncol 2024; 31:396-397. [PMID: 37803090 DOI: 10.1245/s10434-023-14389-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Affiliation(s)
- Cora Griffin
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Imogen Stables
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Shelley Potter
- Bristol Medical School, University of Bristol, Bristol, UK.
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK.
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Sigurdson S, Thibodeau S, Montgomery L, Olding T, Hopman W, Korzeniowski M. Analysis of multicatheter interstitial brachytherapy: Accelerated partial breast irradiation in a retrospective cohort of early-stage breast cancer patients. Brachytherapy 2024; 23:52-57. [PMID: 37806789 DOI: 10.1016/j.brachy.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To determine cardiac dose received by patients treated with high dose rate interstitial brachytherapy. Patients with early-stage, node negative breast cancer can be treated using multi-catheter interstitial brachytherapy accelerated partial breast irradiation (MIB-APBI), with the benefit of reduced treatment volumes and favorable toxicity. METHODS AND MATERIALS We conducted a retrospective review of left-sided breast cancer patients treated using MIB-APBI at our institution since 2014. The mean heart dose (MHD) was calculated using the Oncentra 3.2 planning system. The minimum distance between the planning target volume (PTVeval) and heart contour was measured manually. FINDINGS 81 patients were included. The upper outer quadrant was the most common site. The MHD was 97.8 cGy (EQD2a/b=2) (range 22-229 cGy). MHD significantly correlated with the closest distance between PTVeval and heart contour (correlation coefficient -0.823, p <0.001); size of PTVeval (cc) and quadrant location did not. CONCLUSIONS Appropriately selected women with early-stage, low-risk, left-sided breast cancer who received MIB-APBI had acceptable MHD. There was a strong correlation between the distance of PTVeval and MHD. Quadrant breast tumor is in cannot be used as a surrogate for MHD in brachytherapy. Our findings contribute to the growing evidence of the utility and safety of MIB-APBI.
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Affiliation(s)
- Samantha Sigurdson
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada.
| | - Stephane Thibodeau
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Logan Montgomery
- Department of Oncology, Division of Medical Physics, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Tim Olding
- Department of Oncology, Division of Medical Physics, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Kingston Health Sciences Research Centre & Faculty of Medicine, Queen's University, Ontario, Canada
| | - Martin Korzeniowski
- Department of Oncology, Division of Radiation Oncology, Cancer Centre of Southeastern Ontario & Faculty of Medicine, Queen's University, Ontario, Canada
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Ucurum SG, Felekoglu E, Naz I, Kaya DO, Bayram KB, Alacacioglu A. Investigation of the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in unilateral breast cancer surgery survivors: a cross-sectional study. Support Care Cancer 2023; 31:714. [PMID: 37987877 DOI: 10.1007/s00520-023-08138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Despite the research on structural and functional changes that may occur in breast cancer survivors, no study has investigated the relationship between spinal characteristics and the respiratory system. Therefore, we aimed to investigate the relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions in breast cancer patients who have completed their treatment METHODS: This cross-sectional study included 38 female breast cancer surgery survivors. Participants underwent the following evaluations: Chest wall mobility with a tapeline; postural assessments (spinal curvature, spinal mobility, and spinal inclination) with a non-invasive, computer-assisted electromechanical device; and pulmonary function test and respiratory muscle strength with a portable digital spirometer device. The relationship between spinal posture and mobility to respiratory muscle strength and pulmonary functions was analyzed by the bivariate correlation analysis. RESULTS Increased thoracic curvature angle was associated with decreased FEV1 (r=-0.360, p=0.026) and decreased subcostal mobility (r=-0.385, p=0.017), and the increase in thoracic frontal mobility was associated with decrease in PEF (r=-0.342, p=0.036). Increased lumbar mobility was associated with increased FVC (r=0.324, p=0.047), and increased total spinal inclination mobility was associated with decreased MIP (r=-0.396, p=0.017). Chest wall mobility was associated with postural assessments at varying rates (the r value ranged from -0.357 to 0.661, p<0.05). CONCLUSION The changes in spinal posture and mobility of women who have undergone unilateral breast cancer surgery were associated with respiratory parameters and thoracic cage mobility. These patients' spinal posture and mobility should be taken into account in conjunction with respiratory functions for a comprehensive assessment.
