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Sample records for breast conserving treatment

  1. Factors determining esthetic outcome after breast cancer conservative treatment

    DEFF Research Database (Denmark)

    Cardoso, Maria J; Cardoso, Jaime; Santos, Ana C;

    2007-01-01

    with lower body mass index (BMI) and premenopausal status obtained better cosmetic results. In the group of tumor- and treatment-related factors, larger removed specimens, clearly visible scars, the use of chemotherapy and longer follow-up period were associated with less satisfactory results....... On multivariate analysis, only BMI and scar visibility maintained a significant association with cosmesis. BMI and scar visibility are the only factors significantly associated with cosmetic results of breast cancer conservative treatment, as evaluated by an international consensus panel...

  2. A Novel Segment Classification for Multifocal and Multicentric Breast Cancer to Facilitate Breast-Conservation Treatment.

    Science.gov (United States)

    Tan, Mona P

    2015-01-01

    Breast conservation treatment (BCT) is an appropriate alternative to mastectomy for the treatment of unifocal breast cancer. Multifocal and multicentric breast cancers (MFMCBC) challenge conventional indications for BCT and are often treated with mastectomy. Following progress in treatment strategies for unifocal tumors, there was a movement to evaluate the use of BCT for MFMCBC. Now a growing body of evidence from retrospective data has emerged, demonstrating acceptable local control and overall survival rates with BCT for MFMCBC. Prospective studies are needed to confirm these findings. One of the possible barriers to such trials is the absence of a standardized classification and nomenclature for MFMCBC at this point in time. A novel segment classification is presented in this article in an endeavor to overcome this deficiency and allow future work on this issue.

  3. The national survey of breast cancer treatment pattern in Korea (1998): the use of breast-conserving treatment

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    Shin, Hyun Soo; Chang, Sei Kyung [Bundang CHA General Hospital, Sungnam (Korea, Republic of); Lee, Hyung Sik [DongA University, Busan (Korea, Republic of)] (and others)

    2004-09-15

    In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast-conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

  4. Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal

    Institute of Scientific and Technical Information of China (English)

    Romano Demicheli; Ilaria Ardoino; Federico Ambrogi; Roberto Agresti; Elia Biganzoli

    2013-01-01

    To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT).Methods:A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT.The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment.Results:In a time frame with the time origin at the surgical treatment for IBTR,the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year).Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery,apart from the first two-three years,when IBTR patients do worse.If the patients with time to IBTR longer than 2.5 years are considered,differences disappear.Conclusions:The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal.In particular,patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal.Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which,as suggested by the systemic model of breast cancer,would have reached the clinical level according to their own dynamics.

  5. Is face-only photographic view enough for the aesthetic evaluation of breast cancer conservative treatment?

    DEFF Research Database (Denmark)

    Cardoso, Maria João; Magalhães, André; Almeida, Teresa;

    2008-01-01

    The breast cancer conservative treatment. cosmetic results (BCCT.core) is a new software tool created for the automatic and objective evaluation of the aesthetic result of BCCT. It makes use of a face-only photographic view of each patient and might thus have been considered insufficient for an a...

  6. Locoregional Recurrence by Tumor Biology in Breast Cancer Patients after Preoperative Chemotherapy and Breast Conservation Treatment

    Science.gov (United States)

    Jwa, Eunjin; Shin, Kyung Hwan; Kim, Ja Young; Park, Young Hee; Jung, So-Youn; Lee, Eun Sook; Park, In Hae; Lee, Keun Seok; Ro, Jungsil; Kim, Yeon-Joo; Kim, Tae Hyun

    2016-01-01

    Purpose The purpose of this study is to determine whether breast cancer subtype can affect locoregional recurrence (LRR) and ipsilateral breast tumor recurrence (IBTR) after neoadjuvant chemotherapy (NAC) and breast-conserving therapy (BCT). Materials and Methods We evaluated 335 consecutive patients with clinical stage II-III breast cancer who received NAC plus BCT from 2002 to 2009. Patients were classified according to six molecular subtypes: luminal A (hormone receptor [HR]+/HER2–/Ki-67 < 15%, n=113), luminal B1 (HR+/HER2–/Ki-67 ≥ 15%, n=33), luminal B2 (HR+/HER2+, n=83), HER2 with trastuzumab (HER2[T+]) (HR–/HER2+/use of trastuzumab, n=14), HER2 without trastuzumab (HER2[T–]) (HR–/HER2+, n=31), and triple negative (TN) (HR–/HER2–, n=61). Results After a median follow-up period of 7.2 years, 26 IBTRs and 37 LRRs occurred. The 5-year LRR-free survival rates were luminal A, 96.4%; B1, 93.9%; B2, 90.3%; HER2(T+), 92.9%; HER2(T–), 78.3%; and TN, 79.6%. The 5-year IBTR-free survival rates were luminal A, 97.2%; B1, 93.9%; B2, 92.8%; HER2(T+), 92.9%; HER2(T–), 89.1%; and TN, 84.6%. In multivariate analysis, HER2(T–) (IBTR: hazard ratio, 4.2; p=0.04 and LRR: hazard ratio, 7.6; p < 0.01) and TN subtypes (IBTR: hazard ratio, 6.9; p=0.01 and LRR: hazard ratio, 8.1; p < 0.01) were associated with higher IBTR and LRR rates. A pathologic complete response (pCR) was found to show correlation with better LRR and a tendency toward improved IBTR controls in TN patients (IBTR, p=0.07; LRR, p=0.03). Conclusion The TN and HER2(T–) subtypes predict higher rates of IBTR and LRR after NAC and BCT. A pCR is predictive of improved IBTR or LRR in TN subtype. PMID:26910473

  7. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

    Directory of Open Access Journals (Sweden)

    O'Neill Terry

    2006-04-01

    Full Text Available Abstract Background A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of "propensity" is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Methods Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Results Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Conclusion Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients.

  8. Cosmetic Outcomes and Complications Reported by Patients Having Undergone Breast-Conserving Treatment

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    Hill-Kayser, Christine E., E-mail: hill@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Vachani, Carolyn; Hampshire, Margaret K.; Di Lullo, Gloria A. [Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Metz, James M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2012-07-01

    Purpose: Over the past 30 years, much work in treatment of breast cancer has contributed to improvement of cosmetic and functional outcomes. The goal of breast-conservation treatment (BCT) is avoidance of mastectomy through use of lumpectomy and adjuvant radiation. Modern data demonstrate 'excellent' or 'good' cosmesis in >90% of patients treated with BCT. Methods and Materials: Patient-reported data were gathered via a convenience sample frame from breast cancer survivors using a publically available, free, Internet-based tool for creation of survivorship care plans. During use of the tool, breast cancer survivors are queried as to the cosmetic appearance of the treated breast, as well as perceived late effects. All data have been maintained anonymously with internal review board approval. Results: Three hundred fifty-four breast cancer survivors having undergone BCT and voluntarily using this tool were queried with regard to breast cosmesis and perceived late effects. Median diagnosis age was 48 years, and median current age 52 years. 'Excellent' cosmesis was reported by 27% (n = 88), 'Good' by 44% (n = 144), 'Fair' by 24% (n = 81), and 'Poor' by 5% (n = 18). Of the queries posted to survivors after BCT, late effects most commonly reported were cognitive changes (62%); sexual concerns (52%); changes in texture and color of irradiated skin (48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in the irradiated area (30%). Survivors also described osteopenia/osteoporosis (35%), cardiopulmonary problems (12%), and lymphedema (19%). Conclusions: This anonymous tool uses a convenience sample frame to gather patient reported assessments of cosmesis and complications after breast cancer. Among the BCT population, cosmetic assessment by survivors appears less likely to be 'excellent' or 'good' than would be expected, with 30% of BCT survivors reporting 'fair' or

  9. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

    DEFF Research Database (Denmark)

    Johansen, Jørgen; Overgaard, Jens; Overgaard, Marie

    2007-01-01

    To investigate whether adjuvant treatment with CMF or tamoxifen predisposes to an unfavorable cosmetic outcome or increased breast morbidity after radiotherapy in breast conservation. Data from 266 patients who entered a randomized breast conservation trial (DBCG-82TM protocol) was analyzed......-risk patients: premenopausal patients (n = 67) received eight cycles of CMF intravenously (600/40/600 mg per m(2)) every fourth week; postmenopausal patients (n = 27) received 30 mg of tamoxifen daily for one year. Clinical assessments included cosmetic outcome, breast fibrosis, skin telangiectasia....... In premenopausal patients, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR = 2.2 (95% CI 1.2-4.2), as well as increased skin telangiectasia, RR = 3.3 (1.4-8.2). There was no impact of tamoxifen treatment on cosmetic outcome in postmenopausal patients (p = 0.32). However...

  10. Predicting local recurrence following breast-conserving treatment: parenchymal signal enhancement ratio (SER) around the tumor on preoperative MRI

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    Kim, Mi Young; Cho, Nariya; Koo, Hye Ryoung; Yun, Bo La; Bae, Min Sun; Moon, Woo Kyung [Dept. of Radiology, Seoul National Univ. Coll. of Medicine, Seoul National Univ. Hospital, Seoul (Korea, Republic of)], e-mail: river7774@gmail.com; Chie, Eui Kyu [Dept. of Radiation Oncology, Seoul National Univ. Coll. of Medicine, Seoul National Univ. Hospital, Seoul (Korea, Republic of)

    2013-09-15

    Background: The level of background parenchymal enhancement around tumor is known to be associated with breast cancer risk. However, there is no study investigating predictive power of parenchymal signal enhancement ratio (SER) around tumor for ipsilateral breast tumor recurrence (IBTR). Purpose: To investigate whether the breast parenchymal SER around the tumor on preoperative dynamic contrast-enhanced magnetic resonance imaging (MRI) is associated with subsequent IBTR in breast cancer patients who had undergone breast-conserving treatment. Material and Methods: Nineteen consecutive women (mean age, 44 years; range, 34-63 years) with breast cancer who developed IBTR following breast-conserving treatment and 114 control women matched for age, as well as T and N stages were included. We compared the clinicopathologic features of the two groups including nuclear grade, histologic grade, hormonal receptor status, human epidermal growth factor receptor-2 (HER-2) status, lymphovascular invasion, negative margin width, use of adjuvant therapy, and parenchymal SER around the tumor on preoperative DCE-MRI. The SER was measured on a slice showing the largest dimension of the tumor. Multivariate conditional logistic regression analysis was used to identify independent factors associated with IBTR. Results: In univariate analysis, ER negativity (odds ratio [OR] = 4.7; P = 0.040), PR negativity (OR = 4.0; P = 0.013), HER-2 positivity (OR = 3.6; P = 0.026), and a parenchymal SER greater than 0.53 (OR = 23.3; P = 0.011) were associated with IBTR. In multivariate analysis, ER negativity (OR = 3.8; P = 0.015) and a parenchymal SER greater than 0.53 (OR = 13.2; P = 0.040) on preoperative MRI were independent factors associated with IBTR. Conclusion: In addition to ER negativity, a higher parenchymal SER on preoperative MRI was an independent factor associated with subsequent IBTR in patients with breast cancer who had undergone breast-conserving treatment.

  11. Breast abscesses after breast conserving therapy for breast cancer

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    Fujiwara, Kazuhisa [National Kyoto Hospital (Japan)

    2001-09-01

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  12. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation

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    Johansen, Joergen [Dept. of Oncology, Odense Univ. Hospital, Odense (Denmark); Overgaard, Jens [Dept. of Experimental Clinical Oncology, Danish Cancer Society, Aarhus (Denmark); Overgaard, Marie [Dept. of Oncology, Aarhus Univ. Hospital, Aarhus (Denmark)

    2007-05-15

    To investigate whether adjuvant treatment with CMF or tamoxifen predisposes to an unfavorable cosmetic outcome or increased breast morbidity after radiotherapy in breast conservation. Data from 266 patients who entered a randomized breast conservation trial (DBCG-82TM protocol) was analyzed. The patients were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. High-risk patients (n 94), as well as 31 low-risk patients, received additional radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk patients: premenopausal patients (n = 67) received eight cycles of CMF intravenously (600/40/600 mg/m{sup 2}) every fourth week; postmenopausal patients (n = 27) received 30 mg of tamoxifen daily for one year. Clinical assessments included cosmetic outcome, breast fibrosis, skin telangiectasia, and dyspigmentation which were scored on a 4-point categorical scale after median 6.6 years. The observations were analyzed in multivariate logistic regression analysis which included potential risk factors on outcome related to systemic treatment, surgery, radiation technique, tumor, and patient characteristics. In premenopausal patients, systemic treatment with CMF independently predicted a fair/poor cosmetic outcome, RR = 2.2 (95% CI 1.2-4.2), as well as increased skin telangiectasia, RR = 3.3 (1.4-8.2). There was no impact of tamoxifen treatment on cosmetic outcome in postmenopausal patients (p 0.32). However, univariate analysis showed that tamoxifen was significantly associated with breast fibrosis (p <0.004), as was radiation to the regional lymph nodes (p <0.0001). A strong interaction between axillary irradiation and tamoxifen treatment occurred since 26 of 27 high-risk postmenopausal patients had received both tamoxifen and axillary irradiation. In multivariate regression analysis, axillary irradiation independently predicted moderate/severe breast fibrosis with a relative risk of

  13. Use of Combination Thermal Therapy and Radiation in Breast-Conserving Treatment of Extensive Intraductal Breast Cancer

    Science.gov (United States)

    1997-07-01

    heart size/Per- effusion/Constrictive heart failure wave inversion and ST sistent abnormality T peric~arditis/Maderato Sever. coastric- R changes... Sociedad Venezolana de Mastologia Major Committee Assignments: 1993- Medical Records Committee, Dana-Farber Cancer Institute 1996- Drug Use...1993 Invited speaker, The University of New Mexico ,"Treatment of Breast Cancer: Mastectormy vs Less" and "Sterotactic Core Needle Biopsy", Albuquerque

  14. Breast carcinoma conservative treatment. Stages I and II; Tratamento conservador do carcinoma mamario. Estadios I e II

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    Monti, C.R.

    1990-12-31

    From 1981 to 1988, 265 patients with breast cancer stages I and II (UICC-1987), were evaluated after conservative treatment with quadrantectomy plus axillectomy, radiotherapy and chemotherapy. After surgical treatment, the patients were submitted to radiation therapy in the breast. One hundred and fifty six (58,8%) patients were submitted to adjuvant chemotherapy. The median clinical follow-up period was 42.8 months with a minimum of 24 and a maximum of 99 months. Six (2,3%) patients presented local recurrence and 48 (18,1%) presented distant metastasis. After five years the total survival rate was 89,7% and the disease free survival rate was 75% in the same period. The study did not show significant differences among the clinical stages classified after surgery and the use of adjuvant chemotherapy did not influence the results of the many stages. (author). 194 refs, 33 figs, 6 tabs.

  15. [Lipomodelling for correction of breast conservative treatment sequelae. Medicolegal aspects. Expert opinion on five problematic clinical cases].

    Science.gov (United States)

    Gosset, J; Flageul, G; Toussoun, G; Guérin, N; Tourasse, C; Delay, E

    2008-04-01

    In our unit, breast cancer patients suffering mild sequelae of conservative cancer treatment receive fat transfer (lipomodelling), following a precise protocol, based on mammographic and ultrasound examinations and MRI. Available data do not seem to indicate any deleterious impact on patient outcome, notably in view of radiological images, but recurrence (or rather occurrence of new ipsilateral or contralateral cancer) is frequent. The correlation between new or recurrent breast cancer and lipomodelling is high; misinterpretations are possible and frequently arise. The present paper is a description of five complex clinical cases and a discussion of the medicolegal issues that may possibly arise; it also provides tentative expert evaluation of the cases. Clinical findings are reported and analyzed. The second step is a discussion of the radiological impact of lipomodelling, and of the problems caused by the transfer of potentially malignant cells when no preoperative diagnosis of recurrence is made; the morphological and esthetic benefits of the method are described, as well as the potential beneficial impact of fat transfer, notably associated with lower breast density and injections of fat stem cells. Our conclusion is that specialized radiologists, as well as plastic surgery and oncology experts should address the question of fat transfer in operated breast cancer patients and give their reasoned opinion about potentially litigious cases. This would help minimize or solve the conflicts between patients, doctors and experts. Establishing common ground between the different stakeholders would allow the development of the technique, as lipomodelling is, according to our experience, a tremendous advance in the treatment of sequelae from conservative breast cancer surgery.

  16. Non-Surgical Breast-Conserving Treatment (KORTUC-BCT Using a New Radiosensitization Method (KORTUC II for Patients with Stage I or II Breast Cancer

    Directory of Open Access Journals (Sweden)

    Yasuhiro Ogawa

    2015-11-01

    Full Text Available The purpose of the present study was to establish a non-surgical breast-conserving treatment (BCT using KORTUC II radiosensitization treatment. A new radiosensitizing agent containing 0.5% hydrogen peroxide and 0.83% sodium hyaluronate (a CD44 ligand has been developed for intra-tumoral injection into various tumors. This new method, named KORTUC II, was approved by our local ethics committee for the treatment of breast cancer and metastatic lymph nodes. A total of 72 early-stage breast cancer patients (stage 0, 1 patient; stage I, 23; stage II, 48 were enrolled in the KORTUC II trial after providing fully informed consent. The mean age of the patients was 59.7 years. A maximum of 6 mL (usually 3 mL for tumors of less than approximately 3 cm in diameter of the agent was injected into breast tumor tissue twice a week under ultrasonographic guidance. For radiotherapy, hypofraction radiotherapy was administered using a tangential fields approach including an ipsilateral axillary region and field-in-field method; the energy level was 4 MV, and the total radiation dose was 44 Gy administered as 2.75 Gy/fraction. An electron boost of 3 Gy was added three times. Treatment was well tolerated with minimal adverse effects in all 72 patients. No patients showed any significant complications other than mild dermatitis. A total of 24 patients under 75 years old with stage II breast cancer underwent induction chemotherapy (EC and/or taxane prior to KORTUC II treatment, and 58 patients with estrogen receptor-positive tumors also received hormonal therapy following KORTUC II. The mean duration of follow-up as of the end of September 2014 was 51.1 months, at which time 68 patients were alive without any distant metastases. Only one patient had local recurrence and died of cardiac failure at 6.5 years. Another one patient had bone metastases. For two of the 72 patients, follow-up ended after several months following KORTUC II treatment. In conclusion, non

  17. Breast Cancer Treatment

    Science.gov (United States)

    ... Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Treatment (PDQ®)–Patient Version General Information About Breast Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  18. Loco-regional control after neo-adjuvant chemotherapy and conservative treatment for locally advanced breast cancer patients.

    Science.gov (United States)

    Levy, Antonin; Borget, Isabelle; Bahri, Manel; Arnedos, Monica; Rivin, Eleonor; Vielh, Philippe; Balleyguier, Corinne; Rimareix, Françoise; Bourgier, Céline

    2014-01-01

    Breast-conserving treatment (BCT) has been validated for breast cancer patients receiving adjuvant chemotherapy. Our objective was to evaluate the difference in loco-regional recurrence (LRR) rates between BCT and mastectomy in patients receiving radiation therapy after neo-adjuvant chemotherapy (NCT). A retrospective data base was used to identify all patients with breast cancer undergoing NCT from 2002 to 2007. Patients with initial metastatic disease were excluded from this analysis. LRR was compared between those undergoing BCT and mastectomy. Individual variables associated with LRR were evaluated. Two hundred eighty-four patients were included, 111 (39%) underwent BCT and 173 (61%) mastectomy. Almost all patients (99%) in both groups received postoperative radiation. Pathologic complete response was seen in 37 patients, of which 28 underwent BCT (p loco-regional control rate was 91% (95% CI: 86-94%). The 10-year LRR rate was similar in the BCT group (9.2% [95% CI: 4.9-16.7%]) and in the mastectomy group (10.7% [95% CI: 5.9-15.2%]; p = 0.8). Ten-year overall survival (OS) rates (63% [95% CI: 46-79%] in the BCT group; 60% [95% CI: 47-73%] in the mastectomy group, p = 0.8) were not statistically different between the two patient populations. Multivariate analysis showed that AJCC stage ≥ III (HR: 2.6; 95% CI: 1.2-5.8; p = 0.02), negative PR (HR: 6; 95% CI: 1.2-30.6, p = 0.03), and number of positive lymph nodes ≥3 (HR: 2.5; 95% CI: 1.1-5.9; p = 0.03) were independent predictors of LRR. Ten-year OS was similar in the BCT and in the mastectomy group (p = 0.1). The rate of LRR was low and did not significantly differ between the BCT and the mastectomy group after NCT. Randomized trials assessing whether mastectomy can be safely omitted in selected breast cancer patients (nonstage III tumors or those which do not require adjuvant hormone suppression) which respond to NCT are required.

  19. Breast Conservation Surgery: State of the Art

    Directory of Open Access Journals (Sweden)

    Jonathan White

    2011-01-01

    Full Text Available Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement. Such an approach can also be used in the management of carefully selected cases of multifocal or multicentric breast cancer. The role of novel techniques, such as endoscopic breast surgery and radiofrequency ablation, is yet to be precisely defined.

  20. Ten year results of a randomised trial comparing two conservative treatment strategies for small size breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mariani, L. [Istituto Nazionale per lo Studio e la Cura dei Tumori (INT), Biometry, Via Venezian 1, I-20133 Milan (Italy); Salvadori, B. [INT, Surgical Oncology C, Via Venezian 1, I-20133 Milan (Italy); Marubini, E. [Istituto Nazionale per lo Studio e la Cura dei Tumori (INT), Biometry, Via Venezian 1, I-20133 Milan (Italy); Conti, A.R.; Rovini, D.; Cusumano, F. [INT, Surgical Oncology C, Via Venezian 1, I-20133 Milan (Italy); Rosolin, T. [Istituto Nazionale per lo Studio e la Cura dei Tumori (INT), Biometry, Via Venezian 1, I-20133 Milan (Italy); Andreola, S. [INT, Pathology, Via Venezian 1, I-20133 Milan (Italy); Zucali, R. [INT, Radiotherapy A, Via Venezian 1, I-20133 Milan (Italy); Rilke, F. [Istituto Nazionale per lo Studio e la Cura dei Tumori (INT), Biometry, Via Venezian 1, I-20133 Milan (Italy); Veronesi, U. [European Institute of Oncology, Milan (Italy)

    1998-07-01

    We report the 10-year results of a randomised clinical trial in which two different breast conservation treatment strategies were compared in women with small, non-metastatic primary breast cancer: quadrantectomy, axillary dissection and radiotherapy (QUART) versus tumorectomy and axillary dissection followed by external radiotherapy and a boost with {sup 192}Ir implantation (TART). No second surgery was given to women with affected surgical margins. Axillary node positive women received adjuvant medical therapy. From 1985-1987, this trial accrued 705 patients, 360 in the QUART and 345 in the TART arm. Crude cumulative incidence curves for intrabreast tumour recurrence (IBTR) and metastases as first events and mortality curves in each of the two treatment arms were computed. A crude cumulative incidence curve of IBTR as a second event (in women who had already had a local recurrence) was also computed. The two groups were compared in terms of hazard for IBTR, metastases or death occurrence by using Cox regression models, both with and without adjustment for patient age, tumour size, number of metastatic axillary nodes and histology. Possible interactions between the aforementioned prognostic factors and the type of surgery were also investigated. The two groups were well matched for baseline patient and tumour characteristics, the only exception being resection margins, which were more often positive in the TART group. At the Cox model, a significant difference between groups was detected for IBTR (P<0.0001), but not for distant metastases and overall survival. In particular, 5- and 10-year estimates of crude cumulative incidence of IBTR were 4.7 and 7.4% in the QUART group, and 11.6 and 18.6% in the TART group. The difference was not substantially affected by patient or disease characteristics. Likewise, the status of resection margins in women who underwent TART treatment did not significantly influence the risk of occurrence of IBTRs. Finally, the rate of second

  1. RECURRENCE PATTERN FOLLOWING BREAST - CONSERVING SURGERY FOR EARLY BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Govindaraj

    2015-08-01

    Full Text Available OBJECTIVE: To study the Local Recurrence and metastasis pattern after Breast - Conserving Surgery for early breast cancer. MATERIALS AND METHODS: From 2010 to 2014 in department of surgery in VIMS Bellary, 70 patients with stage I or II invasive breast carcinoma were treated with breast - conserving surgery, radiation and chemotherapy. In this study we investigated the prognostic value of clinical and pathological factors in early breast cancer patients treated with BCS. All of the surgeries were performed by a single surgical team. Recurrence and its risk factors were evaluated.

  2. Clinical Efficacy of Breast-Conserving Surgery and Modified Radical Mastectomy in the Treatment of Early Breast Cancer%保乳手术与改良根治术临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    韩广林

    2016-01-01

    Objective To compare the effect of breast-conserving surgery and modified radical mastectomy in the treatment of early breast cancer. MethodsWe divided 70 patients into two groups, the observation group used breast-conserving surgery, and control group used modified radical mastectomy. compared the effect between two groups.ResultsThe operation time, hospitalization time and complication rate of observation group were significantly lower than control group(P<0.05).Conclusion The effect of breast conserving surgery for early breast cancer is ideal.%目的:探讨保乳术与改良根治术治疗早期乳腺癌的效果。方法随机将70例早期乳腺癌患者平均分为两组,观察组行保乳术,对照组行改良根治术。比较两组临床疗效。结果观察组手术时间、住院时间及并发症发生率等低于对照组(P<0.05)。结论保乳手术治疗早期乳腺癌效果理想。

  3. Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients.

    NARCIS (Netherlands)

    Laar, C. van; Sangen, M.J. van der; Poortmans, P.M.; Nieuwenhuijzen, G.A.; Roukema, J.A.; Roumen, R.M.; Tjan-Heijnen, V.C.; Voogd, A.C.

    2013-01-01

    AIM: To evaluate trends in the risk of local recurrences after breast-conserving treatment (BCT) and to examine the impact of local recurrence (LR) on distant relapse-free survival in a large, population-based cohort of women aged breast cancer. METHODS: All women (n=

  4. Total Mastectomy or Breast Conservation Therapy? How Radiation Oncologist Accessibility Determines Treatment Choice and Quality: A SEER Data-base Analysis.

    Science.gov (United States)

    Churilla, Thomas M; Donnelly, Patrick E; Leatherman, Erin R; Adonizio, Christian S; Peters, Christopher A

    2015-01-01

    Mastectomy and breast conservation therapy (BCT) are equivalent in survival for treatment of early stage breast cancer. This study evaluated the impact of radiation oncologist accessibility on choice of breast conserving surgery (BCS) versus mastectomy, and the appropriate receipt of radiotherapy after BCS. In the National Cancer Institute Survival, Epidemiology, and End Results data base, the authors selected breast cancer cases from 2004 to 2008 with the following criteria: T2N1M0 or less, lobular or ductal histology, and treatment with simple or partial mastectomy. We combined the Health Resources and Services Administration Area Resource File to define average radiation oncologist density (ROD) by county over the same time period. We evaluated tumor characteristics, demographic information, and ROD with respect to BCS rates and receipt of radiation therapy after BCS in univariable and multivariable analyses. In 118,773 cases analyzed, mastectomy was performed 33.2% of the time relative to BCS. After adjustment for demographic and tumor variables, the odds of having BCS versus mastectomy were directly associated with ROD (multiplicative change in odds for a single unit increase in ROD [95% CI] = 1.02 [1.01-1.03]; p < 0.001). Adjuvant radiation therapy was not administered in 28.2% of BCS cases. When adjusting for demographic and tumor variables, the odds of having BCS without adjuvant radiation were inversely associated with ROD (0.95 [0.94-0.97]; p < 0.001). We observed a direct relationship between ROD and BCS rates independent of demographic and tumor variables, and an inverse trend for omission of radiotherapy after BCS. Access to radiation oncologists may represent an important factor in surgical choice and receiving appropriate BCT in early stage breast cancer.

  5. Migratory pneumonitis similar to bronchiolitis obliterans organizing pneumonia after conservative treatment of breast cancer. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Matsuura, Kanji; Hirokawa, Yutaka; Matsuura, Akiko; Akagi, Yukio; Ito, Katsuhide [Hiroshima Univ. (Japan). School of Medicine

    1999-07-01

    We report the case of a 63-year-old woman who developed cough and fever with migratory lung infiltrates three months after completion of right breast irradiation following conservative surgery. Lung infiltrates were initially localized in the irradiated area, but later spread to unirradiated areas in both lungs. No cause of migratory pneumonitis other than irradiation was found, and we clinically diagnosed this case as radiation-induced migratory pneumonitis similar to Bronchiolitis Obliterans Organizing Pneumonia(BOOP), without lung biopsy. Steroid therapy resulted incomplete resolution of lung infiltrates. The reported case clearly differed from typical radiation pneumonitis. We suggest that lung irradiation might trigger the development of migratory pneumonitis with a clinical pattern similar to that of BOOP. (author)

  6. Evolution of surgical treatment for breast cancer

    Directory of Open Access Journals (Sweden)

    V. P. Letyagin

    2012-01-01

    Full Text Available The paper considers main surgical interventions used to treat breast cancer. It defines the role and place of conservative surgery and describes current procedures for the organ-saving treatment of cancer at this site.

  7. A case of BOOP following breast conservative radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Masao; Sekine, Hiroshi; Aoki, Manabu; Kanehira, Chihiro; Sato, Tetsuo; Kubo, Hirotaka; Ikegami, Masahiro [Jikei Univ., Tokyo (Japan). School of Medicine

    1998-12-01

    The great majority of individuals with early breast cancer are potential candidates for treatment with conservative surgery and radiotherapy. A 55 years old women with pre-existing rheumatoid arthritis suffered from severe cough and SOB within 3 months after definitive radiation therapy for breast cancer. The chest radiograph showed bilateral pulmonary infiltrate and the diagnosis of BOOP was confirmed by TBLB findings. After corticosteroid therapy, the clinical improvement was dramatic, and the pulmonary shadow disappeared completely. Radiation oncologists should be cautious in the treatment of early breast cancer with collagen vascular disease even in the remission status. (author)

  8. Breast conserving therapy and magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Tsuneaki; Masuda, Yu; Hachiya, Junichi; Nitatori, Toshiaki; Fukushima, Hisayoshi; Uchigasaki, Shinya [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    1996-12-01

    Recently, breast conserving therapy has been widely accepted in our country. The extensive intraductal component (EIC) is a serious problem in breast conserving therapy, because it is well-known that EIC frequently causes locoregional recurrence in preserved breast parenchyma. Magnetic resonance imaging (MRI) is a useful method for detecting breast masses due to its excellent contrast resolution. We studied the application of MRI to detection of intraductal spread in twenty-two patients. All cases were revealed invasive cancer with intraductal spread by histopathological examination. MRI findings of intraductal spread can be divided into two major groups. One is daugter nodules or strand-like enhancement and the other is bridging enhancement. We also reffered to the preliminary study of MR-guiding transcutaneous aspiration biopsy of mammographically and clinically occult breast masses. (author)

  9. Oncoplastic breast surgery in the setting of breast-conserving therapy: A systematic review

    Directory of Open Access Journals (Sweden)

    Jennifer J. Yoon, BA

    2016-10-01

    Full Text Available Breast-conserving therapy (BCT, or breast-conserving surgery with adjuvant radiation therapy, has become a standard treatment alternative to mastectomy for women with early-stage breast cancer after many long-term studies have reported comparable rates of overall survival and local control. Oncoplastic breast surgery in the setting of BCT consists of various techniques that allow for an excision with a wider margin and a simultaneous enhancement of cosmetic sequelae, making it an ideal breast cancer surgery. Because of the parenchymal rearrangement that is routinely involved in oncoplastic techniques, however, the targeted tissue can be relocated, thus posing a challenge to localize the tumor bed for radiation planning. The goals of this systematic review are to address the challenges, outcomes, and cosmesis of oncoplastic breast surgery in the setting of BCT.

  10. BREAST CONSERVING THERAPY IN STAGE T1 & T2 BREAST CANCER PATIENTS

    Institute of Scientific and Technical Information of China (English)

    FAN Jiang; LIU Bang-ling; SHEN Zhen-zhou; SHAO Zhi-ming; WU Jiong; LU Jin-song; WANG Lei; HOU Yi-feng; WANG Jie; DI Gen-hong; SHEN Kun-wei; HAN Qi-xia

    2005-01-01

    Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.

  11. [Treatment of elderly patients with breast cancer

    DEFF Research Database (Denmark)

    Paaschburg, B.; Pedersen, A.; Tuxen, M.K.;

    2008-01-01

    The latest investigations have been searched in order to present new guidelines for the treatment of elderly patients with primary breast cancer. It is concluded that breast-conserving surgery should be offered as well as the sentinel node technique. Axillary lymph node dissection is not necessary...

  12. Assessing cosmetic results after breast conserving surgery.

    Science.gov (United States)

    Cardoso, Maria João; Oliveira, Helder; Cardoso, Jaime

    2014-07-01

    "Taking less treating better" has been one of the major improvements of breast cancer surgery in the last four decades. The application of this principle translates into equivalent survival of breast cancer conserving treatment (BCT) when compared to mastectomy, with a better cosmetic outcome. While it is relatively easy to evaluate the oncological results of BCT, the cosmetic outcome is more difficult to measure due to the lack of an effective and consensual procedure. The assessment of cosmetic outcome has been mainly subjective, undertaken by a panel of expert observers or/and by patient self-assessment. Unfortunately, the reproducibility of these methods is low. Objective methods have higher values of reproducibility but still lack the inclusion of several features considered by specialists in BCT to be fundamental for cosmetic outcome. The recent addition of volume information obtained with 3D images seems promising. Until now, unfortunately, no method is considered to be the standard of care. This paper revises the history of cosmetic evaluation and guides us into the future aiming at a method that can easily be used and accepted by all, caregivers and caretakers, allowing not only the comparison of results but the improvement of performance.

  13. Clinical Efficacy Analysis of Breast-conserving Surgery Treatment of Early Breast Cancer%保乳手术治疗早期乳腺癌的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    王海; 申阳; 唐朝晖; 江拥军

    2012-01-01

      目的分析保乳手术治疗早期乳腺癌的临床疗效.方法将我院收治的80例Ⅰ期或Ⅱ期早期乳腺癌患者按治疗方式的不同分为实验组(n=40)和对照组(n=40).实验组患者行保乳手术;对照组患者行改良根治手术.比较两组患者的临床指标和疗效.随访2年.结果美容效果上实验组明显优于对照组 P <0.01差异具有统计学意义.实验组患者术中出血量、术后引流量、手术时间、住院时间均明显少于对照组 P <0.05差异具有统计学意义.结论改良根治术与保乳术治疗早期乳腺癌的疗效基本相同,然而保乳术具有出血量少、手术时间、住院时间短、患者心理更容易接受等优点,因此行保乳手术治疗早期乳腺癌,疗效满意,值得推广使用.%  Objective The analysis of the clinical efficacy of breast-conserving surgery for early breast cancer. Methods Our hospital 80 cases of stageⅠ or Ⅱ stage according to the different treatment of early breast cancer patients into the experimental group (n = 40) and control group (n = 40). The experimental group underwent breast-conserving surgery; patients in the control group underwent modified radical surgery. Compared between the two groups of patients with clinical indicators and efficacy. Follow-up of 2 years. Results Cosmetic effect on the experimental group was significantly better than the control group (P<0.01) difference was statistically significant. Experimental group patients with blood loss, postoperative drainage, surgery, hospitalization time were significantly less than the control group (P<0.05) difference was statistically significant. Conclusion Efficacy of modified radical mastectomy and breast-conserving treatment of early breast cancer, breast-conserving surgery, however, has less blood loss, operative time, shorter hospital stay, patients with psychological easier to accept the advantages, so the line of breast-conserving surgery for early

  14. Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] [and others

    1999-03-01

    Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

  15. Local recurrences after breast-conserving treatments in breast cancer: risk factors and effect on survival; Recidives locales apres traitement conservateur du cancer du sein: facteurs de risque et influence sur la survie

    Energy Technology Data Exchange (ETDEWEB)

    Cowen, D.; Resbeut, M.; Largillier, R.; Houvenaeghel, G.; Jacquemier, J.; Bardou, V.J.; Viens, P.; Maraninchi, D. [Institut Paoli-Calmettes, 13 - Marseille (France)

    1998-09-01

    To determine the risk factors for local and distant failure in node-negative breast cancer treated with breast-conservative surgery and radiotherapy and to determine the relationship between these two events. We retrospectively selected 908 patients who received conservative surgery and radiotherapy but no chemotherapy between 1980 and 1995, for a mode-negative breast cancer. Patients were divided in two groups according to the status of the margins of resection. All pathology specimens were reviewed. In case of negative margins, the risk factors for local recurrences picked up by the Cox model were histologic multi-focus (P=0.0076), peritumoral vessel invasion (P=0.021) and age {>=}40 years (P=0.024), and in case of involved margins, negative oestrogen receptors (P=0.0012), histologic multi-focus (P=0.0028), and absence of hormonal therapy (P=0.017). The 10-year local recurrence rate was 18 % in case of negative margins and 29 % in case of involved margins, although in the latter case patients received high-dose adjuvant radiotherapy. Accordingly, the 10-year distant failure rates were 16 % and 27 %, respectively. Many arguments suggest that local and distant failures are closely related. Patients with histologic multi-focus or positive margins are at high risk of local failure and then of distant failure, and require a more aggressive initial treatment. (author)

  16. Conservative surgery and radiation for early-stage breast cancer.

    Science.gov (United States)

    Fowble, B L; Orel, S G; Jardines, L

    1993-07-01

    In selected patients with early-stage breast cancer, conservative surgery and radiation represent an alternative equal to mastectomy in terms of local recurrence, distant metastasis, survival, and long-term complications. Patients with early-stage breast cancer who are candidates for conservative surgery and radiation include those whose primary tumor is less than 4 to 5 cm in size without evidence of gross multicentricity or diffuse microcalcifications. Patients with an extensive intraductal component may be appropriate candidates provided that margins of resection are negative. Young age is not a contraindication to the conservative treatment. A preexisting history of collagen vascular disease or prior mantle irradiation for Hodgkin's or non-Hodgkin's lymphoma represents a contraindication to conservative surgery and radiation because of the potential for severe complications. An additional contraindication is the pregnant woman in whom delivery cannot be accomplished before the initiation of radiation. Mammography is essential in the pretreatment evaluation and posttreatment follow-up of the conservatively treated patient. The goal of the pretreatment mammogram is to assess the extent of disease in the ipsilateral breast as well as to evaluate the contralateral breast. In patients who present with microcalcifications, a postbiopsy mammogram before radiation is essential to document complete removal of all malignant-appearing microcalcifications. Mammography is an essential part of the follow-up program in order to detect a recurrence in the treated breast as well as a cancer in the contralateral breast cancer. The optimal interval for follow-up mammography has not been determined, although programs employing mammography on a yearly basis after treatment have been associated with the detection of early recurrences and excellent survival after salvage mastectomy for these recurrences.

  17. Prognostic Impact of Time to Ipsilateral Breast Tumor Recurrence after Breast Conserving Surgery

    OpenAIRE

    Gosset, Marie; Hamy, Anne-sophie; Mallon, Peter; Delomenie, Myriam; Mouttet, Delphine; Pierga, Jean-Yves; Lae, Marick; Fourquet, Alain; Rouzier, Roman; Reyal, Fabien; Feron, Jean-Guillaume

    2016-01-01

    Background The poor prognosis of patients who experience ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) is established. A short time between primary cancer and IBTR is a prognostic factor but no clinically relevant threshold was determined. Classification of IBTR may help tailor treatment strategies. Purpose We determined a specific time frame, which differentiates IBTR into early and late recurrence, and identified prognostic factors for patients with IBTR a...

  18. Conservative surgery for multifocal/multicentric breast cancer.

    Science.gov (United States)

    Nijenhuis, Matthijs V; Rutgers, Emiel J Th

    2015-11-01

    Multifocal (MF) and multicentric (MC) breast cancer is regularly considered a relative contraindication for breast-conserving therapy (BCT). There are two reasons for this wide spread notion: However, we concur that if optimal 'cytoreductive surgery' is achieved this will result in good local control (i.e. in-breast relapse breast irradiation and systemic treatments as indicated by primary cancer biology. Careful planning and adaptive application of oncoplastic techniques will result in an optimal cosmetic results. The meticulous work of Roland Holland and coworkers(1) in the early 1980's on whole breast specimen showed invasive foci at more then 2 cm distance from the invasive primary cancer in more then 40% of specimen. Although multiple tumor foci may occur in up to 60% of mastectomy specimens, equivalent survival outcomes were observed in prospective trials comparing BCT and mastectomy for clinically unifocal lesions, suggesting that the majority of these foci are not, or do not become, biologically relevant or clinically significant with appropriate treatment. As diagnostic tools advance, MF and MC tumors are more commonly diagnosed. Cancers that previously would have been classified as unifocal now can be detected as MF or MC. In addition, locoregional treatment modalities have improved significantly over the past decade. More recent studies reflect these advances in diagnosis and treatment. Studies evaluated staging MRI showed that up to 19% of woman with diagnosed breast cancer harbor a second malignant ipsilateral lesion. These findings should only have consequences when additional lesions are proven cancer. Multiple enhancing lesions on MRI are in itself not an indication for a mastectomy. The Z0011 trial and the AMAROS trial demonstrated a similar phenomenon for axillary treatment; less surgery does not necessarily lead to inferior local control or survival outcomes. Recent studies supplement the growing evidence that treatment of patients with MF

  19. Research Progress of Early Breast Cancer's Conserving Surgery and Postoperative Treatment%早期乳腺癌保乳术及术后治疗的研究进展

    Institute of Scientific and Technical Information of China (English)

    黎艳萍

    2013-01-01

    The treatment of early breast cancer has been developed from the traditional radical surgery to the breast-conserving surgery combined with postoperative radiotherapy. The treatments after breast-conserving surgery include radiotherapy, chemotherapy, endocrine therapy and comprehensive treatment. The postoprative radiotherapy has significant value to the prognosis. The techniques of radiotherapy after surgery commonly used now include tissue implantation,three-dimensional conformal radiotherapy,brachytherapy and intraoperative radiatiotherapy. Study on the early breast-conserving surgery and postoperative treatment can positively improve the clinical diagnosis and treatment level.%早期乳腺癌治疗手段已经由传统的根治手术发展到现在的保乳术结合术后治疗.保乳术后的四种治疗方式分别是放疗、化疗、内分泌治疗及综合治疗.保乳术后进行放射治疗对预后具有重要意义,目前常用的部分照射技术手段有组织插植,三维适形体外照射,腔内照射,术中放射治疗.研究分析早期乳腺癌保乳术及术后治疗的现状可积极合理地提高临床诊疗水平.

  20. Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Byun, Sang Jun [Dongsan Medical Center, Daegu (Korea, Republic of)

    2009-09-15

    To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10{approx}16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13{approx}179 months, with a median of 92.5 months. The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ({<=}6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

  1. Optimizing Surgical Margins in Breast Conservation

    Directory of Open Access Journals (Sweden)

    Preya Ananthakrishnan

    2012-01-01

    Full Text Available Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy, include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.