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Affiliation(s)
- Sevtap Gunay Ucurum
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey.
| | - Elvan Felekoglu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | - Ilknur Naz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | - Derya Ozer Kaya
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | - Korhan Baris Bayram
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey
| | - Ahmet Alacacioglu
- Faculty of Medicine, Department of Medical Oncology, Izmir Katip Celebi University, Izmir, Turkey
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Håkansson K, Josipovic M, Ottosson W, Behrens CP, Vogelius IR, Persson G. Evaluating the dosimetric effect of intra-fractional variations in deep inspiration breath-hold radiotherapy - a proof-of-concept study. Acta Oncol 2023; 62:1246-1250. [PMID: 37738385 DOI: 10.1080/0284186x.2023.2259084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Affiliation(s)
- K Håkansson
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - W Ottosson
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - C P Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Roskilde, Denmark
| | - I R Vogelius
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - G Persson
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Chau OW, El-Sherif O, Mouawad M, Sykes JM, Butler J, Biernaski H, deKemp R, Renaud J, Wisenberg G, Prato FS, Gaede S. Changes in myocardial blood flow in a canine model of left sided breast cancer radiotherapy. PLoS One 2023; 18:e0291854. [PMID: 37768966 PMCID: PMC10538714 DOI: 10.1371/journal.pone.0291854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Left-sided breast cancer patients receiving adjuvant radiotherapy are at risk for coronary artery disease, and/or radiation mediated effects on the microvasculature. Previously our laboratory demonstrated in canines with hybrid 18FDG/PET a progressive global inflammatory response during the initial one year following treatment. In this study, the objective is to evaluate corresponding changes in perfusion, in the same cohort, where resting myocardial blood flow (MBF) was quantitatively measured. METHOD In five canines, Ammonia PET (13NH3) derived MBF was measured at baseline, 1-week, 1, 3, 6 and 12-months after cardiac external beam irradiation. MBF measurements were correlated with concurrent 18FDG uptake. Simultaneously MBF was measured using the dual bolus MRI method. RESULTS MBF was significantly increased at all time points, in comparison to baseline, except at 3-months. This was seen globally throughout the entire myocardium independent of the coronary artery territories. MBF showed a modest significant correlation with 18FDG activity for the entire myocardium (r = 0.51, p = 0.005) including the LAD (r = 0.49, p = 0.008) and LCX (r = 0.47, p = 0.013) coronary artery territories. CONCLUSION In this canine model of radiotherapy for left-sided breast cancer, resting MBF increases as early as 1-week and persists for up to one year except at 3-months. This pattern is similar to that of 18FDG uptake. A possible interpretation is that the increase in resting MBF is a response to myocardial inflammation.
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Affiliation(s)
- Oi-Wai Chau
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Omar El-Sherif
- Mayo Clinic, Rochester, Minnesota, United States of America
| | - Matthew Mouawad
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Jane M. Sykes
- Thames Valley Veterinary Services, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - John Butler
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Robert deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer Renaud
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Gerald Wisenberg
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Frank S. Prato
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Wang S, Tsai W, Lin K, Yu C, Yang S, Shueng P, Wu Y, Hsu C, Wu T. Integrating subvolume dose and myocardial perfusion imaging parameters to assess the impact of radiation therapy on heart function in breast cancer patients: A comparative analysis between left- and right-sided breast cancer. Thorac Cancer 2023; 14:2696-2706. [PMID: 37553772 PMCID: PMC10493477 DOI: 10.1111/1759-7714.15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND This study aimed to utilize an innovative method of integrating the 20 subvolume dose of left ventricle and the Tl-201 single photon emission computed tomography (SPECT) with myocardial perfusion imaging (MPI) parameters in patients with left- and right-sided breast cancer after radiation therapy. METHODS Female patients with breast cancer underwent SPECT MPI before commencing radiotherapy and 12 months later were enrolled from January 2014 to December 2018. The images of CT simulation and SPECT MPI were integrated into the treatment planning system. The differences of doses and parameters of MPI in all cardiac subvolumes between left- and right-sided breast cancer patients were analyzed. RESULTS Patients with left-sided breast cancer (n = 61) received a higher radiation dose to the heart, left ventricular, and its territories and subvolumes, compared to patients with right-sided breast cancer (n = 19). The 20-segment analysis also showed statistically significant disparities in the average radiation doses received by the two groups. In different coronary artery territories, the end-diastolic perfusion and end-systolic perfusion showed a decrease in both sides, with no significant differences. However, the wall motion and wall thickening showed a significant decline in subregions within the left- and right-sided coronary artery territories. CONCLUSION This study demonstrates an innovative integrated method combining the left ventricular 20 regional doses with SPECT MPI which shows that left-sided breast cancer patients receive a higher subvolume dose than right-sided breast cancer patients. Further research is needed to confirm the potential impact on heart function after radiotherapy on both sides.
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Affiliation(s)
- Shan‐Ying Wang
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Nuclear MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Wei‐Ta Tsai
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Radiation Oncology, Dalin Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationChiayiTaiwan
| | - Kuan‐Heng Lin
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
- Industrial Ph.D. Program of Biomedical Science and EngineeringNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chih‐Wei Yu
- Department of Radiation OncologyChina Medical University Hsinchu HospitalZhubei CityTaiwan
- Institute of Nuclear Engineering and ScienceNational Tsing Hua UniversityHsinchu CityTaiwan
| | - Shu‐Ya Yang
- Department of Nuclear MedicineCheng Hsin General HospitalTaipeiTaiwan
| | - Pei‐Wei Shueng
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yen‐Wen Wu
- Department of Nuclear MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
- School of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Cardiology, Cardiovascular Medical CenterFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Chen‐Xiong Hsu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Tung‐Hsin Wu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
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Versyck B, Vermeylen K, Willemse J, van Geffen GJ, Leunen I, Soetens F, Devos S, Roosens L. Serum concentrations of local anesthetics after unilateral interpectoral-pectoserratus plane block in breast cancer surgery: a pharmacokinetic study. Reg Anesth Pain Med 2023; 48:399-402. [PMID: 36787951 DOI: 10.1136/rapm-2022-104166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION The ultrasound-guided interpectoral-pectoserratus plane block is a fascial plane block for superficial surgery of the anterolateral chest wall. This technique involves injecting a relatively large volume of local anesthetics (typically 30 mL of 0.25%-0.50%, ie, 75-150 mg ropivacaine) underneath the major and minor pectoral muscles of the anterior thoracic wall. There is a potential risk of toxic serum concentrations of local anesthetics due to systemic absorption. METHODS 22 patients scheduled for elective unilateral breast cancer surgery were included in this study. All surgery was performed with general anesthesia and an ultrasound-guided interpectoral-pectoserratus plane block with 2.5 mg/kg ropivacaine. Ten venous blood samples were collected at 0 (two samples) 10, 20, 30, 45, 60, 90 and 120 min and at 4 hours after performing the block. Free and total ropivacaine levels were measured at each time point. Albumin and alpha-1-acid-glycoprotein were measured to monitor shifts between the free and bound fraction of ropivacaine. RESULTS Samples of 20 patients were analyzed. The mean dose of ropivacaine was 172.8 (22.5) mg. In 50% of the patients, the potentially toxic threshold of 0.15 µg/mL free ropivacaine concentration was exceeded. Mean peak serum concentration occurred at 20 min postinjection. CONCLUSIONS This pharmacokinetic study demonstrated that a 2.5 mg/kg ropivacaine interpectoral-pectoserratus plane block may result in exceeding the threshold for local anesthetic systemic toxicity.