  2. Cosmetic results after breast conserving carcinoma treatment in patients with intramammarian seromas; Kosmetische Ergebnisse nach brusterhaltender, radiologischer Mammakarzinomtherapie bei Patientinnen mit intramammaeren Seromen

    Energy Technology Data Exchange (ETDEWEB)

    Schultze, J.; Loessl, K.; Kimmig, B. [Universitaetsklinikum Schleswig-Holstein, Kiel (DE). Klinik fuer Strahlentherapie (Radioonkologie)

    2008-07-01

    Introduction: There were 373 patients irradiated after breast conserving carcinoma treatment. A planning computed tomography revealed in 97 of these patients seromas and tissue defects exceeding 2 cm in diameter. The cosmetic results in those patients and the impact of seromas herein had to be evaluated. Patients and methods: Mean age was 59 years. A quadrant resection was performed in 17,5 percent of the patients, a segmental resection in 27,8 percent and a tumour excision in 54,6 percent. Radiation therapy was applied with the linear accelerator and 6 MeV photons up to a total dose in the residual breast of 50 Gy followed by a boost dose to the former tumour bed on 10 Gy. A distinct evaluation and documentation of therapy related side effects and the resulting cosmesis was done in 51 patients. Results: In all the examined seroma patients there were moderate acute skin reactions grade 1 to 3. As late effects in 82,3 percent scar indurations were noticed. At the skin 51 percent showed enhanced pigmentation, 68,6 percent atrophia and only 11 percent teleangiectasia. Subcutaneous fibrosis occurred in 56,9 percent of the patients, 78,4 percent of the women had breast asymmetries. In 41,2 percent there were a lymphedema subcutaneously, in 72,5 percent impaired sensibility. The overall cosmetic result documented with a 5 point score was 'very good' (score 1) in 19,6 percent and 'good' (score 2) in 33,3 percent, 37,3 percent were 'satisfactory' (score 3) and 9,8 percent 'bad' (score 4) respectively. No 'very bad' results (score 5) were seen. Conclusions: The cosmetic results in the examined group of seroma and hematoma patients were inferior to those reported in the literature. We conclude that post-operative seroma and hematoma have an adverse effect on the resulting cosmesis and that their frequency and extent have to be reduced in future by the responsible surgeons. (orig.)

  3. Conservative treatment for breast cancer: optimization of the tumor bed localization; Traitement conservateur du cancer du sein: optimisation du reperage du lit tumoral

    Energy Technology Data Exchange (ETDEWEB)

    Oden, S.; Thureau, S.; Hanzen, C. [Centre Henri-Becquerel, Dept. de Radiotherapie et de Physique Medicale, 76 - Rouen (France); Oden, S. [CHU de Rouen, Service de Gynecologie et Obstetrique, 76 - Rouen (France); Baron, M. [Centre Henri-Becquerel, Dept. de Chirurgie, 76 - Rouen (France)

    2010-04-15

    Purpose The main objective was to assess contributions and limits of surgical clips combined with computed tomography to define the tumor bed after conservative treatment of breast cancer. This retrospective observational study enrolled 16 patients treated by lumpectomy with surgical clips placed in the tumor bed. Patients and methods We assessed the difficulties in localizing the tumour bed based on collected data (i.e. clinical description, mammography, ultrasound examination, surgical procedure and pathology data). The clip's number and localization, and the volumes of the boost were also analyzed. Results There was no preoperative occurrence of localization in 57 % of cases for palpable tumours, and in 13 % of cases where the lesion was subclinical. The collected data did not allow establishing a precise localization. The mean number of surgical clips per patient was 4 (range 1-9), and the delineation of the target volumes by radiation oncologists was not standardized. Onco plastic techniques may produce difficulties in the localization of tumour bed. Conclusion The placement of surgical clips by the surgeon is helpful, primarily when onco plastic techniques are used. In many situations, these clips may cause problems of interpretation. In order to optimize the delineation of the boost, we propose a multidisciplinary approach and methodology to be used at the Henri Becquerel Cancer Centre. (authors)

  4. Early breast cancer: diagnosis, treatment and survivorship.

    LENUS (Irish Health Repository)

    Meade, Elizabeth

    2013-01-11

    Breast cancer is the most common female cancer and globally remains a major public health concern. The diagnosis and treatment of breast cancer continues to develop. Diagnosis is now more precise, surgery is less mutilating and women now have the option of breast conserving therapy with better cosmesis, and without sacrificing survival. Radiotherapy is more targeted and the selection of patients for adjuvant chemotherapy is based not only on prognostic and predictive factors, but also on newer molecular profiling that will ensure that chemotherapy is given to the patients who need and respond to it. These developments all provide a more tailored approach to the treatment of breast cancer. Management now involves a multidisciplinary team approach in order to provide the highest standard of care for patients throughout their cancer journey from diagnosis through treatment and into follow-up care.

  5. Research Progress of Early-stage Breast Cancer Breast-conserving Surgery Treatment%早期乳腺癌保乳手术治疗的研究进展

    Institute of Scientific and Technical Information of China (English)

    温健

    2011-01-01

    随着病理及生物免疫学的不断发展,对乳腺癌的认识也进一步地加深.乳腺癌患者对生存质量的要求不断提高,势必推动乳腺癌外科的不断发展.尤其早期乳腺癌患者,保乳术及前哨淋巴结活检术的出现及临床应用进展迅猛发展,明显替代传统的乳癌根治术及全腋窝淋巴结清扫术.但是,如何使局部复发率及转移率降到最低,仍是保乳术发展的主要研究目标.%Along with pathological and hiological immuunology 's unceasing development, the understanding of breast cancer is also further deepened. The requirements for quality of life of breast cancer sufferers are increasing continuously as well,which inevitahly promotes the growth of breast cancer surgery. Especially for earlv breast cancer,the occurrence and rapid development of breast-conserving surgery and sentinel lymph node biopsy has ohviously replaced the traditional radical mastectomy and full axillary lymph node dissection.However,how to lower the local recurrence and metastasis to the optimal still remains the major research objective of breast-conserving surgery development.

  6. Treatment Option Overview (Male Breast Cancer)

    Science.gov (United States)

    ... Cancers Breast Cancer Screening Research Male Breast Cancer Treatment (PDQ®)–Patient Version General Information about Male Breast ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  7. Results of Breast Conserving Surgery and Subsequent Postoperative Radiotherapy for Cases of Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chie, Eui Kyu; Kim, Kyu Bo; Choi, Jin Hwa [Seoul National University College of Medicine, Seoul (Korea, Republic of)] (and others)

    2008-09-15

    We analyzed the treatment outcomes and prognostic factors of breast conserving surgery, followed by postoperative radiotherapy. Materials and Methods: A total of 424 breast cancer patients treated with breast conserving surgery and postoperative radiotherapy between February 1992 and January 2001 were retrospectively analyzed. A quadrantectomy and axillary lymph node dissection was performed in 396 patients. A total of 302 patients had T1 disease, and 122 patients had T2 disease. Lymph node involvement was confirmed in 107 patients. Whole breast irradiation was administered at up to 50.4 Gy in 28 fractions, followed by a 10 Gy boost in 5 fractions to the tumor bed. In addition, 57 patients underwent regional lymph node irradiation. Moreover, chemotherapy was administered in 231 patients. A regimen consisting of cyclophosphamide, methotrexate, and 5-fluorouracil was most frequently used with 170 patients. The median follow-up time was 64 months. Results: The 5-year local control rate was 95.6%. During the follow-up period, local tumor recurrence was observed in 15 patients. The 5-year overall and disease-free survival rates were 93.1% and 88.7%, respectively. The 5-year overall survival rates, by stage, were 94.8% for stage I, 95.0% for stage IIA, 91.1% for stage IIB, 75.9% for stage IIIA, and 57.1% for stage IIIC. As for disease-free survival, the corresponding figures, by stage (in the same order), were 93.1%, 89.4%, 82.8%, 62.0%, and 28.6%, respectively. The advanced N stage (p=0.0483) was found to be a significant prognostic factor in predicting poor overall survival, while the N stage (p=0.0284) and age at diagnosis (p=0.0001) were associated with disease-free survival. Conclusion: This study has shown that breast conserving surgery and postoperative radiotherapy for early breast cancer results was excellent for local control and survival.

  8. Cirurgia conservadora no câncer de mama Breast-conserving surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    Daniel Guimarães Tiezzi

    2007-08-01

    Full Text Available O tratamento cirúrgico do câncer de mama sofreu expressivas mudanças nas últimas décadas. A cirurgia conservadora é o tratamento padrão para o câncer de mama em estádio inicial. Com a implementação dos programas de rastreamento e o uso emergente de tratamento sistêmico neoadjuvante, um crescente número de pacientes está sendo considerado elegível para o tratamento conservador. No entanto, uma série de fatores importantes merecem ser considerados no planejamento terapêutico destas pacientes. Esta revisão fornece uma visão geral da metodologia cirúrgica no tratamento conservador do carcinoma da mama.The surgical strategy for breast cancer treatment has changed considerably over the last decade. The breast conserving surgery (BCS is the standard treatment for early stage breast cancer nowadays. With the current population breast cancer screening programs and the emerging use of systemic neoadjuvant therapy, an increasing number of patients have been eligible to BCS. However, several specific factors must be considered for the therapeutic planning for these patients. This review provides a surgical methodology overview for the BCS in breast carcinoma.

  9. Breast conserving treatment in Denmark, 1989-1998. A nationwide population-based study of the Danish Breast Cancer Co-operative Group

    DEFF Research Database (Denmark)

    Ewertz, M.; Kempel, M.M.; During, M.;

    2008-01-01

    of follow-up, the Kaplan-Meier estimate of overall survival was 69% among 3 758 patients who received the recommended treatment. Within the first 10 years of follow-up, the cumulative incidences of loco-regional recurrences, distant metastases or other malignant disease, or death as a first event were 9.......0, 19.9, and 6.0% respectively, when analysed in a competing risk setting. The risk of loco-regional recurrences was significantly decreased in patients aged 50 years or more and increased with increasing tumour size. There was a pronounced beneficial effect of adjuvant radiotherapy with those...... not receiving radiotherapy having a hazard ratio of 3.52 (95% CI 2.21-5.61). The effect of resection margins was significant for loco-regional recurrences only in node negative patients. CONCLUSION: In conclusion, the present study shows that results similar to those from randomised clinical trials can...

  10. Additional Surgery after Breast-Conserving Surgery Varies Widely

    Science.gov (United States)

    A study published in the Feb. 1, 2012, issue of JAMA found that the number of women who have one or more additional surgeries to remove suspected residual tumor tissue (re-excisions) following breast-conserving surgery (BCS) for breast cancer varies widely across surgeons and hospitals.

  11. Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    Liu Qian; Liu Yinhua; Xu Ling; Duan Xuening; Li Ting; Qin Naishan; Kang Hua

    2014-01-01

    Background This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer.Methods The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012.The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group).Enhanced MRI was used to measure breast volume,longest diameter of tumor and tumor volume.The correlations between these measurements and those derived from histopathologic findings were assessed.The relationships between the success rate of breast-conserving surgery and MRI-and pathology-based measurement results were statistically analyzed in the breast-conserving group.Results The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group.Allocation to these groups was based on clinical indications and patient preferences.The cut-off for concurrence between MRI-and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm.In the total mastectomy group,the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%.Correlation coefficients for MRI and histopathology-based measurements of breast volume,tumor volume and tumor volume/breast volume ratio were r=0.861,0.569,and 0.600,respectively (all P <0.001).In the breast-conserving group,with 0.30 cm taken as the cut-off for concurrence,the 95% confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98%-44.01%.The subjective and objective success rates for breast-conserving surgery were 100% and 88.54%,respectively.Conclusions There were significant correlations between dynamic enhanced MRI-and histopathology-based measurements of the longest

  12. Characterization of a phantom setup for breast conserving cancer surgery

    Science.gov (United States)

    Chadwell, Jacob T.; Conley, Rebekah H.; Collins, Jarrod A.; Meszoely, Ingrid M.; Miga, Michael I.

    2016-03-01

    The purpose of this work is to develop an anatomically and mechanically representative breast phantom for the validation of breast conserving surgical therapies, specifically, in this case, image guided surgeries. Using three patients scheduled for lumpectomy and four healthy volunteers in mock surgical presentations, the magnitude, direction, and location of breast deformations was analyzed. A phantom setup was then designed to approximate such deformations in a mock surgical environment. Specifically, commercially available and custom-built polyvinyl alcohol (PVA) phantoms were used to mimic breast tissue during surgery. A custom designed deformation apparatus was then created to reproduce deformations seen in typical clinical setups of the pre- and intra-operative breast geometry. Quantitative analysis of the human subjects yielded a positive correlation between breast volume and amount of breast deformation. Phantom results reflected similar behavior with the custom-built PVA phantom outperforming the commercial phantom.

  13. Radiation dermatitis and pneumonitis following breast conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yoden, Eisaku; Hiratsuka, Junichi; Imajo, Yoshinari [Kawasaki Medical School, Kurashiki, Okayama (Japan)

    2000-09-01

    We investigated the frequency, degree and risk factors of radiation-induced dermatitis and pneumonitis in 255 patients receiving breast conserving therapy between April 1987 and April 1998. The majority of the patients underwent a wide excision or quadrantectomy with a level I, II axillary dissection, followed by radiotherapy consisting of 50 Gy/25 Fr/5 weeks to the preserved breast with a 4 MV beam by tangentially opposed portals using the half-field technique. Eleven patients received an additional 10 Gy/5 Fr of electron therapy to the tumor bed. Most of the patients developed radiation dermatitis which was limited to reddening or dry desquamation, with the exception of 14 patients with a localized moist reaction. The skin reaction was transient in all patients and improved with conservative treatments. Radiation pneumonitis appeared on chest X-rays in 30 patients, with a slight appearance in 21 and patchy appearance in 9. Three patients presented with persistent symptoms requiring medication. They were treated with steroids, resulting in complete resolution of the symptoms. A large volume of the chest wall within the irradiation field and a large area of irradiated skin were the risk factors of radiation dermatitis. The volume of irradiated lung significantly correlated with the frequency and degree of radiation pneumonitis. It was preferable that the maximum thickness of the involved lung should not exceed 3 cm. Complicated disease, adjuvant therapy and boost irradiation had no impact on the radiation dermatitis or pneumonitis. (author)

  14. Systematic review: conservative treatments for secondary lymphedema

    Directory of Open Access Journals (Sweden)

    Oremus Mark

    2012-01-01

    Full Text Available Abstract Background Several conservative (i.e., nonpharmacologic, nonsurgical treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies. Results Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare ( Conclusions The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems.

  15. The Research on the Effectiveness of Breast-conserving Surgery in Treatment of Early Breast Cancer%保乳手术治疗早期乳腺癌实效性研究

    Institute of Scientific and Technical Information of China (English)

    武文杰; 刘瑞丽; 王苏; 毛淑平; 李韶山

    2014-01-01

    To investigate the clinical effects and cosmetic value of breast-conserving surgery for early breast cancer patients,to provide a reference for the clinical selection of surgery.Method:42 patients with early breast cancer were selected from July 2009 to December 2011.According to surgical option,all patients were divided into the observation group for 22 cases and the control group for 20 cases.The control group was given modified radical surgery, the observation group was given breast-conserving surgery.The clinical indicators,postoperative follow-up situation, beauty satisfaction were observed and compared between the two groups.Result:The operative time,length of hospital stay in the observation group were significantly shorter than those in the control group,the blood loss was significantly less than the control group,the differences were statistically significant(P0.05).The control group had 2 cases of distant metastasis for brain metastasis.The beauty satisfaction of the observation group was 100%, it was significantly higher than the 40.00%of the control group,the difference was statistically significant(P0.05)。对照组2例远处转移为脑部转移。观察组的美容满意度100%明显高于对照组的40.00%,差异有统计学意义(P<0.05)。结论:保乳手术与改良根治手术均可以取得较好的临床效果,但保乳手术美容效果好,在严格掌握适应证的前提下,临床可以优先考虑。

  16. Microwaves for breast cancer treatments

    Directory of Open Access Journals (Sweden)

    Heba Abdelhamid Elkayal

    2015-12-01

    Full Text Available Hyperthermia is potentially an effective method for the treatment of cancer, especially breast cancer tumors. One of the most attractive attributes of hyperthermia is the possibility of providing therapeutic benefit noninvasively, minimizing side effects. To be effective, a hyperthermia treatment must selectively heat the cancerous tissue, elevating the temperature in the tumor without exposing healthy tissue to excessive temperature elevations. In this paper, a suggested simple model of Annular Phased Array (APA using eight half wavelength linear dipoles is presented. New software (COMSOL MULTIPHYSICS is used to calculate the temperature distribution inside a model of a three layered breast (skin, breast tissue, and tumor. In addition, the effect of changing the amplitude and phases of the array elements on the temperature distributions and the conditions on the values of the phases are demonstrated in order to achieve the objective of hyperthermia for breast tumor treatment.

  17. [The importance of histological verification in the conservative surgery of breast cancer].

    Science.gov (United States)

    Marinova, L; Todorov, I; Terziev, I

    1996-01-01

    The place and significance of the histological verification in the team method of approach in case of conservative breast cancer treatment are discussed. An accent is made on the histological risk factors increasing the recurrence appearance probability that gathers such patients in a high risk group. On the basis of our own material representing breast cancer patients treated in the period 1987-1993 the significance of the histological verification in the treatment approach is estimated. Requirements for comprehensive histological verification being much needed for breast cancer patients are risen for the pathohistologists.

  18. [Conservative treatment of ectopic pregnancy].

    Science.gov (United States)

    Odland, J O; Maltau, J M; Tollan, A

    1991-01-30

    During the last decades the incidence of ectopic pregnancy has been steadily rising. The chosen therapy has usually been unilateral salpingectomy. Recently, different conservative (tube-preserving) treatment-modalities have been introduced in clinical practice. We have tried conservative treatment by local injection of prostaglandin F2a (total dose 2-4 mg) directly into the tubal pregnancy and, if feasible, also into the corpus luteum graviditate. The treatment was successful in 13 out of 16 patients. In one patient laparotomia was performed because of pain, and revealed a haematoma in fossa Douglasi. Reinjection of prostaglandin was necessary in one patient because of rising HCG titres. One patient was hospitalized for four days because of nausea and pain. The treatment was otherwise successful. The method may be useful as a non-surgical alternative in haemodynamically stable patients without tubal rupture. Further studies are needed to evaluate the outcome in terms of future fertility.

  19. Study of conserving therapy and modified radical mastectomy in the treatment of early breast cancer%早期乳腺癌患者保乳手术与改良根治术治疗的临床研究

    Institute of Scientific and Technical Information of China (English)

    孔珺; 戈伟

    2011-01-01

    目的:比较早期乳腺癌患者行保乳手术与改良根治术后的临床疗效.方法:60例早期乳腺癌患者,随机分为对照组和治疗组,每组30例,治疗组行保乳手术治疗,对照组行改良根治术治疗,比较二组的临床疗效.结果:与对照组相比,治疗组术中出血少,术后并发症发生率较低,同时治疗组美容效果显著优于对照组,两组比较有显著性差异(P<0.05).结论:早期乳腺癌患者行保乳手术具有创伤小、并发症少、美容效果好等优点,临床应用前景广阔.%Objective: To compared the clinical efficacy of the conserving therapy and modified radical mastectomy in the treatment of early breast cancer. Methods: 60 cases of breast cancer patients were randomly divided into treatment group and control group. each 30 patients. The treatment group was treated with breast梒onserving surgery and the control group with modified radical mastectomy. Results: Compared with the modified radical mastectomy, breast梒onserving surgery group had the merits of small wound, less bleeding and postoperative complication rate. However the cosmetic results comparing that of the two group, the treatment group was significantly higher than that of the control group, there were statistically significant between the two groups(P<0. 05). Conclusion: In comparison with modified radical mastectomy, breast conserving surgery has the merits of small wound, postoperative complication rate,good cosmetic results and high quality of life. The clinical application of breast conserving surgery has a extensive future.

  20. Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

    Directory of Open Access Journals (Sweden)

    Hashemi Esmat

    2005-04-01

    Full Text Available Abstract Background There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. Methods A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. Results In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS and this was significantly associated with their breast cancer case load (P Conclusion The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance.

  1. Re-resection rates and risk characteristics following breast conserving surgery for breast cancer and carcinoma in situ

    DEFF Research Database (Denmark)

    Kryh, C G; Pietersen, C A; Rahr, Hans;

    2014-01-01

    OBJECTIVES: To examine the frequency of re-resections and describe risk characteristics: invasive carcinoma or carcinoma in situ (CIS), palpability of the lesion, and neoadjuvant chemotherapy. RESULTS: 1703 breast conserving surgeries were performed: 1575 primary breast conserving surgeries (BCS...

  2. Conservative treatment modalities in retinoblastoma

    Directory of Open Access Journals (Sweden)

    Bhavna Chawla

    2013-01-01

    Full Text Available Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. The purpose of this article is to review the literature on various conservative treatment modalities available for the treatment of retinoblastoma and their effectiveness, when used alone or in combination. Pubmed, Medline, Embase, and the Cochrane library were searched through 2012 for published peer reviewed data on conservative treatment modalities for retinoblastoma. Various studies show that while enucleation remains the standard of care for advanced intraocular tumors, conservative modalities that can result in globe salvage and preservation of useful vision are being increasingly employed. Such modalities include systemic chemotherapy, focal consolidation with transpupillary thermotherapy, laser photocoagulation and cryotherapy, plaque brachytherapy, and delivery of local chemotherapy using subconjunctival, sub-tenon, or intra-arterial routes. When used alone or in combination, these treatment modalities can help in avoidance of external beam radiotherapy or enucleation, thus reducing the potential for long-term side effects, while salvaging useful vision. Radioactive plaque brachytherapy has an established role in selected patients with intraocular retinoblastoma. Local injections of chemotherapeutic agents via the sub-tenon or sub-conjunctival route have been used with varying degrees of success, usually as an adjunct to systemic chemotherapy. Intra-arterial ophthalmic artery delivery of melphalan has shown promising results. It is important to recognize that today, several treatment options are available that can obviate the need for enucleation, and cure the cancer with preservation of functional vision. A thorough knowledge and understanding of these conservative treatment modalities is essential for appropriate management.

  3. Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.

    LENUS (Irish Health Repository)

    Smith, Myles J

    2012-02-03

    OBJECTIVE: We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer. BACKGROUND: Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase\\/Akt (PI3K\\/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer. METHODS: Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb\\/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period. RESULTS: We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K\\/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15). CONCLUSION: Investigating therapies which target tumour survival pathways such as PI3K\\/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.

  4. 具备保留乳房条件的早期乳腺癌治疗方式选择%Treatment choice in early breast cancer patients suitable for breast conservation

    Institute of Scientific and Technical Information of China (English)

    孙春雷; 周士福; 孟东; 时伟锋; 赵于天; 金建荣; 吕庆; 陈玲; 杭建萍

    2013-01-01

    Objective To study the feasibility and the advantages of breast-conserving surgery plus intraoperative radiotherapy plus sentinel lymph node biopsy (SLNB) in early breast cancer patients who are suitable for breast conservation.Methods We retrospectively analvzed the clinical data of 136 early breast cancer patients with breast conservation in our hospital from June 2007 to January 2012.Among them,62received intraoperative radiotherapy at the dosage of 21 Gy with 9 MeV electrons (intraoperative radiotherapy group),including 41 with axillary lymph node dissection (ALND group) and 21 with SLNB (SLNB group) ;74 received conventional postoperative whole-breast radiotherapy at the dosage of 50-60 Gy (5-6 weeks,25-30 times) after breast-conserving surgery (postoperative radiotherapy group).The duration of operation and wound healing,cost of radiotherapy,and cosmetic results were compared between the intraoperative and postoperative radiotherapy group.The events of radiation injury,recurrence and death were recorded.The function of shoulder joint,edema and abnormal sensation of the affected limb,subcutaneous effusion were recorded in SLNB group and ALND group.The non-parametric test was used for quantitative data and ranked data.Results Compared with postoperative radiotherapy group,the intraoperative radiotherapy group had longer operation time [M(QR):120 (15) min vs 90 (15) min,P =0.00],more wound healing days [M (QR):13(4) d vs 8(1) d,P=0.00],less cost [M(QR):3500(200)RMB vs 14100(1000)RMB,P=0.00],and slighter radiation injury.No difference in cosmetic results was showed[95.2% (59/162) vs 86.5% (64/74),P=0.09].There were 2 cases of local recurrences,2 distant metastases and 1 death in the intraoperative group,while there was 1 local recurrence,3 distant metastases and no death in the postoperative radiotherapy group.No contralateral breast cancer occurred in two groups.There were 3 cases of shoulder joint dysfunction,7 edema of affected limb,10 abnormal sensation

  5. 保乳手术与改良根治术治疗早期乳腺癌的效果%Analysis of breast conserving mastectomy and modified radical mastecto-my in treatment of early stage breast cancer

    Institute of Scientific and Technical Information of China (English)

    张海峰; 索文军; 吕品; 刘丽红; 孙永欣

    2015-01-01

    Objective To investigate the effect of breast conserving mastectomy and modified radical mastectomy for early breast cancer. Methods 45 breast cancer patients were randomly divided into the research group (22 cases) and control group (23 cases), who were hospitalized from January 2007 to January 2010 in General Hospital of Fengfeng Group, Jizhong Energy Group Co.Ltd. The research group were treated with breast conserving mastectomy and the con-trol group were treated with modified radical mastectomy. Two groups were both treated with axillary lymph node dis-section and received conventional radiotherapy and chemotherapy after surgery. The duration of operation, intraopera-tive blood loss, length of hospital stay, local recurrence rate and 1, 3, 5 year survival rate were compared in two groups respectively. The patients' quality of life and breast appearance were evaluated with the SF-36 scale and the breast beauty evaluation respectively. Results The duration of operation [(145±26) min], intraoperative blood loss [(248±50) mL], length of hospital stay [(11±1) d] in research group were less than those in control group respectively [(188±31) min, (400±40) mL, (17±2) d], the differences were statistically significant (all P 0.05). The local recurrence rate in the research group and control group were 4.5% and 8.7% respectively, there was no significant difference between two groups (P> 0.05). The breast beauty evaluation in research group after surgery were as follows: excellent in 19 cases, good in 2 cases, poor in 1 cases; the control group: excellent in 7 cases, good in 6 cases, poor in 10 cases. There was significant differ-ence between two groups (P0.05)。研究组与对照组患者局部复发率分别为4.5%与8.7%,两组比较差异无统计学意义(P>0.05)。患者术后乳房美容评定结果院研究组优19例,良2例,差1例;对照组优7例,良6例,差10例;两组比较差异有高度统计学意义(P<0.01)。研究组患者SF-36

  6. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  7. An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] (and others)

    2001-06-01

    Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

  8. Identification of the boundary between normal breast tissue and invasive ductal carcinoma during breast-conserving surgery using multiphoton microscopy

    Science.gov (United States)

    Deng, Tongxin; Nie, Yuting; Lian, Yuane; Wu, Yan; Fu, Fangmeng; Wang, Chuan; Zhuo, Shuangmu; Chen, Jianxin

    2014-11-01

    Breast-conserving surgery has become an important way of surgical treatment for breast cancer worldwide nowadays. Multiphoton microscopy (MPM) has the ability to noninvasively visualize tissue architectures at the cellular level using intrinsic fluorescent molecules in biological tissues without the need for fluorescent dye. In this study, MPM is used to image the microstructures of terminal duct lobular unit (TDLU), invasive ductal carcinoma and the boundary region between normal and cancerous breast tissues. Our study demonstrates that MPM has the ability to not only reveal the morphological changes of the cuboidal epithelium, basement membrane and interlobular stroma but also identify the boundary between normal breast tissue and invasive ductal carcinoma, which correspond well to the Hematoxylin and Eosin (H and E) images. Predictably, MPM can monitor surgical margins in real time and provide considerable accuracy for resection of breast cancerous tissues intraoperatively. With the development of miniature, real-time MPM imaging technology, MPM should have great application prospects during breast-conserving surgery.

  9. Sequence of Radiotherapy and Chemotherapy in Breast Cancer After Breast-Conserving Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Jobsen, Jan J., E-mail: J.Jobsen@mst.nl [Department of Radiation Oncology, Medisch Spectrum Twente, Enschede (Netherlands); Palen, Job van der [Department of Epidemiology, Medisch Spectrum Twente, Enschede (Netherlands); Department of Research Methodology, Measurement and Data Analysis, Faculty of Behavioural Science, University of Twente (Netherlands); Brinkhuis, Marieel [Laboratory for Pathology Oost Nederland, Enschede (Netherlands); Ong, Francisca [Department of Radiation Oncology, Medisch Spectrum Twente, Enschede (Netherlands); Struikmans, Henk [Department of Radiation Oncology, Leiden University Medical Centre, Leiden (Netherlands); Radiotherapy Centre West, Medical Centre Haaglanden, the Hague (Netherlands)

    2012-04-01

    Purpose: The optimal sequence of radiotherapy and chemotherapy in breast-conserving therapy is unknown. Methods and Materials: From 1983 through 2007, a total of 641 patients with 653 instances of breast-conserving therapy (BCT), received both chemotherapy and radiotherapy and are the basis of this analysis. Patients were divided into three groups. Groups A and B comprised patients treated before 2005, Group A radiotherapy first and Group B chemotherapy first. Group C consisted of patients treated from 2005 onward, when we had a fixed sequence of radiotherapy first, followed by chemotherapy. Results: Local control did not show any differences among the three groups. For distant metastasis, no difference was shown between Groups A and B. Group C, when compared with Group A, showed, on univariate and multivariate analyses, a significantly better distant metastasis-free survival. The same was noted for disease-free survival. With respect to disease-specific survival, no differences were shown on multivariate analysis among the three groups. Conclusion: Radiotherapy, as an integral part of the primary treatment of BCT, should be administered first, followed by adjuvant chemotherapy.

  10. Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Heung Lae; Kim, Cheo Ljin; Park, Sung Kwang; Oh, Min Kyung; Lee, Jin Yong; Ahn, Ki Jung [Inje University College of Medicine, Busan (Korea, Republic of)

    2008-12-15

    .0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome. Conclusion: The results of this study have shown that breast conservation surgery and radiation therapy in early breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.

  11. True Local Recurrences after Breast Conserving Surgery have Poor Prognosis in Patients with Early Breast Cancer

    Science.gov (United States)

    Sarsenov, Dauren; Ilgun, Serkan; Ordu, Cetin; Alco, Gul; Bozdogan, Atilla; Elbuken, Filiz; Nur Pilanci, Kezban; Agacayak, Filiz; Erdogan, Zeynep; Eralp, Yesim; Dincer, Maktav

    2016-01-01

    Background: This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy. Methods: 1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded. Results: 53 patients (3.8%) had IBTR after BCS within a median follow-up of 70 months. The mean age was 45.7 years (range, 27-87 years), and 22 patients (41.5%) were younger than 40 years. 33 patients (62.3%) had true recurrence (TR) and 20 were classified as new primary (NP). The median time to recurrence was shorter in TR group than in NP group (37.0 (6-216) and 47.5 (11-192) months respectively; p = 0.338). Progesterone receptor positivity was significantly higher in the NP group (p = 0.005). The overall 5-year survival rate in the NP group (95.0%) was significantly higher than that of the TR group (74.7%, p 20 mm), high grade tumor and triple-negative molecular phenotype along with developing TR negatively affected overall survival (hazard ratios were 4.2 (CI 0.98-22.76), 4.6 (CI 1.07-13.03), 4.0 (CI 0.68-46.10), 6.5 (CI 0.03-0.68), and 6.5 (CI 0.02- 0.80) respectively, p 2 cm), high grade, triple negative phenotype, and having true recurrence were identified as independent prognostic factors with a negative impact on overall survival in this dataset of patients with recurrent breast cancer. In conjunction with a more intensive follow-up program, the role of adjuvant therapy strategies should be explored further in young patients with large and high-risk tumors to reduce the risk of TR. PMID:27158571

  12. 非腋窝清扫保乳手术治疗早期乳腺癌20例近期疗效分析%Clinical analysis of breast-conserving surgery without axillary lymph node dissection in the treatment of 20 cases of early breast cancer

    Institute of Scientific and Technical Information of China (English)

    李宏杰; 杨小平; 胡新荣; 何锋云

    2012-01-01

    Objective To observe the therapeutic effect of breast-conserving surgery without axillary lymph node dissection in the treatment of 20 cases of early brest cancer. Methods A total of 42 patients with breast cancer diagnosed with T1-2 tumors from 2007 to 2011 were enrolled in this study. The patients were divided into two groups according to the patient's willingness. The study group (n=20) were treated by breast-conserving surgery without axillary lymph node dissection, while those in the control group were treated by breast-conserving surgery with axillary lymph node dissection. Results Six months after operation, patients of the study group showed significantly better cosmetic results and less complications, compared with the control group. Conclusion Breast-conserving therapy with omission of axillary lymph node dissection is a safe and effective for treating early breast cancer, with less trauma and less complications, which can improve the quality of life of patients.%目的 探讨非腋窝清扫保乳手术治疗早期乳腺癌的疗效.方法 2007-2011年诊断为T1-2MoNo实施保乳手术联合放疗治疗的42例女性乳腺癌患者,按照患者意愿分为非腋窝淋巴结清扫保乳术组(实验组,n=20)和腋窝淋巴结清扫保乳术组(对照组,n=22).结果 手术后6个月随访,与对照组比较,实验组手术并发症发生率降低,美容效果显著提高.结论 对于未转移的早期乳腺癌实施非腋窝清扫的保乳综合治疗创伤小、疗效确切、形体改变少、能提高生存质量,值得进一步临床开展及推广.

  13. Bilateral mastectomy and the retreat from breast-conserving surgery.

    Science.gov (United States)

    Moffat, Frederick L; Yakoub, Danny

    2016-08-01

    The purpose of this study is to assess the consequences for breast cancer patients of the trend away from breast conservation in favor of bilateral and contralateral mastectomy. The methods are followed from the review of the literature from 1991 to 2015. Breast-conserving surgery and sentinel lymph node biopsy, introduced into mainstream practice in the 1980s and 1990s, respectively, are now the standard of care for early-stage breast cancer. Disruptive change has unexpectedly supervened in the guise of bilateral mastectomy for cancer or prophylaxis and contralateral prophylactic mastectomy. These operations are now being resorted to at a rate which cannot be explained by any of the biological imperatives related to breast cancer and related diseases. This phenomenon extends across the Western world and beyond, driven by patients' cancer concern, a misunderstanding of what surgery can and cannot achieve and preserve, and the current popular media/cultural environment. These developments and their consequences for patients are reviewed. Surgical complications, especially those related to reconstruction, are unusually common. Of equal or greater concern are the physical, esthetic, psychosocial, psychosexual morbidities, and other adverse sequelae of these operations.

  14. [Conservative treatment of acute diverticulitis].

    Science.gov (United States)

    Busser, Nienke; van Hee, Koen; van Dullemen, Hendrik H M; Schipper, D L Lucette

    2013-01-01

    Scientific evidence concerning the treatment of acute diverticulitis is scarce. We describe 2 patients with this condition in this article. The first, a 64-year-old man, came to the emergency room because he had experienced persistent abdominal pain for the previous 4 days. He was diagnosed with uncomplicated diverticulitis. The second patient, a 58-year-old woman, had had pain in her left lower abdomen for 4 weeks; the pain appeared to have been caused by complicated diverticulitis. Both patients were treated conservatively. Only the patient with complicated diverticulitis was administered antibiotics; she underwent surgery at a later date because of persistent pain. Several guidelines recommend the administration of antibiotics; however, a number of recent studies have revealed no benefit to the clinical course from the use of antibiotics. The Dutch guideline, therefore, recommends withholding antibiotics in the acute phase. Conclusive evidence on the best treatment for patients with frequent recurrences or chronic symptoms after an episode of acute diverticulitis is not available. Guidelines advise a personalised treatment strategy for each patient. More research is necessary on the effect of mesalazine in these cases.

  15. Perspectives of Cosmesis following Breast Conservation for Multifocal and Multicentric Breast Cancers

    Directory of Open Access Journals (Sweden)

    Mona P. Tan

    2015-01-01

    Full Text Available Background. Contemporary data suggest that breast conservation treatment (BCT for multifocal and multicentric breast cancer (MFMCBC may be appropriate with noninferior local control rates. However, there is a paucity of data to evaluate patient’s satisfaction with cosmetic outcomes after BCT for MFMCBC. This study was performed to bridge this information gap. Methods. All patients treated at the authors’ healthcare facility were included in the study. Patients with MFMCBC who were assessed to be eligible for BCT underwent tumour resection using standard surgical techniques with direct parenchymal closure through a single incision. After at least three years of follow-up, they were invited to participate in a survey regarding their cosmetic outcomes. Results. Of a total of 160 patients, 40 had MFMCBC, of whom 34 (85% underwent successful BCT. Five-year cancer-specific survival and disease-free survival were 95.7%. Twenty of the 34 patients responded to the survey. No patient rated her cosmetic outcome as “poor.” Analysis indicated low agreement between patients’ self-assessment and clinician-directed evaluation of aesthetic results. Conclusion. BCT for MFMCBC is feasible with acceptable survival and cosmetic outcomes. However, there appears to be a disparity between patient and clinician-directed evaluation of cosmetic results which warrant further research.

  16. Comparison of Locoregional Recurrence with Mastectomy vs. Breast Conserving Surgery in Pregnancy Associated Breast Cancer (PABC

    Directory of Open Access Journals (Sweden)

    Paniti Sukumvanich

    2009-12-01

    Full Text Available We have compared outcomes, including the locoregional recurrence, between mastectomy and breast conserving therapy in PABC. Patients were divided into those who were treated with mastectomies (group 1 and those with breast conserving surgery (group 2. The groups were comparable except for lower mean age in group 2 and more patients with stage III disease and higher number of nodes positive in the group 1. Five-year actuarial LRR, distant metastases free survival and overall survival in group 1 vs. 2 were 10% vs. 37%, 73% vs. 81% and 57% vs. 59% respectively. The patients with PABC treated with breast conserving therapy, despite having lower stage disease, have a higher risk of local regional recurrence in comparison with those treated with mastectomy.

  17. Treatment Approaches to Recurrent Phyllodes Tumors of the Breast

    Directory of Open Access Journals (Sweden)

    Fazilet Erözgen

    2012-06-01

    Full Text Available Aim: Phyllodes tumors of the breast are a rarely encountered clinical condition. Recurrent cases are even rarer. Treatment protocols vary among breast centers. In our study, we aimed to investigate the prognosis of recurrent breast phyllodes tumors and to present our treatment approach. Methods: Among 31000 patients, who presented to our breast outpatient clinic between March 2005 and December 2011, we retrospectively evaluated three patients with recurrent phyllodes tumors of the breast. Results: The three female patients, aged 24, 28 and 30 years, had been previously operated for phyllodes tumor of the breast. The first tumor localization was the superolateral part of the right breast in all subjects. Recurrences were in the same localizations, but pathologies were more aggressive than the previous reports. In two patients mastectomy and in one breast-conserving surgery were performed. Conclusion: Relapse of phyllodes tumors can result in mastectomy and recurrent phyllodes tumors seem to be more aggressive than the original tumor. (The Me di cal Bul le tin of Ha se ki 2012; 50: 43-7

  18. Conservative treatment of sciatica : A systematic review

    NARCIS (Netherlands)

    Vroomen, PCAJ; de Krom, MCTFM; Slofstra, PD; Knottnerus, JA

    2000-01-01

    Most patients with sciatica (often caused by disc herniations) are managed conservatively at first. The natural course seems to be favorable. The additional value of many conservative therapies remains controversial. Because a systematic review of the conservative treatment of sciatica is lacking, s

  19. Treatment of symptomatic macromastia in a breast unit

    Directory of Open Access Journals (Sweden)

    Schneider José

    2010-11-01

    Full Text Available Abstract Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28% presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy

  20. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: Long-term results of European Organisation for Research and Treatment of Cancer studies

    NARCIS (Netherlands)

    de Bock, Truuske; van der Hage, J.A.; Putter, H.; Bonnema, J.; Bartelink, H.; van de Velde, C.J.

    2006-01-01

    The aim of this study was to evaluate prognostic factors for isolated loco-regional recurrence in patients treated for invasive stage I or H breast cancer. The study population comprised 3602 women who had undergone primary surgery for early stage breast cancer, who were enrolled in European Organis

  1. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy : Long-term results of European Organisation for Research and Treatment of Cancer studies

    NARCIS (Netherlands)

    de Bock, GH; van der Hage, JA; Putter, H; Bonnema, J; Bartelink, H; van de Velde, CJ

    2006-01-01

    The aim of this study was to evaluate prognostic factors for isolated loco-regional recurrence in patients treated for invasive stage I or H breast cancer. The study population comprised 3602 women who had undergone primary surgery for early stage breast cancer, who were enrolled in European Organis

  2. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Senthi, Sashendra, E-mail: sashasenthi@msn.com [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne (Australia); Link, Emma [Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne (Australia); Chua, Boon H. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne (Australia); University of Melbourne, Melbourne (Australia)

    2012-10-01

    Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

  3. Results of a conservative treatment combining induction (neoadjuvant) and consolidation chemotherapy, hormonotherapy, and external and interstitial irradiation in 98 patients with locally advanced breast cancer (IIIA-IIIB)

    Energy Technology Data Exchange (ETDEWEB)

    Jacquillat, C.; Baillet, F.; Weil, M.; Auclerc, G.; Housset, M.; Auclerc, M.; Sellami, M.; Jindani, A.; Thill, L.; Soubrane, C.

    1988-05-15

    Ninety-eight patients with locally advanced breast cancer (Stage IIIA-IIIB) were entered into a pilot study combining intensive induction (neoadjuvant) chemotherapy (VTMFAP) with or without hormonochemotherapy, external and interstitial radiotherapy, and consolidation chemotherapy with or without hormonochemotherapy. Tumor regression over 50% was observed in 91% patients after chemotherapy, and complete clinical remission occurred in 100% patients after irradiation. The rate of local relapse is 13%. The 3-year disease-free survival is 62% and 3-year global survival is 77%. Initial chemotherapeutic tumor regression greater than 75% is the main predictive factor for disease-free survival.

  4. Pregnancy associated breast cancer and pregnancy after breast cancer treatment

    OpenAIRE

    Doğer, Emek; Çalışkan, Eray; Mallmann, Peter

    2011-01-01

    Breast cancer is one of the most common cancers diagnosed during pregnancy and its frequency is increasing as more women postpone their pregnancies to their thirties and forties. Breast cancer diagnosis during pregnancy and lactation is difficult and complex both for the patient and doctors. Delay in diagnosis is frequent and treatment modalities are difficult to accept for the pregnant women. The common treatment approach is surgery after diagnosis, chemotherapy after the first trimester and...

  5. Analysis of radiation pneumonitis outside the radiation field in breast conserving therapy for early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ogo, Etsuyo; Fujimoto, Kiminori; Hayabuchi, Naofumi [Kurume Univ., Fukuoka (Japan). School of Medicine] (and others)

    2002-02-01

    In a retrospective study of radiation-induced pulmonary changes for patients with breast conserving therapy for early breast cancer, we sent questionnaires to the main hospitals in Japan. In this study, we analyzed pulmonary changes after tangential whole-breast irradiation. The purpose of this study was to determine the incidence and risk factors for radiation pneumonitis outside the radiation field. The questionnaires included patients data, therapy data, and lung injury information between August 1999 and May 2000. On the first questionnaires, answer letters were received from 107 institutions out of 158 (67.7%). On the second questionnaires, response rate (hospitals which had radiation pneumonitis outside the radiation field) was 21.7% (23/106). We could find no risk factors of this type of pneumonitis. We suggested that lung irradiation might trigger this type of pneumonitis which is clinically similar to BOOP (bronchiolitis obliterans organizing pneumonia). It developed in 1.5-2.1% among the patients with breast conserving surgery and tangential whole-breast irradiation. And it is likely appeared within 6 months after radiotherapy. (author)

  6. [Special considerations in breast cancer treatment of an augmented breast].

    Science.gov (United States)

    Mátrai, Zoltán; Gulyás, Gusztáv; Tóth, László; Sávolt, Akos; Kunos, Csaba; Pesthy, Pál; Bartal, Alexandra; Szabó, Eva; Kásler, Miklós

    2011-10-16

    Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.

  7. Breast cancer. Part 2: present and future treatment modalities.

    Science.gov (United States)

    Harmer, Victoria

    This is the second article in a series of three on breast cancer. Part 1 discussed breast anatomy, the principles behind breast awareness and breast health, detailing common benign breast diseases, types of breast cancer and staging. In this article, treatment for breast cancer is discussed. The article will follow the usual order of modalities in the trajectory, starting with surgery, then chemotherapy, radiotherapy and endocrine treatment, finishing with a discussion of future and biological treatments.

  8. Clinical efficacy of breast-conserving surgery combined with neoadjuvant chemotherapy for locally advanced breast cancer: a report of 81 cases

    Directory of Open Access Journals (Sweden)

    Zhi-yu CAO

    2015-07-01

    Full Text Available Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with breast-conserving surgery for locally advanced breast cancer. Methods Eighty-one patients with locally advanced breast cancer were selected from those who were admitted into 309 Hospital of PLA from January 2009 to October 2013, consisting of 65 patients in stage Ⅲa and 16 in stage Ⅲb, and they were treated with neoadjuvant chemotherapy combined with breast-conserving surgery. The clinical efficacy [complete response (CR, partial response (PR, stable disease (SD and progress disease (PD] was observed during follow-up. Results All the patients were followed-up for 12-60 months with a median of 34 months. There were 12 CR patients (14.8%, including 4 with pathological complete response (4.9%, and 52 PR patients (64.2%, 17 SD patients (21.0%. No PD was observed. The overall response rate(ORR was 79.0%(64/81. After follow-up for 12-60 months (median 34 months, distant metastasis to the lung, liver, meninges and bone occurred in 3 patients (3.7%, 3/81 and 1 of them died. Forty-eight patients received breastconserving surgery. The local recurrence rate was 6.3% (3/48. Assessment of cosmetic result was carried out in 48 patients who received breast-conserving surgery and comprehensive treatment for one year, and excellent results were obtained in 14.6% (7/48, good in 43.8% (21/48, and poor in 41.7% (20/48. Conclusions The therapeutic efficacy of locally advanced breast cancer is satisfactory by neoadjuvant chemotherapy and breast-conserving surgery. Standardization of excision and postoperative radiotherapy, systemic comprehensive treatment is the key to the success of the treatment. DOI: 10.11855/j.issn.0577-7402.2015.06.14

  9. The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer

    Science.gov (United States)

    McGuire, Kandace; Alco, Gul; Nur Pilanci, Kezban; Koksal, Ulkuhan I; Elbüken, Filiz; Erdogan, Zeynep; Agacayak, Filiz; Ilgun, Serkan; Sarsenov, Dauren; Öztürk, Alper; İğdem, Şefik; Okkan, Sait; Eralp, Yeşim; Dincer, Maktav; Ozmen, Vahit

    2016-01-01

    Background Premenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women. Methods Three hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS). Results Most patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24–252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35–40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015). Conclusion Young age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35–40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival. PMID:27433412

  10. Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a Prospective Phase I trial

    Directory of Open Access Journals (Sweden)

    El-Sayed Mohamed I

    2010-08-01

    Full Text Available Abstract Background Neoadjuvant chemotherapy is the standard care for locally advanced breast cancer. Our study aimed at evaluating the feasibility of breast conversation surgery (BCS after neoadjuvant chemotherapy. Patients and methods Forty five patients had stage IIB (except those with T2N1 disease and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤5 cm underwent a tentative BCS while patients who had tumour size >5 cm underwent radical surgery. Negative margin is essential for BCS. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients. Results Thirty four patients had BCS. Response to chemotherapy was the only statistically significant factor which influences the BCS. Incidence of local recurrence was 5.9% for patients who had BCS at a median follow up 24 months. Conclusion Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤4 cm after chemotherapy are the best candidates for BCS.

  11. Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.ca [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Cherian, Anil [Station Health Centre, Royal Air Force Lossiemouth, Moray (United Kingdom); Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, Ontario (Canada); Perera, Francisco [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

    2015-02-01

    Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distant disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone.

  12. Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands

    NARCIS (Netherlands)

    M.J. Aarts (Mieke); V.C. Hamelinck (V.); E. Bastiaannet (Esther); J.W.W. Coebergh (Jan Willem); G.-J. Liefers (Gerrit-Jan); A.C. Voogd (Adri); M.J.C. van der Sangen (Maurice); M.W.J. Louwman (Marieke)

    2012-01-01

    textabstractBackground: The use of sentinel node biopsy (SNB), lymph node dissection, breast-conserving surgery, radiotherapy, chemotherapy and hormonal treatment for breast cancer was evaluated in relation to socioeconomic status (SES) in the Netherlands, where access to care was assumed to be equa

  13. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands : a population-based study

    NARCIS (Netherlands)

    van Maaren, Marissa C.; de Munck, Linda; de Bock, Geertruida H.; Jobsen, Jan J.; van Dalen, Thijs; Linn, Sabine C.; Poortmans, Philip; Strobbe, Luc J. A.; Siesling, Sabine

    2016-01-01

    Background Investigators of registry-based studies report improved survival for breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer. As these studies did not present long-term overall and breast cancer-specific survival, the effect of breast-conserving surgery

  14. Treatment planning in conservative dentistry.

    Science.gov (United States)

    Sivakumar, Andamuthu; Thangaswamy, Vinod; Ravi, Vaiyapuri

    2012-08-01

    A patient attending for treatment of a restorative nature may present for a variety of reasons. The success is built upon careful history taking coupled with a logical progression to diagnosis of the problem that has been presented. Each stage follows on from the preceding one. A fitting treatment plan should be formulated and should involve a holistic approach to what is required.

  15. PRONE ACCELERATED PARTIAL BREAST IRRADIATION AFTER BREAST-CONSERVING SURGERY: FIVE YEAR RESULTS OF 100 PATIENTS

    Science.gov (United States)

    Formenti, Silvia C.; Hsu, Howard; Fenton-Kerimian, Maria; Roses, Daniel; Guth, Amber; Jozsef, Gabor; Goldberg, Judith D.; DeWyngaert, J. Keith

    2013-01-01

    Purpose To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position (P-APBI). Methods Post-menopausal patients with Stage I breast cancer with non palpable <2 cm tumors, negative margins, and negative nodes, positive hormonal receptors, and no extensive intraductal component (EIC) were eligible. The trial was offered only once eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone set-up. The 3D-CRT delivered was 30 Gy in five 6 Gy/daily fractions over 10 days with port film verification at each treatment. Ipsilateral breast, ipsilateral nodal, contralateral breast, and distant failure (IBF, INF, CBF, DF) were estimated using the cumulative incidence method. Disease-free, overall, and cancer-specific survival (DFS, OS, CSS) were recorded. Results One hundred patients accrued to this IRB- approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation and another elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients are evaluable for toxicity and, in one case, both breasts were treated with PBI. Median patient age was 68 years (range 53–88 years); in 55% the tumor size was <1 cm. All patients had hormonal receptor positive cancers: 87% underwent adjuvant anti-hormonal therapy. At a median follow-up of 64 months (range, 2–125 months), there was one local recurrence (1% IBF) and one contralateral breast cancer (1% CBF). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (1 breast edema, 1 transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36 months follow-up. Conclusions Five-year efficacy and toxicity of 3D-CRT to deliver prone-PBI are comparable to other experiences with similar

  16. Long-term age-dependent failure pattern after breast-conserving therapy or mastectomy among Danish lymph-node-negative breast cancer patients

    DEFF Research Database (Denmark)

    Laurberg, Tinne; Lyngholm, Christina Daugaard; Christiansen, Peer

    2016-01-01

    PURPOSE: To describe long-term failure pattern after early-stage breast cancer in relation to local treatment (breast-conserving therapy (BCT) or mastectomy) and age. MATERIALS AND METHODS: Cohort study with balanced 5-year age groups and prospectively collected data; 813 Danish lymph......: BCT patients with no adjuvant systemic treatment developed LR throughout 20-year period and faced higher LR risk than mastectomy patients. LR was associated with DM among younger patients, and younger BCT patients had higher mortality than younger mastectomy patients....

  17. Breast-conserving therapy: its relation to pneumonopathy

    Energy Technology Data Exchange (ETDEWEB)

    Ogo, Etsuyo; Fujimoto, Kiminori; Uchida, Masafumi; Terasaki, Hiroshi; Sadohara, Junko; Azuma, Sanae; Suzuki, Gen; Hayabuchi, Naofumi [Kurume Univ., Fukuoka (Japan). School of Medicine

    2000-10-01

    Time-dependent changes in the lungs induced by radiotherapy after breast-conserving surgery were monitored by high-resolution CT (HR-CT), and acute and delayed radiation effects were assessed. The subjects were 55 patients who had undergone tangential irradiation after breast-conserving surgery (age: 34-86 years). Patients were irradiated with 4-MV linear accelerator X-rays, 50 Gy/25 fr/5 w, within 50 days after surgery. Based on a histopathological findings in the stump, 10 Gy/5 fr/1 w boost irradiation was added to the base of the tumor with a 9-12 MeV electron beam. The lymph nodes of some patients were also irradiated. Regular CT examinations were as a rule performed before radiotherapy and 1-2 months (acute phase), 6 months (subacute phase), and 12 months (late phase) after radiotherapy. Whenever possible additional examinations were performed at 24 and 36 months. All images were interpreted by three radiotherapists and classified into the following 7 patterns; septal line, nodular opacity, ground glass opacity, consolidation, curvilinear opacity, air-cyst accumulation, and irregular pleural surface. Pathological changes in the lungs were found in a total of 49 of the 55 patients (89%) within 12 months. In 31 patients they were observed every time examined (1-12 months), and in 6 patients at 1-6 months alone. A septal line was observed throughout the entire 1-to-12 month period. Nodular opacities, ground glass opacities, and consolidation occurred in the acute phase (1-2 months, 41 patients). Air-cyst accumulation and irregularity of the pleural surface appeared in the subacute-late phase, and 33 patients had these findings from 12 months onward. Curvilinear opacities were observed from 6 months onward. The frequency of the findings after 24 and 36 months, was the same as up to 12 months, but the pathological changes in the pleura became more severe with the passage of time, and the irregularity of the pleural surface was the main finding (60-64%). The

  18. Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hala M.S. ELdeen

    2016-01-01

    Conclusion: In conclusion, both Pecs and TSB provide effective intraoperative anesthesia and prolonged postoperative pain relief after breast surgery, but the Pecs block is technically simple and easy to learn with few contraindications, provides hemodynamic stability, and has a low complication rate and it is therefore a safe and effective technique in performing intraoperative anesthesia and controlling postoperative pain after unilateral conservative breast surgery.

  19. A dosimetric study of supine and prone treatment setups for breast cancer patients after breast conserving surgery%早期乳腺癌保乳术后仰卧及俯卧位调强放疗的剂量学比较

    Institute of Scientific and Technical Information of China (English)

    铁剑; 张健; 张艺宝; 吴昊

    2014-01-01

    parameters.Treatment plans of the two setups were evaluated by comparing the target dose distribution,the doses and irradiated volumes of the heart,left lung,and right breast,and the monitor units (MUs).Results Superior conformal index (CI) was observed in the plans of prone setup than the supine cases (0.79 ± 0.05 vs.0.72 ± 0.04,W =138,P < 0.01).The homogeneity index (HI) of prone positioning was also better than that of supine setup (1.09 ±0.01 vs.1.12 ± 0.02,t =-4.7,P <0.01).The planning target volume (PTV) receiving 95% of prescribed dose (V95%),and the minimum doses (Dmin) of the prone cases were significantly higher than the supine patients (t =7.1,6.4,P<0.01).Higher mean doses (D) were observed in prone cases (W=153,P<0.01).The maximum doses (Dmax) of the supine plans were lower than the prone cases (t =-3.6,P <0.01).The right breast volumes receiving 5 Gy doses or higher (V5) were less in the supine cases than the prone plans (W=160,P <0.01).The heart volumes received no less than 30 Gy (V30),D of the heart,and the left lung volumes received higher than 20 Gy or 5 Gy (V20,V5) of the supine plans were significantly higher than the prone cases (W =133,120,120,P <0.01).No significant difference was observed on the MUs.Conclusions For cancer patients with large and pendulous breasts receiving IMRT after breast conserving surgery,prone setup leads to better homogeneity of target dose distribution,and reduces the doses and irradiated volumes of the heart and lungs.

  20. Conservative management of breast cancer in the elderly in a developing country

    Directory of Open Access Journals (Sweden)

    de V Odendaal Jacobus

    2007-10-01

    Full Text Available Abstract Background The cost effective treatment of cancer in developing countries remains challenging. In the elderly with possible limited life expectancy, the health expenditure associated with standard treatment regimes should be carefully considered. We present the results of conservative management of breast cancer in the aged in a resource-limited environment. Methods Patients aged 70 or older with early breast cancer were treated with tumour excision or simple mastectomy and adjuvant tamoxifen. The records of patients presenting to the Breast Unit between January 1990 and December 2004 were retrieved and demographic, clinical, pathological and oncological data were reviewed. Survival statistics were calculated using the life table method. Results A total of 483 patients above 70 years of age were identified. One hundred and eighty eight patients were managed according to the conservative protocol. Forty-one had a simple mastectomy and 147 tumour excision. Their mean age was 77.3 years. The mean follow-up is 62 months. Thirty-one patients (16.4% were not compliant with tamoxifen use. TNM staging was 0 in 4 patients, I in 42 patients, II in 116 patients and III in 26 patients. There was no 30-day mortality. The cumulative incidence of local recurrence was 3.3% at 5 and 10 years. The cumulative incidence of regional recurrence was 3.3% at 5 years and 4.5% at 10 years. The cumulative incidence of distant recurrence was 6.2% at 5 years and 12.2% at 10 years. The cumulative overall, disease specific and disease free survival at 10 years was 59%, 88% and 81% respectively. Conclusion Limited surgery and tamoxifen provide excellent control of breast cancer in the elderly in a resource restricted environment. Radiotherapy and axillary dissection and can be safely omitted thereby reducing health care resource utilization.

  1. Exercise after breast cancer treatment: current perspectives

    Directory of Open Access Journals (Sweden)

    Dieli-Conwright CM

    2015-10-01

    Full Text Available Christina M Dieli-Conwright, Breanna Z Orozco Division of Biokinesiology and Physical Therapy, Women's Health and Exercise Laboratory, University of Southern California, Los Angeles, CA, USA Abstract: Over the past 2 decades, great strides have been made in the field of exercise-oncology research, particularly with breast cancer. This area of research is particularly important since there are >2.8 million breast cancer survivors who are in need of an intervention that can offset treatment-related side effects. Noticeable reductions in physical fitness (ie, cardiopulmonary fitness and muscular strength, negative changes in body composition (ie, increase in body mass, decrease in lean body mass, and increase in fat mass, increased fatigue, depression, or anxiety are some of the common side effects of cancer treatments that negatively impact overall quality of life and increase the risk for the development of comorbidities. Exercise plays a vital role in improving cardiopulmonary function, psychological events, muscular strength, and endurance in breast cancer survivors, and thus should be considered as a key factor of lifestyle intervention to reverse negative treatment-related side effects. The purpose of this review is to address current perspectives on the benefits of aerobic and resistance exercise after breast cancer treatments. This review is focused on the well-established benefits of exercise on physical and emotional well-being, bone health, lymphedema management, and the postulated benefits of exercise on risk reduction for recurrence of breast cancer. Keywords: breast cancer, exercise, physical well-being

  2. Radiation therapy and chemotherapy after breast conserving surgery for invasive breast cancer: an intermediate result

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seok Ho; Lee, Kyu Chan; Choi, Jin Ho; Lee, Young Don; Park, Heoung Kyu; Kim, Hyun Young; Park, Se Hoon [Gachon Medical School, Incheon (Korea, Republic of)

    2007-03-15

    Breast conserving surgery (BCS) followed by chemotherapy (CT{sub x}.) and radiation therapy (RT) is widely performed for the treatment of early breast cancer. This retrospective study was undertaken to evaluate our interim results in terms of failure patterns, survival and relative risk factors. From January 1999 through December 2003, 129 patients diagnosed with invasive breast cancer and treated with BCS followed by RT were subject to retrospective review. The median age of the patients was 45 years (age distribution, 27 {approx} 76 years). The proportions of patients according to their tumor, nodes, and metastases (TNM) stage were 65 (50.4%) in stage I, 41 (31.7%) in stage IIa, 13 (10.1%) in stage IIb, 9 (7.0%) in stage III, and 1 patient (0.8%) in stage IIIc. For 32 patients (24.8%), axillary node metastasis was found after dissection, BCS consisted of quadrantectomy in 115 patients (89.1%) and lumpectomy in 14 patients (10.6%). Axillary node dissection at axillary level I and II was performed for 120 patients (93%). For 7 patients (5.4%), only sentinel node dissection was performed with BCS. For 2 patients (1.6%) axillary dissection of any type was not performed. Postoperative RT was given with 6 MV X-rays. A tumor dose of 50.4 Gy was delivered to the entire breast area using a tangential field with a wedge compensator. An additional dose of 9 {approx} 16 Gy was given to the primary tumor bed areas with electron beams. In 30 patients (23.3%), RT was delivered to the supraclavicular node. Most patients had adjuvant CT{sub x}. with 4 {approx} 6 cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens. The median follow-up period was 50 months (range: 17 {approx} 93 months). The actuarial 5 year survival rate (5Y-OSR) was 96.9%, and the 5 year disease free survival rate (5Y-DFSR) was 93.7%. Local recurrences were noted in 2 patients (true: 2, regional node: 1) as the first sign of recurrence at a mean time of 29.3 months after surgery. Five

  3. Neoadjuvant endocrine treatment in early breast cancer: An overlooked alternative?

    Science.gov (United States)

    van Dam, P A; van Dam, V C N; Altintas, S; Papadimitriou, K; Rolfo, C; Trinh, X B

    2016-03-01

    During the last decade neoadjuvant endocrine therapy (NET) has moved from being reserved for elderly and frail non-chemotherapy candidates to a primary systemic modality in selected patients with hormone sensitive breast cancer. Neoadjuvant hormonal treatment in patients with hormone receptor positive, HER-2 negative early breast cancer is proven to be an effective and safe option; it is associated with a higher rate of breast conserving surgery (BCS), may reduce the need for adjuvant chemotherapy and enables a delay of surgery for medical or practical reasons. Clinical responses range from 13% to 100% with at least 3 months of NET. Methods of assessing response should include MRI of the breast, particularly in lobular tumours. In studies comparing tamoxifen with aromatase inhibitors (AI), AI proved to be superior in terms of tumour response and rates of BCS. Change in Ki67 is accepted as a validated endpoint for comparing endocrine neoadjuvant agents. Levels of Ki67 during treatment are more closely related to long-term prognosis than pretreatment Ki67. Neoadjuvant endocrine therapy provides a unique opportunity for studies of endocrine responsiveness and the development of new experimental drugs combined with systemic hormonal treatment.

  4. Reactive intramammary lymph node mimicking recurrence on MRI study in a patient with prior breast conservation therapy

    Directory of Open Access Journals (Sweden)

    Seema A Kembhavi

    2013-01-01

    Full Text Available Breast conservative therapy (BCT is a well accepted form of treatment for patients with early stage breast cancer. The incidence of ipsilateral breast tumor recurrence is higher in patients undergoing BCT than in those patients undergoing Modified Radical Mastectomy (MRM without any adverse effect on survival. Patients treated with BCT are put on active surveillance using clinical breast examination and mammography. The radiologist reading the follow-up mammograms is on high alert and any neo-density is viewed with suspicion. MRI may be used as a problem solving tool. At such a time, an innocuous intra-mammary node can mimic malignancy on MRI. We want to showcase one such typical example with histological proof and highlight that type III curve may be seen in an intramammary node. Our case also reinforces the utility of second look ultrasound which is a faster, cheaper and easier method for localization and biopsy of abnormalities seen on MRI.

  5. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    FAN Lin-jun; JIANG Jun; YANG Xin-hua; ZHANG Yi; LI Xing-gang; CHEN Xian-chun; ZHONG Ling

    2009-01-01

    Background Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting.Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P>0.05).The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P>0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence-one of these patients died of multiple organ metastasis.Conclusions After considering the wide Indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants-the new surgery of choice for breast cancer-warrants serious consideration as the prospective next standard surgical procedure.

  6. Evaluation of Contralateral Breast Surface Dose in FIF (Field In Field) Tangential Irradiation Technique for Patients Undergone Breast Conservative Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Moon; Bang, Dong Wan; Bae, Yong Ki; Lee, Jeong Woo [Dept. of Radiation Oncology, Konkuk University Medical Center, Seoul (Korea, Republic of); Kim, You Hyun [Dept. of Radiological Science, College of Health Science, Korea University, Seoul (Korea, Republic of)

    2008-12-15

    The aim of this study is to evaluate contra-lateral breast (CLB) surface dose in Field-in-Field (FIF) technique for breast conserving surgery patients. For evaluation of surface dose in FIF technique, we have compared with other techniques, which were open fields (Open), metal wedge (MW), and enhanced dynamic wedge (EDW) techniques under same geometrical condition and prescribed dose. The three dimensional treatment planning system was used for dose optimization. For the verification of dose calculation, measurements using MOSFET detectors with Anderson Rando phantom were performed. The measured points for four different techniques were at the depth of 0 cm (epidermis) and 0.5 cm bolus (dermis), and spacing toward 2 cm, 4 cm, 6 cm, 8 cm, 10 cm apart from the edge of tangential medial beam. The dose calculations were done in 0.25 cm grid resolution by modified Batho method for inhomogeneity correction. In the planning results, the surface doses were differentiated in the range of 19.6-36.9, 33.2-138.2 for MW, 1.0-7.9, 1.6-37.4 for EDW, and for FIF at the depth of epidermis and dermis as compared to Open respectively. In the measurements, the surface doses were differentiated in the range of 11.1-71, 22.9-161 for MW, 4.1-15.5, 8.2-37.9 for EDW, and 4.9% for FIF at the depth of epidermis and dermis as compared to Open respectively. The surface doses were considered as underestimating in the planning calculation as compared to the measurement with MOSFET detectors. Was concluded as the lowest one among the techniques, even if it was compared with Open method. Our conclusion could be stated that the FIF technique could make the optimum dose distribution in Breast target, while effectively reduce the probability of secondary carcinogenesis due to undesirable scattered radiation to contra-lateral breast.

  7. Nipple- and areola-sparing mastectomy for the treatment of breast cancer

    OpenAIRE

    Mota, BS; R. Riera; Ricci, MD; Barrett, JK; de Castria, TB; Atallah, ÁN; Bevilacqua, JLB

    2016-01-01

    $\\textbf{Background}$ The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. $\\textbf{Objectives}$ To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and ...

  8. Comparison of the clinical effect of breast-conserving surgery and modified radical mastectomy in the treatment of early breast cancer%保乳手术与改良根治术治疗早期乳腺癌的临床效果比较

    Institute of Scientific and Technical Information of China (English)

    谢莉

    2014-01-01

    social factors scores of the observation group were (67.44 ± 3.87),(48.64 ± 3.73),(117.34 ± 8.33)and (61.56 ± 5.32),which were significantly higher than those of the control group (t =5.43,5.87,6.29,7.11,all P < 0.05).The postoperative 3-year local recurrence,distant metastasis and survival rate showed no significant differences between the two groups (x2 =1.22,1.09,1.29,all P > 0.05).Conclusion Breast-conserving surgery in the treatment of early breast cancer has significant effect,and it has less trauma,less bleeding and cosmetic results,and it can be used as the preferred method for the treatment of early breast cancer,which is worth to be further applied in clinical.

  9. Single dose IOERT versus whole breast irradiation. Cosmetic results in breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Struikmans, Henk [Medical Centre Haaglanden, Radiotherapy Centre West, The Hague (Netherlands); Leiden University Medical Centre, Department of Radiotherapy, Leiden (Netherlands); Snijders, Malou; Mast, Mirjam E.; Fisscher, Ursula; Petoukhova, Anna; Koper, Peter [Medical Centre Haaglanden, Radiotherapy Centre West, The Hague (Netherlands); Franssen, Jan-Huib; Speijer, Gabrielle [HAGA Medical Centre, Department of Radiotherapy, The Hague (Netherlands); Immink, Marcelle J. [Reinier de Graaf Medical Centre, Department of Radiotherapy, Delft (Netherlands); Leiden University Medical Centre, Department of Radiotherapy, Leiden (Netherlands); Marinelli, Andreas [Medical Centre Haaglanden, Department of Surgery, The Hague (Netherlands); Merkus, Jos [HAGA Medical Centre, Department of Surgery, The Hague (Netherlands)

    2016-10-15

    Scarce data are available about the cosmetic result of single dose intraoperative electron radiotherapy (IOERT) in breast-conserving radiotherapy. We included 71 breast cancer patients. Breast-conserving surgery and sentinel node procedure had started almost 3 years earlier. Subsequently, 26 patients were treated with IOERT and 45 patients received postoperative whole breast irradiation (WBI). For both groups we determined seven dimensionless asymmetry features. We compared the subjectively and the objectively derived cosmetic scores with each other. For four asymmetry features we noted significantly smaller differences for patients treated with IOERT when compared to those treated with WBI: relative breast contour difference, relative breast area difference and relative breast overlap difference. After correcting for excision volume a significant difference was noticed also for relative lower breast contour. For the IOERT group the cosmetic scores ''excellent or good'' as determined by each patient and one physician were 88 and 96 %, respectively. When the overall cosmetic scores for patients treated with IOERT and WBI were compared to those of the objectively derived scores, there was a fair level of agreement. For patients treated with IOERT we noted less asymmetry and high rates of ''good or excellent'' subjectively derived cosmetic scores. The level of agreement between the subjectively and the objectively derived cosmetic scores was limited. Due to the small sample size and the design of the study no definitive conclusions can be drawn. (orig.) [German] Es sind nur wenige Daten zum kosmetischen Ergebnis nach alleiniger intraoperativer Radiotherapie mittels Elektronen (IOERT) in der brusterhaltenden Behandlung verfuegbar. In einer komparativen Kohortenanalyse wurden 71 Brustkrebspatientinnen eingeschlossen. Ihre brusterhaltende Operation mit Sentinel-Lymphknotenverfahren begann 3 Jahre vorher. Im Anschluss erhielten 26

  10. Hypofractionated whole breast irradiation: New standard in early breast cancer after breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Su; Shin, Kyung Hwan; Choi, Noorie; Lee, Sea Won [Dept. of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    Hypofractionated whole breast irradiation (HF-WBI) has been proved effective and safe and even better for late or acute radiation toxicity for early breast cancer. Moreover, it improves patient convenience, quality of life and is expected to be advantageous in the medical care system by reducing overall cost. In this review, we examined key randomized trials of HF-WBI, focusing on adequate patient selection as suggested by the American Society of Therapeutic Radiology and Oncology (ASTRO) guideline and the radiobiologic aspects of HF-WBI in relation to its adoption into clinical settings. Further investigation to identify the current practice pattern or cost effectiveness is warranted under the national health insurance service system in Korea.

  11. Neoadjuvant endocrine treatment of women with breast cancer

    Directory of Open Access Journals (Sweden)

    Julian Iturbe

    2011-09-01

    Full Text Available Neoadjuvant therapy has four goals in breast cancer: decrease tumor volume to operate tumors that initially were inoperable, increase the number of conservative surgeries, evaluate the chemosensitivity in vivo and analyze the management of micrometastases. Neoadjuvant treatment provides a unique setting in which we can monitor clinical, pathological, proliferative and molecular responses. Combining different strategies such us surgery, radiation therapy, chemotherapy, and endocrine therapy has contributed substantially to the survival improvement in breast cancer. Thirdgeneration aromatase inhibitors have proven to be superior to tamoxifen in the adjuvant and, more recently, the neoadjuvant treatment of postmenopausal patients. The need to define how to select the patients that will benefit the most from these therapies, the optimal duration of treatment, the bestmethod to evaluate the treatment response, the identification of predictive factors for response, and the superiority of certain endocrine agents over others have been reviewed. We have carried out a critical analysis of the current literature on the utilization of endocrine therapy in the neoadjuvant setting for breast cancer. This review discusses the current evidence regarding primary endocrine therapy and the current opinions on length of treatment and measurement of response prior to surgery.

  12. Lactation following conservation surgery and radiotherapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Varsos, G.; Yahalom, J. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))

    1991-02-01

    A 38-year-old woman with early stage invasive breast cancer was treated with wide excision of the tumor, axillary lymph node dissection, and breast irradiation. Three years later, she gave birth to a normal baby. She attempted breast feeding and had full lactation from the untreated breast. The irradiated breast underwent only minor changes during pregnancy and postpartum but produced small amounts of colostrum and milk for 2 weeks postpartum. There are only a few reports of lactation after breast irradiation. These cases are reviewed, and possible factors affecting breast function after radiotherapy are discussed. Because of scant information available regarding its safety for the infant, nursing from the irradiated breast is not recommended.

  13. Dosimetric consequences of the shift towards computed tomography guided target definition and planning for breast conserving radiotherapy

    Directory of Open Access Journals (Sweden)

    Korevaar Erik W

    2008-01-01

    Full Text Available Abstract Background The shift from conventional two-dimensional (2D to three-dimensional (3D-conformal target definition and dose-planning seems to have introduced volumetric as well as geometric changes. The purpose of this study was to compare coverage of computed tomography (CT-based breast and boost planning target volumes (PTV, absolute volumes irradiated, and dose delivered to the organs at risk with conventional 2D and 3D-conformal breast conserving radiotherapy. Methods Twenty-five patients with left-sided breast cancer were subject of CT-guided target definition and 3D-conformal dose-planning, and conventionally defined target volumes and treatment plans were reconstructed on the planning CT. Accumulated dose-distributions were calculated for the conventional and 3D-conformal dose-plans, taking into account a prescribed dose of 50 Gy for the breast plans and 16 Gy for the boost plans. Results With conventional treatment plans, CT-based breast and boost PTVs received the intended dose in 78% and 32% of the patients, respectively, and smaller volumes received the prescribed breast and boost doses compared with 3D-conformal dose-planning. The mean lung dose, the volume of the lungs receiving > 20 Gy, the mean heart dose, and volume of the heart receiving > 30 Gy were significantly less with conventional treatment plans. Specific areas within the breast and boost PTVs systematically received a lower than intended dose with conventional treatment plans. Conclusion The shift towards CT-guided target definition and planning as the golden standard for breast conserving radiotherapy has resulted in improved target coverage at the cost of larger irradiated volumes and an increased dose delivered to organs at risk. Tissue is now included into the breast and boost target volumes that was never explicitly defined or included with conventional treatment. Therefore, a coherent definition of the breast and boost target volumes is needed, based on

  14. Successful conservative treatment of emphysematous gastritis.

    Science.gov (United States)

    Takano, Yuichi; Yamamura, Eiichi; Gomi, Kuniyo; Tohata, Misako; Endo, Toshiyuki; Suzuki, Reika; Hayashi, Masafumi; Nakanishi, Toru; Hanamura, Shotaro; Asonuma, Kunio; Ino, Satoshi; Kuroki, Yuichiro; Maruoka, Naotaka; Nagahama, Masatsugu; Inoue, Kazuaki; Takahashi, Hiroshi

    2015-01-01

    Emphysematous gastritis is an extremely rare disease with an unfavorable prognosis. To date, very few studies have been conducted regarding the intragastric recovery process based on endoscopic findings. We herein report a case of emphysematous gastritis that improved with long-term (five months) conservative treatment in which we were able to observe the intragastric recovery process endoscopically. In cases in which emphysematous gastritis is suspected, it is important to provide prompt diagnostic imaging (including CT) and early appropriate treatment in order to improve the prognosis.

  15. Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M;

    2017-01-01

    the Danish National Patient Registry that were cross-checked with the Danish Breast Cancer Group database and the Danish Pathology Register. Main Outcomes and Measures: Reoperation rate after wire-guided BCS in patients with IBC or DCIS. Results: Wire-guided BCS was performed in 4118 women (mean [SD] age, 60......Importance: New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs...... to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. Objectives: To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS...

  16. Intraoperative Radiotherapy for Breast Cancer: The Lasting Effects of a Fleeting Treatment

    Directory of Open Access Journals (Sweden)

    Harriet B. Eldredge-Hindy

    2014-01-01

    Full Text Available In well-selected patients who choose to pursue breast conservation therapy (BCT for early-stage breast cancer, partial breast irradiation (PBI delivered externally or intraoperatively, may be a viable alternative to conventional whole breast irradiation. Two large, contemporary randomized trials have demonstrated breast intraoperative radiotherapy (IORT to be noninferior to whole breast external beam radiotherapy (EBRT when assessing for ipsilateral breast tumor recurrence in select patients. Additionally, IORT and other PBI techniques are likely to be more widely adopted in the future because they improve patient convenience by offering an accelerated course of treatment. Coupled with these novel techniques for breast radiotherapy (RT are distinct toxicity profiles and unique cosmetic alterations that differ from conventional breast EBRT and have the potential to impact disease surveillance and patient satisfaction. This paper will review the level-one evidence for treatment efficacy as well as important secondary endpoints like RT toxicity, breast cosmesis, quality of life, patient satisfaction, and surveillance mammography following BCT with IORT.

  17. Improvements in locoregional treatment of breast cancer

    NARCIS (Netherlands)

    Donker, M.

    2014-01-01

    Breast cancer represents the most common female malignancy in the developed world, affecting approximately one out of eight women during her lifetime. Nowadays local control is excellent as a result of several improvements in diagnosis and treatment over the past few decades. This means that many pa

  18. Tailoring endocrine treatment for early breast cancer

    NARCIS (Netherlands)

    Fontein, Duveken Berthe Yvonne

    2014-01-01

    This thesis describes several important aspects of adjuvant endocrine therapy for postmenopausal women with endocrine-sensitive, early-stage breast cancer. In our ongoing efforts to tailor treatment so as to provide the best possible care to each of our patients, we studied the influence of various

  19. Pattern of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jobsen, Jan, E-mail: j.jobsen@mst.nl [Department of Radiation Oncology, Medisch Spectrum Twente, Enschede (Netherlands); Palen, Job van der [Department of Epidemiology, Medisch Spectrum Twente, Enschede (Netherlands); Department of Research Methodology, Measurement, and Data Analysis, Faculty of Behavioral Science, University of Twente, Enschede (Netherlands); Riemersma, Sietske [Laboratory for Pathology Oost Nederland, Hengelo (Netherlands); Heijmans, Harald [Department of Surgery, Ziekenhuis Groep Twente, Hengelo (Netherlands); Ong, Francisca [Department of Radiation Oncology, Medisch Spectrum Twente, Enschede (Netherlands); Struikmans, Henk [Department of Radiation Oncology, Leiden University Medical Centre, Leiden (Netherlands); Radiotherapy Centre West, Medical Centre Haaglanden, The Hague (Netherlands)

    2014-08-01

    Purpose: To analyze the incidence and prognostic factors of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) in a large, population-based, single-center study with long-term follow-up. Methods and Materials: We analyzed 3595 cases in which BCT was performed in 3824 women with stage I or II breast cancer. The incidence of IBTR was analyzed over time and was based on IBTR as first event. Results: The 15-year local relapse-free survival was 90.9%. The hazard estimates for IBTR showed a time course with 2 peaks, the first at approximately 5 years and the second, twice as high, at 12 years. Stratifying subjects by age and margin status showed that, for women ≤40 years old with negative margins, adjuvant systemic therapy led to a 5-fold reduced risk of recurrence compared to none, and the presence of lymph vascular space invasion (LVSI) had a 3-fold increased risk compared to its absence. For women >40 years old, the presence of LVSI (hazard ratio [HR] 2.5) and the presence of lobular carcinoma in situ in the lumpectomy specimen (HR 2.3) were the only 2 risk factors. Conclusions: We demonstrated a pattern in risk of IBTR over time, with 2 peaks, first at approximately 5 years and a second, much higher peak at approximately 12 years, especially for women ≤40 years old. For women ≤40 years old with tumor-free resection margins, we noted that the absence of adjuvant systemic therapy and the presence of LVSI were independent prognostic factors of IBTR. For women >40 years old, the presence of LVSI and the presence of lobular carcinoma in situ were independent risk factors.

  20. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Nesvold, Inger-Lise (Dept. of Cancer Rehabilitation-Physiotherapy, Rikshospitalet, Univ. of Oslo, Div. The Norwegian Radium Hospital, Montebello, Oslo (Norway)); Dahl, Alv A.; Fossaa, Sophie D. (Dept. of Clinical Cancer Research, Rikshospitalet, Univ. of Oslo: Division The Norwegian Radiumhospital, Montebello, Oslo (Norway)); Loekkevik, Erik (Dept. of Oncology, Rikshospitalet, Montebello, Oslo (Norway)); Marit Mengshoel, Anne (Inst. of Nursing and Health Sciences, Univ. of Oslo: Medical Faculty, Oslo (Norway))

    2008-06-15

    Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

  1. Recurrent and second breast cancer detected on follow-up mammography and breast ultrasound after breast-conserving surgery: Findings and clinicopathologic factors

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Ga Young; Cha, Joo Hee; Kim, Hak Hee; Shin, Hee Jung; Chae, Eun Young; Choi, Woo Jung [Dept. of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul (Korea, Republic of)

    2016-01-15

    To assess the imaging and clinicopathologic outcomes of recurrent and second breast cancer after breast-conserving surgery for invasive ductal carcinomas detected on follow-up mammography and breast ultrasound (US). Seventy-six women with an ipsilateral breast tumor recurrence (IBTR) or regional lymph node recurrence and/or contralateral breast cancer (RLNR and CBC) after breast-conserving surgery were included in this study. The mammography and US images were analyzed and the clinicopathologic parameters were compared between the groups. Thirty had an IBTR, and 46 had a RLNR and CBC. The IBTR group's mammography and US images frequently revealed calcification and masses on the breast, respectively. The most frequent site of RLNR detected during follow-up mammography and breast US was the axilla. In univariate analysis, the tumors in the IBTR group were predominantly estrogen receptor (ER)-negative, HER-2 overexpression, and p53-positive. ER and HER-2 were shown by the multivariate analysis to be independent parameters associated for both types of recurrences. A mass or calcification is frequently present in IBTR and the axillary lymph node is the most frequent site of RLNR. ER and HER-2 status are major independent factors associated with recurrent and second breast cancer.

  2. Similar Survival With Breast Conservation Therapy or Mastectomy in the Management of Young Women With Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mahmood, Usama, E-mail: usama.mahmood@gmail.com [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Morris, Christopher; Neuner, Geoffrey [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States); Koshy, Matthew [Department of Cellular and Radiation Oncology, University of Chicago, Chicago, Illinois (United States); Kesmodel, Susan; Buras, Robert [Department of Surgery, University of Maryland, Baltimore, Maryland (United States); Chumsri, Saranya; Bao Ting; Tkaczuk, Katherine [Department of Medicine, University of Maryland, Baltimore, Maryland (United States); Feigenberg, Steven [Department of Radiation Oncology, University of Maryland, Baltimore, Maryland (United States)

    2012-08-01

    Purpose: To evaluate survival outcomes of young women with early-stage breast cancer treated with breast conservation therapy (BCT) or mastectomy, using a large, population-based database. Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all female patients, ages 20 to 39 years old, diagnosed with T1-2 N0-1 M0 breast cancer between 1990 and 2007, who underwent either BCT (lumpectomy and radiation treatment) or mastectomy. Multivariable and matched pair analyses were performed to compare overall survival (OS) and cause-specific survival (CSS) of patients undergoing BCT and mastectomy. Results: A total of 14,764 women were identified, of whom 45% received BCT and 55% received mastectomy. Median follow-up was 5.7 years (range, 0.5-17.9 years). After we accounted for all patient and tumor characteristics, multivariable analysis found that BCT resulted in OS (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.83-1.04; p = 0.16) and CSS (HR, 0.93; CI, 0.83-1.05; p = 0.26) similar to that of mastectomy. Matched pair analysis, including 4,644 BCT and mastectomy patients, confirmed no difference in OS or CSS: the 5-, 10-, and15-year OS rates for BCT and mastectomy were 92.5%, 83.5%, and 77.0% and 91.9%, 83.6%, and 79.1%, respectively (p = 0.99), and the 5-, 10-, and 15-year CSS rates for BCT and mastectomy were 93.3%, 85.5%, and 79.9% and 92.5%, 85.5%, and 81.9%, respectively (p = 0.88). Conclusions: Our analysis of this population-based database suggests that young women with early-stage breast cancer have similar survival rates whether treated with BCT or mastectomy. These patients should be counseled appropriately regarding their treatment options and should not choose a mastectomy based on the assumption of improved survival.

  3. Cosmetic outcome 1-5 years after breast conservative surgery, irradiation and systemic therapy.

    Science.gov (United States)

    Kelemen, Gyöngyi; Varga, Zoltán; Lázár, György; Thurzó, László; Kahán, Zsuzsanna

    2012-04-01

    The late side-effects of the local therapy of early breast cancer depend on many patient- and therapy-related parameters. We aimed at investigating the factors that influence the cosmetic and functional outcomes among our breast cancer patients after breast-conserving surgery and conformal radiotherapy, with or without adjuvant systemic therapy. A study was made of the association of the cosmetic outcome after a median follow-up time of 2.4 years and the clinical data on 198 patients extracted from a prospectively compiled database. Breast tenderness occurred more frequently among patients ≤50 years old (p cosmetic outcome after breast-conserving surgery and postoperative radiotherapy.

  4. The 10-Year Local Recurrence and Partial Breast Radiotherapy for Early Breast Cancer Treated by Conservative Surgery

    Institute of Scientific and Technical Information of China (English)

    Zhizhen Wang; Ruiying Li

    2006-01-01

    OBJECTIVE To study the local recurrence and the role of whole breast radiotherapy for early breast cancer treated by conservative surgery.METHODS From April 1990 to December 2000, 49 patients with early primary breast cancer were treated by conservative surgery in our hospital. The cases were comprised of Stage 0, 1; Stage Ⅰ, 31; and Stage Ⅱa,17. Forty cases underwent quadrantectomy plus axillary lymph node dissection, and the other 9 cases had lumpectomy alone. Irradiation, which was received by 39 patients, was administered by using low tangential half fields with 6 MV X-ray to decrease the pulmonary irradiative volume.The dose to the whole breast was 45 Gy/22~23f/4.5W, then a 15 Gy boost dose was delivered to the tumor bed by an electron beam. The other patients underwent an irradiated regional field according to postoperative pathology.RESULTS All patients were followed-up for 10 years or more. The 10year local recurrence rates, distant metastasis rates and survival rates were 6.1%, 4.1% and 98.0% respectively. All of the 3 patients who had a local recurrence had infiltrative carcinomas and negative lymph nodes.The 10-year local recurrence rate was higher (2.6% vs. 20.0%) with nonpostoperative whole breast radiotherapy, but the statistical difference was not marked because of the low number of cases. All of the recurrent lesions localized within 3 cm of the primary lesion.CONCLUSION Original recurrence of the tumor was the main type of local recurrence. Radiotherapy after conservative surgery is very essential.After conservative surgery it is feasible that irradiation can be delivered alone to the neighboring region of the tumor bed. Partial breast radiotherapy can substitute for whole breast radiotherapy.