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Affiliation(s)
- Barbara Versyck
- Department of Anesthesia and Intensive Care, AZ Turnhout Campus Sint-Jozef, Turnhout, Antwerpen, Belgium
- Department of Anesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Kris Vermeylen
- Department of Anesthesia and Intensive Care, AZ Turnhout Campus Sint-Jozef, Turnhout, Antwerpen, Belgium
| | - Johan Willemse
- Department of Clinical Biology, AZ Turnhout Campus Sint Elisabeth, Turnhout, Antwerpen, Belgium
| | | | - Ine Leunen
- Department of Anesthesia and Intensive Care, AZ Turnhout Campus Sint-Jozef, Turnhout, Antwerpen, Belgium
| | - Filiep Soetens
- Department of Anesthesia and Intensive Care, AZ Turnhout Campus Sint-Jozef, Turnhout, Antwerpen, Belgium
| | - Sylvie Devos
- Department of Clinical Biology, University Hospital Antwerp, Edegem, Belgium
| | - Laurence Roosens
- Department of Clinical Biology, University Hospital Antwerp, Edegem, Belgium
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Chau OW, Islam A, Lock M, Yu E, Dinniwell R, Yaremko B, Brackstone M, Pavlosky W, Butler J, Biernaski H, Graf C, Wisenberg G, Prato FS, Gaede S. PET/MRI Assessment of Acute Cardiac Inflammation 1 Month After Left-Sided Breast Cancer Radiation Therapy. J Nucl Med Technol 2023; 51:133-139. [PMID: 37192822 DOI: 10.2967/jnmt.122.264960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/30/2023] [Indexed: 05/18/2023] Open
Abstract
Our purpose was to investigate the utility of 18F-FDG PET/MRI and serial blood work to detect early inflammatory responses and cardiac functionality changes at 1 mo after radiation therapy (RT) in patients with left-sided breast cancer. Methods: Fifteen left-sided breast cancer patients who enrolled in the RICT-BREAST study underwent cardiac PET/MRI at baseline and 1 mo after standard RT. Eleven patients received deep-inspiration breath-hold RT, whereas the others received free-breathing RT. A list-mode 18F-FDG PET scan with glucose suppression was acquired. Myocardial inflammation was quantified by the change in 18F-FDG SUVmean (based on body weight) and analyzed on the basis of the myocardial tissue associated with the left anterior descending, left circumflex, or right coronary artery territories. MRI assessments, including left ventricular functional and extracellular volumes (ECVs), were extracted from T1 (before and during a constant infusion of gadolinium) and cine images, respectively, acquired simultaneously during the PET acquisition. Cardiac injury and inflammation biomarker measurements of high-sensitivity troponin T, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate were measured at the 1-mo follow-up and compared with preirradiation values. Results: At the 1-mo follow-up, a significant increase (10%) in myocardial SUVmean in left anterior descending segments (P = 0.04) and ECVs in slices at the apex (6%) and base (5%) was detected (P ≤ 0.02). Further, a significant reduction in left ventricular stroke volume (-7%) was seen (P < 0.02). No significant changes in any circulating biomarkers were seen at follow-up. Conclusion: Myocardial 18F-FDG uptake and functional MRI, including stroke volume and ECVs, were sensitive to changes at 1 mo after breast cancer RT, with findings suggesting an acute cardiac inflammatory response to RT.