  5. [Conservative treatment of female urinary incontinence].

    Science.gov (United States)

    Kerdraon, Jacques; Denys, Pierre; Amarenco, Gérard

    2011-09-01

    Female urinary incontinence can be improved by nonsurgical pharmacologic as well as non-pharmacologic treatments. Hygiene and dietary rules apply to all forms of incontinence. If overweight, weight loss improves stress urinary incontinence. There are levels of evidence to show that pelvic floor muscle training and behavioral therapy improve incontinence. Duloxetine is better than placebo for improvement of quality of life and for the impression of an improvement, but its place is still not determined in the algorithm of conservative treatments. The effects of vaginal electrostimulation and oestrogen are inconsistent or inhomogeneous. In case of urgency incontinence, anticholinergics remain the first line treatment and the place of stimulation of posterieur tibial nerve is still to be defined.

  6. Evidence on conservative clinical treatments for haemorrhoids

    Directory of Open Access Journals (Sweden)

    Fernanda da Silva Barbosa

    2013-12-01

    Full Text Available Objective: The objective of this health technology assessment was to analyse the evidence on conservative clinical treatments for haemorrhoids usable in Primary Health Care. Methods: We searched in Embase, LILACS and MEDLINE through Pubmed for meta-analyses, systematic reviews and randomized controlled trials published until December 2012, without limits of language. Studies should evaluate the effects of conservative medical treatments (fibres or laxatives, flavonoids, analgesics, corticosteroids, sitz baths or nitro-glycerine ointments compared to placebo or each other. The outcomes considered were overall symptom improvement, bleeding, itching, pain, prolapse and adverse effects. Results: One meta-analysis showed that fibres promote overall improvement of symptoms and bleeding; and decrease recurrence after outpatient procedures. Three meta-analyses showed efficacy of flavonoids for acute and postoperative bleeding, overall symptom improvement, perianal discharge and recurrence after acute episode. There was no statistical difference for itching, pain, prolapse, or adverse effects in both cases. Rutosides, a type of flavonoid, reduced symptoms in pregnant women, despite the insufficiency of data to prove its safety. No studies were found on other types of treatment that met the selection criteria. Conclusions: In Primary Health Care, oral fibres or flavonoids can be used to improve overall symptoms and bleeding in haemorrhoid patients at grades I and II; to patient grade III who does not wish to undergo outpatient procedure; and postoperatively. Randomized controlled trials with adequate methodological quality are needed to confirm these results.

  7. Life After Breast Cancer Treatment

    Science.gov (United States)

    ... treatment It is normal to have different feelings, emotions and fears after treatment ends. Not everyone feels ... to normal over many months. You may dye, color or treat your hair whenever you like. Regular ...

  8. 早期保乳治疗在乳腺癌中的作用%The Effect of Early Breast Conserving Therapy in Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    闫庆会

    2015-01-01

    Objective To explore the clinical effect of early breast conserving therapy for breast cancer.Methods Selected 70 patients with early breast cancer clinical data from June 2013 to June 2015 in our hospital were randomly divided into early group (early breast conserving therapy ) and the control group (conventional breast conserving surgery), each group had 35 cases, followed up for 1 to 5 years, compared with the treatment effect of the two groups.Results Compared with the two groups of patients in the treatment effect, mortality, and beautiifcation effect, the early group was better than the contrast group,P<0.05, had difference statistically signiifcance.Conclusion With conventional breast cancer treatment, early cover milk therapy for earlier intervention, treatment effect is good, death rate is low, but the operation should be attention in patients with clinical indications, contraindications, landscaping practices, surgical techniques, to ensure the best effect of clinical treatment.%目的探究早期保乳治疗术对乳腺癌的临床治疗效果。方法选取我院2013年6月~2015年6月收治的70例早期乳腺癌患者的临床治疗资料,随机将其分为早期组(早期保乳治疗术)和对照组(常规保乳术),每组35例,术后随访1~5年,对比两组患者的治疗效果。结果对比两组患者治疗效果、致死率、美化效果,早期组均优于对比组,P<0.05,差异具有统计学意义。结论与常规乳腺癌治疗方法相比,早期保乳治疗术的介入时间早、治疗效果好、致死率低,但行术时应注意患者的临床适应证、禁忌证、美化手法、手术技巧等,以保证最佳的临床治疗效果。

  9. Accelerated hypofractionated adjuvant whole breast radiotherapy with concomitant photon boost after conserving surgery for early stage breast cancer: a prospective evaluation on 463 patients.

    Science.gov (United States)

    Cante, Domenico; Rosa La Porta, Maria; Casanova-Borca, Valeria; Sciacero, Piera; Girelli, Giuseppe; Pasquino, Massimo; Franco, Pierfrancesco; Ozzello, Franca

    2011-01-01

    The current standard therapeutic option for early stage breast cancer (EBC) employs a multimodality treatment approach including conservative surgery, radiotherapy, chemotherapy, and hormone therapy. The most common adjuvant radiotherapeutic strategy consists of external beam radiation therapy (EBRT) delivered to the whole breast using 1.8-2 Gy fractions given five times a week, up to a total dose of 45-50 Gy over a period of 5 weeks. In recent years, altered schedules employing larger dose per fraction delivered in fewer treatment sessions over a shorter overall treatment time began to be explored. We herein present clinical data on accelerated hypofractionated adjuvant whole-breast radiotherapy delivered on a daily basis for a total treatment time of 20 fractions. Between February 2005 and June 2009, a total of 463 patients underwent hypofractionated accelerated adjuvant radiation after conservative surgery for early breast cancer (pathological stage pTis, pT1 or pT2, pN0-N1). The basic course of radiotherapy consisted of 45 Gy, to the whole breast in 20 fractions with 2.25 Gy/fraction; an additional daily boost dose of 0.25 Gy was concomitantly delivered, to the lumpectomy cavity, for an additional total dose of 5 Gy. The cumulative nominal dose was 50 Gy. At follow-up, patients were examined at 3 and 6 months after the end of radiotherapy and twice a year afterward. Toxicity was scored according to the Common Terminology Criteria for Adverse Events, using the Radiation Therapy Oncology Group /European Organization for Research and Treatment of Cancer toxicity scale. Cosmetic results were assessed in agreement with the Harvard criteria. All the 463 patients treated with the accelerated hypofractionated adjuvant whole-breast radiotherapy schedule achieved at least 6 months' follow-up and subsequently were considered for the present analysis. With a median follow-up of 27 months, 5-year DFS is 93.1%. Only three patients experienced disease recurrence: two of them

  10. Autonomy and reason: treatment choice in breast cancer.

    Science.gov (United States)

    Twomey, Mary

    2012-10-01

    The practice of offering choice to those women with breast cancer for whom either breast conserving surgery or mastectomy would be equally beneficial has come to be seen as an important aspect of medical care. As well as improving satisfaction with treatment, this is seen as satisfying the ethical principle of respect for autonomy. A number of studies, however, show that women are not always comfortable with such choice, preferring to leave treatment decisions to their surgeons. A question then arises as to the extent that these women can be seen as autonomous or as exercising autonomy. This paper argues, however, that the understanding of autonomy which is applied in current approaches to breast cancer care does not adequately support the exercise of autonomy, and that the clinical context of care means that women are not able to engage in the kind of reasoning that might promote the exercise of autonomy. Where respect for autonomy is limited to informed consent and choice, there is a danger that women's interests are overlooked in those aspects of their care where choice is not appropriate, with very real, long-term consequences for some women. Promoting the exercise of autonomy, it is argued, needs to go beyond the conception of autonomy as rational individuals making their own decisions, and clinicians need to work with an understanding of autonomy as relational in order to better involve women in their care.

  11. Seven-year follow-up on 334 patients treated by breast conserving surgery and short course radical postoperative radiotherapy: a report of the Yorkshsire Breast Cancer Group

    Energy Technology Data Exchange (ETDEWEB)

    Ash, D.V. [Cookridge Hospital, Leeds (United Kingdom); Benson, E.A. [Leeds General Infirmary (United Kingdom); Sainsbury, J.R. [Royal Infirmary, Huddersfield (United Kingdom); Round, C.; Head, C. [Yorkshire Clinical Trials and Research Unit, Leeds (United Kingdom)

    1995-12-01

    A total of 334 patients have been entered into a prospective protocol of breast conserving treatment, which consisted of clinically complete excision, axillary dissection, and radical post-operative radiotherapy given in 20 fractions over 4 weeks. After 7 years` follow-up, 22 patients (6.6%) have had an isolated local recurrence and 24 (7.2%) a local recurrence associated with metastatic disease. Cosmetic assessment shows that patients are more satisfied with the result than their treating consultants, and that 81% have scored themselves as having an excellent or very good result more than 5 years after treatment. (author).

  12. Preoperative breast MRI can reduce the rate of tumor-positive resection margins and reoperations in patients undergoing breast-conserving surgery

    NARCIS (Netherlands)

    A.I.M. Obdeijn (Inge-Marie); M.M.A. Tilanus-Linthorst (Madeleine); S. Spronk (Sandra); C.H.M. van Deurzen (Carolien); C. de Monyé (Cécile); M.G.M. Hunink (Myriam); M.B. Menke (Marian )

    2013-01-01

    textabstractOBJECTIVE. In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations. SUBJECTS AND METHODS. The study group consisted of 1

  13. Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pengel, Kenneth E., E-mail: k.pengel@nki.nl [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Loo, Claudette E. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Wesseling, Jelle [Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Pijnappel, Ruud M. [Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Rutgers, Emiel J.Th. [Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Gilhuijs, Kenneth G.A. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    2014-02-15

    Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted.

  14. Appendicitis/diverticulitis: diagnostics and conservative treatment.

    Science.gov (United States)

    Kruis, Wolfgang; Morgenstern, Julia; Schanz, Stefan

    2013-01-01

    Appendicitis and diverticulitis are very common entities that show some similarities in diagnosis and course of disease. Both are widely believed to be simple clinical diagnoses, which is in contrast to scientific evidence. An accurate diagnosis has to describe not only the initial detection, but particularly the severity of the disease. It is based mainly on cross-sectional imaging by ultrasound (US) and computed tomography (CT). Appendectomy is the standard treatment for acute appendicitis and is mandatory in complicated cases. Antibiotic therapy is similarly effective in uncomplicated appendicitis, but long-term results are not sufficiently known. Treatment of diverticulitis is related to the disease status. Complications such as perforation and bleeding require intervention. Uncomplicated diverticulitis as graded by US or CT are subject to conservative management, in the form of outpatient or hospital care. It is an unresolved debate as to whether antibiotic treatment offers benefits. Mesalazine seems at least to improve pain. The real challenge is treatment of recurrent diverticulitis. Lifestyle measures such as nutritional habits and physical activity are found to influence diverticular disease. Besides immunosuppression, obesity is a significant risk factor for complicated diverticulitis. Whether any medication such as chronic antibiotics, probiotics or mesalazine offers benefits is unclear. The indication for sigmoid resection has changed; it is no longer given by the number of attacks, but rather by structural changes as depicted by cross-sectional imaging.

  15. Lung cancer after treatment for breast cancer.

    Science.gov (United States)

    Lorigan, Paul; Califano, Raffaele; Faivre-Finn, Corinne; Howell, Anthony; Thatcher, Nick

    2010-12-01

    Breast cancer is the most common cancer in women, and the second most common cause of cancer death after lung cancer. Improvements in the outcome of breast cancer mean that more patients are living longer and are, therefore, at risk of developing a second malignancy. The aim of this review is to present the current understanding of the risk of lung cancer arising in patients previously treated for early stage breast cancer. We review data on the effect of treatment factors (ie, surgery type, radiotherapy technique, and adjuvant chemotherapy) and patient factors (ie, age and smoking) on the risk of developing a subsequent lung cancer. The evidence suggests that older radiotherapy techniques were associated with a substantially increased risk of developing lung cancer in the ipsilateral lung, but there is no clear evidence of an increased risk with modern techniques. Smoking is an important risk factor, and increases the risk of lung cancer in those receiving radiotherapy. Adjuvant chemotherapy is not significantly associated with an increased risk. The risk of developing lung cancer increases with time elapsed since treatment, but any effect of age at treatment is unclear.

  16. The Value of Intraoperative Frozen Section Analysis for Margin Status in Breast Conservation Surgery in a Nontertiary Institution

    Directory of Open Access Journals (Sweden)

    Mona P. Tan

    2014-01-01

    Full Text Available Introduction. Breast conservation treatment (BCT for early-stage breast malignancies requires negative margins and good cosmesis. Reoperations may be needed to achieve negative margins, which can have an adverse impact on outcomes. This study was performed to evaluate the efficacy of intraoperative frozen section analysis (IFSA for margin assessment to reduce excision rates. Methods. All patients treated at the authors’ private healthcare facility between 2009 and 2011 for breast cancer were included in the study. Those for whom BCT was intended underwent wide excision with IFSA. Six margins of the excised tissue, and the sentinel lymph node (SLN, where appropriate, were submitted for IFSA. Patient demographics, tumour characteristics, number of operations performed, and outcomes were analysed. Results. Of the 161 patients analysed, 138 (85.7% had successful breast conservation. Four patients required a reoperation for incomplete surgical extirpation. One had a false negative SLN assessment on IFSA, and was returned to the operating room for an axillary dissection. Three patients required reoperations for inadvertently missed multicentric disease. None had false negative margin evaluation with IFSA necessitating reexcision. Conclusion. The use of IFSA allows low rates of reoperation with BCT. Further research is needed to establish consistency in low reexcision rates for cost-effectiveness and optimum resource allocation.

  17. Income level and regional policies, underlying factors associated with unwarranted variations in conservative breast cancer surgery in Spain

    Directory of Open Access Journals (Sweden)

    Peiró-Moreno Salvador

    2011-04-01

    Full Text Available Abstract Background Geographical variations in medical practice are expected to be small when the evidence about the effectiveness and safety of a particular technology is abundant. This would be the case of the prescription of conservative surgery in breast cancer patients. In these cases, when variation is larger than expected by need, socioeconomic factors have been argued as an explanation. Objectives: Using an ecologic design, our study aims at describing the variability in the use of surgical conservative versus non-conservative treatment. Additionally, it seeks to establish whether the socioeconomic status of the healthcare area influences the use of one or the other technique. Methods 81,868 mastectomies performed between 2002 and 2006 in 180 healthcare areas were studied. Standardized utilization rates of breast cancer conservative (CS and non-conservative (NCS procedures were estimated as well as the variation among areas, using small area statistics. Concentration curves and dominance tests were estimated to determine the impact of income and instruction levels in the healthcare area on surgery rates. Multilevel analyses were performed to determine the influence of regional policies. Results Variation in the use of CS was massive (4-fold factor between the highest and the lowest rate and larger than in the case of NCS (2-fold, whichever the age group. Healthcare areas with higher economic and instruction levels showed highest rates of CS, regardless of the age group, while areas with lower economic and educational levels yielded higher rates of NCS interventions. Living in a particular Autonomous Community (AC, explained a substantial part of the CS residual variance (up to a 60.5% in women 50 to 70. Conclusion The place where a woman lives -income level and regional policies- explain the unexpectedly high variation found in utilization rates of conservative breast cancer surgery.

  18. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Five-year Results of 100 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Hsu, Howard; Fenton-Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Roses, Daniel; Guth, Amber [Department of Surgery, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Jozsef, Gabor [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Goldberg, Judith D. [Division of Biostastistics, Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York (United States); DeWyngaert, J. Keith [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States)

    2012-11-01

    Purpose: To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position. Methods and Materials: Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded. Results: One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36

  19. Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki [Kumamoto City Hospital (Japan); Koyama, Hiroki

    1998-09-01

    To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ``occult`` inflammatory breast cancer. (author)

  20. The clinical course of immediate breast implant reconstruction after breast cancer

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Friis, Søren; Frederiksen, Kirsten;

    2011-01-01

    The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed.......The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed....

  1. Male Malignant Phyllodes Breast Tumor After Prophylactic Breast Radiotherapy and Bicalutamide Treatment: A Case Report.

    Science.gov (United States)

    Karihtala, Peeter; Rissanen, Tarja; Tuominen, Hannu

    2016-07-01

    Phyllodes tumor in male breast is an exceptionally rare neoplasm with only few published case reports. Herein, we present a case of malignant phyllodes tumor in male breast nine years after prophylactic breast 10 Gy radiotherapy and after nine year bicalutamide treatment. The imaging findings of the tumor and pathological correlation are also presented.

  2. [Conservative treatment in male urinary incontinence].

    Science.gov (United States)

    Kirschner-Hermanns, R; Anding, R

    2014-03-01

    Prevalence, pathophysiology, diagnostic and therapeutic approaches of urinary incontinence are well studied in women; however, studies on male urinary incontinence focus on incontinence following surgery of the bladder or prostate, predominantly incontinence after radical prostatectomy. Aging men suffer from incontinence, most frequently urge incontinence (overactive bladder, OAB), nearly as often as women do.The domain of conservative therapy of urinary stress incontinence in men is pelvic floor training. It remains unclear whether biofeedback procedures, electrostimulation therapy, or magnetic stimulation therapy can enhance pelvic floor training. There are data suggesting that an off-label therapy with Duloxetin®, a selective serotonin-noradrenaline reuptake inhibitor (SSNRI), improves urinary incontinence following radical prostatectomy. Antimuscarinic agents in combination with bladder training have been proven as safe and effective treatment in men with OAB. Data, however, suggest that men with OAB are far less frequently treated than women.

  3. 早期老年乳腺癌的保乳治疗%Breast Conservation Surgical Therapy for Breast Carcinoma of Prophase in the Aged Women

    Institute of Scientific and Technical Information of China (English)

    李平

    2011-01-01

    目的 总结早期老年乳腺癌保乳治疗的l临床疗效.方法 保乳手术治疗23例早期老年乳腺癌患者,其中I期7例,ⅡA期12例,ⅡB期4例,术中切除距肿块边缘2 cm以上乳腺,术后予放疗、化疗及激素治疗.结果 随访3.5(2~5)年,未见复发及远处转移.采用Harris提出的四等分类法为美容评定标准,佳4例(17.4%),良16例(69.6%),一般2例(8.7%),差1例(4.3%),总优良率87.0%.结论 保乳治疗早期老年乳腺癌具有机体创伤小、组织器官破坏少、美容效果好和保存功能的优点,在严格掌握手术适应证的前提下,并不增加复发及远处转移的风险.%Objective To analyze the clinical results of the breast conserving surgery for early stage breast cancer in the old women. Methods 23 cases of breast cancer with 7 of stage Ⅰ, 13 of Ⅱ A and 4 of Ⅱ B received breast conserving surgery. The tumor was exsected 2 cm of edge from the lesion. All the cases were given radiotherapy, chemotherapy and hormone treatment postoperatively. Results All the cases were followed up for 2 to 5 years, 3.5 years in average. Harris cosmetic evaluation standard was used. The breasts were scored cosmetically as excellent in 4 cases ( 17.4% ), good in 16 cases (69.6%), fair in 2 cases (8.7%)andworsein1case(4.3%). The total fineness rate was 87. 0% . Conclusions It shows the advantages of little pain, good cosmetic results and good functions of the breast conserving surgery for early stage breast cancer in the aged women. With the strictly handling o f the indication, it does not increase the risk of recurrence and metastasis.

  4. Treatment of locally advanced/locally recurrent breast cancer and inflammatory breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Masao [Tenri Hospital, Nara (Japan)

    2000-10-01

    This paper summarizes the treatment of locally advanced breast cancer, inflammatory breast cancer, and locally recurrent breast cancer. A multidisciplinary approach considering subclinical distant metastases is needed to treat these types of breast cancer. Subclinical distant metastasis is observed in about 80% of case of locally advanced cancer, and treatment of subclinical distant metastases, e.g., by endocrinotherapy and chemotherapy, is therefore essential to improving the prognosis. The standard therapy for unresectable locally advanced breast cancer consists of induction chemotherapy with anthracyclines and local treatment with mastectomy or irradiation. Previous reports have stated that induction chemotherapy was effective in 60-80% of the primary lesions or lymph node metastasis, and the CR rates were in the 10-20% range. Combination therapy with induction chemotherapy clearly improved the outcome over local treatment alone. The usual irradiation dose is 50 to 60 Gy/5 to 7 weeks to the whole breast or the thoracic wall. Boost irradiation at a dose of 10 to 25 Gy is performed in unresectable cases. The boost irradiation dose to the lymph node area is usually 45 to 50 Gy/5 to 6 weeks in cases without gross lesions and 10 to 15 Gy in cases with gross lesions. Combination therapy consisting of conservative pectoral mastectomy and postoperative adjuvant chemo- endocrino-therapy (i.e., adjuvant therapy) has become the standard regimen for treating resectable locally advanced breast cancer, because it significantly improves the recurrence rate and survival rate compared to local treatment alone. Some clinical have studies indicated that neoadjuvant therapy (i.e., induction chemotherapy + surgery/radiation therapy) is comparable or superior to adjuvant therapy in terms of improving the prognosis. However, the efficacy and most appropriate method of breast-conserving therapy after induction chemotherapy are still unclear. More clinical trials are needed. It has been

  5. Two cases of bronchiolitis obliterans organizing pneumonia syndrome after the radiation of breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Komuro, Youko; Nakagomi, Hiroshi; Akaike, Hidenori; Chiba, Shigehiro; Miyashita, Yoshihiro; Obu, S.; Yamaguchi, Motoshi; Oyama, Toshio [Yamanashi Prefectural Central Hospital, Kofu (Japan)

    2001-12-01

    Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome is a recently reported complication of the adjuvant radiotherapy of breast-conserving surgery. We report two cases of BOOP syndrome in 100 patients who underwent breast-conserving therapy. A 75 year-old woman had a cough 3 months after radiation therapy for cancer of the left breast. Chest radiography and computed tomography showed consolidation with air bronchograms in the upper left lung. Transbronchial lung biopsy showed lymphocyte infiltration and fibrosis in the alveoli. A 45-year old woman with bilateral breast cancer had a cough and palpitations for 3 month after radiation therapy for cancer of the right breast. Chest radiography and computed tomography showed consolidation in upper and middle fields of the left lung. Transbronchial lung biopsy showed granulation formation in the alveolar duct, which is a typical feature of BOOP. The symptoms and radiographic findings improved with oral administration of prednisolone. BOOP syndrome may occur as a complication of breast-conserving therapy. (author)

  6. Double-edged sword of radiotherapy: a cause of secondary angiosarcoma after breast conservation therapy.

    Science.gov (United States)

    Iqbal, Fahad Mujtaba; Ahmed, Balen; Vidya, Raghavan

    2016-04-25

    Angiosarcomas are rare and aggressive malignant tumours of vascular or endothelial origin that can originate in the breast. They can be classified as primary or secondary, with the latter most commonly due to postoperative radiotherapy as part of breast conservation therapy (wide local excision and adjuvant radiotherapy) for breast cancer. We report a case of postirradiation secondary angiosarcoma in a 56-year-old woman, alongside a review of the current literature, to inform clinicians of its clinical presentation and characteristics as a high index of clinical suspicion is required for an accurate diagnosis.

  7. In vivo dosimetry during tangential breast treatment

    Energy Technology Data Exchange (ETDEWEB)

    Heukelom, S.; Lanson, J.H.; Tienhoven, G. van; Mijnheer, B.J. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands))

    1991-12-01

    Three-dimensional (3-D) dose distribution as calculated in clinical practice for tangential breast treatment was verified through in vivo dosimetry. Clinical practice at Netherlands Cancer Institute implies use of 8MV X-ray beams, 2-D treatment planning system, collimator rotation and a limited set of patient data for dose calculations. By positioning diodes at the central beam axes as well as in the periphery of the breast the magnitude of dose values at the isocentre and in points situated in high-dose regions behind the lung could be assessed. The position of diodes was verified by means of an on-line portal imaging device. Reproducibility of these in vivo dose measurements was better than 2% (1SD). This study shows that on the average dose delivery at the isocentre is 2% less at the points behind the lung, 5.7% higher with respect to the calculated dose values. Detailed analysis of these in vivo dosimetry results, based on dose measurements performed with a breast shaped phantom, yielded the magnitudes of errors in predicted dose due to several limitations in dose calculation algorithms and dose calculation procedure. These limitations are each introducing an error of several percent but are compensating each other for the dose calculation at the isocentre. It is concluded that dose distribution in patient for this treatment technique and dose calculation procedure can be predicted with a 2-D treatment planning system in an acceptable way. A more accurate prediction of dose distribution can be performed but requires an estimation of the lack of scatter due to missing tissue, the change in the dose distribution due to oblique incident beams and incorporation of the actual output of the treatment machine in the assessment of the number of monitor units. (author). 28 refs.; 3 figs.; 4 tabs.

  8. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients.

    Science.gov (United States)

    Veronesi, U; Salvadori, B; Luini, A; Greco, M; Saccozzi, R; del Vecchio, M; Mariani, L; Zurrida, S; Rilke, F

    1995-09-01

    Breast conservation has become well-established in the treatment of early mammary carcinoma. However, a standardised treatment modality has not emerged. We have analysed the data from 1,973 patients treated in three consecutive randomised trials by four different radiosurgical procedures: Halsted mastectomy, quadrantectomy plus radiotherapy, lumpectomy plus radiotherapy, and quadrantectomy without radiotherapy, to compare the outcomes of these procedures in terms of local recurrence rate and overall survival. Eligibility criteria were similar in the three trials, and comparability between the four subgroups was excellent. Median follow-up for all patients was 82 months. The annual rates of local recurrence varied markedly according to the treatment. Patients treated with Halsted mastectomy and quadrantectomy plus radiotherapy had low annual rates of local recurrence (0.20 and 0.46, respectively) while both lumpectomy plus radiotherapy and quadrantectomy without radiotherapy had significantly higher rates (2.45 and 3.28, respectively). Patients under 45 years of age had a much higher incidence of local recurrences, while in women over 55 years local recurrences were much less frequent. Overall survival curves were identical in the four groups of patients, so that the three breast conserving radiosurgical procedures had the same survival rates as Halsted mastectomy. However, local recurrence rates were markedly influenced by the treatment method, patient age and specific histological features.

  9. Oncoplastic breast surgery in Denmark

    DEFF Research Database (Denmark)

    Klit, Anders; Henriksen, Trine Foged; Siersen, Hans Erik

    2014-01-01

    With improved survival rates after breast cancer treatment, more attention is drawn to improve the cosmetic outcome after surgical treatment of breast cancer. In this process the oncoplastic breast surgery was conceived. It supplements the traditional surgical treatments (mastectomy and breast...... conserving surgery) with increased focus on individualized therapy. The ambition is to obtain the best possible cosmetic outcome without compromising recurrence rates and survival. This article provides an overview of the current oncoplastic breast surgery treatment offered in Denmark....

  10. Tumor residual pós-quimioterapia neoadjuvante para câncer de mama: impacto sobre o tratamento cirúrgico conservador Residual tumor after neoadjuvant chemotherapy for breast cancer: impact on conservative surgical treatment

    Directory of Open Access Journals (Sweden)

    Edison Mantovani Barbosa

    1999-05-01

    Full Text Available Objetivo: analisar as alterações histopatológicas provocadas pela ação da quimioterapia neoadjuvante (fluoracil, epirrubicina e ciclofosfamida; FEC -- 4 ciclos na área tumoral, no tecido mamário adjacente e nos linfonodos homolaterais, em peças cirúrgicas obtidas de pacientes portadoras de carcinomas primários da mama. Método: estudo histológico detalhado de 30 peças cirúrgicas obtidas por mastectomia radical (Patey de pacientes portadoras de carcinomas primários da mama, previamente submetidas a esse tipo de terapêutica sistêmica. Resultados: observamos regressão tumoral, de grau variável, em todas as peças analisadas. Esta regressão ocorreu de forma irregular, restando inúmeros focos refratários na área ocupada pelo tumor primário. Observamos focos celulares resistentes independentes do tumor primário no tecido mamário. Detalhamos outros achados histopatológicos decorrentes da ação quimioterápica nos tecidos tumoral e mamário, como calcificações e fibrose, e nos linfonodos axilares homolaterais. Conclusão: concluímos que a ação da quimioterapia neoadjuvante não é uniforme, restando focos tumorais refratários, tanto na área do tumor inicial, quanto à distância. A regressão do tumor independe da resposta de regressão dos linfonodos axilares metastáticos. A utilização da cirurgia conservadora pós-quimioterapia neoadjuvante (FEC deve ser evitada.Purpose: analysis of histopathologic alterations caused by neoadjuvant chemotherapy (fluorouracil, epirubicine, cyclophosphamide; FEC - 4 cycles at the tumor site, adjacent mammary tissue and homolateral lymph nodes, as observed in sections of patients with primary breast carcinomas. Method: histological studies performed on 30 surgical sections obtained from radical mastectomy (Patey of patients with primary breast carcinomas, who underwent prior neoadjuvant systemic therapy. Results: all sections showed tumor regression with variable intensity. This

  11. Treatment of breast cancer brain metastases.

    Science.gov (United States)

    Hofer, Silvia; Pestalozzi, Bernhard C

    2013-10-05

    Breast cancer represents the second most frequent cause of brain metastases. Treatment planning should consider several tumor and patient factors to estimate prognosis based on the Karnofsky Performance Status (KPS), age, extent of extra-cerebral disease as well as genetic subtype. When systemic disease is under control patients with up to three metastases qualify for local therapy, such as surgical excision or stereotactic radiotherapy. After the local treatment the addition of whole brain radiation therapy may be postponed until disease progression in the brain is observed and overall survival will not be compromised. Asymptomatic brain metastases may be first approached with a systemic treatment to which the primary tumor is considered to be sensitive.

  12. [Diagnostics and conservative treatment of anal incontinence].

    Science.gov (United States)

    Geile, Dorothea; Osterholzer, Georg; Rosenberg, Robert

    2004-01-01

    Anal incontinence is diagnosed primarily by clinical and proctologic examination. Etiological factors of the disease are found in 85% of the patients by additional examinations. Motility dysfunction of colon and rectum has to be excluded (stenosis, dyschezia, internal hernias). Because anal incontinence is a multifactorial disease as a rule, the single compounds have to be diagnosed and have to undergo therapy. Accordingly, useful investigations are: endorectal ultrasound (defect of muscle, inflammatory or tumour infiltration), manometry (alteration of either anal resting pressure and/or anal squeezing pressure) and surface electromyography (ability of contraction, duration of contraction, strength). Neurophysiological examinations are: needle electromyography, pudendal nerve latency time measurement (PNLT). The occurrence of nerve damage determines the outcome of operative intervention! Conservative treatment is indicated in 80 to 90% of all patients, even higher when one includes all patients in the perioperative period. Possible therapy modalities are: nutrition consultation, physiotherapy, pelvic floor training, biofeedback training of pelvic floor and sphincter muscles, electrostimulation and the combination of both (EMG-triggered electrostimulation). Short-term results are satisfying in up to 85% of patients, but later, successful results depend on the patient's willingness or ability to continue training, and on his/her age.

  13. Limited benefit of inversely optimised intensity modulation in breast conserving radiotherapy with simultaneously integrated boost

    NARCIS (Netherlands)

    van der Laan, Hans Paul; Dolsma, Willemtje; Schilstra, C; Korevaar, Erik W; de Bock, Geertruida H; Maduro, John H; Langendijk, Johannes A

    2010-01-01

    BACKGROUND AND PURPOSE: To examine whether in breast-conserving radiotherapy (RT) with simultaneously integrated boost (SIB), application of inversely planned intensity-modulated radiotherapy (IMRT-SIB) instead of three-dimensional RT (3D-CRT-SIB) has benefits that justify the additional costs, and

  14. Mastectomy versus conservative surgical treatment: the impact on the quality of life of women with breast cancer Mastectomia versus tratamento cirúrgico conservador: impacto na qualidade de vida de mulheres com câncer mamário

    Directory of Open Access Journals (Sweden)

    Daniela Francescato Veiga

    2010-03-01

    Full Text Available OBJECTIVES: to compare the impact of mastectomy and conservative surgery on the quality of life of patients with breast cancer. METHODS: an assessment was made of the quality of life of patients undergoing mastectomy or segmentary mastectomy, at the Pouso Alegre Clinical Hospital, in the Brazilian State of Minas Gerais, using SF-36. The patients were grouped by age (50 years and years of schooling (8 years. The Mann-Whitney test was used to compare the groups with regard to the age and schooling domains of SF-36. RESULTS: a significant difference between the two groups was found in the domains of "physical functioning" (p=0.04 and "pain" (p=0.01: with the patients undergoing a mastectomy registering the worst scores. Young patients who had undergone a mastectomy displayed the worst quality of life in terms of "physical functioning" (p=0.03, "pain" (p=0.01 and "social functioning" (p=0.01; those undergoing conservative surgery aged over 50 years scored worst on "role emotional" (p=0.05. Patients undergoing a mastectomy with lower levels of schooling scored lower in "physical functioning" (p=0.01, "role physical" (p=0.05 and "pain" (p=0.05. Among those who had attended school for more than eight years, those having undergone a mastectomy scored less in the "pain" domain (p=0.04. CONCLUSIONS: patients who had undergone a mastectomy had worse results in the physical component of the evaluation of quality of life and this negative impact was more strongly felt among younger patients and those with lower levels of schooling.OBJETIVOS: comparar o impacto da mastectomia e da cirurgia conservadora na qualidade de vida de pacientes com câncer mamário. MÉTODOS: avaliou-se qualidade de vida de pacientes submetidas à mastectomia ou à mastectomia segmentar, no Hospital das Clínicas de Pouso Alegre, Minas Gerais, Brasil, utilizando-se o SF-36. As pacientes foram estratificadas quanto à idade (50 anos e escolaridade (8 anos. Aplicou-se o teste de Mann

  15. High grade angiosarcoma fifteen years after breast conservation therapy with radiation therapy: A case report

    Directory of Open Access Journals (Sweden)

    William Boyan, Jr.

    2014-01-01

    CONCLUSION: Secondary breast angiosarcoma diagnosis requires frequent follow ups and a high index of suspicion. With mastectomy giving the best chance of treatment in these cases, early detection is crucial in this rare sequela.

  16. Breast; Sein

    Energy Technology Data Exchange (ETDEWEB)

    Bourgier, C.; Garbay, J.R.; Pichenot, C.; Uzan, C.; Delaloge, S.; Andre, F.; Spielmann, M.; Arriagada, R.; Lefkopoulos, D.; Marsigli, H.; Bondiau, P.Y.; Courdi, A.; Lallemand, M.; Peyrotte, I.; Chapellier, C.; Ferrero, J.M.; Chiovati, P.; Baldissera, A.; Frezza, G.; Vicenzi, L.; Palombarini, M.; Martelli, O.; Degli Esposti, C.; Donini, E.; Romagna CDR, E.; Romagna CDF, E.; Benmensour, M.; Bouchbika, Z.; Benchakroun, N.; Jouhadi, H.; Tawfiq, N.; Sahraoui, S.; Benider, A.; Gilliot, O.; Achard, J.L.; Auvray, H.; Toledano, I.; Bourry, N.; Kwiatkowski, F.; Verrelle, P.; Lapeyre, M.; Tebra Mrad, S.; Braham, I.; Chaouache, K.; Bouaouin, N.; Ghorbel, L.; Siala, W.; Sallemi, T.; Guermazi, M.; Frikha, M.; Daou, J.; El Omrani, A.; Chekrine, T.; Mangoni, M.; Castaing, M.; Folino, E.; Livi, L.; Dunant, A.; Mathieu, M.C.; Bitib, G.P.; Arriagada, R.; Marsigli, H

    2007-11-15

    Nine articles treat the question of breast cancer. Three-dimensional conformal accelerated partial breast irradiation: dosimetric feasibility study; test of dose escalation neo-adjuvant radiotherapy focused by Cyberknife in breast cancer; Three dimensional conformal partial irradiation with the technique by the Irma protocol ( dummy run multi centers of the Emilie Romagne area Italy); Contribution of the neo-adjuvant chemotherapy in the treatment of locally evolved cancers of the uterine cervix; Post operative radiotherapy of breast cancers (N0, pN) after neo-adjuvant chemotherapy. Radiotherapy of one or two mammary glands and ganglions areas,The breast cancer at man; breast conservative treatment; breast cancers without histological ganglions invasion; the breast cancer at 70 years old and more women; borderline mammary phyllod tumors and malignant. (N.C.)

  17. Diagnosis and minimally invasive treatment of early stage breast carcinoma

    NARCIS (Netherlands)

    van Esser, S.

    1979-01-01

    In this thesis the diagnostic work up and minimally invasive surgical treatment of early stage breast carcinoma is studied. Although the surgical treatment of breast carcinoma has improved significantly over the past decades, there is still room for improvement. On the one hand the focus is on early

  18. Persistent pain and sensory disturbances after treatment for breast cancer

    DEFF Research Database (Denmark)

    Mejdahl, Mathias Kvist; Andersen, Kenneth Geving; Gärtner, Rune;

    2013-01-01

    To examine the development of persistent pain after treatment for breast cancer and to examine risk factors associated with continuing pain.......To examine the development of persistent pain after treatment for breast cancer and to examine risk factors associated with continuing pain....

  19. [Conservative or operative treatment for chondropathia patellae?].

    Science.gov (United States)

    Ziegler, R; Rau, R

    1980-04-01

    Results of the conservative and operative therapy in chondropathia patellae are reported. A high percentage of freedom from symptoms was achieved by physiotherapeutic measures and intra-articular Arteparon-injections.

  20. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

    Energy Technology Data Exchange (ETDEWEB)

    Wen Bixiu [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States); Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080 (China); Hsu, Howard; Formenti-Ujlaki, George F.; Lymberis, Stella; Magnolfi, Chiara; Zhao Xuan; Chang Jenghwa; DeWyngaert, J. Keith; Jozsef, Gabor [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States); Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States)

    2012-11-15

    Purpose: The dosimetric results from our institution's trials of prone accelerated partial breast irradiation are compared with the dosimetric requirements of RTOG-0413. Methods and Materials: Trial 1 and Trial 2 are 2 consecutive trials of prone-accelerated partial breast irradiation. Eligible for both trials were stage I breast cancer patients with negative margins after breast-conserving surgery. The planning target tumor volume (PTV) was created by extending the surgical cavity 2.0 cm for Trial 1 and 1.5 cm for Trial 2, respectively. Contralateral breast, heart, lungs, and thyroid were contoured. Thirty Gray was delivered in five daily fractions of 6 Gy by a three-dimensional conformal radiation therapy technique in Trial 1 and were by image-guided radiation therapy/intensity-modulated radiation therapy in Trial 2. Dosimetric results from the trials are reported and compared with RTOG 0413 requirements. Results: One hundred forty-six consecutive plans were analyzed: 67 left and 79 right breast cancers. The plans from the trials complied with the required >90% of prescribed dose covering 90% of PTV{sub E}VAL (=generated from the PTV by cropping 0.5 cm from the skin edge and excluding the chest wall): V90% was 98.1 {+-} 3.0% (with V100% and V95%, 89.4 {+-} 12.8%, 96.4 {+-} 5.1%, respectively). No significant difference between laterality was found (Student's t test). The dose constraints criteria of the RTOG-0413 protocol for ipsilateral and contralateral lung (V30 <15% and Dmax <3%), heart (V5 <40%), and thyroid (Dmax <3%) were satisfied because the plans showed an average V5% of 0.6% (range, 0-13.4) for heart, an average V30% of 0.6% (range, 0-9.1%) for ipsilateral lung, and <2% maximum dose to the thyroid. However, our partial breast irradiation plans demonstrated a higher dose to contralateral breast than that defined by RTOG constraints, with a median value of maximum doses of 4.1% (1.2 Gy), possibly as a result of contouring differences

  1. Malignant phyllodes tumor of the breast: treatment and prognosis.

    Science.gov (United States)

    Mituś, Jerzy; Reinfuss, Marian; Mituś, Jerzy W; Jakubowicz, Jerzy; Blecharz, Pawel; Wysocki, Wojciech M; Skotnicki, Piotr

    2014-01-01

    Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50 years (21-76), and the mean size of the tumor was 6 cm. Thirty-four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1 cm. Remaining 6 (8.6%) patients treated with BCS margins were tumor-free margin ≥1 cm) and BCS with irradiation (tumor-free margin tumor-free margins cannot be obtained by BCS. Adjuvant radiotherapy may be considered if tumor-free margins are <1 cm.

  2. Histopathological Features of Invasion of Breast Invasive Ductal Carcinoma and Safety of Breast-conserving Surgery

    Institute of Scientific and Technical Information of China (English)

    Chunping LIU; Huaxiong PAN; Zhi LI; Lan SHI; Tao HUANG

    2009-01-01

    In order to investigate the relationship between the extent of tumor invasion and the tu-mor size,axillary lymph nodes metastasis,Her-2 gene overexpression,and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery,the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed.The correlation analysis on invasive extent,which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre,and the tumor size,axillary lymph nodes metastasis,Her-2 gene overexpression,and his-tologic grading was processed.There was a significant correlation between invasive extent and tumor size (r=0.766,P0.05),and histologic grading (r=0.228,P>0.05).The 100% negative rate of infiltration in patients without nipple discharge with tumor size 3 cm was obtained at 1.5,2.0 and 2.5 cm away from the tumor respectively.It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

  3. Breast Cancer: subgroups specific blood-biomarkers for early / predictive diagnosis and personalized treatment — EDRN Public Portal

    Science.gov (United States)

    Breast-conserving lumpectomy followed by radiation therapy has been shown to be an alternative strategy, competitive to mastectomy, in preventing mortality caused by breast cancer. However, besides negative short-term effects (blood flow disturbances, painful erythema, etc.) breast irradiation causes severe long-term side-effects (leucopenia, anemia, breast edema, fibrosis, increase of angiosarcoma, leukemia, myelodysplastic syndromes). Therefore, the identification of individual susceptibility to radiation and improved patient-specific radiotherapy planning are highly desirable for personalised treatment in breast cancer. Why early and predictive diagnosis is crucial for long-term outcomes of breast cancer? Breast cancer is the most common cause of cancer death among women with an average incidence rate of 10-12 per 100 women. In 2005, breast cancer led to 502,000 deaths worldwide. Advanced stages of breast cancer lead to the development of metastasis predominantly in the lymph nodes, bone, lung, skin, brain, and liver. Although breast-MRI is currently the most sensitive diagnostic tool for breast imaging, its specificity is limited resulting in a negative impact for surgical management in approximately 9 % of cases. Early diagnosis has been demonstrated to be highly beneficial, enabling significantly enhanced therapy efficiency and possibly full recovery.

  4. Carboplatin treatment of antiestrogen-resistant breast cancer cells

    DEFF Research Database (Denmark)

    Larsen, Mathilde S; Yde, Christina Westmose; Christensen, Ib J

    2012-01-01

    Antiestrogen resistance is a major clinical problem in current breast cancer treatment. Therefore, biomarkers and new treatment options for antiestrogen-resistant breast cancer are needed. In this study, we investigated whether antiestrogen‑resistant breast cancer cell lines have increased...... sensitivity to carboplatin, as it was previously shown with cisplatin, and whether low Bcl-2 expression levels have a potential value as marker for increased carboplatin sensitivity. Breast cancer cells resistant to the pure antiestrogen fulvestrant, and two out of four cell lines resistant...... to the antiestrogen tamoxifen, were more sensitive to carboplatin treatment compared to the parental MCF-7 cell line. This indicates that carboplatin may be an advantageous treatment in antiestrogen‑resistant breast cancer; however, a marker for increased sensitivity would be needed. Low Bcl-2 expression...

  5. Status of Survival and Recurrence of Breast-conserving Surgery for Early Breast Cancer Patients%早期乳腺癌患者保乳手术后的生存和复发状况研究

    Institute of Scientific and Technical Information of China (English)

    章骏; 赵怡; 王群; 张舟; 邢戍健

    2015-01-01

    Objective To investigate the survival and recurrence of breast -conserving surgery for early breast cancer pa -tients.Methods 100 cases of early breast cancer patients were divided into breast -conserving surgery group (BCT group) and modified radical mastectomy group (radical groups) according to different treatment ,each with 50 cases.Surgical situation and prognosis of the 2 groups,and risk factors of local recurrence after breast -conserving surgery were compared .Results Operation time,blood loss,average drainage,length of hospital stay and complications of the 2 groups had statistically significant difference (P 0.05);BCT group had higher de-gree of satisfaction with the breast shape ;Age was independent factor for local recurrence of early breast cancer after breast -con-serving surgery.Conclusion Breast-conserving surgery for early breast cancer has better survival ,local control rate and cosmetic results.%目的:探讨早期乳腺癌患者保乳手术后的生存和复发状况。方法100例早期乳腺癌患者根据治疗方式的不同分为保乳术组(保乳组)50例及改良根治术组(根治组)50例。对比分析保乳术与根治术的手术情况和预后以及影响保乳术后局部复发的危险因素。结果保乳组手术时间、术中出血量、平均引流量、住院时间以及并发症发生率与根治组比较差异显著,具有统计学意义(P <0.05);两组患者术后的局部复发情况无明显差异(P >0.05);保乳术组对乳房外形满意度较高;年龄是影响早期乳腺癌患者保乳手术后局部复发的独立因素。结论早期乳腺癌患者行保乳术后能获得良好生存率、局部控制率和美容效果。

  6. Anxious Personality and Breast Cancer: Possible Negative Impact on Quality of Life After Breast-Conserving Therapy

    NARCIS (Netherlands)

    van der Steeg, A.F.W.; de Vries, J.; Roukema, J.A.

    2010-01-01

    Background Quality of Life (QoL) is an important outcome measure in oncology. To assess the influence of surgical treatment and personality on QoL in women with breast cancer, a longitudinal prospective cohort study was done. Methods Women (n = 222) completed questionnaires concerning QoL (WHOQOL 10

  7. Concurrent chemo-radiotherapy in the treatment of early breast cancer: Current status

    Directory of Open Access Journals (Sweden)

    Nabil Ismaili

    2013-01-01

    Full Text Available Concurrent chemo-radiotherapy (CCRT in early breast cancer was investigated by few authors and remains controversial. This treatment is more commonly used for locally advanced breast cancer and showed high rate of complete pathological response. A search of articles published in English literature, between 1980 and November 2012, was conducted on Medline using the following terms: "breast cancer", "chemotherapy", "concurrent radiotherapy", and "Trastuzumab". We identified five phase I/II trials and three randomized phase three trials evaluating concurrent chemoradiotherapy in the adjuvant of breast cancer. In patients with early breast cancer having positive lymph nodes, phases III clinical trials showed that CCRT improved local control after conservative breast surgery. However, these randomized trials used non-standard regimen: Cyclophosphamide, methotrexate and fluorouracil (CMF or fluorouracil, mitoxantrone and cyclophosphamide (FNC. In addition, in phases II clinical trials, concurrent use of taxanes and anthracycline with standard whole-breast irradiation showed high rate of toxicity: Pulmonary toxicity with taxane; and cardiac and skin toxicity with anthracycline. Consequentely, CCRT is not be used in practice because of concerns of toxicity with the standard drugs (anthracyclines and taxanes and radiation. Anthracyclines with partial breast irradiation (PBI was feasible according to one phase I clinical trial, and should be investigated in randomized clinical trials. Concurrent Trastuzumab plus radiotherapy is safe and can be used in HER2-positive breast cancer; in this case, cardiac volume sparing and patient selections for internal mammary chain irradiation are highly recommended. The present paper aimed to review the current data evaluating the efficacy and safety of CCRT in early breast cancer.

  8. Presence of extensive intraductal component in patients undergoing breast conservative surgery predicts presence of residual disease in subsequent completion mastectomy

    Institute of Scientific and Technical Information of China (English)

    Christopher C. P. Yiu; Wings T. Y. Loo; C. K. Lam; Louis W. C. Chow

    2009-01-01

    Background Local recurrence remains a serious problem among patients undergoing breast conservative surgery. This study aimed at identifying risk factors for residual disease after breast conservative surgery.Methods This retrospective study was based on patients with invasive breast cancer who have received breast conservative surgery and subsequent completion mastectomy. All patients had a clear resection margin in the initial operation. We analyzed the association between the presence of residual disease during completion mastectomy and the following risk factors: T staging, young age, and presence of extensive intraductal component (EIC), a close margin, lymphovascular permeation (LVP), positivity of estrogen receptor, progesterone receptor, and c-erbB-2.Results Residual disease was encountered in 21 (45.7%) of 46 patients; EIC was present in 28 patients (60.9%), of whom 17 had residual disease. Presence of EIC during breast conservation surgery was associated with a higher risk of residual disease during completion mastectomy (P=0.011). Other variables were not statistically significant risk factors for presence of residual disease. No local recurrence was recorded in our cohort, and the disease-free survival and overall survival after completion mastectomy were similar for patients who had residual disease and those who had not.Conclusions The presence of EIC is a significant risk factor for residual disease in patients after breast conservative surgery. Our findings may suggest the indicated value of completion mastectomy in patients with EIC during initial breast conservative surgery to decrease the risk of subsequent local failure.

  9. Lipoplatin treatment in lung and breast cancer.

    Science.gov (United States)

    Fantini, Manuela; Gianni, Lorenzo; Santelmo, Carlotta; Drudi, Fabrizio; Castellani, Cinzia; Affatato, Alessandra; Nicolini, Mario; Ravaioli, Alberto

    2011-01-01

    The introduction of cisplatin in cancer treatment represents an important achievement in the oncologic field. Many types of cancers are now treated with this drug, and in testicular cancer patients major results are reached. Since 1965, other compounds were disovered and among them carboplatin and oxaliplatin are the main Cisplatin analogues showing similar clinical efficacy with a safer toxicity profile. Lipoplatin is a new liposomal cisplatin formulation which seems to have these characteristics. Lipoplatin was shown to be effective in NSCLC both in phase 2 and phase 3 trials, with the same response rate of Cisplatin, a comparable overall survival but less toxicity. A new protocol aiming to elucidate the double capacity of Lipoplatin to act as a chemotherapeutic and angiogenetic agent in triple-negative breast cancer patients is upcoming.

  10. Exploring circulating micro-RNA in the neoadjuvant treatment of breast cancer.

    Science.gov (United States)

    Casey, Máire-Caitlín; Sweeney, Karl J; Brown, James Andrew Lawrence; Kerin, Michael J

    2016-07-01

    Breast cancer is the most frequently diagnosed malignancy amongst females worldwide. In recent years the management of this disease has transformed considerably, including the administration of chemotherapy in the neoadjuvant setting. Aside from increasing rates of breast conserving surgery and enabling surgery via tumour burden reduction, use of chemotherapy in the neoadjuvant setting allows monitoring of in vivo tumour response to chemotherapeutics. Currently, there is no effective means of identifying chemotherapeutic responders from non-responders. Whilst some patients achieve complete pathological response (pCR) to chemotherapy, a good prognostic index, a proportion of patients derive little or no benefit, being exposed to the deleterious effects of systemic treatment without any knowledge of whether they will receive benefit. The identification of predictive and prognostic biomarkers could confer multiple benefits in this setting, specifically the individualization of breast cancer management and more effective administration of chemotherapeutics. In addition, biomarkers could potentially expedite the identification of novel chemotherapeutic agents or increase their efficacy. Micro-RNAs (miRNAs) are small non-coding RNA molecules. With their tissue-specific expression, correlation with clinicopathological prognostic indices and known dysregulation in breast cancer, miRNAs have quickly become an important avenue in the search for novel breast cancer biomarkers. We provide a brief history of breast cancer chemotherapeutics and explore the emerging field of circulating (blood-borne) miRNAs as breast cancer biomarkers for the neoadjuvant treatment of breast cancer. Established molecular markers of breast cancer are outlined, while the potential role of circulating miRNAs as chemotherapeutic response predictors, prognosticators or potential therapeutic targets is discussed.

  11. Is standard breast-conserving therapy (BCT in elderly breast cancer patients justified? A prospective measurement of acute toxicity according CTC-classification

    Directory of Open Access Journals (Sweden)

    Eilf Kirsten

    2010-11-01

    Full Text Available Abstract Background Breast conserving therapy (BCT is an accepted treatment for early-stage breast cancer. This study aimed to measure prospectively acute radiation-related toxicity and to create a comprehensive data base for long-term temporal analyses of 3D conformal adjuvant radiotherapy. The specific aspect of age has been neglected by traditional research. Therefore, the impact of age on acute BCT toxicity should be also specifically adressed. Methods Toxicity was measured in 109 patients at initiation (t1, during radiotherapy (t2-t7, and 6 weeks after treatment completion (t8 using a new topographic module. Organ systems were recorded in 15 scales and scored according to symptom intensity (grade 0-5 based on CTC (Common Toxicity Criteria -classification. Radiotherapy was virtually CT-based planned and applied with 6-MeV-photons. Mean total dose was 60.1 Gy. Patients were stratified by age in 3 Groups: 60 years. Results Registered toxicity was generally low. Mean overall-grade climbed from 0.29-0.40 (t1-t7, and dropped to 0.23 (t8. Univariate analyses revealed slightly higher toxicity in older (> 60 years versus young patients ( 60 years patients (p = 0.039. Toxicity differences in all other scales were not significant. Between older (> 60 years and midaged patients (50-60 years no significant differences in toxicity were found. This was also true for the comparison between young ( Conclusion The treatment concept of BCT for breast cancer is generally well tolerated. The toxicity-measurement with the new topographic module is feasible. Not modified standard treatment for BC should be performed in elderly women.

  12. Megestrol acetate in the treatment of metastatic breast cancer

    NARCIS (Netherlands)

    J. Alexieva-Figusch (Jana)

    1984-01-01

    textabstractThere are many non-elucidated questions concerning cancer, especially of the breast, in which hormones are involved. The scope of this particular study is to bring more clarity on the role of the progestin megestrol acetate in the hormonal treatment of breast cancer. It should be kept in

  13. Concerns on diagnosis and treatment of breast cancer in China

    Institute of Scientific and Technical Information of China (English)

    WANG Shen-ming

    2007-01-01

    @@ Breast cancer is one of the neoplasms that have greatest negative psychological impact on the sufferers. Although China is among the low morbidity country of breast cancer, its yearly increasing rate in China is 1%-2% higher than the average rate of the word.1 Due to its largest population in the word, China tops the world in its breast cancer cases but general medical care for the patients still lags behind the developed countries. These issues are related to the diagnosis and treatment of breast cancer in China.

  14. Controversies on cosmetic outcomes in black women after breast conservation therapy: hyperperception or hyperpigmentation?

    Directory of Open Access Journals (Sweden)

    Sophia M Edwards-Bennett

    2011-03-01

    Full Text Available Sophia M Edwards-Bennett1, Carol L Brown21Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL; 2Department of Gynecologic Oncology and Surgery, Memorial Sloan Kettering Cancer Center, NY, USAAbstract: Multiple studies have reported inferior cosmetic outcomes after breast conservation surgery and adjuvant radiation therapy in black women. However, cosmetic analysis scales contemporarily utilized in the field of radiation oncology rely largely on subjective visual and tactile perception. These methods are undeniably fraught with intraobserver and interobserver variability. Herein, we uncover how and why these methods may unwittingly and disparately misjudge cosmetic outcomes in black women, and the clinical ramifications thereof. In addition, we highlight more objective cosmetic outcomes assessment programs that promise to yield more reproducible and unbiased results.Keywords: cosmetic outcomes, black women, breast conservation

  15. The influence of simultaneous integrated boost, hypofractionation and oncoplastic surgery on cosmetic outcome and PROMs after breast conserving therapy

    NARCIS (Netherlands)

    Lansu, J.T.; Essers, M.; Voogd, A.C.; Luiten, E.J.; Buijs, C.; Groenendaal, N.; Poortmans, P.M.P.

    2015-01-01

    INTRODUCTION: We retrospectively investigated the possible influence of a simultaneous integrated boost (SIB), hypofractionation and oncoplastic surgery on cosmetic outcome in 125 patients with stage I-II breast cancer treated with breast conserving therapy (BCT). PATIENTS AND METHODS: The boost was

  16. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer

    NARCIS (Netherlands)

    A.C. Voogd (Adri); F.J. van Oost (F.); E.J.T. Rutgers (Emiel); S. Elkhuizen (Sylvia); A.N. van Geel (Albert); L.J.E.E. Scheijmans (L. J E E); M.J.C. van der Sangen (Maurice); G. Botke (G.); C.J.M. Hoekstra (C. J M); J.J. Jobsen (Jan); C.J.H. van de Velde (Cornelis); M.F. von Meyenfeldt (Maarten); J.M. Tabak (J.); J.L. Peterse (J.); M.J. Vijver (Marc ); J.W.W. Coebergh (Jan Willem); G. van Tienhoven (Geertjan)

    2005-01-01

    textabstractWe have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years. At

  17. Three-dimensional conformal hypofractionated simultaneous integrated boost in breast conserving therapy : Results on local control and survival

    NARCIS (Netherlands)

    Bantema-Joppe, Enja J.; van der Laan, Hans Paul; de Bock, Geertruida H.; Wijsman, Robin; Dolsma, Wil V.; Busz, Dianne M.; Langendijk, Johannes A.; Maduro, John H.

    2011-01-01

    PURPOSE: To report on local control and survival after breast conserving therapy (BCT) including three-dimensional conformal simultaneous integrated boost irradiation (3D-CRT-SIB) and on the influence of age on outcome. PATIENT AND METHODS: For this study, 752 consecutive female breast cancer patien

  18. A case of bronchiolitis obliterans organizing pneumonia (BOOP) after breast conserving therapy for early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Shinya; Kiryuu, Takuji; Maeda, Sunao; Hoshi, Hiroaki; Shimokawa, Kuniyasu [Gifu Univ. (Japan). School of Medicine; Kawaguchi, Shimpei

    2001-03-01

    A case of BOOP occurring after radiotherapy for breast cancer was reported. TBLB and BAL were performed at the time of diagnosis. This case suggested that radiographic changes began in the irradiated area, then later spread to non-irradiated areas. In this article, we discussed the peculiary radiographic image, pathological manifestation, BAL characteristics and clinical course in this sequela. (author)

  19. 76 FR 47518 - Energy Conservation Program: Treatment of “Smart” Appliances in Energy Conservation Standards and...

    Science.gov (United States)

    2011-08-05

    ... Parts 430 and 431 Energy Conservation Program: Treatment of ``Smart'' Appliances in Energy Conservation... Energy, Building Technologies Program, Mailstop EE-2J, Energy Conservations Standards: Treatment of Smart... INFORMATION: In support of its Energy Conservation Standards Rulemakings, DOE conducts in-depth technical...

  20. SPLEEN CLOSED TRAUMA: SURGICAL TREATMENT VERSUS CONSERVATIVE TREATMENT

    Directory of Open Access Journals (Sweden)

    M. Lo Gatto

    2012-01-01

    Full Text Available Introduction. In closed trauma of the most frequent causes of injuries are haemoperitoneus of parenchymatous organs such as liver and spleen. Patients and methods. Clinical Case No.1. R.F. (spleen injury: 2nd degree sec. Moore, 1st degree sec. Buntain WL, Tc-based score of 2 is subject to clinical monitoring with ultrasound control, tc, and several blood exams with a satisfactory clinical outcome. Clinical Case No.2. A.C. presents a clinical picture attributable to 3rd grade sec. Moore and the 2nd grade sec. Buntain WL with a Tc-based score of 4, therefore, performed emergency splenectomy was not delayed, thus saving the patient at the death. Results. The rupture of the spleen is the most frequent complication of closed abdominal trauma (contusion or direct backlash. It appears as isolated lesion in 30-70% of cases. Conclusions. In our experience individual spleen injuries, undercapslular that does not involve the hilum and without spillage of liquid peritoneal deserve a conservative, on the other hand, the spleen injury in excess of 4 cm, manyfragments, with spreading of free peritoneal fluid in need of treatment Surgical sudden.

  1. Treatment helps young women preserve fertility during breast cancer chemo

    Science.gov (United States)

    Researchers have found that young women with breast cancer were able to better preserve their fertility during cancer treatments by using hormone-blocking drug injections that put them into temporary menopause. The results announced today at the annual me

  2. For Some Breast Cancers, New Drug May Be Treatment Option

    Science.gov (United States)

    Results from an international clinical trial suggest that women with metastatic, HER2-positive breast cancer that is no longer responding to the targeted therapy trastuzumab (Herceptin) may soon have a new treatment option.

  3. Seroma indicates increased risk of lymphedema following breast cancer treatment

    DEFF Research Database (Denmark)

    Toyserkani, Navid Mohamadpour; Jørgensen, Mads Gustaf; Haugaard, Karen

    2017-01-01

    Introduction Lymphedema is one of the most serious complications following breast cancer treatment. While many risk factors are well described the role of seroma formation has recently produced mixed results. Therefore, we aimed to evaluate if seroma is a risk factor for development of lymphedema...... in one of the largest retrospective cohort studies. Material and methods We included all patients with unilateral breast cancer treated in the period of 2008-2014. Data regarding treatment and breast cancer characteristics were retrieved from the national breast cancer registry. Data regarding lymphedema...... treatment and seroma aspirations were retrieved from local treatment codes. Results In total 1822 patients were included of which 291 developed lymphedema. Multivariate cox regression analysis showed that seroma was an independent risk factor (HR 1.92 CI 1.30-2.85, p= 0.001). Other independent risk factors...

  4. Pharmacological treatment of depression in women with breast cancer

    DEFF Research Database (Denmark)

    Toftegård Andersen, Lærke; Voigt Hansen, Melissa; Rosenberg, Jacob

    2013-01-01

    that escitalopram and the norepinephrine reuptake inhibitor, reboxetine, significantly improved depression and QOL compared with baseline values. In conclusion, depression is a clinical problem in patients with breast cancer. Pharmacological treatment with antidepressants may improve depression and QOL. However...

  5. The Comparison 2D and 3D Treatment Planning in Breast Cancer Radiotherapy with Emphasis on Dose Homogeneity and Lung Dose

    Directory of Open Access Journals (Sweden)

    Zahra Falahatpour

    2010-09-01

    Full Text Available Introduction: Breast conserving radiotherapy is one of the most common procedures performed in any radiation oncology department. A tangential parallel-opposed pair is usually used for this purpose. This technique is performed using 2D or 3D treatment planning systems. The aim of this study was to compare 2D treatment planning with 3D treatment planning in tangential irradiation in breast conserving radiotherapy. In this comparison, homogeneity of isodoses in the breast volume and lung dose were considered. Material and Methods: Twenty patients with breast cancer treated with conservative surgery were included in this study. The patients were CT scanned. Two-dimensional treatment planning with the Alfard 2D TPS was performed for each patient using a single central CT slice. The data used on the Alfard 2D TPS was imported into the Eclipse 3D TPS, on which 3D treatment planning was performed. Cobalt-60 beams were used in all plans. Results: Comparing 2D and 3D treatment planning, homogeneity of isodoses was improved in 3D treatment planning (p30Gy was increased in 3D treatment planning (p< 0.01. Discussion and Conclusion: 3D treatment planning is a more suitable option for patients with breast cancer treated with conservative surgery because of improved dose homogeneity in 3D treatment planning. The results of the treatment can be improved with reduced recurrence probability and skin problems.

  6. New ways to optimize breast cancer treatment

    NARCIS (Netherlands)

    Schröder, Carolina Pia

    2001-01-01

    Breast cancer patients without apparent distant metastases at the time of primary tumor removal, may later suffer from a distant relapse, indicating the presence of occult micrometastases at the time of diagnosis. Sensitive methods to detect micrometastatic breast cancer may be helpful in optimizing

  7. Giant Cell Tumor: Role of Conservative Treatment

    Institute of Scientific and Technical Information of China (English)

    Anatolii Diedkov[1; Pavlo Kovalchuk[1; Marija Kukushkina[2; Sergey Bojchuk[1; Viktor Kostyuk[1

    2014-01-01

    Giant cell tumor is aggressive bone tumor. Surgical treatment is considered to be the only effective method of treatment ofthese tumors. The problem of inoperable patients with giant cell tumors is a challenge. A total of 8 patients had giant cell bone tumorsof pelvis and sacrum. 3 patients were treated by bisphosphonates, radiation therapy and embolization of tumor-nutrient arteries. 5patients received denosumab. The efficiency was assessed according to clinical data and CT scan control. Median follow up is 28months. All 8 patients had reduction of pain intensity. Treatment with denosumab demonstrated more than 30% tumor regression. Allof the patients are in remission.

  8. [Conservative treatment for the penis carcinoma].

    Science.gov (United States)

    Slampa, P; Kost'áková, G; Hynková, L; Růzicková, J; Horová, H; Jezková, B

    2004-01-01

    No explicit recommendation has been determined in a treatment for the verified squamous cell penis carcinoma till now. The application of ionizing radiation is included in traditional treatment methods for this disease, in addition to surgical operations and chemotherapy cure. It is possible to apply external radiotherapy or brachy-radiotherapy (a moulage or an intersticial application) as well as their combination. In individual cases it is possible to use chemo-radiotherapy. In the case of the localized tumor a curative radiotherapy can be used as it is more save towards this organ. Radiotherapy has its place in the neoadjuvans treatment with the goal to reduce the disease extent. It can be also used as an adjuvans--postoperatively and paliatively. This review is describing principles of the radiotherapy treatment for this disease.

  9. Failure pattern and survival after breast conserving therapy. Long-term results of the Danish Breast Cancer Group (DBCG) 89 TM cohort

    DEFF Research Database (Denmark)

    Lyngholm, C D; Laurberg, T; Alsner, J

    2016-01-01

    to the DBCG 89 program and compare recurrence pattern and survival both overall and when separated in age groups, with the results from the randomized DBCG 82 TM trial. Material and methods: A total of 1847 patients treated between 1989 and 1999 were included in a retrospective population-based cohort study....... In an adjusted analysis age maintained a significant and independent effect on both LR and DSM. Conclusion: The DBCG 82 TM program was successfully implemented. The women treated with BCT in the DBCG 89 program displayed equal failure pattern and improved survival in comparison with women from the DBCG 82 TM......Based on the results from the DBCG 82 trial, breast conserving therapy (BCT) has been implemented as standard in Denmark since 1989, and today constitutes more than 70% of the primary treatment. Our aim was to evaluate the implementation of BCT as a routine procedure in patients treated according...

  10. Breast Cancer Basics and You: Staging and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Breast Cancer Breast Cancer Basics and You: Staging and Treatment Past Issues / ... Table of Contents Staging The extent (stage) of breast cancer needs to be determined to help choose the ...

  11. 早期乳腺癌保乳手术与改良根治术临床疗效观察%Clinical Observation on Breast Conserving Surgery and Modified Radical Mastectomy for Early Stage Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    潘金栋

    2016-01-01

    ObjectiveTo investigate and analyze the clinical effect of breast conserving surgery and modified radical mastectomy for early breast cancer. And the practical value of the two treatment methods were compared and analyzed.Methods Using the method of statistical analysis in recent three years in our hospital for treatment of 100 cases of breast cancer patients. According to the treatment methods,divided into the experimental group and the control group.They were treated with breast conserving surgery or modified radical mastectomy. The clinical effects of the two groups were compared.Results Two groups of patients after the corresponding treatment,there was no significant difference in local recurrence rate and metastasis rate between breast conserving surgery and radical mastectomy. The results were not statisticaly significant(P>0.05).Conclusion Compared with breast conserving surgery,modified radical mastectomy for breast cancer patients has good effect.%目的:探讨并分析早期乳腺癌保乳手术与改良根治手术的临床实际效果,并对比分析两种治疗方法的实用价值。方法采用统计分析方法以近3年在我院接受治疗的乳腺癌患者100例,按照采用的治疗手段为划分标准分为实验组与对照组,分别采用保乳术和改良根治术进行治疗,比较两组患者的实际临床效果。结果两组患者经过相应的治疗,保乳术与根治术的患者术后局部复发率、转移率等参数对比,差异无统计学意义(P>0.05)。结论针对乳腺癌患者,采用保乳术相比较改良根治术效果更佳。

  12. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fehlauer, F.; Tribius, S.; Alberti, W.; Rades, D. [Dept. of Radiation Oncology, Univ. Medical Clinic Hamburg-Eppendorf, Hamburg (Germany)

    2005-10-01

    Background and purpose: breast irradiation after lumpectomy is an integral component of breast-conserving therapy (BCT). As the prognosis is general good following BCT, late morbidity and cosmesis are important. The present study compares two different radiation schedules with respect to these two endpoints. Patients and methods: 129 breast cancer patients (pT1-2 pN0-1 cM0) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule (2.5 Gy to 55 Gy, 4 x /week, n = 65) or with a conventional fractionation schedule (28 days, 2.0 Gy to 55 Gy, 5 x /week, n = 64), both without additional boost. The equivalent dose of 2-Gy fractions (EQD2) was 55 Gy and 62 Gy, respectively. Late toxicity, assessed according to the LENT-SOMA criteria, and cosmetic outcome, graded on a 5-point scale, were evaluated after a median of 86 months (range 72-94 months) in tumor-free breast cancer patients. Results: LENT-SOMA grade 2/3 toxicity (2.5 Gy vs. 2.0 Gy): breast pain (18% vs. 11%; p = 0.3), fibrosis (57% vs. 16%; p < 0.001), telangiectasia (22% vs. 3%; p = 0.002), atrophy (31% vs. 3%; p < 0.001). Medication to breast pain was taken by 8% versus 9% of patients. Cosmesis was very good/good/acceptable in 75% versus 93% (2.5 Gy vs. 2.0 Gy; p = 0.006). Conclusion: late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy (2.5 Gy to 55 Gy). However, morbidity was not associated with major implications on daily life. (orig.)

  13. Breast cancer in BRCA mutation carriers: medical treatment.

    Science.gov (United States)

    Milani, Andrea; Geuna, Elena; Zucchini, Giorgia; Aversa, Caterina; Martinello, Rossella; Montemurro, Filippo

    2016-10-01

    About 10% of breast cancers are associated with the inheritance of autosomal dominant breast cancer susceptibility alleles BRCA1 and BRCA2. Until recently, the medical management of BRCA mutation-associated breast cancer has not differed from that of the sporadic breast cancer counterpart. However, there is mounting evidence that this molecular alteration confers sensitivity or resistance to systemic therapies that can be exploited in terms of medical management. For example, studies support the use of platinum salts chemotherapy in BRCA mutated cancers. Moreover, a number of targeted therapies are showing activity in BRCA mutation carriers. Above all, BRCA defective tumor cells are particularly sensitive to Poly(ADP-ribose) polymerase (PARP) inhibitors. This review will summarize the state of the art of the medical treatment of breast cancer in BRCA mutation carriers, with a particular focus on chemotherapies and targeted therapies.

  14. Surgical margins in breast-conserving therapy: current trends and future prospects.

    Science.gov (United States)

    Sanguinetti, Alessandro; Lucchini, Roberta; Santoprete, Stefano; Bistoni, Giovanni; Avenia, Stefano; Triola, Roberto; Avenia, Nicola

    2013-01-01

    Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radio-guided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

  15. Techniques of tumour bed boost irradiation in breast conserving therapy: Current evidence and suggested guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Jalali, Rakesh; Singh, Suruchi; Budrukkar, Ashwini [Tata Memorial Hospital, Mumbai (India)

    2007-10-15

    Breast conservation surgery followed by external beam radiotherapy to breast has become the standard of care in management of early carcinoma breast. A boost to the tumour bed after whole breast radiotherapy is employed in view of the pattern of tumour bed recurrences in the index quadrant and was particularly considered in patients with some adverse histopathological characteristics such as positive margins, extensive intraductal carcinoma (EIC), lymphovascular invasion (LVI), etc. There is however, now, a conclusive evidence of improvement in local control rates after a boost radiotherapy dose in patients even without such factors and for all age groups. The maximum absolute reduction of local recurrences by the addition of boost is especially seen in young premenopausal patients. At the same time, the addition of boost is associated with increased risk of worsening of cosmesis and no clear cut survival advantage. Radiological modalities such as fluoroscopy, ultrasound and CT scan have aided in accurate delineation of tumour bed with increasing efficacy. A widespread application of these techniques might ultimately translate into improved local control with minimal cosmetic deficit. The present article discusses the role of radiotherapy boost and the means to delineate and deliver the same, identify the high risk group, optimal technique and the doses and fractionations to be used. It also discusses the extent of adverse cosmetic outcome after boost delivery, means to minimise it and relevance of tumour bed in present day scenario of advanced radiotherapy delivery techniques like (IMRT)

  16. Conservative treatment in a patient with diabetic osteomyelitis

    DEFF Research Database (Denmark)

    Jeppesen, Sune Møller; Frokjaer, J.; Yderstraede, K.

    2015-01-01

    Diabetic foot ulcers are commonly complicated by bone involvement and osteomyelitis. Diagnosing diabetic osteomyelitis can be problematic. However, positive findings at clinical examination and X-ray may set the diagnosis. Recent guidelines suggest that selected cases of diabetic osteomyelitis can...... be treated conservatively with antibiotics. We report on the successful treatment of a 52-year-old man with diabetes with osteomyelitis in the distal phalanx of a toe. On X-ray, the affected phalanx appeared completely eroded. However, regeneration of the bone tissue was observed following outpatient...... treatment with antibiotics. We therefore encourage doctors to provide conservative treatment for selected cases of diabetic osteomyelitis....

  17. Surgical versus conservative treatment of distal radius fractures in elderly.

    Science.gov (United States)

    Trevisan, C; Klumpp, R; Nava, V; Riccardi, D; Recalcati, W

    2013-10-01

    The distal radius fractures (DRFs) are the second most common fracture in the elderly population. Despite their frequency, the optimal treatment of these fractures remains controversial. Several dogmatic myths on DRFs management may adversely affect their outcome and despite a strong trend versus surgical options, systematic reviews suggest that conservative treatment remains the safest option for DRFs in most cases.

  18. Intensity-modulated radiotherapy for early-stage breast cancer after breast-conserving surgery%早期乳腺癌保乳术后调强适形放疗的应用

    Institute of Scientific and Technical Information of China (English)

    冶秀鹏

    2010-01-01

    传统的保乳术后放疗方法是做全乳腺照射5~6周,引起的不良反应多见.随着放射治疗技术的发展,以最小的侵袭或损伤达到最佳疗效,已成为肿瘤学者追求的目标.调强适形放疗(IMRT)的发展有很大的空间,日益受到广大学者的重视,将可能会成为早期乳腺癌保乳术后的标准治疗方式.%Conventional radiotherapy after breast-conserving surgery is generally delivered to the overall breast over a period of 5 to 6 weeks,but its negative effects are significant.With the development of radiotherapy techniques,achieving optimal curative effect with least invasion becomes the researchers aims.Intensitymodulated radiotherapy(IMRT) has come to the forefront as a potential alternative.IMRT attracts more and more attention ,and has a promising perspect.IMRT may become the standard treatment for early-stage breast cancer after breast conservation treatment.

  19. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)

    1999-09-01

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  20. Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness based on ipsilateral breast tumor recurrence and long-term follow-up

    Science.gov (United States)

    Carrara, Guilherme Freire Angotti; Scapulatempo-Neto, Cristovam; Abrahão-Machado, Lucas Faria; Brentani, Maria Mitzi; Nunes, João Soares; Folgueira, Maria Aparecida Azevedo Koike; da Costa Vieira, René Aloisio

    2017-01-01

    OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01). CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors. PMID:28355358

  1. Whole breast irradiation vs. APBI using multicatheter brachytherapy in early breast cancer – simulation of treatment costs based on phase 3 trial data

    Science.gov (United States)

    Harat, Maciej; Makarewicz, Roman

    2016-01-01

    Purpose A recent large phase 3 trial demonstrated that the efficacy of accelerated partial-breast irradiation (APBI) in the treatment of early breast cancer is non-inferior to that of whole breast irradiation (WBI) commonly used in this indication. The aim of this study was to compare the costs of treatment with APBI and WBI in a population of patients after conserving surgery for early breast cancer, and to verify if the use of APBI can result in direct savings of a public payer. Material and methods The hereby presented cost analysis was based on the results of GEC-ESTRO trial. Expenditures for identified cost centers were estimated on the basis of reimbursement data for the public payer. After determining the average cost of early breast cancer treatment with APBI and WBI over a 5-year period, the variance in this parameter resulting from fluctuations in the price per single procedure was examined on univariate sensitivity analysis. Then, incremental cost-effectiveness ratio (ICER) was calculated to verify the cost against clinical outcome. Finally, a simulation of public payer’s expenditures for the treatment of early breast cancer with APBI and WBI in 2013 and 2025 has been conducted. Results The average cost of treatment with APBI is lower than for WBI, even assuming a potential increase in the unit price of the former procedure. There was no additional health benefit of WBI and the calculation of cost-effectiveness was based on the absolute difference in overall local control rate. However, this difference (0.92% vs. 1.44%) was fairly minimal and was not identified as statistically significant during 5 years. Conclusions The use of APBI as an alternative to WBI in the treatment of early breast cancer would substantially reduce healthcare expenditures in both 2013 and 2025, even assuming an increase in the price per single APBI procedure.

  2. 76 FR 56126 - Energy Conservation Program: Treatment of “Smart” Appliances in Energy Conservation Standards and...

    Science.gov (United States)

    2011-09-12

    ... Parts 430 and 431 Energy Conservation Program: Treatment of ``Smart'' Appliances in Energy Conservation...'' appliances in the development of DOE's energy conservation standards, as well as in test procedures used to...'' appliances in the development of DOE's energy conservation standards, as well as in test procedures used...

  3. Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery.

    Science.gov (United States)

    Izumi, Ken; Fujikawa, Masakazu; Tashima, Hiroki; Saito, Takuya; Sotsuka, Yohei; Tomita, Koichi; Hosokawa, Ko

    2013-11-01

    Recent advances in perforator flap surgical techniques have allowed for safe and reliable autologous tissue transfer with minimal donor-site morbidity. Between April 2012 and January 2013, we performed immediate breast reconstruction using free medial circumflex femoral artery perforator (MCFAP) flaps in 15 patients after breast-conserving surgery. The flaps were harvested from patients in the lithotomy position, while a second surgical team simultaneously conducted tumour resection. Of the 15 procedures performed, three flaps were dissected as true perforator flaps, while 12 flaps were dissected as muscle-sparing perforator flaps. The mean flap weight was 138.5 g (range, 77-230 g) and the mean pedicle length was 5.7 cm (range, 3.0-9.0 cm). Recipient vessels for anastomosis were serratus branches in 10 patients, internal mammary vessels in three patients and thoracodorsal vessels in two patients. The mean duration of surgery was 6.74 h (range, 5.65-9.45 h). There were no major complications requiring surgical intervention. Researchers observed partial flap necrosis, which manifested as small firm lesions in two patients, as well as local wound infection and dehiscence in one patient, which resolved spontaneously. There were no instances of donor-site seroma formation or lymphoedema in any of the patients. An objective assessment of postoperative photographs showed that cosmetic results were mostly satisfactory. Donor-site scars along the medial groin crease were inconspicuous and readily concealed by clothing. Given its reliable vascularity and minimal donor-site morbidity, the free MCFAP flap can be a good alternative for partial breast reconstruction after breast-conserving surgery.

  4. A pilot study to investigate the role of the 26S proteasome in radiotherapy resistance and loco-regional recurrence following breast conserving therapy for early breast cancer.

    Science.gov (United States)

    Elfadl, Dalia; Hodgkinson, Victoria C; Long, Ervine D; Scaife, Lucy; Drew, Philip J; Lind, Michael J; Cawkwell, Lynn

    2011-08-01

    Breast conserving therapy is a currently accepted method for managing patients with early stage breast cancer. However, approximately 7% of patients may develop loco-regional tumour recurrence within 5 years. We previously reported that expression of the 26S proteasome may be associated with radio-resistance. Here we aimed to analyse the 26S proteasome in a pilot series of early breast cancers and correlate the findings with loco-regional recurrence. Fourteen patients with early breast cancer who developed loco-regional recurrence within 4 years of completing breast conserving therapy were selected according to strict criteria and compared with those from 14 patients who were disease-free at 10 years. Decreased expression of the 26S proteasome was significantly associated with radio-resistance, manifested as the development of a loco-regional recurrence within 4 years of breast conserving therapy (p = 0.018). This small pilot study provides further suggestion that the 26S proteasome may be associated with response to radiotherapy.

  5. Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer

    Directory of Open Access Journals (Sweden)

    Wiseman Janice

    2011-05-01

    Full Text Available Abstract Background Weekly docetaxel has occasionally been used in the neoadjuvant to downstage breast cancer to reduce toxicity and possibly enhance quality of life. However, no studies have compared the standard three weekly regimen to the weekly regimen in terms of quality of life. The primary aim of our study was to compare the effects on QoL of weekly versus 3-weekly sequential neoadjuvant docetaxel. Secondary aims were to determine the clinical and pathological responses, incidence of Breast Conserving Surgery (BCS, Disease Free Survival (DFS and Overall Survival (OS. Methods Eighty-nine patients receiving four cycles of doxorubicin and cyclophosphamide were randomised to receive twelve cycles of weekly docetaxel (33 mg/m2 or four cycles of 3-weekly docetaxel (100 mg/m2. The Functional Assessment of Cancer Therapy-Breast and psychosocial questionnaires were completed. Results At a median follow-up of 71.5 months, there was no difference in the Trial Outcome Index scores between treatment groups. During weekly docetaxel, patients experienced less constipation, nail problems, neuropathy, tiredness, distress, depressed mood, and unhappiness. There were no differences in overall clinical response (93% vs. 90%, pathological complete response (20% vs. 27%, and breast-conserving surgery (BCS rates (49% vs. 42%. Disease-free survival and overall survival were similar between treatment groups. Conclusions Weekly docetaxel is well-tolerated and has less distressing side-effects, without compromising therapeutic responses, Breast Conserving Surgery (BCS or survival outcomes in the neoadjuvant setting. Trial registration ISRCTN: ISRCTN09184069

  6. Women’s experiences and preferences regarding breast imaging after completing breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Brandzel S

    2017-02-01

    Full Text Available Susan Brandzel,1 Dori E Rosenberg,1 Dianne Johnson,1 Mary Bush,1 Karla Kerlikowske,2–5 Tracy Onega,6,7 Louise Henderson,8 Larissa Nekhlyudov,9,10 Wendy DeMartini,11 Karen J Wernli1 1Group Health Research Institute, Group Health Cooperative, Seattle, WA, 2Department of Medicine, 3Department of Epidemiology, 4Department of Biostatistics, 5Department of Veterans Affairs, University of California, San Francisco, San Francisco, CA, 6Department of Biomedical Data Science, 7Department of Epidemiology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, 8Department of Radiology, University of North Carolina, Chapel Hill, NC, 9Department of Population Medicine, Harvard Medical School, 10Department of Medicine, Brigham and Women’s Hospital, Boston, MA, 11Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA Background: After treatment for breast cancer, most women receive an annual surveillance mammography to look for subsequent breast cancers. Supplemental breast MRI is sometimes used in addition to mammography despite the lack of clinical evidence for it. Breast imaging after cancer treatment is an emotionally charged experience, an important part of survivorship care, and a topic about which limited patient information exists. We assessed women’s experiences and preferences about breast cancer surveillance imaging with the goal of determining where gaps in care and knowledge could be filled. Participants and methods: We conducted six focus groups with a convenience sample of 41 women in California, North Carolina, and New Hampshire (USA. Participants were aged 38–75 years, had experienced stage 0–III breast cancer within the previous 5 years, and had completed initial treatment. We used inductive thematic analysis to identify key themes from verbatim transcripts. Results: Women reported various types and frequencies of surveillance imaging and a range of surveillance imaging

  7. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Pei-Hong Wu

    2013-01-01

    Image-guided high-intensity focused ultrasound (HIFU) has been used for more than ten years,primarily in the treatment of liver and prostate cancers.HIFU has the advantages of precise cancer ablation and excellent protection of healthy tissue.Breast cancer is a common cancer in women.HIFU therapy,in combination with other therapies,has the potential to improve both oncologic and cosmetic outcomes for breast cancer patients by providing a curative therapy that conserves mammary shape.Currently,HIFU therapy is not commonly used in breast cancer treatment,and efforts to promote the application of HIFU is expected.In this article,we compare different image-guided models for HIFU and reviewed the status,drawbacks,and potential of HIFU therapy for breast cancer.

  8. Five-year results of a prospective case series of accelerated hypofractionated whole breast radiation with concomitant boost to the surgical bed after conserving surgery for early breast cancer.

    Science.gov (United States)

    Cante, Domenico; Franco, Pierfrancesco; Sciacero, Piera; Girelli, Giuseppe; Marra, Anna Maria; Pasquino, Massimo; Russo, Giuliana; Borca, Valeria Casanova; Mondini, Guido; Paino, Ovidio; Barmasse, Roberto; Tofani, Santi; Numico, Gianmauro; La Porta, Maria Rosa; Ricardi, Umberto

    2013-06-01

    Accelerated hypofractionation (HF) using larger dose per fraction, delivered in fewer fractions over a shorter overall treatment time, is presently a consistent possibility for adjuvant whole breast radiation (WBRT) after breast-conserving surgery for early breast cancer (EBC). Between 2005 and 2008, we submitted 375 consecutive patients to accelerated hypofractionated WBRT after breast-conserving surgery for EBC. The basic course of radiation consisted of 45 Gy in 20 fractions over 4 weeks to the whole breast (2.25 Gy daily) with an additional daily concomitant boost of 0.25 Gy up to 50 Gy to the surgical bed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) and local control (LC) were assessed. Late toxicity was scored according to the CTCAE v3.0; acute toxicity using the RTOG/EORTC toxicity scale. Cosmesis was assessed comparing treated and untreated breast. Quality of life (QoL) was determined using EORTC QLQ-C30/QLQ-BR23 questionnaires. With a median follow-up of 60 months (range 42-88), 5 years OS, CSS, DFS and LC were 97.6, 99.4, 96.6 and 100 %, respectively. Late skin and subcutaneous toxicity was generally mild, with few events > grade 2 observed. Cosmetic results were excellent in 75.7 % of patients, good in 20 % and fair in 4.3 %. QoL, assessed both through QLQ-C30/QLQ-BR23, was generally favorable, within the functioning and symptoms domains. Our study is another proof of principle that HF WBRT with a concurrent boost dose to the surgical cavity represents a safe and effective postoperative treatment modality with excellent local control and survival, consistent cosmetic results and mild toxicity.