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Affiliation(s)
- Oi Wai Chau
- London Regional Cancer Program, London, Ontario, Canada;
- Western University, London, Ontario, Canada
| | - Ali Islam
- Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada; and
| | - Michael Lock
- London Regional Cancer Program, London, Ontario, Canada
- Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Edward Yu
- London Regional Cancer Program, London, Ontario, Canada
- Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Robert Dinniwell
- London Regional Cancer Program, London, Ontario, Canada
- Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Brian Yaremko
- London Regional Cancer Program, London, Ontario, Canada
- Western University, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Muriel Brackstone
- Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada; and
- London Health Sciences Centre, London, Ontario, Canada
| | - William Pavlosky
- Lawson Health Research Institute, London, Ontario, Canada; and
- London Health Sciences Centre, London, Ontario, Canada
| | - John Butler
- Lawson Health Research Institute, London, Ontario, Canada; and
| | | | - Chantelle Graf
- Lawson Health Research Institute, London, Ontario, Canada; and
| | - Gerald Wisenberg
- Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada; and
- London Health Sciences Centre, London, Ontario, Canada
| | - Frank S Prato
- Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada; and
| | - Stewart Gaede
- London Regional Cancer Program, London, Ontario, Canada
- Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada; and
- London Health Sciences Centre, London, Ontario, Canada
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11
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Oshima M, Shikama N, Usui K, Nojiri S, Isobe A, Muramoto Y, Kawamoto T, Yamaguchi N, Kosugi Y, Sasai K. Development of deep-inspiration breath-hold system that monitors the position of the chest wall using infrared rangefinder. J Radiat Res 2023; 64:171-179. [PMID: 36527722 PMCID: PMC9855317 DOI: 10.1093/jrr/rrac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/17/2022] [Indexed: 06/17/2023]
Abstract
We conducted a prospective study to quantitatively evaluate the movement of the chest wall to establish the simple and reproducible deep-inspiration breath-hold (DIBH) method. The left nipple position was monitored to confirm the inspiratory state. Planning computed tomography (CT) was performed under DIBH and free-breath. We conducted radiation plans with DIBH and free-breath CT and evaluated organ at risk (OAR) and target doses according to two different plans. The relationship between positioning errors of the chest wall and patient factors was evaluated using univariate analysis and fixed-effects models. Twenty-three patients aged ≤ 60 years were enrolled during January-August 2021; 358 daily radiation treatments were evaluated. The median time of treatment room occupancy was 16 minutes (interquartile range, 14-20). The area of the planning target volume (PTV) surrounded by the 95% isodose line was more extensive in DIBH than in free breathing (71.6% vs 69.5%, P < 0.01), whereas the cardiac and left anterior descending (LAD) artery doses were lower (both P < 0.01). In the fixed-effects model analysis, the occupation time of the treatment room was correlated with positioning error. The difference between the planned and irradiated dose was the largest in the LAD branch of the coronary artery (-2.5 Gy), although the OAR dose decreased owing to positional error. The current DIBH method, wherein a single point on the chest wall is monitored to confirm that the patient is in an inspiratory state, allows radiation to be performed in a short time with a small dose error.