  9. Conservative compensatory Angle Class III malocclusion treatment

    Directory of Open Access Journals (Sweden)

    Marcio Costa Sobral

    2012-12-01

    Full Text Available INTRODUCTION: Angle's Class III malocclusion is a dental discrepancy in a sagittal view that may appear or not with an important skeletal discrepancy. Facial esthetics may be affected by this skeletal discrepancy and it is one of the most common complaints of patients who seek orthodontic treatment. Class III treatment, in adults, may be done by compensatory tooth movement, in simple cases, or through an association between orthodontics and orthognathic surgery, in more severe cases. OBJECTIVE: This article describes a non-extraction compensatory Class III treatment case, applying the Tweed-Merrifield mechanical principles with headgear (J-Hook in the mandibular arch. This case was presented at the V Brazilian Association of Orthodontics and Dentofacial Orthopedics (ABOR Meeting, it was evaluated by members of Brazilian Board of Orthodontics and obtained third place in the general classification.INTRODUÇÃO: a má oclusão de Classe III se caracteriza por uma desarmonia dentária anteroposterior, podendo estar ou não acompanhada por discrepâncias esqueléticas. A estética facial pode se apresentar comprometida, em maior ou menor grau, a depender da magnitude da discrepância, constituindo um dos principais fatores motivadores da procura por tratamento ortodôntico. O tratamento da Classe III em pacientes adultos pode ser realizado mediante compensação dentária, nos casos mais simples, ou, em situações mais severas, mediante a associação entre Ortodontia e Cirurgia Ortognática. OBJETIVO: o presente artigo objetiva relatar um caso clínico caracterizado por uma má oclusão de Classe III de Angle, tratado de forma compensatória, com extração dos terceiros molares inferiores, mediante a utilização de aparelhagem extrabucal na arcada inferior (J-hook, aplicando-se princípios da técnica de Tweed-Merrifield. Esse caso foi apresentado no 5º Congresso da Associação Brasileira de Ortodontia e Ortopedia Facial (ABOR, na categoria

  10. Hemangiosarcoma after breast-conserving therapy of breast cancer. Report of four cases with molecular genetic diagnosis and literature review; Haemangiosarkom nach brusterhaltender Therapie beim Mammakarzinom. Vier Fallbeispiele mit molekulargenetischer Diagnostik und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Nestle-Kraemling, Carolin [Universitaetsklinikum, Duesseldorf (Germany). Frauenklinik; Boelke, Edwin; Budach, Wilfried [Universitaetsklinikum Duesseldorf (DE). Klinik und Poliklinik fuer Strahlentherapie und radiologische Onkologie] (and others)

    2011-10-15

    Hemangiosarcomas of the breast represent a rare disease of the breast mainly occurring as secondary neoplasias with a latency of 5-10 years after primary treatment of breast cancer and are associated with an unfavourable prognosis. Radiation therapy, which is integrated within the concept of breast conserving therapy ranks as the main risk factor. In this report we describe the clinical course of 4 patients including their molecular genetic pattern and give a summary of the actual literature. Hemangiosarcomas occur as a secondary neoplasm with a latency of 5-10 years after primary treatment of breast cancer and have an unfavorable prognosis. A genetic predisposition is assumed, but we could not find a significant role of tumor suppressor genes BRCA1, BRCA2 or p53 in our patients. Due to limited data available for these tumors, recommendations for therapy include radical tumor resection achieving wide free margins and inconsistent regimens of chemo- and/or immunetherapy modalities. In the majority these are based on systemic therapy regimens for other cutaneous sarcomas, such as Kaposi's sarcoma. Efforts should be taken for a nation-wide systematic registration of all cases of post-irradiation hemangiosarcomas.

  11. Giant mid-esophageal diverticulum. Conservative treatment of postoperative leakage.

    Science.gov (United States)

    Dallatomasina, S; Casaccia, M; Chessa, M; Serrano, J; Nardi, I; Troilo, B; Miggino, M; Valente, U

    2009-01-01

    Mid-esophageal diverticula are rare entities. Only symptomatic patients usually receive surgical treatment. Esophageal leakage is one of the most common complications after these procedures. Though in literature, operative management is the preferred treatment for esophageal fistula, conservative approach is described in case of small leaks. We report a case of an operated giant mid-esophageal diverticulum complicated with an esophageal fistula. The patient underwent a surgical treatment and recovered completely.

  12. Late effects of breast cancer treatment and potentials for rehabilitation

    Energy Technology Data Exchange (ETDEWEB)

    Ewertz, Marianne (Dept. of Oncology, Odense Univ. Hospital, Odense (Denmark)); Bonde Jensen, Anders (Inst. of Clinical Research, Univ. of Southern Denmark (Denmark))

    2011-02-15

    Background. Breast cancer is the most frequent malignant disease among women world wide. Survival has been improving leading to an increasing number of breast cancer survivors, in the US estimated to about 2.6 million. Material and methods. The literature was reviewed with focus on data from the Nordic countries. Results. Local therapies such as breast cancer surgery and radiotherapy may cause persistent pain in the breast area, arm, and shoulder reported by 30-50% of patients after three to five years, lymphedema in 15-25% of patients, and restrictions of arm and shoulder movement in 35%. Physiotherapy is the standard treatment for the latter while no pain intervention trials have been published. Chemotherapy may cause infertility and premature menopause, resulting in vasomotor symptoms, sexual dysfunction, and osteoporosis, which are similar to the side effects of endocrine treatment in postmenopausal women. Awareness of cardiotoxicity is needed since anthracyclines, trastuzumab, and radiotherapy can damage the heart. Breast cancer survivors have an increased risk of a major depression and far from all receive adequate anti-depressive treatment. Other psychological symptoms include fear of recurrence, sleep disturbances, cognitive problems, fatigue, and sexual problems. Discussion. To improve rehabilitation, specific goals have to be formulated into national guidelines and high priority directed towards research into developing and testing new interventions for alleviating symptoms and side effects experienced by breast cancer survivors

  13. Closed internal degloving injury with conservative treatment.

    Science.gov (United States)

    Lin, Hsing-Lin; Lee, Wei-Che; Kuo, Liang-Chi; Chen, Chao-Wen

    2008-02-01

    In the emergency department, we frequently manage patients with multiple contusions and bruise over the trunk without severe injuries. Emergency department discharge is a common option for these patients, and we may neglect the existence of closed internal degloving injury, which is a soft tissue injury with pelvic trauma, combining the subcutaneous tissue torn away from the underlying fascia followed by a cavity being filled with hematoma and liquefied fat created in the next few days (Harefuah 2006;145:111-3:66, J Trauma 1997;42:1046). We report the unusual occurrence of this entity in an 18-year-old man. He encountered a scooter accident and experienced a few days of hospitalization because of thoracispinal (T10 and T11) process fracture. He was discharged, but a fluctuating mass developed at the lumbar area 10 days later. The comprehensive survey excluded the cerebrospinal fluid leakage associated with spinal fracture, and internal degloving injury was diagnosed. Percutaneous drainage with compressive bondage was aggressively used. Even though the treatment course was time consuming, the lesion eventually disappeared 10 months after his first visit.

  14. [Indications and counter-indications for non-mutilating treatment of breast cancer].

    Science.gov (United States)

    Cosendey, B A

    1992-05-01

    Progress achieved in understanding the biology of breast cancer, as well as the desire of patients to avoid major mutilation, have resulted in ever increasing indications for breast-conserving surgery. Such indications depend on two considerations: the medical consideration which seeks to achieve the same rate of control of loco-regional disease as mutilating surgery and the aesthetic consideration, permitting a satisfactory result on a functional plane. Nevertheless, a case of breast cancer appearing unifocal under clinical examination and radiology is frequently accompanied by tumoral intramammal dissemination, the evaluation of which after histological examination varies according to the author. Should the coexistence of cancer in situ and invasive cancer radically modify the choice of therapy? It seems absurd to accept non-mutilating surgery for invasive cancer and to choose mutilating treatment for certain cases of cancer in situ. Although there appears to be only relative counter-indication for conservatory treatment in cases of advanced cancer (T3N1b and above), it is not recommended in the presence of several types of histology and in certain specific circumstances when associated with cancer in situ. A review of the literature will enable us to cover in detail other risk factors and to enumerate indications and counter-indications for non-mutilating treatment of breast cancer.

  15. Treatment outcome in patients with triple negative early stage breast cancers compared with other molecular subtypes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ja Young; Chang, Sei Kyung; Lee, Bo Mi; Shin, Hyun Soo [Dept. of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of); Park, Heily [Dept. of Radiation Oncology, Presbyterian Hospital, Jeonju (Korea, Republic of)

    2012-09-15

    To determine whether triple negative (TN) early stage breast cancers have poorer survival rates compared with other molecular types. Between August 2000 and July 2006, patients diagnosed with stage I, II early stage breast cancers, in whom all three markers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor [HER]-2) were available and treated with modified radical mastectomy or breast conserving surgery followed by radiotherapy, were retrospectively reviewed. Of 446 patients, 94 (21.1%) were classified as TN, 57 (12.8%) as HER-2 type, and 295 (66.1%) as luminal. TN was more frequently associated with young patients younger than 35 years old (p = 0.002), higher histologic grade (p < 0.0001), and nuclear (p < 0.0001). The median follow-up period was 78 months (range, 4 to 130 months). There were 9 local relapses (2.0%), 15 nodal (3.4%), 40 distant metastases (9.0%), and 33 deaths (7.4%) for all patients. The rates of 5-year OS, DFS, LFS, and DMFS for all patients were 95.5%, 89.9%, 95.4%, and 91.7%, respectively. There were no significant differences in OS, DFS, LFS, and DMFS between triple negative and other subtypes (p > 0.05). We found that patients with TN early stage breast cancers had no difference in survival rates compared with other molecular subtypes. Prospective study in homogeneous treatment group will need for a prognosis of TN early stage breast cancer.

  16. Accelerated partial breast irradiation

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Whole breast radiotherapy afier tumor lumpectomy is based on the premise that that the breast cancer recurrence rate is reduced through the elimination of residual cancer foci in the remaining tissue immediately adjacent to the lumpectomy site and occult multicentric areas of in situ or infiltrating cancer in remote areas of the breast. The relevance of remote foci to ipsilateral breast failure rates after breast conserving treatment is debatable, because 65%~100% of recurrences develop in the same quadrant as the initial tumor. This has led several investigators to question whether radiotherapy must be administered to the entire breast.

  17. Oral health after breast cancer treatment in postmenopausal women

    Directory of Open Access Journals (Sweden)

    Juliana Amódio

    2014-12-01

    Full Text Available OBJECTIVE: Oral health can affect a patient’s general health and quality of life. Given the increase in breast cancer survival rates, investigations of factors influencing the quality of life of survivors have gained importance. Therefore, the objective of our study was to characterize oral health in postmenopausal breast cancer survivors. METHODS: We conducted a matched case-control study. Forty-eight women who survived breast cancer (age 62.1±9.1 years and 48 healthy controls (age 61.8±8.6 years were included. For each case and control, a complete oral evaluation chart was completed. RESULTS: The prevalence of chronic periodontal disease was 98% in breast cancer survivors and 87% in controls. The breast cancer survivors had a median of 16 remaining teeth, whereas controls had a median of 22 remaining teeth (p = 0.03. The percentage of sites with gingival bleeding was 16.05% (0-100% in breast cancer survivors and 0% (0-72% in controls (p = 0.04. CONCLUSION: Chronic periodontal disease and tooth loss were highly prevalent in postmenopausal breast cancer survivors. To improve survivors’ quality of life, a preventive oral health evaluation should be available prior to cancer treatment.

  18. Profile of palbociclib in the treatment of metastatic breast cancer.

    Science.gov (United States)

    Ehab, Moataz; Elbaz, Mohamad

    2016-01-01

    Breast cancer is the most common cancer diagnosed in women. Each year, thousands die either because of disease progression or failure of treatment. Breast cancer is classified into different subtypes based on the molecular expression of estrogen receptor (ER), progesterone receptor, and/or human epidermal growth factor receptor 2 (HER2). These receptors represent important therapeutic targets either through monoclonal antibodies or through small-molecule inhibitors directed toward them. However, up to 40% of patients develop either a primary or a secondary resistance to the current treatments. Therefore, there is an urgent need for investigating new targets in order to overcome the resistance and/or enhance the current therapies. Cell cycle is altered in many human cancers, especially in breast cancer. Cyclin-dependent kinases (CDKs), especially CDK4 and CDK6, play a pivotal role in cell cycle progression that makes them potential targets for new promising therapies. CDK inhibition has shown strong antitumor activities, ranging from cytostatic antiproliferative effects to synergistic effects in combination with other antitumor drugs. In order to overcome the drawbacks of the first-generation CDK inhibitors, recently, new CDK inhibitors have emerged that are more selective to CDK4 and CDK6 such as palbociclib, which is the most advanced CDK4/6 inhibitor in trials. In preclinical studies, palbociclib has shown a very promising antitumor activity, especially against ERα+ breast cancer subtype. Palbociclib has gained world attention, and US the Food and Drug Administration has accelerated its approval for first-line treatment in combination with letrozole for the first-line systematic treatment of postmenopausal women with ERα+/HER2- locally advanced or metastatic breast cancer. In this review, we discuss the potential role of CDK inhibition in breast cancer treatment, and focus on palbociclib progress from preclinical studies to clinical trials with mentioning the

  19. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: A systematic review

    NARCIS (Netherlands)

    P.A.J. Luijsterburg (Pim); A.P. Verhagen (Arianne); R.W.J.G. Ostelo (Raymond); T.A.G. van Os (Ton); W.C. Peul (Wilco); B.W. Koes (Bart)

    2007-01-01

    textabstractPatients with a lumbosacral radicular syndrome are mostly treated conservatively first. The effect of the conservative treatments remains controversial. To assess the effectiveness of conservative treatments of the lumbosacral radicular syndrome (sciatica). Relevant electronic databases

  20. Breast cancer treatment and sexual dysfunction: Moroccan women's perception

    Directory of Open Access Journals (Sweden)

    Ismaili Nabil

    2011-06-01

    Full Text Available Abstract Background This exploratory prospective study evaluated women's responses to questions that asked them to describe how their body image and sexual functioning had changed since their breast cancer diagnosis to treatment. Methods A questionnaire concerning body image scale and various sexual problems experienced after diagnosis and treatment was anonymously completed by 120 women in the outpatient clinic of our hospital's Division of medical Oncology. To be eligible, subjects had to be sexually active and had histology proven breast cancer. They also had to have received treatment for breast cancer. Results 100% of participants have never spoken with their doctor about this subject. 84% of the participants continued sexual activity after treatment, but there was an increase in the incidence of sexual functioning problems which resulted in a slight reduction in the quality of their sex lives. 65% of the women experienced dyspareunia followed by lubrication difficulties (54% and the absence or reduction of sexual desire (48% and 64%, respectively while, 37% had lack of satisfaction (37%. Female orgasmic disorder and brief intercourse and arousal were reported respectively by 40% and 38% of the subjects. The sexual dysfunctions were absent before diagnosis and management of breast cancer in 91.5% subjects and of these 100% subjects complained of a deterioration of the symptomatology after the various treatments. 90% of the dysfunctions were observed after chemotherapy, 9% after surgery and 3% after radiotherapy; none of the subjects indicated the onset of dysfunctions to have been associated with hormonotherapy. 100% expressed not having received sufficient information about how the disease and treatment (including surgery might affect their sexual life. Conclusion Breast cancer and its treatment may result in significant difficulties with sexual functioning and sexual life. Addressing these problems is essential to improve the quality of

  1. Cost of treatment for breast cancer in central Vietnam

    Directory of Open Access Journals (Sweden)

    Nguyen Hoang Lan

    2013-02-01

    Full Text Available Background: In recent years, cases of breast cancer have been on the rise in Vietnam. To date, there has been no study on the financial burden of the disease. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam. Methods: Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Cost analysis was conducted from the health care payers’ perspective. Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. For each cost category, the mean, standard deviation, median, and cost range were estimated. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. Results: The total direct medical cost for a 5-year treatment course for breast cancer in central Vietnam was estimated at $975 per patient (range: $11.7–$3,955. The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%. Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter. The absence of health insurance was the main factor limiting service uptake. Conclusion: From the health care payers’ perspective, the Government subsidization of public hospital charges lowered the direct medical costs of a 5-year treatment course for primary breast cancer in central Vietnam. However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance.

  2. Clinicopathological classification and individualized treatment of breast cancer

    Institute of Scientific and Technical Information of China (English)

    HU Hui; LIU Yin-hua; XU Ling; ZHAO Jian-xin; DUAN Xue-ning; YE Jing-ming; LI Ting

    2013-01-01

    Background The clinicopathological classification was proposed in the St.Gallen Consensus Report 2011.We conducted a retrospective analysis of breast cancer subtypes,tumor-nodal-metastatic (TNM) staging,and histopathological grade to investigate the value of these parameters in the treatment strategies of invasive breast cancer.Methods A retrospective analysis of breast cancer subtypes,TNM staging,and histopathological grading of 213 cases has been performed by the methods recommended in the St.Gallen International Expert Consensus Report 2011.The estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor-2 (HER2),and Ki-67 of 213 tumor samples have been investigated by immunohistochemistry according to methods for classifying breast cancer subtypes proposed in the St.Gallen Consensus Report 2011.Results The luminal A subtype was found in 53 patients (24.9%),the luminal B subtype was found in 112 patients (52.6%),the HER2-positive subtype was found in 22 patients (10.3%),and the triple-negative subtype was found in 26 patients (12%).Histopathological grade and TNM staging differed significantly among the four subtypes of breast cancer (P<0.001).Conclusion It is important to consider TNM staging and histopathological grading in the treatment strategies of breast cancer based on the current clinicopathological classification methods.

  3. Systemic Treatment Approaches in Breast Cancer

    NARCIS (Netherlands)

    M. Bontenbal (Marijke)

    1997-01-01

    textabstractBreast cancer is the most conmlon malignant tumor among women, with an estimated 135,000 new cases and 58,000 recorded deaths per year in the Europeau Community in 1990. With respect to the Netherlands, the most recent data of The Netherlands Cancer Registry show an incidence of nearly 1

  4. Pregnancy after treatment of breast cancer--a population-based study on behalf of Danish Breast Cancer Cooperative Group

    DEFF Research Database (Denmark)

    Kroman, N.; Jensen, M.B.; Wohlfahrt, J.;

    2008-01-01

    at diagnosis, tumour size, nodal status, or pregnancy history before diagnosis of breast cancer. Neither spontaneous abortions nor induced abortions subsequent to breast cancer treatment had a negative impact on prognosis. CONCLUSION: In line with our previous study, but based on more than twice the patient...... material, we found no evidence that a pregnancy after treatment of breast cancer has a negative influence the prognosis Udgivelsesdato: 2008......BACKGROUND: Estrogen is an established growth factor in breast cancer and it has been hypothesized that pregnancy associated estrogens may increase the risk of recurrence of breast cancer. In 1997 we published a population-based Danish study indicating no negative prognostic effect of pregnancy...

  5. Implantable magnetic nanocomposites for the localized treatment of breast cancer

    Science.gov (United States)

    Kan-Dapaah, Kwabena; Rahbar, Nima; Soboyejo, Wole

    2014-12-01

    This paper explores the potential of implantable magnetic nanocomposites for the localized treatment of breast cancer via hyperthermia. Magnetite (Fe3O4)-reinforced polydimethylsiloxane composites were fabricated and characterized to determine their structural, magnetic, and thermal properties. The thermal properties and degree of optimization were shown to be strongly dependent on material properties of magnetic nanoparticles (MNPs). The in-vivo temperature profiles and thermal doses were investigated by the use of a 3D finite element method (FEM) model to simulate the heating of breast tissue. Heat generation was calculated using the linear response theory model. The 3D FEM model was used to investigate the effects of MNP volume fraction, nanocomposite geometry, and treatment parameters on thermal profiles. The implications of the results were then discussed for the development of implantable devices for the localized treatment of breast cancer.

  6. Conservative treatment of thumb base osteoarthritis : A systematic review

    NARCIS (Netherlands)

    Spaans, Anne J.; Van Minnen, L. Paul; Kon, Moshe; Schuurman, Arnold H.; Schreuders, A. R.; Vermeulen, Guus M.

    2015-01-01

    Purpose To provide a systematic review of randomized controlled trials regarding the conservative treatment of thumb base osteoarthritis (OA). Methods A systematic literature search was conducted in the electronic bibliographic databases Medline (Pubmed) and Embase (both starting year to May 2014) u

  7. Defining central themes in breast cancer biology by differential proteomics: conserved regulation of cell spreading and focal adhesion kinase.

    Science.gov (United States)

    Bateman, Nicholas W; Sun, Mai; Hood, Brian L; Flint, Melanie S; Conrads, Thomas P

    2010-10-01

    Breast cancer is a highly heterogeneous disease, an observation that underscores the importance of elucidating conserved molecular characteristics, such as gene and protein expression, across breast cancer cell types toward providing a greater understanding of context-specific features central to this disease. Motivated by the goal of defining central biological themes across breast cancer cell subtypes, we conducted a global proteomic analysis of three breast cancer cell lines, MCF7, SK-BR-3, and MDA-MB-231, and compared these to a model of nontransformed mammary cells (MCF10A). Our results demonstrate modulation of proteins localized to the extracellular matrix, plasma membrane, and nucleus, along with coordinate decreases in proteins that regulate "cell spreading," a cellular event previously shown to be dysregulated in transformed cells. Protein interaction network analysis revealed the clustering of focal adhesion kinase (FAK), a fundamental regulator of cell spreading, with several proteins identified as mutually, differentially abundant across breast cancer cell lines that impact expression and activity of FAK, such as neprilysin and keratin 19. These analyses provide insights into conservation of protein expression across breast cancer cell subtypes, a subset of which warrants further investigation for their roles in the regulation of cell spreading and FAK in breast cancer.

  8. A conservative treatment for ingrown toenails in children.

    Science.gov (United States)

    Lazar, L; Erez, I; Katz, S

    1999-01-01

    Ingrowing nails are not uncommon in children, and even so receive little attention in the pediatric surgery literature. The purpose of the present study was to demonstrate our modification of the conservative treatment of ingrowing nails. Our technique of local treatment combined with patient education for better foot and toe care was successfully used and well tolerated by 19 out of 20 young patients with ingrown toenails.

  9. SU-E-T-588: Characterization and Clinical Validation of the Varian Pivotal™ Treatment Solution for Prone Breast Care

    Energy Technology Data Exchange (ETDEWEB)

    Dewyngaert, K; Jozsef, G; Formenti, S [NY University Medical Center, NY, NY (United States)

    2014-06-01

    Purpose: To report on the clinical validation of the Varian Pivotal™ Treatment Solution for Prone Breast Care: a platform for prone breast radiation therapy. Methods: Patients treated using Breast Conserving Radiation Therapy may benefit from treatment in the prone position with the breast tissue falling freely away from the body. This geometry allows the breast tissue to be treated while avoiding the lung and heart tissue. Eighteen patients simulated and treated using the Varian Medical Systems Pivotal™ Treatment Solution for Prone Breast Care were monitored over the course of treatment for positioning integrity and reproducibility. As this carbon-fiber platform actually replaces a portion of the couch top, indexing is inherent to its design. Patients were positioned on the couch and aligned using fiducial markers and lateral SSD to the breast fiducial point. The daily couch coordinates then serves as indicators for positioning variability with this system. Results: The variations in couch vertical, longitudinal and lateral positions were centered on a mean value of zero with standard deviations of 0.44cm, 0.75cm and 0.79cm respectively. Other factors explored were variations in distance of mid-sternum to table edge and patient rotation into the opening. The median rotation of the chest wall was found to be 11.5 degrees at CT-Simulation with a median distance of 2.5cm from midsternum to support opening. Patient rotation was not associated with either breast size or distance from edge of platform. Conclusion: The Pivotal™ Treatment solution consists of a couch top that replaces the standard top and as such is open from beneath without obstruction. This is a distinction from all other solutions which rely on a platform positioned above and indexed to the treatment couch. We found the reproducibility to be consistent with our historical measures while offering benefits of an integrated solution as stated above. supported by Professional Services Agreeement with

  10. Timing of radiotherapy in breast-conserving therapy: a large prospective cohort study of node-negative breast cancer patients without adjuvant systemic therapy

    NARCIS (Netherlands)

    Jobsen, J.J.; Palen, van der J.; Baum, M.; Brinkhuis, M.; Struikmans, H.

    2013-01-01

    Background: To investigate the issue of timing of radiation therapy (RT) after lumpectomy in relation to recurrences and outcome. Methods: Analysis was done on 1107 breast-conserving therapies (BCT) with 1070 women, all without lymph node metastasis and without any adjuvant systemic therapy. Timing

  11. Detection of multiple clustered microcalcifications by mammography following breast-conserving surgery

    Institute of Scientific and Technical Information of China (English)

    LI Juan; BAO Min; XU Hui-mian; WANG Zhen-ning

    2010-01-01

    @@ Breast cancer is the most common cause of cancer related death among women around the world.~1 Each year, 1.1 million more women are diagnosed with it, representing more than 10% of all new cancer cases annually. With more than 410 000 deaths each year, the disease accounts for more than 1.6% of all female deaths worldwide.~(2'3) Prompt diagnosis and appropriate treatment may increase life expectancy and recovery rate.

  12. Ductal in situ carcinoma: is it ethical to consider the breast conserving?; Carcinome canalaire in situ: est-il ethique de considerer le traitement conservateur comme un standard?

    Energy Technology Data Exchange (ETDEWEB)

    Barillot, I. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Dept. de Radiotherapie, 21 - Dijon (France); Cutuli, B. [Polyclinique de Courlancy, Service de Radiotherapie-Cancerologie, 51 - Reims (France); Arnould, L. [Centre de Lutte Contre le Cancer Georges-Francois-Leclerc, Service d' Anatomie Pathologique, 21 - Dijon (France)

    2004-02-01

    The increasing incidence of DCIS during the past 20 years needs a continuous evaluation of the treatment strategies and a multidisciplinary decision process. The management of the DCIS remains a challenging issue in 2003. Mastectomy should still be considered as the reference treatment which is able to guarantee cure in almost all cases, whereas breast conserving surgery followed by radiation therapy is associated with 7-10% of local recurrence. However, the increasing knowledge of the predictive factors of the local recurrence allows to propose a conservative treatment strategy to a large amount of patients, without negative impact on their prognosis. This review presents the arguments that permit to justify, the reasoned choice of the different therapeutic options according to the clinico-pathological situations. (author)

  13. Recurrent breast cancer: presentation, diagnosis, and treatment.

    Science.gov (United States)

    Jardines, L; Callans, L S; Torosian, M H

    1993-10-01

    Patients must be followed up closely after primary therapy for invasive breast cancer so that locoregional recurrences can be detected early. Once a recurrence has been detected, a thorough evaluation is indicated to exclude distant metastatic disease. If none is found, the patient may be a candidate for aggressive surgical intervention to render the patient disease-free. If distant disease is found, certain sites, such as the CNS or long bones, may warrant aggressive therapy because failure to treat these sites may lead to excessive morbidity. In most situations, patients with distant disease are treated with palliative measures. In selected instances, however, patients with metastatic breast cancer are candidates for aggressive intervention, including pulmonary or liver resection or high-dose chemotherapy in combination with autologous bone marrow transplantation, to rid the patient of the disease.

  14. Lipoplatin Treatment in Lung and Breast Cancer

    Directory of Open Access Journals (Sweden)

    Manuela Fantini

    2011-01-01

    Lipoplatin is a new liposomal cisplatin formulation which seems to have these characteristics. Lipoplatin was shown to be effective in NSCLC both in phase 2 and phase 3 trials, with the same response rate of Cisplatin, a comparable overall survival but less toxicity. A new protocol aiming to elucidate the double capacity of Lipoplatin to act as a chemotherapeutic and angiogenetic agent in triple-negative breast cancer patients is upcoming.

  15. Advancements of antisense oligonucleotides in treatment of breast cancer

    Institute of Scientific and Technical Information of China (English)

    YANGShuan-Ping; SONGSan-Tai; 等

    2003-01-01

    Breast cancer is one kind of multi-gene related malignancy.Overexpression of some oncogenes such as HER-2(c-erbB-2,Neu),bcl-2/bcl-xL,protein kinase A(PKA),and transferrin receptor gene(TfR gene),etc significantly affect the prognosis of breast cancer.It was shown that specific suppression of the overexpressed genes above resulted in the improvement of the therapy of breast cancer.Antisense interference.one of useful tools for inhibiting the overexpression of specific oncogenes,was involved in the therapy of breast cancer in recent years. Data indicated that antisense oligonucleotides(ON)could inhibit specially the expression of the target genes on mRNA or protein levels in most of cases;some ON candidates showed encouraging therapeutic effects in vitro and in vivo on breast cancer cell lines or xenografts.Furthermore,the combination use of the antisense ON and normal chemotherapeutic agents indicated synergistic antitumor effects,which was probably the best utilization of antisense ON in the treatment of breast cancer.

  16. Comparison of health utility weights among elderly patients receiving breast-conserving surgery plus hormonal therapy with or without radiotherapy

    Science.gov (United States)

    Ali, Askal Ayalew; Xiao, Hong; Tawk, Rima; Campbell, Ellen; Semykina, Anastasia; Montero, Alberto J.; Diaby, Vakaramoko

    2017-01-01

    Background The selection of the most appropriate treatment combinations requires the balancing of benefits and harms of these treatment options as well as the patients’ preferences for the resulting outcomes. Objective This research aimed at estimating and comparing the utility weights between elderly women with early stage hormone receptor positive (HR+) breast cancer receiving a combination of radiotherapy and hormonal therapy after breast conserving surgery (BCS) and those receiving a combination of BCS and hormonal therapy. Methods The Surveillance, Epidemiology, and End Results (SEER) linked with Medicare Health Outcomes Survey (MHOS) was used as the data source. Health utility weights were derived from the VR-12 health-related quality of life instrument using a mapping algorithm. Descriptive statistics of the sample were provided. Two sample t-tests were performed to determine potential differences in mean health utility weights between the two groups after propensity score matching. Results The average age at diagnosis was 72 vs. 76 years for the treated and the untreated groups, respectively. The results showed an inverse relationship between the receipt of radiotherapy and age. Patients who received radiotherapy had, on average, a higher health utility weight (0.70; SD = 0.123) compared with those who did not receive radiotherapy (0.676; SD = 0.130). Only treated patients who had more than two comorbid conditions had significantly higher health utility weights compared with patients who were not treated. Conclusions The mean health utility weights estimated for the radiotherapy and no radiotherapy groups can be used to inform a comparative cost-effectiveness analysis of the treatment options. However, the results of this study may not be generalizable to those who are outside a managed care plan because MHOS data is collected on managed care beneficiaries. PMID:27819160

  17. Comparision of Breast-conserving Surgery and Modified Radical Mastectomy for Early Breast Cancer%早期乳腺癌保乳术与根治术的临床对照研究

    Institute of Scientific and Technical Information of China (English)

    包召玉; 王坤; 周雷; 倪进斌

    2013-01-01

    Objective To compare breast-conserving surgery and modified radical mastectomy for early breast cancer prognosis. Methods Clinically relevant information of menstrual reserved breast surgical treatment of 50 patients with early breast cancer patients in Department of Surgical Oncology of Anhui Suzhou Municipal Hospital from June 2005 to June 2011 was compared with modified radical mastectomy with the same period in 50 patients, a retrospective analysis was conducted. Results Breast-conserving surgery did not increase in patients with local recurrence rate, metastasis rate, mortality and survival rates with the same period in the implementation of the modified radical mastectomy fairly, and kept well in patients with breast appearance. Conclusion To fully grasp the premise of breast-conserving treatment indications, standardize the surgical approach, formal postoperative adjuvant therapy,radiotherapy,chemotherapy and endocrine therapy,can not only treat tumor,but also significantly improve the quality of life of patients, the treatment was the ideal method of early breast cancer. Practice had proved that for early stage breast cancer, breast-conserving surgery was a surgical procedure-kind of practical and worth promoting.%目的 比较保留乳房手术与改良根治术对早期乳腺癌预后的影响.方法 回顾性分析安徽宿州市立医院肿瘤外科2005年6月-2011年6月经保留乳腺手术治疗的50例早期乳腺癌患者临床相关资料,并与同期在该科行改良根治术50例早期乳腺癌患者进行临床对比分析.结果 保乳手术治疗不仅没有增加患者的局部复发率、转移率、病死率,且生存率与同期实施的改良根治术相当,并且保持了患者良好的乳房外形.结论 在充分严格掌握保乳治疗适应证的前提下,规范手术方式,术后正规的辅助治疗如放化疗及内分泌治疗,不仅可治疗肿瘤,而且能明显提高患者的生活质量,是一种治疗早期乳腺癌

  18. The Treatment of Breast Cancer Using Liposome Technology

    Directory of Open Access Journals (Sweden)

    Sarah Brown

    2012-01-01

    Full Text Available Liposome-based chemotherapeutics used in the treatment of breast cancer can in principle enhance the therapeutic index of otherwise unencapsulated anticancer drugs. This is partially attributed to the fact that encapsulation of cytotoxic agents within liposomes allows for increased concentrations of the drug to be delivered to the tumor site. In addition, the presence of the phospholipid bilayer prevents the encapsulated active form of the drug from being broken down in the body prior to reaching tumor tissue and also serves to minimize exposure of the drug to healthy sensitive tissue. While clinically approved liposome-based chemotherapeutics such as Doxil have proven to be quite effective in the treatment of breast cancer, significant challenges remain involving poor drug transfer between the liposome and cancerous cells. In this review, we discuss the recent advancements made in the development of liposome-based chemotherapeutics with respect to improved drug transfer for use in breast cancer therapy.

  19. Arm lymphedema after treatment of breast cancer: Etiology, diagnosis, and management

    Directory of Open Access Journals (Sweden)

    Ashish Goel

    2015-01-01

    Full Text Available Breast cancer related lymphedema (BCRL is a chronic debilitating condition seen after treatment of breast cancer. The overall incidence varies from 20% to 56% in all patients treated for breast cancer. Every patient is at a lifelong risk for BCRL and the risk goes on increasing as the followup period increases. Locoregional treatment including surgery or radiotherapy is the most common risk factor for development of arm lymphedema. There are two phases of arm lymphedema. There is increased fluid accumulation in the fluid phase of lymphedema which later on goes into the solid phase where fat and fibrotic tissue is deposited in the subcutaneous tissue. The treatment of BCRL is a challenge both for the patient and the treating surgeon and it needs multidisciplinary team work to be successful. Non-surgical treatment modalities include complete decongestive therapy (CDT and pneumatic compression therapy. Surgery for BCRL is usually undertaken as a salvage modality after failure of conservative approaches. The surgical spectrum for BCRL varies from extensive excisional operations which were commonly done in the past to newer methods like suction assisted protein lipectomy, lymphatic reconstruction and vascular lymph node transfer (VLNT using super-microsurgical techniques. There is no consensus regarding the preference of one procedure over other due to lack of randomised control trials. It is however suggested to do lymphovenous anastomosis and complete decongestive therapy for early cases in fluid phase; while patients in the solid phase may be treated with a combination of liposuction with CDT or VLNT alone.

  20. Profile of palbociclib in the treatment of metastatic breast cancer

    Directory of Open Access Journals (Sweden)

    Ehab M

    2016-05-01

    Full Text Available Moataz Ehab,1 Mohamad Elbaz2,31Department of Pharmacy Practice, 2Department of Pharmacology, Pharmacy School, Helwan University, Egypt; 3Department of Pathology, The Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USAAbstract: Breast cancer is the most common cancer diagnosed in women. Each year, thousands die either because of disease progression or failure of treatment. Breast cancer is classified into different subtypes based on the molecular expression of estrogen receptor (ER, progesterone receptor, and/or human epidermal growth factor receptor 2 (HER2. These receptors represent important therapeutic targets either through monoclonal antibodies or through small-molecule inhibitors directed toward them. However, up to 40% of patients develop either a primary or a secondary resistance to the current treatments. Therefore, there is an urgent need for investigating new targets in order to overcome the resistance and/or enhance the current therapies. Cell cycle is altered in many human cancers, especially in breast cancer. Cyclin-dependent kinases (CDKs, especially CDK4 and CDK6, play a pivotal role in cell cycle progression that makes them potential targets for new promising therapies. CDK inhibition has shown strong antitumor activities, ranging from cytostatic antiproliferative effects to synergistic effects in combination with other antitumor drugs. In order to overcome the drawbacks of the first-generation CDK inhibitors, recently, new CDK inhibitors have emerged that are more selective to CDK4 and CDK6 such as palbociclib, which is the most advanced CDK4/6 inhibitor in trials. In preclinical studies, palbociclib has shown a very promising antitumor activity, especially against ERα+ breast cancer subtype. Palbociclib has gained world attention, and US the Food and Drug Administration has accelerated its approval for first-line treatment in combination with letrozole for the first-line systematic

  1. High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

    Directory of Open Access Journals (Sweden)

    Hart Vern P

    2011-10-01

    Full Text Available Abstract Background In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Methods Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. Results The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each

  2. Application analysis of breast magnetic resonance imaging in occult breast cancer and breast-conserving surgery%乳腺 MRI 在隐匿性乳腺癌和保乳手术中的应用分析

    Institute of Scientific and Technical Information of China (English)

    王芹; 马行天; 石岚

    2014-01-01

    Objective: To discuss application values of breast magnetic resonance imaging (MRI) in occult breast cancer and breast-conserving surgery. Methods: Breast MRI was performed in 120 grouped patients. The examination results were analyzed and summarized. Results: In the 58 cases of occult breast cancer patients with breast MRI, 32 cases were found with breast lesions, in which 19 cases were confirmed by pathology as the original site; the diagnosis rate was 32. 7% . In the 62 cases of breast cancer being performed breast-conserving surgery with breast MRI, multiple lesions was found in 25 cases, in which 23 cases gave up breast-con-serving surgery. Conclusions: Breast MRI has a higher resolution in finding the primary lesion of occult breast cancer, and has impor-tant value in the display of breast cancers with multicentric lesions and the indication of breast-conserving surgery.%目的::探讨乳腺核磁共振成像(MRI)在隐匿性乳腺癌和保乳手术中的应用价值。方法:对120例隐匿性乳腺癌及早期患者进行 MRI 检查,对检查结果进行分析和归纳。结果:入组的58例隐匿性乳腺癌患者 MRI 检查,发现乳腺病灶32例,其中19例经病理证实为原发灶,确诊率为32.7%;入组的62例拟行保乳手术的乳腺癌患者 MRI 检查,有25例发现多中心病灶,其中23例放弃保乳手术。结论:MRI 检查对检出隐匿性乳腺癌原发灶有着有较高的分辨率,对多中心乳腺癌的显示以及明确乳腺癌的保乳适应症,有着重要的临床价值。

  3. Conservative integrated treatment of adhesive capsulitis of the shoulder

    Science.gov (United States)

    RUSSO, ADRIANO; ARRIGHI, ANNALISA; VIGNALE, LUIGI; MOLFETTA, LUIGI

    2014-01-01

    Purpose the aim of this study was to present the results of a conservative treatment for adhesive capsulitis based on an original protocol of combined pharmacological and rehabilitation treatment. Methods fifty-two patients with idiopathic adhesive capsulitis were enrolled in the present study. The treatment protocol included the use of hyaluronic acid and anaesthetic periarticular and intra-articular injections followed by a specific program of capsule and muscle stretching. Results the results of this treatment showed complete recovery of range of motion (ROM) in 50 of the 52 cases. The mean pre-treatment ROM values were: 85° for forward elevation, 75° for abduction, 25° for external rotation, and 15° for internal rotation. The post-treatment mean ROM values showed marked improvements: 175° for forward elevation, 175° for abduction, 87.5° for external rotation and 75° for internal rotation. Conclusions conservative treatment of adhesive capsulitis based on a combined pharmacological and rehabilitation approach was found to be effective in resolving pain and stiffness in 96% of the patients. Level of evidence level IV, therapeutic case series. PMID:25606536

  4. Fat grafting for alleviating persistent pain after breast cancer treatment

    DEFF Research Database (Denmark)

    Juhl, Alexander A; Karlsson, Páll; Damsgaard, Tine E

    2016-01-01

    BACKGROUND: Persistent pain is a common side effect of breast cancer treatment, affecting 24-52% of women after mastectomy. Recent studies have described analgesic effects of fat grafting in various settings. We aimed to investigate whether fat grafting had an analgesic effect on persistent pain...

  5. Treatment results in males with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pakisch, B. [Dept. of Radiotherapy, Karl Franzens Univ. of Graz (Austria); Stoeger, H. [Dept. of Clinical Oncology, Karl Franzens Univ. of Graz (Austria); Poschauko, H. [Dept. of Radiotherapy, Karl Franzens Univ. of Graz (Austria); Samonigg, H. [Dept. of Clinical Oncology, Karl Franzens Univ. of Graz (Austria); Bauernhofer, T. [Dept. of Clinical Oncology, Karl Franzens Univ. of Graz (Austria); Pojer, E. [Dept. of Clinical Oncology, Karl Franzens Univ. of Graz (Austria); Leitner, H. [Dept. of Radiotherapy, Karl Franzens Univ. of Graz (Austria); Stuecklschweiger, G. [Dept. of Radiotherapy, Karl Franzens Univ. of Graz (Austria); Peichl, K.H. [Dept. of Radiotherapy, Karl Franzens Univ. of Graz (Austria); Quehenberger, F. [Dept. of Statistics and Documentation, Karl Franzens Univ. of Graz (Austria); Hackl, A. [Dept. of Radiotherapy, Karl Franzens Univ. of Graz (Austria)

    1995-08-01

    Because cancer of the male breast is rare knowledge about its biology and behavior is essentially due to a compilation of pooled experiences. Hence, a continued report of cases appears to be important. Therefore a retrospective review of patients suffering from male breast cancer was carried out. Twenty-four evaluable cases were analyzed. Eight patients (1 patient with bilateral Stage I carcinoma was included) were in Stage I, 7 in Stage II, 2 in Stage IIIa, 4 in Stage IIIb, and 3 in Stage IV. Of 23 patients who were treated with mastectomy, 22 had modified radical mastectomy and postoperative irradiation to the chest wall as well as to the peripheral lymphatic areas in most cases. One patient underwent radical mastectomy. Another patient had an excision biopsy only, followed by irradiation. One of 24 patients received tamoxifen; another received cyclophosphamide, methotrexate, 5-fluorouracil, prednisone (CMF) regimen in an adjuvant setting. Local recurrence developed in one of 23 (4%) patients treated with mastectomy and radiation therapy to the chest wall and peripheral lymphatics. Four (17%) patients developed distant metastases. The 5-year overall survival (Kaplan-Maier) was 90% for the entire group, 100% for patients in Stage I-III disease, and 60% in Stage IV disease (P = < 0.005). As observed in former reports the stage of disease at initial presentation seems to be a parameter that significantly contributes to survival in male breast cancer patients. To what extent improved local control by adequate local therapy, such as surgery and postoperative radiotherapy, may improve overall survival remains to be discussed. (orig.)

  6. Treatment outcomes of occult breast carcinoma and prognostic analyses

    Institute of Scientific and Technical Information of China (English)

    WANG Jing; ZHANG Ye-fan; WANG Xin; WANG Jian; YANG Xue; GAO Yin-qi; FANG Yi

    2013-01-01

    Background The surgical management of occult breast cancer is controversial.We compared the outcomes of different treatments of occult breast cancer and evaluated the potential prognostic factors for overall survival and recurrence.Methods We retrospectively reviewed 77 patients who presented to our hospital from 1968 to 2011 with a diagnosis of occult breast cancer.Patients were divided into three groups:42 patients (63%) were treated with modified radical mastectomy+axillary lymph node dissection (ALND),16 patients (24%) were treated with ALND+postoperative radiotherapy,and 9 patients (13%) with only ALND.Survival analyses were undertaken to compare the efficacy of these three treatments.Results Of the 77 patients with occult breast cancer,2 patients were lost to follow-up and 8 patients refused surgical treatment:67 patients (90.4%) were included in this analysis.The median follow-up was 62.2 (0.6-328.0)months.Kaplan-Meier analyses showed no significant difference in overall survival and recurrence-free survival between the three groups (P=0.494 and 0.397,respectively).The prevalence of local recurrence was 11.9% for the mastectomy+ALND,18.8% for ALND+radiotherapy,and 11.1% for ALND-only groups,and those for distant recurrence were 2.4%,12.5%,and 11.1%,respectively.Compared with progesterone receptor-negative subjects,progesterone receptor-positive patients had better overall survival and lower recurrence rates (P=0.057 and 0.062,respectively).Conclusions There was no significant difference in outcomes between mastectomy and breast-preserving surgery.Expression of the progesterone receptor should be taken into account when evaluating the prognosis of occult breast cancer.

  7. Breast-conserving surgery and combined therapy for women breast cancer:a report of 216 cases%216例女性乳腺癌保乳手术及综合治疗的临床分析

    Institute of Scientific and Technical Information of China (English)

    Xianju Qin; Junxue Chen; Hongwei Zhang; Dafang Zhao; Hua Zhang; Wenjie Luo; Qian Huang; Shixian Lian; Hanxing Tong

    2007-01-01

    Objective:To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage Ⅰand stage Ⅱ breasl cancer.Methods:216 female patients with breast cancer underwent breast-conserving therapy from December 1993 to October 2004.Their data were analyzed retrospectively.The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast,postoperative radiotherapy.chemotherapy and endocrine therapy.of them.209 patients underwent axillary lymph node dissection.Results:There were no operative complications.216patients were followed-up 3 to 147 months.the medial follow-up time was 78 months.The local recurrence rate was 1.85%.Two patients died and one of them was not related with breast cancer.Presence or absence of fibrosis,shape of breast,asymmetry,pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon.Breasts were scored cosmetically asexcellent and good in 199 patients.the rate of satisfactory was92.13%.Conclusion:Breast-conserving therapy for early breast cancer is a safe and effective therapy.It has less trauma and less complications and can also raise the quality of life in the patients.But we must obey the strict indications and reasonable techniques.

  8. Imaging Surveillance of Patients with Breast Cancer after Primary Treatment: Current Recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jung Hyun; Kim, Min Jung; Kim, Eun-Kyung; Moon, Hee Jung [Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752 (Korea, Republic of)

    2015-11-01

    Women who have been treated for breast cancer are at risk for second breast cancers, such as ipsilateral recurrence or contralateral metachronous breast cancer. As the number of breast cancer survivors increases, interest in patient management and surveillance after treatment has also increased. However, post-treatment surveillance programs for patients with breast cancer have not been firmly established. In this review, we focus on the imaging modalities that have been used in post-treatment surveillance for patients with breast cancer, such as mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography, the effectiveness of each modality for detecting recurrence, and how they can be applied to manage patients.

  9. Targeted intraoperative radiotherapy tumour bed boost during breast-conserving surgery after neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kolberg, Hans-Christian; Akpolat-Basci, Leyla; Stephanou, Miltiades [Marienhospital Bottrop gGmbH, Department of Gynecology and Obstetrics, Bottrop (Germany); Loevey, Gyoergy [BORAD, Bottrop (Germany); Fasching, Peter A. [University of Erlangen, Erlangen (Germany); Untch, Michael [Helios Klinikum Berlin-Buch, Berlin (Germany); Liedtke, Cornelia [University Hospital Schleswig-Holstein/Campus Luebeck, Luebeck (Germany); Bulsara, Max [University of Notre Dame, Fremantle (Australia); University College, London (United Kingdom); Vaidya, Jayant S. [University College, London (United Kingdom)

    2017-01-15

    The use of targeted intraoperative radiotherapy (TARGIT-IORT) as a tumour bed boost during breast-conserving surgery (BCS) for breast cancer has been reported since 1998. We present its use in patients undergoing breast conservation following neoadjuvant therapy (NACT). In this retrospective study involving 116 patients after NACT we compared outcomes of 61 patients who received a tumour bed boost with IORT during lumpectomy versus 55 patients treated in the previous 13 months with external (EBRT) boost. All patients received whole breast radiotherapy. Local recurrence-free survival (LRFS), disease-free survival (DFS), distant disease-free survival (DDFS), breast cancer mortality (BCM), non-breast cancer mortality (NBCM) and overall mortality (OS) were compared. Median follow up was 49 months. The differences in LRFS, DFS and BCM were not statistically significant. The 5-year Kaplan-Meier estimate of OS was significantly better by 15% with IORT: IORT 2 events (96.7%, 95%CI 87.5-99.2), EBRT 9 events (81.7%, 95%CI 67.6-90.1), hazard ratio (HR) 0.19 (0.04-0.87), log rank p = 0.016, mainly due to a reduction of 10.1% in NBCM: IORT 100%, EBRT 89.9% (77.3-95.7), HR (not calculable), log rank p = 0.015. The DDFS was as follows: IORT 3 events (95.1%, 85.5-98.4), EBRT 12 events (69.0%, 49.1-82.4), HR 0.23 (0.06-0.80), log rank p = 0.012. IORT during lumpectomy after neoadjuvant chemotherapy as a tumour bed boost appears to give results that are not worse than external beam radiotherapy boost. These data give further support to the inclusion of such patients in the TARGIT-B (boost) randomised trial that is testing whether IORT boost is superior to EBRT boost. (orig.) [German] Die intraoperative Radiotherapie (TARGIT-IORT) als vorgezogener Boost im Rahmen der brusterhaltenden Therapie (BET) ist seit 1998 Gegenstand der wissenschaftlichen Diskussion. Wir praesentieren Daten zum Einsatz der IORT bei der BET nach neoadjuvanter Therapie (NACT). In diese retrospektive Analyse

  10. The effect of age in breast conserving therapy : A retrospective analysis on pathology and clinical outcome data

    NARCIS (Netherlands)

    Chen, Wei; Sonke, Jan-Jakob; Stroom, Joep; Bartelink, Harry; Verheij, Marcel; Gilhuijs, Kenneth

    2015-01-01

    Background and propose: Age is an important prognostic marker of patient outcome after breast conserving therapy; however, it is not clear how age affects the outcome. This study aimed to explore the relationship between age with the cell quantity and the radiosensitivity of microscopic disease (MSD

  11. [Multimodal treatment of pain and nausea in breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Kroman, N.; Callesen, T.;

    2008-01-01

    INTRODUCTION: Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV...... associated with surgery for these patients. MATERIALS AND METHODS: 116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime...... severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later. CONCLUSION: It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain...

  12. A conservative treatment for plastic bronchitis in pediatric age.

    Science.gov (United States)

    Berlucchi, Marco; Pelucchi, Francesca; Timpano, Silviana; Zorzi, Annalisa; Padoan, Rita

    2014-01-01

    Plastic bronchitis is a rare disorder in pediatric age. This disease can cause life-threatening episodes. Broncoscopy plus bronchial lavage is considered the gold standard therapeutic technique. Knowledge of this disease is mandatory to perform correct diagnosis and provide prompt treatment. The authors report the history of a 5-year-old girl affected by plastic bronchitis who was successfully treated by a conservative therapy avoiding the traditional more invasive management.

  13. The Therapy Discussion of 68 Cases of Breast Cancer by Conserving Surgery%68例早期乳腺癌保乳手术临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    何志刚; 尹宏

    2012-01-01

      Objective:To explore the treatment and efficacy of early breast conserving surgery. Methods:Choose 68 cases of women with breast cancer from June 2003 to August 2007, the breast conservative surgery was performed on 68 cases of early breast cancer in our hospital, and the clinical data was studied after the operation. Results: The 5 year survival rate was 92.6%, the satisfaction rate of breast cosmetic was 91.2%. Conclusion: For the success of conservative surgery, applying to the indication strictly and the comprehensive treatment normatively are very important.%  目的:探讨早期乳腺癌保留乳房手术的近期疗效.方法:对我院2003年6月至2007年8月收治的68例早期乳腺癌行保留乳房手术,并于术后进行随访.结果:术后5年生存率为92.6%,乳房美容优良率91.2%.结论:保留乳房手术治疗早期乳腺癌的近期疗效满意,术前严格掌握适应症,术后给予规范的综合治疗是保留乳房手术获得成功的关键.

  14. Breast- conserving therapy for breast cancer: 10 - years follow - up%乳腺癌保乳治疗十年随访

    Institute of Scientific and Technical Information of China (English)

    周鑫; 吴诚义

    2011-01-01

    目的 研究乳腺癌保乳治疗的远期疗效及规范化治疗.方法 对1990年3月至2010年3月行保乳治疗的93例乳腺癌进行回顾性分析.结果 经过125个月的中位随访期,局部复发率3.2%(3/93),总生存率89.2%(83/93),美容效果满意率90.3%(84/93).5年生存率92.3%,无瘤生存率为89.2%;10年生存率89.3%,无瘤生存率为85.7%.在预后相关指标单因素分析中,未能发现年龄、肿瘤大小、临床分期、腋淋巴结转移等因素对预后产生影响.结论 早期乳腺癌行保乳治疗,原发肿瘤较大甚至临床分期较晚的乳腺癌经新辅助化疗缩小病灶后行保乳治疗,局部复发率较低,生存率较高,并且明显改善了患者的生活质量.%Objective To study the long - term outcomes of breast cancer undergoing breast -conserving therapy and find a standardized protocol. Methods Ninety - three cases of breast cancer undergoing breast - conserving therapy were retrospectively reviewed March 1990 to March 2010. Results During a median follow- up period of 125 months,the local recurrence rate was 3.2% ;The total survival rate was 89.2% ,and the cosmetic satisfaction rate was 90.3%. The 5 - year survival rate was 92.3% ,and the disease - free survival was 89.2%. The 10 - year survival rate was 89.3% ,and the disease - free survival was 85.7%. Single - indictor analysis revealed that age, tumor size, TNM stage and axiilary lymph node metastases had no influence on prognosis. Conclusion The patients with breast cancer, including early breast cancer, breast cancer with large tumor size and breast cancer with late TN M classification, who undergo breast - conserving therapy after receiving neoadjuvant chemotherapy, have low local recurrence rate, high survival rate and good life quality.

  15. Resin splint as a new conservative treatment for ingrown toenails.

    Science.gov (United States)

    Matsumoto, Kazuya; Hashimoto, Ichiro; Nakanishi, Hideki; Kubo, Yoshiaki; Murao, Kazutoshi; Arase, Seiji

    2010-08-01

    Several conservative as well as surgical methods are used for the treatment of ingrown toenails until date. The conservative methods are either based on nail splinting or on orthonyxia, but no methods employing both principles have been reported thus far. Moreover, surgical methods usually involve postoperative pain, prolonged wound healing and restricted activities of daily living. Therefore, considering the need of a simplified, non-invasive method, in this study, we applied a novel splint to treat patients with ingrown toenails and estimated the clinical efficacy as well as rate of recurrence following treatment. The splint is a plate made of resin that is attached to the lateral edge of the nail using a bandage. We studied 61 patients (19 men and 42 women; mean age 36 years), with an average application duration of 9.3 months and an average follow-up period of 10 months in all patients. All patients experienced pain relief within a week of splint application and a decrease in the degree of nail deformity. Moreover, follow-up revealed a recurrence rate of 8.2%. Therefore, we believe that this new device is an excellent conservative treatment method for patients with ingrown toenails.

  16. The importance of rehabilitation in the treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Elżbieta Kamusińska

    2014-09-01

    Full Text Available Mastectomy due to breast cancer results in many problems and physical dysfunctions related with the constant necessity to protect the upper extremity at the site of the operated breast, and application of a specialist physiotherapeutic procedure. Rehabilitation is an integral part of the process of breast cancer treatment, and its primary goal is the limitation of selected physical, psychological, and social consequences of this cancerous disease. The achievement of rehabilitation goals requires teamwork – the simultaneous solving of problems in various spheres of the patient’s life. This work should be considered as overall care activity concerning a human being according to a holistic approach. A very important element of rehabilitation after mastectomy is to reassure the patient that with the help of specialists she can overcome difficulties, solve her problems, and return to normal daily life.

  17. Pain in Breast Cancer Treatment: Aggravating Factors and Coping Mechanisms

    Directory of Open Access Journals (Sweden)

    Maria de Fatima Guerreiro Godoy

    2014-01-01

    Full Text Available The objective of this study was to evaluate pain in women with breast cancer-related lymphedema and the characteristics of aggravating factors and coping mechanisms. The study was conducted in the Clinica Godoy, São Jose do Rio Preto, with a group of 46 women who had undergone surgery for the treatment of breast cancer. The following variables were evaluated: type and length of surgery; number of radiotherapy and chemotherapy sessions; continued feeling of the removed breast (phantom limb, infection, intensity of pain, and factors that improve and worsen the pain. The percentage of events was used for statistical analysis. About half the participants (52.1% performed modified radical surgery, with 91.3% removing only one breast; 82.6% of the participants did not perform breast reconstruction surgery. Insignificant pain was reported by 32.60% of the women and 67.3% said they suffered pain; it was mild in 28.8% of the cases (scale 1–5, moderate in 34.8% (scale 6–9, and severe in 4.3%. The main mechanisms used to cope with pain were painkillers in 41.30% of participants, rest in 21.73%, religious ceremonies in 17.39%, and chatting with friends in 8.69%. In conclusion, many mastectomized patients with lymphedema complain of pain, but pain is often underrecognized and undertreated.

  18. Conservative treatment for amelogenesis imperfecta: a case report.

    Science.gov (United States)

    Campos, Roberto Elias; Miranda Valdivia, Andrea Dolores Correia; Santos-Filho, Paulo Cesar de Freitas; Menezes, Murilo de Souza; de Oliveira Junior, Osmir Batista; Soares, Carlos Jose

    2014-01-01

    Amelogenesis imperfecta is a hereditary condition that can alter the thickness, color, and shape of tooth enamel. Recent adhesive materials and techniques have provided less invasive treatment options. This case report presents the treatment of a patient whose anterior teeth had color alterations, white spots, pits, and shape defects. Using a more conservative technique, the mandibular and maxillary anterior teeth were restored using veneer direct composite restorations. After 6 years, the restorations demonstrated no deterioration, and no pathology was seen in association with the rehabilitation.

  19. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Leon Paola G

    2007-08-01

    Full Text Available Abstract Background To investigate whether Radiation therapy (RT should follow breast conserving surgery in women with ductal carcinoma in situ from breast cancer (DCIS with objective of decreased mortality, invasive or non invasive recurrence, distant metastases and contralateral breast cancer rates. We have done a meta-analysis of these results to give a more balanced view of the total evidence and to increase statistical precision. Methods A meta-analysis of randomized controlled trials (RCT was performed comparing RT treatment for DCIS of breast cancer to observation. The MEDLINE, EMBASE, CANCERLIT, Cochrane Library databases, Trial registers, bibliographic databases, and recent issues of relevant journals were searched. Relevant reports were reviewed by two reviewers independently and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. Results The reviewers identified four large RCTs, yielding 3665 patients. Pooled results from this four randomized trials of adjuvant radiotherapy showed a significant reduction of invasive and DCIS ipsilateral breast cancer with odds ratio (OR of 0.40 (95% CI 0.33 – 0.60, p Conclusion The conclusion from our meta-analysis is that the addition of radiation therapy to lumpectomy results in an approximately 60% reduction in breast cancer recurrence, no benefit for survival or distant metastases compared to excision alone. Patients with high-grade DCIS lesions and positive margins benefited most from the addition of radiation therapy. It is not yet clear which patients can be successfully treated with lumpectomy alone; until further prospective studies answer this question, radiation should be recommended after lumpectomy for all patients without contraindications.

  20. A prognosis classifier for breast cancer based on conserved gene regulation between mammary gland development and tumorigenesis: a multiscale statistical model.

    Science.gov (United States)

    Tian, Yingpu; Chen, Baozhen; Guan, Pengfei; Kang, Yujia; Lu, Zhongxian

    2013-01-01

    Identification of novel cancer genes for molecular therapy and diagnosis is a current focus of breast cancer research. Although a few small gene sets were identified as prognosis classifiers, more powerful models are still needed for the definition of effective gene sets for the diagnosis and treatment guidance in breast cancer. In the present study, we have developed a novel statistical approach for systematic analysis of intrinsic correlations of gene expression between development and tumorigenesis in mammary gland. Based on this analysis, we constructed a predictive model for prognosis in breast cancer that may be useful for therapy decisions. We first defined developmentally associated genes from a mouse mammary gland epithelial gene expression database. Then, we found that the cancer modulated genes were enriched in this developmentally associated genes list. Furthermore, the developmentally associated genes had a specific expression profile, which associated with the molecular characteristics and histological grade of the tumor. These result suggested that the processes of mammary gland development and tumorigenesis share gene regulatory mechanisms. Then, the list of regulatory genes both on the developmental and tumorigenesis process was defined an 835-member prognosis classifier, which showed an exciting ability to predict clinical outcome of three groups of breast cancer patients (the predictive accuracy 64∼72%) with a robust prognosis prediction (hazard ratio 3.3∼3.8, higher than that of other clinical risk factors (around 2.0-2.8)). In conclusion, our results identified the conserved molecular mechanisms between mammary gland development and neoplasia, and provided a unique potential model for mining unknown cancer genes and predicting the clinical status of breast tumors. These findings also suggested that developmental roles of genes may be important criteria for selecting genes for prognosis prediction in breast cancer.

  1. Analysis of margin index as a method for predicting residual disease after breast-conserving surgery in a European cancer center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2012-02-01

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) x 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  2. Analysis of Margin Index as a Method for Predicting Residual Disease After Breast-Conserving Surgery in a European Cancer Center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2011-06-03

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) × 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  3. Natural cures for breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Munazza Shareef

    2016-05-01

    Full Text Available For centuries, herbs and plants have been used for medicinal purposes and as food as well. This review concerns about different types of plants that retain the immune stimulating and anti-tumor properties. Large variety of active phytochemicals such as carotenoids, flavonoids, ligands, polyphenolics, terpenoids, sulfides, lignans and plant sterols has been identified in different types of herbs. These phytochemicals have different mechanisms of action. They either stimulate the protective enzyme like glutathione transferase or prevent the cell proliferation. This review has centered on the biochemical properties of Allium sativum, Echinacea, Curcuma longa, Arctium lappa, Camellia sinensis, Panax ginseng and Flax seed. Extracts and juices of Withania somnifera, Amoora rohituka, Dysoxylum binectariferum and Vaccinium macrocarpon, respectively also used as anti-breast cancer. The volatile oils and extracts of these herbs and plants inhibit the synthesis of mevalonate that lessen the tumor growth and cholesterol synthesis.

  4. Natural cures for breast cancer treatment.

    Science.gov (United States)

    Shareef, Munazza; Ashraf, Muhammad Aqeel; Sarfraz, Maliha

    2016-05-01

    For centuries, herbs and plants have been used for medicinal purposes and as food as well. This review concerns about different types of plants that retain the immune stimulating and anti-tumor properties. Large variety of active phytochemicals such as carotenoids, flavonoids, ligands, polyphenolics, terpenoids, sulfides, lignans and plant sterols has been identified in different types of herbs. These phytochemicals have different mechanisms of action. They either stimulate the protective enzyme like glutathione transferase or prevent the cell proliferation. This review has centered on the biochemical properties of Allium sativum, Echinacea, Curcuma longa, Arctium lappa, Camellia sinensis, Panax ginseng and Flax seed. Extracts and juices of Withania somnifera, Amoora rohituka, Dysoxylum binectariferum and Vaccinium macrocarpon, respectively also used as anti-breast cancer. The volatile oils and extracts of these herbs and plants inhibit the synthesis of mevalonate that lessen the tumor growth and cholesterol synthesis.

  5. Using surface markers for MRI guided breast conserving surgery: a feasibility survey

    Science.gov (United States)

    Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Holloway, Claire M. B.; Plewes, Donald B.; Martel, Anne L.

    2014-04-01

    Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM

  6. Uncaria tomentosa-Adjuvant Treatment for Breast Cancer: Clinical Trial.

    Science.gov (United States)

    Santos Araújo, Maria do Carmo; Farias, Iria Luiza; Gutierres, Jessie; Dalmora, Sergio L; Flores, Nélia; Farias, Julia; de Cruz, Ivana; Chiesa, Juarez; Morsch, Vera Maria; Chitolina Schetinger, Maria Rosa

    2012-01-01

    Breast cancer is the most frequent neoplasm affecting women worldwide. Some of the recommended treatments involve chemotherapy whose toxic effects include leukopenia and neutropenia. This study assessed the effectiveness of Uncaria tomentosa (Ut) in reducing the adverse effects of chemotherapy through a randomized clinical trial. Patients with Invasive Ductal Carcinoma-Stage II, who underwent a treatment regimen known as FAC (Fluorouracil, Doxorubicin, Cyclophosphamide), were divided into two groups: the UtCa received chemotherapy plus 300 mg dry Ut extract per day and the Ca group that only received chemotherapy and served as the control experiment. Blood samples were collected before each one of the six chemotherapy cycles and blood counts, immunological parameters, antioxidant enzymes, and oxidative stress were analyzed. Uncaria tomentosa reduced the neutropenia caused by chemotherapy and was also able to restore cellular DNA damage. We concluded that Ut is an effective adjuvant treatment for breast cancer.

  7. Uncaria tomentosa—Adjuvant Treatment for Breast Cancer: Clinical Trial

    Science.gov (United States)

    Santos Araújo, Maria do Carmo; Farias, Iria Luiza; Gutierres, Jessie; Dalmora, Sergio L.; Flores, Nélia; Farias, Julia; de Cruz, Ivana; Chiesa, Juarez; Morsch, Vera Maria; Chitolina Schetinger, Maria Rosa

    2012-01-01

    Breast cancer is the most frequent neoplasm affecting women worldwide. Some of the recommended treatments involve chemotherapy whose toxic effects include leukopenia and neutropenia. This study assessed the effectiveness of Uncaria tomentosa (Ut) in reducing the adverse effects of chemotherapy through a randomized clinical trial. Patients with Invasive Ductal Carcinoma—Stage II, who underwent a treatment regimen known as FAC (Fluorouracil, Doxorubicin, Cyclophosphamide), were divided into two groups: the UtCa received chemotherapy plus 300 mg dry Ut extract per day and the Ca group that only received chemotherapy and served as the control experiment. Blood samples were collected before each one of the six chemotherapy cycles and blood counts, immunological parameters, antioxidant enzymes, and oxidative stress were analyzed. Uncaria tomentosa reduced the neutropenia caused by chemotherapy and was also able to restore cellular DNA damage. We concluded that Ut is an effective adjuvant treatment for breast cancer. PMID:22811748

  8. Uncaria tomentosa—Adjuvant Treatment for Breast Cancer: Clinical Trial

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Santos Araújo

    2012-01-01

    Full Text Available Breast cancer is the most frequent neoplasm affecting women worldwide. Some of the recommended treatments involve chemotherapy whose toxic effects include leukopenia and neutropenia. This study assessed the effectiveness of Uncaria tomentosa (Ut in reducing the adverse effects of chemotherapy through a randomized clinical trial. Patients with Invasive Ductal Carcinoma—Stage II, who underwent a treatment regimen known as FAC (Fluorouracil, Doxorubicin, Cyclophosphamide, were divided into two groups: the UtCa received chemotherapy plus 300 mg dry Ut extract per day and the Ca group that only received chemotherapy and served as the control experiment. Blood samples were collected before each one of the six chemotherapy cycles and blood counts, immunological parameters, antioxidant enzymes, and oxidative stress were analyzed. Uncaria tomentosa reduced the neutropenia caused by chemotherapy and was also able to restore cellular DNA damage. We concluded that Ut is an effective adjuvant treatment for breast cancer.

  9. Molecular genetic analysis of the yellow-breasted capuchin monkey: recommendations for ex situ conservation.

    Science.gov (United States)

    Oliveira, C G; Gaiotto, F A; Costa, M A; Martinez, R A

    2011-01-01

    The yellow-breasted capuchin monkey, Cebus xanthosternos, is one of the most endangered species of the Brazilian Atlantic Forest. In situ conservation for this species is problematic due to habitat destruction; therefore, captive conservation has been considered as an alternative strategy. A Studbook for C. xanthosternos has been kept for more than 20 years; however, no genetic data has been collected. Our aim was to provide a preliminary assessment of the genetic variability of C. xanthosternos in captivity in Brazil and compare it with data from the wild. Microsatellite and mtDNA sequencing were carried out in 40 samples from five Brazilian institutions registered in the international Studbook and compared with 8 samples collected in a wild population from REBIO-Una/BA. DNA for analysis was extracted from hair, feces and blood. Our results showed that two of the five captive groups assessed had a genetic variability comparable to wild animals. However, the other three groups apparently require urgent management to improve its genetic variability. Considering that inbreeding effects are more pronounced in captivity due to lack of gene flow, our data indicate a need to increase population size by introducing newly rescued individuals into these captive groups. Our results are the first attempt to provide genetic information for captive C. xanthosternos in Brazil.

  10. Follow-up after treatment for breast cancer

    Science.gov (United States)

    Sisler, Jeffrey; Chaput, Genevieve; Sussman, Jonathan; Ozokwelu, Emmanuel

    2016-01-01

    Objective To offer FPs a summary of evidence-based recommendations to guide their follow-up survivorship care of women treated for breast cancer. Quality of evidence A literature search was conducted in MEDLINE from 2000 to 2016 using the search words breast cancer, survivorship, follow-up care, aftercare, guidelines, and survivorship care plans, with a focus on review of recent guidelines published by national cancer organizations. Evidence ranges from level I to level III. Main message Survivorship care involves 4 main tasks: surveillance and screening, management of long-term effects, health promotion, and care coordination. Surveillance for recurrence involves only annual mammography, and screening for other cancers should be done according to population guidelines. Management of the long-term effects of cancer and its treatment addresses common issues of pain, fatigue, lymphedema, distress, and medication side effects, as well as longer-term concerns for cardiac and bone health. Health promotion emphasizes the benefits of active lifestyle change in cancer survivors, with an emphasis on physical activity. Survivorship care is enhanced by the involvement of various health professionals and services, and FPs play an important role in care coordination. Conclusion Family physicians are increasingly the main providers of follow-up care after breast cancer treatment. Breast cancer should be viewed as a chronic medical condition even in women who remain disease free, and patients benefit from the approach afforded other chronic conditions in primary care. PMID:27737976

  11. Dosimetric effects of setup uncertainties on breast treatment delivery.

    Science.gov (United States)

    Harron, Elizabeth Christine; McCallum, Hazel Mhairi; Lambert, Elizabeth Lyn; Lee, Daniela; Lambert, Geoffrey David

    2008-01-01

    This study aimed to assess the dosimetric impact of setup errors during the delivery of radiotherapy to the breast, and use this information to make recommendations on intervention tolerances for portal imaging of breast treatments. Translational and rotational setup errors were simulated for 10 recent breast patients using an Oncentra MasterPlan treatment planning system. The effect of these errors on the breast and tumor bed target volumes receiving 95% and 107% of the prescribed dose were assessed. For the majority of patients, shifts of up to 10 mm or a 4 degrees patient rotation about the cranio-caudal axis had no significant effect on the dose distribution. Changes in dosimetry were more likely if the reference plan contained large hot or cold spots. For a typical patient, it is estimated that a shift of 5 mm in any one direction, or a 2 degrees patient rotation would not cause more than a 5% change in the target volume receiving between 95% and 107% of the prescribed dose. If combinations of errors occur, greater dosimetric changes would be expected. It is concluded that individual patient shifts of up to 5 mm or rotations about the cranio-caudal axis of 2 degrees or less are unlikely to affect dose-volume histogram parameters by an amount judged as clinically significant. Setup errors exceeding these values may cause large dosimetric changes for some patients, particularly those with larger hot or cold regions in the dose distribution, and intervention is therefore recommended.

  12. Extracorporeal High-Intensity Focused Ultrasound Treatment for Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    HuiZhu; FengWu; WenzhiChen; YoudeCao; JinBai; ZhibiaoWang

    2004-01-01

    OBJECTIVE To evaluate the clinical safety and efficacy of using highintensity focused ultrasound (HIFU) therapy, for breast cancer, and to select the appropriate methods in evaluating the therapeutic effects.METHODS A total of 24 patients with breast cancer underwent HIFU treatment 1-2 weeks before receiving modified radical mastectomy. During and after HIFU therapy, changes in blood pressure, breath, pulse and peripheral blood oxygen saturation were monitored. At the same time, the damage of the skin and tissue produced by HIFU at the target region was evaluated as well. Surgically excised samples were used for pathological examinations to evaluate the HIFU-induced destruction of the targeted tissue. Three patients received Tc-ECT and 1 MRI examinations before and after HIFU.RESULTS HIFU treatment had no apparent influence on either the tissue nearby the target or on vital signs of the patients. Pathological, tc-ECT and MRI examinations demonstrated that targeted tissue showed complete coagulative necrosis.CONCLUSION Under the guidance of real-time ultrasonic imaging, HIFU can effectively and safely destroy the breast cancer mass and 99MTc-ECT and MRI examination can be utilized to evaluate the therapeutic effects.HIFU may become one of the options for breast cancer therapy in the future.

  13. A RETROSPECTIVE ANALYSIS OF SURGICAL TREATMENT FOR BREAST MALIGNANT TUMORS

    Institute of Scientific and Technical Information of China (English)

    范志民; 刘国津; 盖学良; 王晓军; 辛志泳

    2002-01-01

    Objective: To review the evolution of the current surgical treatment for breast malignant tumors over the past twenty years in the First Hospital of Jilin University (the former Bethune University of Medical Sciences). Methods: 1195 eligible patients with primary breast malignant tumor diagnosed and surgically treated at the First Teaching Hospital from January 1980 and December 2000 were retrospectively analyzed. Results: The peak frequency was in 40-49 years of age (40.00%), the age of the patients with breast malignant tumors trends to become young. The most common pTNM classification was Stage Ⅱ. The most common histological type was infiltrating ductal carcinoma (398 patients, 33.31%), and simple carcinoma (279 patients, 23.53%). Modified radical mastectomy was the most common operation procedure performed (779 patients, 65.19%), and was increasingly used while radical mastectomy was adopted decreasingly in recent decade. Conclusion: The variation of operation procedures performed on patients with breast malignant tumors reflected the advance of our understanding of the biology of cancer and the progression of new treatment principles.

  14. Breast Image Analysis for Risk Assessment, Detection, Diagnosis, and Treatment of Cancer

    NARCIS (Netherlands)

    Giger, M.L.; Karssemeijer, N.; Schnabel, J.A.

    2013-01-01

    The role of breast image analysis in radiologists' interpretation tasks in cancer risk assessment, detection, diagnosis, and treatment continues to expand. Breast image analysis methods include segmentation, feature extraction techniques, classifier design, biomechanical modeling, image registration

  15. Fusions of Breast Carcinoma and Dendritic Cells as a Vaccine for the Treatment of Metastatic Breast Cancer. Addendum

    Science.gov (United States)

    2009-07-01

    Dendritic Cells as a Vaccine for the Treatment of Metatastic Breast Cancer PRINCIPAL INVESTIGATOR: Donald W. Kufe, M.D...COVERED 1 Jul 2008 – 30 Jun 2009 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Fusions of Breast Carcinoma and Dendritic Cells as a Vaccine for the...David Avigan, MD, Beth Israel Deaconess Medical Center, Boston, MA, in Support of Proposal, "Fusions of Breast Carcinoma and Dendritic Cells as a

  16. [Acute small bowel obstruction: conservative or surgical treatment?].

    Science.gov (United States)

    Schwenter, F; Dominguez, S; Meier, R; Oulhaci-de Saussure, W; Platon, A; Gervaz, P; Morel, P

    2011-06-22

    Small bowel obstruction (SBO) is a common clinical syndrome caused mainly by postoperative adhesions. In complement to clinical and biological evaluations, CT scan has emerged as a valuable imaging modality and may provide reliable information. The early recognition of signs suggesting bowel ischemia is essential for urgent operation. However appropriate management of SBO remains a common clinical challenge. Although a conservative approach can be successful in a substantial percentage of selected patients, regular and close re-assessement is mandatory. Any persistance or progression of the critical symptoms and signs should indeed lead to surgical exploration. Here we review the principles of adhesive SBO management and suggest a decision procedure for conservative versus surgical treatment.

  17. Dosimetric comparison of the simultaneous integrated boost in whole-breast irradiation after breast-conserving surgery: IMRT, IMRT plus an electron boost and VMAT.

    Directory of Open Access Journals (Sweden)

    Sangang Wu

    Full Text Available To compare the target volume coverage and doses to organs at risks (OARs using three techniques that simultaneous integrated boost (SIB in whole-breast irradiation (WBI after breast-conserving surgery, including intensity-modulated radiation therapy (IMRT, IMRT plus an electron boost (IMRT-EB, and volumetric-modulated arc therapy (VMAT.A total of 10 patients with early-stage left-sided breast cancer after breast-conserving surgery were included in this study. IMRT, IMRT-EB and VMAT plans were generated for each patient.The conformity index (CI of the planning target volumes evaluation (PTV-Eval of VMAT was significantly superior to those of IMRT and IMRT-EB (P 0.05.Considered the target volume coverage and radiation dose delivered to the OARs (especially the heart and lung, IMRT may be more suitable for the SIB in WBI than IMRT-EB and VMAT. Additional clinical studies with a larger sample size will be needed to assess the long-term feasibility and efficacy of SIB using different radiotherapy techniques.

  18. Prevention and Treatment of Bone Metastases in Breast Cancer

    Directory of Open Access Journals (Sweden)

    Ripamonti Carla

    2013-09-01

    Full Text Available In breast cancer patients, bone is the most common site of metastases. Medical therapies are the basic therapy to prevent distant metastases and recurrence and to cure them. Radiotherapy has a primary role in pain relief, recalcification and stabilization of the bone, as well as the reduction of the risk of complications (e.g., bone fractures, spinal cord compression. Bisphosphonates, as potent inhibitors of osteoclastic-mediated bone resorption are a well-established, standard-of-care treatment option to reduce the frequency, severity and time of onset of the skeletal related events in breast cancer patients with bone metastases. Moreover bisphosphonates prevent cancer treatment-induced bone loss. Recent data shows the anti-tumor activity of bisphosphonates, in particular, in postmenopausal women and in older premenopausal women with hormone-sensitive disease treated with ovarian suppression. Pain is the most frequent symptom reported in patients with bone metastases, and its prevention and treatment must be considered at any stage of the disease. The prevention and treatment of bone metastases in breast cancer must consider an integrated multidisciplinary approach.

  19. Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy

    NARCIS (Netherlands)

    M.M. Stuiver; M.R. ten Tusscher; C.S. Agasi-Idenburg; C. Lucas; N.K. Aaronson; P.M.M. Bossuyt

    2015-01-01

    Background: Breast cancer-related lymphoedema can be a debilitating long-term sequela of breast cancer treatment. Several studies have investigated the effectiveness of different treatment strategies to reduce the risk of breast cancer-related lymphoedema. Objectives: To assess the effects of conser

  20. Comparison of different breast planning techniques and algorithms for radiation therapy treatment.

    Science.gov (United States)

    Borges, C; Cunha, G; Monteiro-Grillo, I; Vaz, P; Teixeira, N

    2014-03-01

    This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques--forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT--and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques--f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART - were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.

  1. Advances in the surgical treatment of breast cancer and postoperative physiotherapy

    Directory of Open Access Journals (Sweden)

    Anna Opuchlik

    2016-07-01

    Full Text Available In recent years, radical surgical techniques have been replaced with conserving ones, and a sentinel lymph node biopsy was introduced in the case of routine lymphadenectomy. Subcutaneous amputation with an immediate breast reconstruction or radical breast amputation in Madden modification are used in advanced tumours. Breast conserving surgery and effective neoadjuvant therapy reduce the range of the operation and postoperative complications. Similarly, breast reconstructions do not increase the risk of cancer development, and they do not impede the detection of a local recurrence. This paper presents the most commonly used types of surgery used to treat breast cancer, and the possibility of a surgical reconstruction of the breast. The methods of physiotherapeutic management in particular stages of treating women both after radical surgeries and reconstructions, including the aspect of maintaining their physical activity and mental balance are discussed.

  2. A Prospective Longitudinal Clinical Trial Evaluating Quality of Life After Breast-Conserving Surgery and High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garsa, Adam A.; Ferraro, Daniel J.; DeWees, Todd A. [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Deshields, Teresa L. [Department of Medicine, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Margenthaler, Julie A.; Cyr, Amy E. [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Naughton, Michael [Department of Medicine, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Aft, Rebecca [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Department of Surgery, John Cochran Veterans Hospital, St. Louis, Missouri (United States); Gillanders, William E.; Eberlein, Timothy [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Matesa, Melissa A.; Ochoa, Laura L. [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Zoberi, Imran, E-mail: izoberi@radonc.wustl.edu [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-12-01

    Purpose: To prospectively examine quality of life (QOL) of patients with early stage breast cancer treated with accelerated partial breast irradiation (APBI) using high-dose-rate (HDR) interstitial brachytherapy. Methods and Materials: Between March 2004 and December 2008, 151 patients with early stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients included those with Tis-T2 tumors measuring ≤3 cm excised with negative surgical margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, version 3.0, and QLQ-BR23 questionnaires. The QLQ-C30 and QLQ-BR23 questionnaires were evaluated during pretreatment and then at 6 to 8 weeks, 3 to 4 months, 6 to 8 months, and 1 and 2 years after treatment. Results: The median follow-up was 55 months. Breast symptom scores remained stable in the months after treatment, and they significantly improved 6 to 8 months after treatment. Scores for emotional functioning, social functioning, and future perspective showed significant improvement 2 years after treatment. Symptomatic fat necrosis was associated with several changes in QOL, including increased pain, breast symptoms, systemic treatment side effects, dyspnea, and fatigue, as well as decreased role functioning, emotional functioning, and social functioning. Conclusions: HDR multicatheter interstitial brachytherapy was well tolerated, with no significant detrimental effect on measured QOL scales/items through 2 years of follow-up. Compared to pretreatment scores, there was improvement in breast symptoms, emotional functioning, social functioning, and future perspective 2 years after treatment.

  3. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    Energy Technology Data Exchange (ETDEWEB)

    Lalani, Nafisha; Paszat, Lawrence [University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Sutradhar, Rinku; Thiruchelvam, Deva [Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta [University of Toronto, Toronto, Ontario (Canada); Department of Anatomic Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Done, Susan J. [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Campbell Family Institute for Breast Cancer Research, Toronto, Ontario (Canada); Miller, Naomi; Youngson, Bruce [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Tuck, Alan [Pathology and Laboratory Medicine, London Health Sciences Centre and Saint Joseph' s Health Care, London, Ontario (Canada); Sengupta, Sandip [Department of Pathology and Molecular Medicine, Kingston General Hospital, Kingston, Ontario (Canada); Elavathil, Leela [Department of Anatomical Pathology, Juravinski Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Chang, Martin C. [Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Jani, Prashant A. [Department of Anatomical Pathology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario (Canada); Bonin, Michel [Pathology and Laboratory Medicine, Sudbury Regional Hospital, Sudbury, Ontario (Canada); and others

    2014-12-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  4. Conservative treatment of the anal carcinoma. Retrospective results - radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dobrowsky, W.

    1987-09-01

    The results of primary radiotherapy in anal carcinoma are reported in a retrospective study. Fourteen patients have been treated by primary radiotherapy between 1970 and 1982. The three-year survival rate is 11/14 (corrected 11/12). Among eleven patients followed up, ten have a normal anal function. The importance of radio-oncology as a therapy of choice in conservative, function-preserving treatment of the anal carcinoma is discussed regarding the retrospective results as well as possible combinations of radiotherapy and chemotherapy.

  5. [Conservative treatment of anal cancer. Retrospective results--radiotherapy].

    Science.gov (United States)

    Dobrowsky, W

    1987-09-01

    The results of primary radiotherapy in anal carcinoma are reported in a retrospective study. Fourteen patients have been treated by primary radiotherapy between 1970 and 1982. The three-year survival rate is 11/14 (corrected: 11/12). Among eleven patients followed up, ten have a normal anal function. The importance of radio-oncology as a therapy of choice in conservative, function-preserving treatment of the anal carcinoma is discussed regarding the retrospective results as well as possible combinations of radiotherapy and chemotherapy.

  6. Costs of conservative treatment of patients with cholangitis and cholesystitis

    Directory of Open Access Journals (Sweden)

    Mikić Sandra Stefan

    2014-01-01

    Full Text Available Introduction. There are no guidelines for treating bacterial infections in our country. Antibacterial drugs are selected empirically, which is not always in accordance with the recommended therapy coming from the countries that have their own pharmacotherapy protocols. This study reviews the differences between the standard conservative treatment of cholangitis/cholecystitis and treatment implemented in accordance with current pharmacotherapy guidelines of other countries. The assessment of the therapeutic efficacy of antibacterial drugs implemented in the treatment of cholangitis/cholecystitis and economic viability of that implementation was one of the aims of this study, and another one was comparison of the efficiency and cost of medical treatment using physician’s therapy of choice and treatment according to pharmacotherapy guidelines. Material and Methods. The study was carried out over a threeyear period at the Department of Infectious Diseases of the Clinical Center of Vojvodina. It included 72 patients with the diagnosis of cholangitis/cholecystitis who were divided into two groups. The control group was treated according to the physician’s therapy of choice, while the test group was treated in accordance with pharmacotherapy guidelines. The efficiency and cost of medical treatment were determined for both groups. Results. The comparison of the efficiency and costs of medical treatment of cholangitis/cholecystitis before and after introducing pharmacotherapy guidelines showed no significant differences in the efficiency of administered therapies. However, the cost of medical treatment carried out in accordance with pharmacotherapy guidelines showed a decrease of 17.24%. Conclusion. Medical treatment using physician’s antibacterial therapy of choice and the one which is in accordance with pharmacotherapy guidelines for treating cholangitis/cholecystitis show no differences in terms of efficiency. However, medical treatment proved

  7. Breast cancer causes and treatment: where are we going wrong?

    OpenAIRE

    Seymour CB; Mothersill C

    2013-01-01

    Colin B Seymour, Carmel MothersillMedical Physics and Applied Radiation Sciences Department, McMaster University, Hamilton, ON, CanadaAbstract: This discussion paper seeks to provoke thoughts about cancer research in general, and why breast cancer in particular is not yet “curable”. It asks the question – are we looking at the disease in the right way? Should we regard cancer as a progressive state, which is part of aging? Should we tailor treatment to &ldquo...

  8. Monitor unit calculations for breast or chest wall treatments.

    Science.gov (United States)

    Cheng, P C; Ames, T; Howard-Ames, T; Kohut, H; Heleba, V; Krishnamoorthy, J

    1989-01-01

    Tangential breast fields always "flash" beyond the surface of the patient. Since the portion of the beam that is in air does not contribute scatter, external beam treatment planning computers that utilize stored beam data can lead to dose errors of up to 10%. These errors can be reduced by using an irregular field calculation program to adjust the monitor units to account for the loss of scatter.