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Affiliation(s)
- Masaki Oshima
- Corresponding author. 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. Tel: +81-3-3813-3111; Fax: +81-3-3813-3622; E-mail:
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Keisuke Usui
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Radiological Technology, Juntendo University, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Akira Isobe
- Department of Radiology, Juntendo University Hospital, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoichi Muramoto
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Nanae Yamaguchi
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yasuo Kosugi
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, 21-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Misugikai Satou Hospital, Department of Radiation Oncology, 65-1 Yabuhigashimachi, Hirakata-shi, Osaka 573-1124, Japan
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12
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Watt GP, Knight JA, Nguyen TL, Reiner AS, Malone KE, John EM, Lynch CF, Brooks JD, Woods M, Liang X, Bernstein L, Pike MC, Hopper JL, Bernstein JL. Association of contralateral breast cancer risk with mammographic density defined at higher-than-conventional intensity thresholds. Int J Cancer 2022; 151:1304-1309. [PMID: 35315524 PMCID: PMC9420749 DOI: 10.1002/ijc.34001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 11/06/2022]
Abstract
Mammographic dense area (MDA) is an established predictor of future breast cancer risk. Recent studies have found that risk prediction might be improved by redefining MDA in effect at higher-than-conventional intensity thresholds. We assessed whether such higher-intensity MDA measures gave stronger prediction of subsequent contralateral breast cancer (CBC) risk using the Women's Environment, Cancer, and Radiation Epidemiology (WECARE) Study, a population-based CBC case-control study of ≥1 year survivors of unilateral breast cancer diagnosed between 1990 and 2008. Three measures of MDA for the unaffected contralateral breast were made at the conventional intensity threshold ("Cumulus") and at two sequentially higher-intensity thresholds ("Altocumulus" and "Cirrocumulus") using the CUMULUS software and mammograms taken up to 3 years prior to the first breast cancer diagnosis. The measures were fitted separately and together in multivariable-adjusted logistic regression models of CBC (252 CBC cases and 271 unilateral breast cancer controls). The strongest association with CBC was MDA defined using the highest intensity threshold, Cirrocumulus (odds ratio per adjusted SD [OPERA] 1.40, 95% CI 1.13-1.73); and the weakest association was MDA defined at the conventional threshold, Cumulus (1.32, 95% CI 1.05-1.66). In a model fitting the three measures together, the association of CBC with Cirrocumulus was unchanged (1.40, 95% CI 0.97-2.05), and the lower brightness measures did not contribute to the CBC model fit. These results suggest that MDA defined at a high-intensity threshold is a better predictor of CBC risk and has the potential to improve CBC risk stratification beyond conventional MDA measures.
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Affiliation(s)
- Gordon P. Watt
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Julia A. Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Tuong L. Nguyen
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Anne S. Reiner
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Kathleen E. Malone
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Esther M. John
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | | | - Jennifer D. Brooks
- Dalla Lana School of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Meghan Woods
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Xiaolin Liang
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Leslie Bernstein
- Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Malcolm C. Pike
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - John L. Hopper
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jonine L. Bernstein
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
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13
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Baaken D, Merzenich H, Schmidt M, Bekes I, Schwentner L, Janni W, Wöckel A, Mayr M, Mose S, Merz T, Ghilescu V, Renner J, Bartkowiak D, Wiegel T, Blettner M, Schmidberger H, Wollschläger D. A nested case-control study on radiation dose-response for cardiac events in breast cancer patients in Germany. Breast 2022; 65:1-7. [PMID: 35716531 PMCID: PMC9207715 DOI: 10.1016/j.breast.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background Previous studies with the majority of breast cancer (BC) patients treated up to 2000 provided evidence that radiation dose to the heart from radiotherapy (RT) was linearly associated with increasing risk for long-term cardiac disease. RT techniques changed substantially over time. This study aimed to investigate the dose-dependent cardiac risk in German BC patients treated with more contemporary RT. Methods In a cohort of 11,982 BC patients diagnosed in 1998–2008, we identified 494 women treated with 3D-conformal RT who subsequently developed a cardiac event. Within a nested case-control approach, these cases were matched to 988 controls. Controls were patients without a cardiac event after RT until the index date of the corresponding case. Separate multivariable conditional logistic regression models were used to assess the association of radiation to the complete heart and to the left anterior heart wall (LAHW) with cardiac events. Results Mean dose to the heart for cases with left-sided BC was 4.27 Gy and 1.64 Gy for cases with right-sided BC. For controls, corresponding values were 4.31 Gy and 1.66 Gy, respectively. The odds ratio (OR) per 1 Gy increase in dose to the complete heart was 0.99 (95% confidence interval (CI): 0.94–1.05, P = .72). The OR per 1 Gy increase in LAHW dose was 1.00 (95% CI: 0.98–1.01, P = .68). Conclusions Contrary to previous studies, our study provided no evidence that radiation dose to the heart from 3D-conformal RT for BC patients treated between 1998 and 2008 was associated with risk of cardiac events. Dose-response analysis on cardiac late effects in irradiated breast cancer patients. Nested case-control study with individual retrospective heart dosimetry. Included 494 cases and 988 controls treated in 1998–2008 in Germany. No association for cardiac late effects of 3D-conformal radiotherapy observed. No association for the complete heart and left anterior heart wall observed.
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Affiliation(s)
- Dan Baaken
- University Medical Center of the Johannes Gutenberg-University Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, 55101, Mainz, Germany.
| | - Hiltrud Merzenich
- University Medical Center of the Johannes Gutenberg-University Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, 55101, Mainz, Germany
| | - Marcus Schmidt
- University Medical Center of the Johannes Gutenberg-University Mainz, Department of Obstetrics and Gynecology, 55101, Mainz, Germany
| | - Inga Bekes
- University Hospital Ulm, Department of Gynecology and Obstetrics, 89075, Ulm, Germany
| | - Lukas Schwentner
- University Hospital Ulm, Department of Gynecology and Obstetrics, 89075, Ulm, Germany
| | - Wolfgang Janni
- University Hospital Ulm, Department of Gynecology and Obstetrics, 89075, Ulm, Germany
| | - Achim Wöckel
- University Hospital Ulm, Department of Gynecology and Obstetrics, 89075, Ulm, Germany; University Hospital Würzburg, 97080, Würzburg, Germany
| | - Manfred Mayr
- Strahlentherapie Süd am Klinikum Kaufbeuren, 87600, Kaufbeuren, Germany
| | - Stephan Mose
- Schwarzwald-Baar Klinikum, Klinik für Strahlentherapie und Radioonkologie, 78052, Villingen-Schwenningen, Germany
| | - Thomas Merz
- Kliniken Landkreis Heidenheim gGmbH, Department of Radiation Oncology and Radiotherapy, 89522, Heidenheim, Germany
| | - Voica Ghilescu
- Kliniken Landkreis Heidenheim gGmbH, Department of Radiation Oncology and Radiotherapy, 89522, Heidenheim, Germany
| | - Jona Renner
- University Hospital Ulm, Department of Radiation Oncology, 89081, Ulm, Germany
| | - Detlef Bartkowiak
- University Hospital Ulm, Department of Radiation Oncology, 89081, Ulm, Germany
| | - Thomas Wiegel
- University Hospital Ulm, Department of Radiation Oncology, 89081, Ulm, Germany
| | - Maria Blettner
- University Medical Center of the Johannes Gutenberg-University Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, 55101, Mainz, Germany
| | - Heinz Schmidberger
- University Medical Center of the Johannes Gutenberg-University Mainz, Department of Radiation Oncology and Radiation Therapy, 55101, Mainz, Germany
| | - Daniel Wollschläger
- University Medical Center of the Johannes Gutenberg-University Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics, 55101, Mainz, Germany
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14
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Byun H, Jang Y, Kim JY, Kim JM, Lee CH. Effects of preoperative personal education on shoulder function and lymphedema in patients with breast cancer: A consort. Medicine (Baltimore) 2022; 101:e30810. [PMID: 36197257 PMCID: PMC9509096 DOI: 10.1097/md.0000000000030810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the incidence and severity of ipsilateral shoulder dysfunction and lymphedema of 2 groups of patients needing to undergo unilateral breast cancer surgery, one of which had only received printed education materials and the other group which had received educational materials plus preoperative education. METHODS We selected 61 patients who had been diagnosed with unilateral breast cancer and planned to undergo surgery. Before surgery, patients were randomly assigned, either to a control group that only received printed education materials about exercise for shoulder pain relief and lymphatic edema prevention following breast cancer surgery, or to an experimental group that received the printed education material with personal education. Participants were evaluated at 1, 3, 6, and 12 months after the surgery. To evaluate the impairment of shoulder function, we measured the passive shoulder range of motion (ROM), the degree of pain as visual analog scale (VAS), the short version of the disability of arm, shoulder, and hand (short DASH) scores, and the shoulder pain and disability index (SPADI). We checked arm circumferences to evaluate lymphedema. RESULTS There was no significant difference in demographic or clinical variables between the control and experimental groups. The experimental group showed significantly less limitation in abduction (P = .042) and forward flexion (P = .039) in the 6 months following surgery. Change in the VAS, short DASH, and SPADI scores were 1.633 (P < .001), 2.167 (P < .001), and 4.1 (P = .003) at 1 month following surgery, respectively. These then decreased with time. These changes started before shoulder ROM and arm circumference changes had occurred, which had started 3 months following surgery. CONCLUSIONS Preoperative education might be helpful for the prevention of a shoulder ROM limitation, and we need to focus on pain and disability in patients immediately following breast cancer surgery, and then on ROM and lymphedema.
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Affiliation(s)
- Hayoung Byun
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yunjeong Jang
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- *Correspondence: Chang Han Lee, Department of Rehabilitation Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital and Institute of Health Science, Gyeongsang National University College of Medicine, 79 Gangnam-ro, Jinju, 52727, Republic of Korea (e-mail: )
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15
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Bai X, Liu Z, Zhang J, Wang S, Hou Q, Shan G, Chen M, Wang B. Comparing of two dimensional and three dimensional fully convolutional networks for radiotherapy dose prediction in left-sided breast cancer. Sci Prog 2021; 104:368504211038162. [PMID: 34519556 PMCID: PMC10466025 DOI: 10.1177/00368504211038162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fully convolutional networks were developed for predicting optimal dose distributions for patients with left-sided breast cancer and compared the prediction accuracy between two-dimensional and three-dimensional networks. Sixty cases treated with volumetric modulated arc radiotherapy were analyzed. Among them, 50 cases were randomly chosen to conform the training set, and the remaining 10 were to construct the test set. Two U-Net fully convolutional networks predicted the dose distributions, with two-dimensional and three-dimensional convolution kernels, respectively. Computed tomography images, delineated regions of interest, or their combination were considered as input data. The accuracy of predicted results was evaluated against the clinical dose. Most types of input data retrieved a similar dose to the ground truth for organs at risk (p > 0.05). Overall, the two-dimensional model had higher performance than the three-dimensional model (p < 0.05). Moreover, the two-dimensional region of interest input provided the best prediction results regarding the planning target volume mean percentage difference (2.40 ± 0.18%), heart mean percentage difference (4.28 ± 2.02%), and the gamma index at 80% of the prescription dose are with tolerances of 3 mm and 3% (0.85 ± 0.03), whereas the two-dimensional combined input provided the best prediction regarding ipsilateral lung mean percentage difference (4.16 ± 1.48%), lung mean percentage difference (2.41 ± 0.95%), spinal cord mean percentage difference (0.67 ± 0.40%), and 80% Dice similarity coefficient (0.94 ± 0.01). Statistically, the two-dimensional combined inputs achieved higher prediction accuracy regarding 80% Dice similarity coefficient than the two-dimensional region of interest input (0.94 ± 0.01 vs 0.92 ± 0.01, p < 0.05). The two-dimensional data model retrieves higher performance than its three-dimensional counterpart for dose prediction, especially when using region of interest and combined inputs.
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Affiliation(s)
- Xue Bai
- Key Lab of Radiation Physics and
Technology, Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, China
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Ze Liu
- School of Electronic Information and
Electronical Engineering, Chengdu University, China
| | - Jie Zhang
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Shengye Wang
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Qing Hou
- Key Lab of Radiation Physics and
Technology, Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, China
| | - Guoping Shan
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Ming Chen
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Binbing Wang
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
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