  9. Prognosis after Ipsilateral Breast Tumor Recurrence and Locoregional Recurrences in Patients Treated by Breast-Conserving Therapy in Five National surgical Adjuvant Breast and Bowel Project Protocols of Node-Negative Breast Cancer%淋巴结阴性乳腺癌保乳术后局部复发后的预后分析:来自NSABP 5个临床研究的结果

    Institute of Scientific and Technical Information of China (English)

    陈佳艺; 李学瑞

    2010-01-01

    @@ 1 文献来源 Anderson SJ,Wapnir I,Dignam JJ,et al.Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of nodenegative breast cancer[J].J Clin Oncol,2009,27(15):2466-2473.

  10. Combination treatment of tamoxifen with risperidone in breast cancer.

    Directory of Open Access Journals (Sweden)

    Wei-Lan Yeh

    Full Text Available Tamoxifen has long been used and still is the most commonly used endocrine therapy for treatment of both early and advanced estrogen receptor-positive breast cancer in pre- and post-menopause women. Tamoxifen exerts its cytotoxic effect primarily through cytostasis which is associated with the accumulation of cells in the G0/G1 phase of the cell cycle. Apoptotic activity can also be exerted by tamoxifen which involves cleavage of caspase 9, caspase 7, caspase 3, and poly-ADP-ribose polymerase (PARP. Down-regulation of anti-apoptotic proteins Bcl-2 and Bcl-xL and up-regulation of pro-apoptotic proteins Bax and Bak have also been observed. In addition, stress response protein of GRP 94 and GRP 78 have also been induced by tamoxifen in our study. However, side effects occur during tamoxifen treatment in breast cancer patients. Researching into combination regimen of tamoxifen and drug(s that relieves tamoxifen-induced hot flushes is important, because drug interactions may decrease tamoxifen efficacy. Risperidone has been shown to be effective in reducing or eliminating hot flushes on women with hormonal variations. In this present study, we demonstrated that combination of tamoxifen with risperidone did not interfered tamoxifen-induced cytotoxic effects in both in vitro and in vivo models, while fluoxetine abrogated the effects of tamoxifen. This is the first paper suggesting the possibility of combination treatment of tamoxifen with risperidone in breast cancer patients, providing a conceivable resolution of tamoxifen-induced side effects without interfering the efficacy of tamoxifen against breast cancer.

  11. Early-Stage Young Breast Cancer Patients: Impact of Local Treatment on Survival

    Energy Technology Data Exchange (ETDEWEB)

    Bantema-Joppe, Enja J. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Munck, Linda de [Comprehensive Cancer Center North East, Groningen/Enschede (Netherlands); Visser, Otto [Comprehensive Cancer Center Amsterdam, Amsterdam (Netherlands); Willemse, Pax H.B. [Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands); Siesling, Sabine [Comprehensive Cancer Center North East, Groningen/Enschede (Netherlands); Department of Health Technology and Services Research, University of Twente, Enschede (Netherlands); Maduro, John H., E-mail: j.h.maduro@rt.umcg.nl [Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen (Netherlands)

    2011-11-15

    Purpose: In young women, breast-conserving therapy (BCT), i.e., lumpectomy followed by radiotherapy, has been associated with an increased risk of local recurrence. Still, there is insufficient evidence that BCT impairs survival. The aim of our study was to compare the effect of BCT with mastectomy on overall survival (OS) in young women with early-stage breast cancer. Methods and Materials: From two Dutch regional population-based cancer registries (covering 6.2 million inhabitants) 1,453 women <40 years with pathologically T1N0-1M0 breast cancer were selected. Cox regression survival analysis was used to study the effect of local treatment (BCT vs. mastectomy) stratified for nodal stage on survival and corrected for tumor size, age, period of diagnosis, and use of adjuvant systemic therapy. Results: With a median follow-up of 9.6 years, 10-year OS was 83% after BCT and 78% after mastectomy, respectively (unadjusted hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.09-1.72). In N0-patients, 10-year OS was 84% after BCT and 81% after mastectomy and local treatment was not associated with differences in OS (HR 1.19; 95% CI, 0.89-1.58; p = 0.25). Within the N1-patient group, OS was better after BCT compared with mastectomy, 79% vs. 71% at 10 years (HR 1.91; 95% CI, 1.28-2.84; p = 0.001) and in patients treated with adjuvant hormonal therapy (HR 0.34; 95% CI, 0.18-0.66; p = 0.001). Conclusions: In this large population-based cohort of early-stage young breast cancer patients, 10-year OS was not impaired after BCT compared with mastectomy. Patients with 1 to 3 positive lymph nodes had better prognosis after BCT than after mastectomy.

  12. Lymphoscintigraphy in breast cancer: a short review about the impact on upper limb after surgical treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bergmann, Anke; Resende, Juliana Miranda Dutra de; Bello, Marcelo Adeodato; Oliveira, Juliana Flavia de; Bernardo-Filho, Mario [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil); Santos-Filho, Sebastiao David [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Lab. de Radiofarmacia Experimental; Palestro, Christopher J. [Yeshiva University, NY (United States). Albert Einstein College of Medicine

    2008-12-15

    Breast cancer is still associated with high mortality rates and one of the most important factors governing long survival is accurate and early diagnosis. In underdeveloped countries, this disease frequently is only detected in advanced stages; however, through mammography, many women have been diagnosed at early stages. In this context, the sentinel lymph node (SLN) technique is associated with less postoperative morbidity compared to axillary lymphadenectomy. Lymphoscintigraphy has emerged as a method for the evaluation of lymphatic drainage chains in various tumours, being both accurate and non invasive. The aim of this work is to present the main aspects which cause controversy about SLN and lymphoscintigraphy and the impact that these procedures have had on lymphedema after surgical treatment for breast cancer. A short review including papers in English, Spanish and Portuguese, available on Lilacs and Medline database, published between January, 2000 and July, 2008 was performed. The key words breast cancer, lymphoscintigraphy, SLN biopsy, lymphedema were used. Various studies have aimed to compare the incidence and prevalence of lymphedema according to the technique used; however, the population subjected to SLN is different from the one with indication for axillary lymphadenectomy regarding staging. Moreover, little is known about long term morbidity since it is a relatively new technique. In conclusion, the development of surgical techniques has permitted to minimize deformities and the current trend is that these techniques be as conservative as possible. Thus, lymphoscintigraphy plays an important role in the identification of SLN, contributing to the prevention and minimization of postoperative complications. (author)

  13. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    Science.gov (United States)

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  14. Multimodality imaging of breast cancer for selection and monitoring of treatment

    NARCIS (Netherlands)

    Pengel, K.E.

    2015-01-01

    Despite major improvements in breast cancer care, breast cancer is still a substantial cause of cancer death in Western women. Moreover, research from the past decades demonstrated that breast cancer is a heterogeneous disease. This heterogeneity warrants a personalized treatment approach. With this

  15. Lipoplatin Treatment in Lung and Breast Cancer

    OpenAIRE

    Manuela Fantini; Lorenzo Gianni; Carlotta Santelmo; Fabrizio Drudi; Cinzia Castellani; Alessandra Affatato; Mario Nicolini; Alberto Ravaioli

    2011-01-01

    The introduction of cisplatin in cancer treatment represents an important achievement in the oncologic field. Many types of cancers are now treated with this drug, and in testicular cancer patients major results are reached. Since 1965, other compounds were disovered and among them carboplatin and oxaliplatin are the main Cisplatin analogues showing similar clinical efficacy with a safer toxicity profile. Lipoplatin is a new liposomal cisplatin formulation which seems to have these cha...

  16. Combination Immunotherapy for the Treatment of High-Risk HER2-Positive Breast Cancer

    Science.gov (United States)

    2015-10-01

    have withdrawn. Blood samples for immunologic monitoring are being collected in support of specific aims 2 and 3. 15. SUBJECT TERMS Breast cancer ...inflammatory breast cancer (MD Anderson Cancer Center Morgan Welch Inflammatory Breast Cancer Program Seed Grant)  New active grant o Immunologic ...1 AWARD NUMBER: W81XWH-14-1-0109 TITLE: Combination Immunotherapy for the Treatment of High-Risk HER2-Positive Breast Cancer PRINCIPAL

  17. BRIEF REVIEW ON DIAGNOSTIC TECHNIQUE AND NOVEL MOLECULES IN CLINICAL TRIALS FOR TREATMENT OF BREAST CANCER

    Directory of Open Access Journals (Sweden)

    VISHAL KUMAR S. MODI

    2015-01-01

    Full Text Available Breast cancer is the most common cancer in women in both developed and undeveloped countries, and the second most frequent cause of cancer deaths after lung cancer. Although there have been many chemotherapeutic agents like 5-fluorouracil, taxol, tamoxifen, doxorubicin, cisplatin, and camptothecin and hormones are used to treat breast cancer. This review focuses on the causes of breast cancer, latest diagnostic techniques and various molecules under clinical trials for the treatment of breast cancer.

  18. Phyllodes tumors of the breast: diagnosis, treatment and prognostic factors related to recurrence

    Science.gov (United States)

    Zhou, Zhi-Rui; Wang, Chen-Chen; Yang, Zhao-Zhi

    2016-01-01

    Phyllodes tumors of the breast are rare tumor types that consist of 0.3–1.0% in all breast tumors. The naming and classification of breast phyllodes tumor have been debated for years. Based on the classification criteria modified by WHO in 2003, this review mainly introduced the clinicopathologic characteristics, pre-operational diagnosis and the treatment of breast phyllodes tumors, and also summarized the prognostic factors related to tumor recurrence. PMID:28066617

  19. Cosmetic Analysis Following Breast-Conserving Surgery and Adjuvant High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer: A Prospective Clinical Study

    Energy Technology Data Exchange (ETDEWEB)

    Garsa, Adam A.; Ferraro, Daniel J.; DeWees, Todd [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Margenthaler, Julie A. [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Naughton, Michael [Department of Medicine, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Aft, Rebecca [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Department of Surgery, John Cochran Veterans Hospital, St. Louis, Missouri (United States); Gillanders, William E.; Eberlein, Timothy [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Matesa, Melissa A. [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Zoberi, Imran, E-mail: izoberi@radonc.wustl.edu [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-03-15

    Purpose: To prospectively evaluate cosmetic outcomes in women treated with accelerated partial breast irradiation using high-dose-rate interstitial brachytherapy for early-stage breast cancer. Methods and Materials: Between 2004 and 2008, 151 patients with early-stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients had stage Tis-T2 tumors of ≤3 cm that were excised with negative margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. Both the patients and the treating radiation oncologist qualitatively rated cosmesis as excellent, good, fair, or poor over time and ascribed a cause for changes in cosmesis. Cosmetic outcome was evaluated quantitatively by percentage of breast retraction assessment (pBRA). Patients also reported their satisfaction with treatment over time. Results: Median follow-up was 55 months. The rates of excellent-to-good cosmesis reported by patients and the treating radiation oncologist were 92% and 97% pretreatment, 91% and 97% at 3 to 4 months' follow-up, 87% and 94% at 2 years, and 92% and 94% at 3 years, respectively. Breast infection and adjuvant chemotherapy were independent predictors of a fair-to-poor cosmetic outcome at 3 years. Compared to pretreatment pBRA (7.35), there was no significant change in pBRA over time. The volume receiving more than 150 Gy (V150) was the only significant predictor of pBRA. The majority of patients (86.6%) were completely satisfied with their treatment. Conclusions: Patients and the treating physician reported a high rate of excellent-to-good cosmetic outcomes at all follow-up time points. Acute breast infection and chemotherapy were associated with worse cosmetic outcomes. Multicatheter interstitial brachytherapy does not significantly change breast size as measured by pBRA.

  20. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials

    DEFF Research Database (Denmark)

    Darby, S; McGale, P; Correa, C;

    2011-01-01

    After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolu...

  1. [Pregnancy-associated breast cancer: current opinions on diagnosis and treatment].

    Science.gov (United States)

    Slingerland, Marije; Kroep, Judith R; Liefers, Gerrit-Jan; Scholten, Astrid N; Nortier, J W R Hans

    2012-01-01

    Because of the trend to postpone childbirth until later in life we will be increasingly confronted with pregnancy-associated breast cancer. We report on two patients with pregnancy-associated breast cancer. Complete treatment of this condition during pregnancy by means of surgery, radiotherapy and chemotherapy is possible without any known damage to the foetus, even if the breast cancer is diagnosed early in pregnancy. Treatment should be multidisciplinary and preferably centralized. Pregnancy does not seem to influence the prognosis of breast cancer. All patients with pregnancy-associated breast cancer should be registered in a registration study.

  2. 隐匿性乳腺癌的诊断与治疗%Diagnosis and Treatment of Occult Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    郭朝猛; 聂梦良

    2015-01-01

    Objective To investigate the clinical characteristics,diagnosis and treatment of occult breast cancer. Methods The data of 7 patients with occult breast cancer were retrospectively analyzed. Results Primary tumors were detected in 5 of the 7 patients,3 of the 5 patients treated by modified radical mastectomy for breast cancer sur-vived without local recurrence or distant metastases,2 patients occurred distant metastases;2 patients were treated by breast conserving surgery,all survived without diseases. Conclusion Occult breast cancer should be considered in female patients with metastatic adenocarcinoma of the axillary lymph nodes and without obvious primary cancer;treatment of the occult breast cancer could be modified radical mastectomy for breast cancer,breast conserving sur-gery and axillary lymph nodes dissection,followed by radiotherapy to the full-breast and drainage areas of regional lymph nodes ,and chemotherapy ,endocrine therapy and possibly targeted therapy.%目的:探讨隐匿性乳腺癌的临床特点及诊治方案。方法对7例隐匿性乳腺癌患者的临床资料进行回顾性分析。结果7例患者中,5例找到乳腺癌原发灶,并行乳腺癌改良根治术,3例未出现局部复发或远处转移,2例出现远处转移;2例行保乳术患者无局部复发或转移。结论对有腋窝淋巴结转移腺癌无明显原发灶的患者,应高度警惕隐匿性乳腺癌;治疗应采用乳腺癌改良根治术或保乳术及腋窝淋巴结清扫,并行全乳腺及区域淋巴结引流区放疗、化疗、内分泌治疗和可能的靶向治疗。

  3. Breast conserving treatment of breast carcinoma T2 ({<=} 4 cm) and T3 by neoadjuvant chemotherapy, quadrantectomy, high dose rate brachytherapy as a boost, external beam radiotherapy and adjuvant chemotherapy: local control and overall survival analysis; Tratamento conservador do cancer de mama T2 ({<=} 4 cm) e T3 por quimioterapia neoadjuvante, quadrantectomia, braquiterapia com alta taxa de dose como reforco de dose, teleterapia complementar e quimioterapia adjuvante: analise de controle local e sobrevida global

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Celia Regina; Miziara Filho, Miguel Abrao; Fogaroli, Ricardo Cesar; Baraldi, Helena Espindola; Pellizzon, Antonio Cassio Assis; Pelosi, Edilson Lopes [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Radioterapia], e-mail: celiarsoares@terra.com.br; Fristachi, Carlos Elias [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil). Servico de Onco-Ginecologia e Mastologia; Paes, Roberto Pinto [Instituto do Cancer Dr. Arnaldo Vieira de Carvalho (ICAVC), Sao Paulo, SP (Brazil)

    2008-12-15

    Objective: to assess the treatment of breast cancer T2 ({<=} 4 cm) and T3 through neoadjuvant chemotherapy, quadrantectomy and high dose rate brachytherapy as a boost, complementary radiotherapy and adjuvant chemotherapy, considering local control and overall survival. Material and method: this clinical prospective descriptive study was based on the evaluation of 88 patients ranging from 30 to 70 years old, with infiltrating ductal carcinoma, clinical stage IIb and IIIa, responsive to the neoadjuvant chemotherapy, treated from June/1995 to December/2006. Median follow-up was 58 months. Using clinical methods the tumor was evaluated before and after three or four cycles of chemotherapy based on anthracyclines. Overall survival and local control were assessed according to Kaplan-Meier methodology. Results: Local control and overall survival in five years were 90% and 73.5%, respectively. Conclusion: local control and overall survival were comparable to other forms of treatment. (author)

  4. Conservative treatment of a comminuted cervical fracture in a racehorse

    Directory of Open Access Journals (Sweden)

    Vos NJ

    2008-04-01

    Full Text Available Abstract The 'classical' or 'Hangman' neck fracture involves the odontoid peg (process of the second cervical vertebra (C2, and is described as an axial, dens or odontoid peg fracture in both the veterinary and human literature. Possible surgical treatment in both foals and adult horses requires a technique that allows decompression, anatomical alignment and stabilisation of the odontoid fracture. A limited number of surgical cases in foals have been reported in literature, but never in an adult horse. A mature Irish Thoroughbred racehorse was diagnosed with a type 2a odontoid peg fracture. Clinical signs included reluctance to move the head and neck, a left hind limb lameness and a neurological status of grade 2. The horse was treated conservatively and raced successfully five months after the diagnosed injury.

  5. Conservative treatment of acute knee osteoarthritis: A review of the Cochrane Library

    OpenAIRE

    Emerito Carlos Rodriguez-Merchan

    2016-01-01

    Objective: To analyze conservative treatment of knee pain in patients with osteoarthritis. Methods: A Cochrane Library search related to knee osteoartritis was analyzed. Five main strategies for the conservative treatment of knee osteoartritis have been reviewed: medical treatment, physical medicine and rehabilitation, intra-articular injections, and acupuncture. Results: Regarding medical treatment, non-steroidal antiinflammatory drugs (ibuprofen, diclofenac, arthrotec, celecoxib, napr...

  6. Adaptive Randomization of Veliparib–Carboplatin Treatment in Breast Cancer

    Science.gov (United States)

    Rugo, Hope S.; Olopade, Olufunmilayo I.; DeMichele, Angela; Yau, Christina; van ‘t Veer, Laura J.; Buxton, Meredith B.; Hogarth, Michael; Hylton, Nola M.; Paoloni, Melissa; Perlmutter, Jane; Symmans, W. Fraser; Yee, Douglas; Chien, A. Jo; Wallace, Anne M.; Kaplan, Henry G.; Boughey, Judy C.; Haddad, Tufia C.; Albain, Kathy S.; Liu, Minetta C.; Isaacs, Claudine; Khan, Qamar J.; Lang, Julie E.; Viscusi, Rebecca K.; Pusztai, Lajos; Moulder, Stacy L.; Chui, Stephen Y.; Kemmer, Kathleen A.; Elias, Anthony D.; Edmiston, Kirsten K.; Euhus, David M.; Haley, Barbara B.; Nanda, Rita; Northfelt, Donald W.; Tripathy, Debasish; Wood, William C.; Lyandres, Julia; Davis, Sarah E.; Hirst, Gillian L.; Sanil, Ashish; Berry, Donald A.; Esserman, Laura J.

    2017-01-01

    Background I-SPY 2 is a phase 2 standing multicenter platform trial designed to screen multiple experimental regimens in combination with standard neoadjuvant chemotherapy for breast cancer. The goal is to matching experimental regimens with responding patient subtypes. We report results for veliparib, a poly(ADP-ribose) polymerase (PARP) inhibitor, combined with carboplatin (VC). Methods Eligible women had ≥2.5 cm stage II/III breast cancer, categorized into 8 biomarker subtypes based on HER2, hormone-receptor status (HR) and MammaPrint. Patients are adaptively randomized within subtype to better performing regimens compared to standard therapy (control). Regimens are evaluated within 10 signatures, prospectively defined combinations of subtypes. VC plus standard therapy was considered for HER2-negative tumors and therefore evaluated in 3 signatures. The primary endpoint of I-SPY 2 is pathologic complete response (pCR). MR volume changes during treatment inform the likelihood that a patient will achieve pCR. Regimens graduate if and when they have a high (Bayesian) predictive probability of success in a subsequent phase 3 neoadjuvant trial within the graduating signature. Results VC graduated in triple-negative breast cancer with 88% predicted probability of phase 3 success. A total of 72 patients were randomized to VC and 44 to concurrent controls. Respective pCR estimates (95% probability intervals) were 51% (35%–69%) vs 26% (11%–40%). Greater toxicity of VC was manageable. Conclusion The design of I-SPY 2 has the potential to efficiently identify responding tumor subtypes for the various therapies being evaluated. VC added to standard therapy improves pCR rates specifically in triple-negative breast cancer. PMID:27406347

  7. Role of radiotherapy after breast conservative surgery for early stage breast cancer%早期乳腺癌保乳术后精确适形放射治疗的临床观察

    Institute of Scientific and Technical Information of China (English)

    刘建波; 王跃伟

    2013-01-01

    Objective:To explore the effective and optimal procedure of standard radiotherapy to whole breast with additional radiation to tumor bed and chemotherapy after conservative breast surgery for early stage breast cancer. Methods:36 patients with early stage breast cancer received three-dimensional conformal radiotherapy after conservative breast surgery, radiotherapy total dose to whole breast was 40~50Gy, and a 10~15Gy boost dose was delivered to the tumor bed in 30 of these patients.Results:Regarding al patients the 5-year survival rate was 100%, the tumor-free survival rate was 94.3%, and the recurrence rate was 5.6%.Conclusion:Radiotherapy for early stage breast cancer with breast conservative treatment was essential, and the local recurrence rate was reduced by additional radiotherapy for tumor bed.%目的:通过对早期乳腺癌保乳术后放射治疗的研究,探讨其远期疗效。方法:36例早期乳腺癌患者行保乳手术后全乳腺精确三维适形放疗,DT 40~50Gy/25次,1次/天,5次/周,瘤床局部加量DT10~15Gy/5~10次。结果:全组病人5年生存率100%,5年无瘤生存率94.3%。全组出现复发及转移共2例,总复发率5.6%;部位是骨、肝,其中骨转移者经放化疗后仍健在,1例肝转移者死于肿瘤转移;4例(11.1%)出现放射性肺炎/肺纤维化,分别在放疗结束后6.0、6.5、7.5和9.0个月发生,均无明显临床症状;出现1级、2级心脏毒性分别为3和4例(19.4%),尚未发现3、4级心脏损伤。结论:放射治疗是早期乳腺癌保乳治疗的重要组成部分,瘤床加量照射可降低局部复发率。

  8. Bioresponsive polymer coated drug nanorods for breast cancer treatment

    Science.gov (United States)

    Laemthong, Tunyaboon; Kim, Hannah H.; Dunlap, Kelly; Brocker, Caitlin; Barua, Dipak; Forciniti, Daniel; Huang, Yue-Wern; Barua, Sutapa

    2017-01-01

    Ineffective drug release at the target site is among the top challenges for cancer treatment. This reflects the facts that interaction with the physiological condition can denature active ingredients of drugs, and low delivery to the disease microenvironment leads to poor therapeutic outcomes. We hypothesize that depositing a thin layer of bioresponsive polymer on the surface of drug nanoparticles would not only protect drugs from degradation but also allow the release of drugs at the target site. Here, we report a one-step process to prepare bioresponsive polymer coated drug nanorods (NRs) from liquid precursors using the solvent diffusion method. A thin layer (10.3 ± 1.4 nm) of poly(ε-caprolactone) (PCL) polymer coating was deposited on the surface of camptothecin (CPT) anti-cancer drug NRs. The mean size of PCL-coated CPT NRs was 500.9 ± 91.3 nm length × 122.7 ± 10.1 nm width. The PCL polymer coating was biodegradable at acidic pH 6 as determined by Fourier transform infrared spectroscopy. CPT drugs were released up to 51.5% when PCL coating dissolved into non-toxic carboxyl and hydroxyl groups. Trastuzumab (TTZ), a humanized IgG monoclonal antibody, was conjugated to the NR surface for breast cancer cell targeting. Combination treatments using CPT and TTZ decreased the HER-2 positive BT-474 breast cancer cell growth by 66.9 ± 5.3% in vitro. These results suggest effective combination treatments of breast cancer cells using bioresponsive polymer coated drug delivery.

  9. Breast cancer-related lymphoedema: risk factors and treatment.

    Science.gov (United States)

    Harmer, Victoria

    Lymphoedema is a condition where there is an obstruction of the flow of lymph, partnered with a swelling of the limb. Within the breast cancer arena lymphoedema can occur in the arm where the cancer was/is. The various approaches to treating lymphoedema include skin care, elevation of the affected arm, the use of compression hosiery, multi-layer bandaging, massage (manual lymphatic drainage), or even surgery. This article will discuss the treatments for lymphoedema along with relevant evidence and illustrate current practice.

  10. Long-term side effects of adjuvant breast cancer treatment

    NARCIS (Netherlands)

    Buijs, Ciska

    2008-01-01

    Breast cancer is the most common malignancy in women. Breast cancer accounts for one-third of all cancers in females and 24% of the patients are younger than 55 years of age. More than 10% all Dutch women will develop breast cancer and 70-80% of all breast cancer patients will survive over 5 years.

  11. Diagnosis and treatment of breast cancer%乳腺癌的诊断与治疗体会

    Institute of Scientific and Technical Information of China (English)

    徐金翔

    2013-01-01

    目的:研究乳腺癌的发病原因、临床表现及治疗。方法回顾性分析2009年6月-2010年12月我院外科12例乳腺癌的病例。结果在12例患者中,病理类型主要是浸润性导管癌与小叶癌,10例采取改良根治与保乳术,效果满意。结论女性患者定期进行体检、自检、门诊、综合应用各类辅助检查,对提高乳腺癌诊断率意义重大,以新辅助化疗作为前提的综合性治疗,能够增加手术或保乳的机会。%Purpose: The incidence of breast cancer causes, clinical manifestations and treatment. Method: Retrospective analysis of June 2009 -2010 gynecological hospital in December of 12 cases of breast cancer cases. Results: 12patients, pathological type is mainly invasive ductal cancer and lobular carcinoma, 10 cases of modified radical and to breast-conserving surgery, results were satisfactory. Conclusion: Women with regular physical examination, self-test, out-patient, comprehensive application of various types of laboratory examinations, to improve breast cancer diagnosis is of great significance to neoadjuvant chemotherapy as a prerequisite for comprehensive treatment, can increase the chance of breast conserving surgery.

  12. A systematic review of decision aids for patients making a decision about treatment for early breast cancer.

    Science.gov (United States)

    Nicholas Zdenkowski; Butow, Phyllis; Tesson, Stephanie; Boyle, Frances

    2016-04-01

    Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.

  13. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol

    DEFF Research Database (Denmark)

    Blichert-Toft, M.; Nielsen, M.; During, M.;

    2008-01-01

    The main objective of the present study aims at comparing the long-term efficacy of breast conserving surgery (BCS) vs. mastectomy (M) based on a randomized design. The Danish Breast Cancer Cooperative Group (DBCG) conducted the trial (DBCG-82TM) from January 1983 to March 1989 recruiting 1154...... patients with invasive breast carcinoma. Follow-up time ended 1(st) May 2006 with a median follow-up time of 19.6 years (time span 17.1-23.3 years). Eligibility criteria included a one-sided, unifocal, primary operable breast carcinoma, patient age below 70 years, probability of satisfactory cosmetic......% of the complete series. 10-year recurrence free survival (RFS) and 20-year overall survival (OS) based on intent to treat did not reveal significant differences in outcome between breast conserving surgery vs. mastectomy, p=0.95 and p=0.10, respectively. Including the complete series comprising 1133 eligible...

  14. Oncologic safety of breast conserving surgery after tumour downsizing by neoadjuvant therapy: a retrospective single centre cohort study.

    Science.gov (United States)

    Fitzal, F; Riedl, O; Mittlböck, M; Dubsky, P; Bartsch, R; Steger, G; Jakesz, R; Gnant, M

    2011-05-01

    The objective of this study is to analyse local recurrence rates in patients receiving neoadjuvant chemotherapy (nCT) comparing mastecomized (MX) patients with those undergoing breast conserving therapy (BCT). Patients undergoing breast cancer surgery after nCT (3xCMF or 3-6xED) between 1995 and 2007 at our department were retrospectively analysed. The median follow up was 60 months for 308 patients. Patients who were downsized from MX to BCT with partial or complete response (n = 104) had a similar local recurrence free survival (LRFS) compared to patients who did not experience successful downsizing (n = 67) and finally undergoing MX (LRFS MX-BCT 81% vs. MX-MX 91%; P = 0.79). Uni- and multivariate analyses demonstrated that BCT itself was not an independent prognostic factor for a worse LRFS (P = 0.07 and 0.14). After no pathologic change or progressive disease the risk of local recurrence was increased in patients undergoing BCT (MX-BCT; n = 6 LRFS 66%) compared with MX (n = 44; LRFS 90%; P = 0.04). Overall survival in general was better for the BCT group (n = 197) compared with MX group (n = 111) regardless of clinical response (92% vs. 72%; P downsizing by nCT in patients primarily scheduled for mastectomy. These patients, however, should not be treated with breast conservation in the absence of any proven response after nCT.

  15. Conservative treatment of acute knee osteoarthritis: A review of the Cochrane Library

    Directory of Open Access Journals (Sweden)

    Emerito Carlos Rodriguez-Merchan

    2016-05-01

    Conclusions: Five main strategies for the conservative treatment of knee osteoarthritis exist that must be used before indicating surgical treatment: medical treatment, physical medicine and rehabilitation, intra-articular injections, acupuncture, and self-management education programs.

  16. Inflammatory breast cancer: what are the treatment options?

    Science.gov (United States)

    Iniesta, Maria D; Mooney, Colin J; Merajver, Sofia D

    2009-12-01

    An otherwise healthy, 68-year-old woman presents to her primary-care physician complaining of right breast enlargement, warmth, and progressive pink to dark red skin changes over the past month. She denies fever, pain, or breast discharge. Physical examination reveals erythema of the whole right breast, warmth, swelling, induration, and nipple retraction. Palpable axillary lymphadenopathy is appreciated on the right only. The left breast is uninvolved. The physician is concerned that she may have inflammatory breast cancer.

  17. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Neboori, Hanmanth J.R. [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Haffty, Bruce G., E-mail: hafftybg@umdnj.edu [Department of Radiation Oncology, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Wu Hao [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Yang Qifeng [Department of Breast Surgery, Qilu Hospital, Shandong University, Ji' nan (China); Aly, Amal [Division of Medical Oncology, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Goyal, Sharad; Schiff, Devora [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Moran, Meena S. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Golhar, Ryan [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Chen Chunxia; Moore, Dirk [Department of Biostatistics, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); and others

    2012-08-01

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log-rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence-free survival (IBRFS), distant metastasis-free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their clinical

  18. Quality assurance of the EORTC trial 22881/10882 : 'assessment of the role of the booster dose in breast conserving therapy'; The Dummy Run

    Energy Technology Data Exchange (ETDEWEB)

    Tienhoven, G. van; Bree, N.A.M. van; Mijnheer, B.J.; Bartelink, H. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands) the EORTC Radiotherapy Group)

    1991-12-01

    The EORTC trial 22881/10882 is a randomised trial with the aim to assess the role of the boost dose in breast conserving therapy in stage I and II breast cancer.In order to detect potential protocol deviations concerning irradiation technique and in dose specification procedure of participating institutions before actual patient accrual, a Dummy Run was performed. Three transverse sections of a patient were sent to 16 institutions with a request to make a 3-plane treatment plan according to protocol prescriptions. A treatment chart and beam data were also requested for recalculation of the dose. Additional information was asked in a questionnaire. On evaluation, the techniques differed considerably with respect to photon beam energy, varying between {sup 60}Co gamma-rays and 8MV X-rays, and use of wedge filters. Two institutions did not apply wedges, whereas wedge angles in the other institutions varied between 6deg and 45 deg. Twelve institutions used collimator rotation and/or a table wedge to diminish the amount of irradiated lung volume. The dose was specified in a point according to the protocol prescription in 11 institutions and to the 90, 95 or 100% isodose curve in four. Twelve institutions applied lung density corrections during treatment planning, while nine reported problems with their planning system in off-axis dose distribution calculation and/or the stimulation of collimator rotation. Recalculation of dose at the isocentre showed agreement within 2% compared with stated dose. Dose reported in the tumor excision area varied between 93 and 100%. It can be concluded that good accordance and high quality breast irradiation can be achieved by all institutions participating in the trial, provided a few recommendations are followed. The results of this analysis show the necessity and usefulness of a quality assurance programme at the initial phase of a clinical trial. (author). 27 refs.; 3 figs.; 4 tabs.

  19. Breast cancer in young women: poor survival despite intensive treatment.

    Directory of Open Access Journals (Sweden)

    Hanna Fredholm

    Full Text Available BACKGROUND: Breast cancer is uncommon in young women and correlates with a less favourable prognosis; still it is the most frequent cancer in women under 40, accounting for 30-40% of all incident female cancer. The aim of this study was to study prognosis in young women, quantifying how much stage at diagnosis and management on the one hand, and tumour biology on the other; each contribute to the worse prognosis seen in this age group. METHODOLOGY/PRINCIPAL FINDINGS: In a registry based cohort of women aged 20-69 (n = 22 017 with a primary diagnosis of invasive breast cancer (1992-2005, women aged 20-34 (n = 471, 35-39 (n = 858 and 40-49 (n = 4789 were compared with women aged 50-69 years (n = 15 899. The cumulative 5-year relative survival ratio and the relative excess mortality (RER were calculated. The cumulative 5-year relative survival ratio was lowest in women aged 20-34. The RER was 2.84 for women aged 20-34 and decreased with increasing age (RER 1.76 and 1.17 for women aged 35-39 and 40-49, respectively. The excess risk was, however, present only in disease stages I and II. For women aged 20-34 with stage I disease RER was 4.63, and 6.70 in the subgroup with tumour size 1-10 mm. The absolute difference in stage I between the youngest and the reference groups amounted to nearly 8%, with a 90% 5-year survival in women aged 20-34. In stages IIa and IIb, the relative excess risk was not as dramatic, but the absolute differences approached 15%. The youngest women with small tumours generally received more aggressive treatment than women in older age groups. CONCLUSIONS: After correction for stage, tumour characteristics and treatment, age remained an independent risk factor for breast cancer death in women <35 years of age. The excess risk for young women was only seen in early stages of disease and was most pronounced in women with small tumours. Young women affected by breast cancer have a high risk of dying compared to their middle

  20. Triple-negative breast cancer: treatment challenges and solutions

    Directory of Open Access Journals (Sweden)

    Collignon J

    2016-05-01

    Full Text Available Joëlle Collignon,1 Laurence Lousberg,1 Hélène Schroeder,1 Guy Jerusalem,1,21Medical Oncology Department, CHU Sart Tilman Liege, Domaine Universitaire du Sart Tilman, Liege, Belgium; 2University of Liege, Liege, Belgium Abstract: Triple-negative breast cancers (TNBCs are defined by the absence of estrogen and progesterone receptors and the absence of HER2 overexpression. These cancers represent a heterogeneous breast cancer subtype with a poor prognosis. Few systemic treatment options exist besides the use of chemotherapy (CT. The heterogeneity of the disease has limited the successful development of targeted therapy in unselected patient populations. Currently, there are no approved targeted therapies for TNBC. However, intense research is ongoing to identify specific targets and develop additional and better systemic treatment options. Standard adjuvant and neoadjuvant regimens include anthracyclines, cyclophosphamide, and taxanes. Platinum-based CT has been proposed as another CT option of interest in TNBC. We review the role of this therapy in general, and particularly in patients carrying BRCA germ-line mutations. Available data concerning the role of platinum-based CT in TNBC were acquired primarily in the neoadjuvant setting. The routine use of platinum-based CT is not yet recommended by available guidelines. Many studies have reported the molecular characterization of TNBCs. Several actionable targets have been identified. Novel therapeutic strategies are currently being tested in clinical trials based on promising results observed in preclinical studies. These targets include androgen receptor, EGFR, PARP, FGFR, and the angiogenic pathway. We review the recent data on experimental drugs in this field. We also discuss the recent data concerning immunologic checkpoint inhibitors. Keywords: triple-negative breast cancer, molecular subtype, platinum-based chemotherapy, targeted therapy, androgen receptor, BRCA1/2 mutation

  1. Surgery for Breast Cancer

    Science.gov (United States)

    ... Cancer During Pregnancy Breast Cancer Breast Cancer Treatment Surgery for Breast Cancer Surgery is a common treatment ... removed (breast reconstruction) Relieve symptoms of advanced cancer Surgery to remove breast cancer There are two main ...

  2. The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy.

    Science.gov (United States)

    Jobsen, J J; van der Palen, J; Meerwaldt, J H

    2001-10-01

    The aim of the study was to evaluate the importance of young age with regard to local control in a prospective cohort of 1085 women with pathological T1 tumours treated with breast conservative treatment (BCT). Patients were divided into two age groups: 40 years or younger, 7.8%, and older than 40 years, 92.2%. With a median follow-up of 71 months, the local recurrence rate was 10.6% in women 40 years (P=0.0046). A separate analysis showed a significantly decreased LRFS for young women with a positive family history, 75.4% versus 98.4% 5-year LRFS for older women. A worse LRFS for young women with a negative lymph node status was also observed, respectively 84% versus 98% 5-year LRFS (both P<0.001). In a multivariate analysis, taking into account the pre-treatment and treatment factors, age < or =40 years, was the only significant predictor of a decreased LRFS. Thus, young age is an important factor in relation to local control. In a subset analysis, this significant adverse effect of young age on outcome appears to be limited to the node-negative patients and those with a positive family history. To date, there is no evidence that young women with pT1 breast cancer, treated by mastectomy have an improved outcome when compared with those treated with conservative surgery and radiotherapy. Taking into account results from a subset analysis suggests that giving systemic therapy to a subgroup of women who are < or =40 years, node-negative and/or have a positive family history might give a better local control.

  3. Fusions of Breast Carcinoma and Dendritic Cells as a Vaccine for the Treatment of Metatastic Breast Cancer

    Science.gov (United States)

    2012-07-01

    Dendritic Cells as a Vaccine for the Treatment of Metatastic Breast Cancer PRINCIPAL INVESTIGATOR: Donald Kufe, M.D...COVERED 1 July 2011 – 30 June 2012 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Fusions of Breast Carcinoma and Dendritic Cells as a Vaccine for...have been enrolled thus far. We reported in detail the characterization of the tumor cells, the generated dendritic cells and the DC/tumor fusions

  4. Risk of regional recurrence in triple-negative breast cancer patients: a Dutch cohort study

    NARCIS (Netherlands)

    Roozendaal, van Lori M.; Smit, Leonie H.M.; Duijsens, Gaston H.N.M.; Vries, de Bart; Siesling, Sabine; Lobbes, Marc B.I.; Boer, de Maaike; Wilt, de Johannes H.W.; Smidt, Marjolein L.

    2016-01-01

    Triple-negative breast cancer is associated with early recurrence and low survival rates. Several trials investigate the safety of a more conservative approach of axillary treatment in clinically T1-2N0 breast cancer. Triple-negative breast cancer comprises only 15 % of newly diagnosed breast cancer

  5. [Monitoring of patients with breast cancer after multimodal treatment].

    Science.gov (United States)

    Prieto, Marcela Martínez; de la Torre, Celia B Flores; Basurto, Carlos Sánchez; Forgach, Ernesto Sánchez

    2008-02-01

    Breast cancer is a frequent neoplasm in Latin America. Its control implies surveillance for about 10 years after diagnosis. The possibilities of metastatic disease depend on stage at diagnosis and the treatment administered to the patient. It is important that all medical centers implement their own follow-up that fits its needs. Surveillance must include physical therapy, attention to psychosocial aspects as well as treatment for toxicity, secondary effects, recurrence and second primaries. The American Society of Clinical Oncology (ASCO) includes monthly self-examination, annual mammography, office visits every three months for the first three years, and then biannual visits for the next two years and then annually. Randomized studies and the Cochrane database have proved that intensive follow-up is of no value compared with periodic appointments and annual mammography. Existing evidence suggests that postoperative surveillance of breast cancer patients is extremely expensive, time consuming and of no benefit in terms of survival. Most of recurrences present out of context from follow up visits. Thus, efficacy of routine doctor visits is questionable and a prospective study is needed to outline the adequate strategy.

  6. Surgical Treatment of Giant Recurrent Breast Phyllodes Tumor

    Institute of Scientific and Technical Information of China (English)

    Xiru LI; Yungong YANG; Jiandong WANG; Bing MA; Yuanchao JIN; Rong LI

    2008-01-01

    In this study, a recurrent massive phyllodes tumor of the breast was surgically removed and the grafting was used to repair the local skin defects. A 29-y female patient had recurring breast phyllodes tumor of extremely large size in the chest wall after the excision of a previous tumor. The massive phyllodes tumor was eliminated by completely removing the layers of the skin and tissues above the costal bones with incisal margin being 2 cm away from the tumor lesion. The latissimus dorsi myocutaneous flap, lateral thoracic skin flap, and rectus abdominis myocutaneous flap were grafted to replace the lost tissues due to the surgery. Anti-infection and anticoagulation treatments were used after the surgery. The graft flaps had sufficient blood supply and good blood circulation,and the incisions mostly healed. The outcome of the surgery was acceptable. For the surgical treatment of the massive phyllodes tumor in the chest wall, it is an alternative of choice to use latissimus dorsi myocutaneous flap, lateral thoracic skin flap and rectus abdominis myocutaneous flap in combination for skin grafting.

  7. The results of conservative and surgical treatments of styloiditis radii de Quervain

    OpenAIRE

    2004-01-01

    Though styloiditis radii de Quervain is a little disease condition, it sometimes necessitates surgery. in this research we examined the result of 147 patients who was admitted to the Department of Orthopaedics of Ev. Krankenhaus retrospectively. We compared corticosteroid which mentionted injection with conservative treatment. We prefer conservative methods instead of corticosteroid treatment which mentionted in the literature. Conservative treatment was necessary in 78,91% of cases. 31 of ou...

  8. Pattern of Breast Cancer Distribution in Ghana: A Survey to Enhance Early Detection, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Frank Naku Ghartey Jnr

    2016-01-01

    Full Text Available Background. Nearly 70% of women diagnosed with breast cancer in Ghana are in advanced stages of the disease due especially to low awareness, resulting in limited treatment success and high death rate. With limited epidemiological studies on breast cancer in Ghana, the aim of this study is to assess and understand the pattern of breast cancer distribution for enhancing early detection and treatment. Methods. We randomly selected and screened 3000 women for clinical palpable breast lumps and used univariate and bivariate analysis for description and exploration of variables, respectively, in relation to incidence of breast cancer. Results. We diagnosed 23 (0.76% breast cancer cases out of 194 (6.46% participants with clinically palpable breast lumps. Seventeen out of these 23 (0.56% were premenopausal (<46.6 years with 7 (0.23% being below 35 years. With an overall breast cancer incidence of 0.76% in this study, our observation that about 30% of these cancer cases were below 35 years may indicate a relative possible shift of cancer burden to women in their early thirties in Ghana, compared to Western countries. Conclusion. These results suggest an age adjustment for breast cancer screening to early twenties for Ghanaian women and the need for a nationwide breast cancer screening to understand completely the pattern of breast cancer distribution in Ghana.

  9. Cardiovascular surveillance in breast cancer treatment : A more individualized approach is needed

    NARCIS (Netherlands)

    Maas, Angela H E M; Ottevanger, Nelleke; Atsma, Femke; Cramer, Maarten J; Leiner, Tim; Poortmans, Philip

    2016-01-01

    Newly developed treatment strategies for breast cancer have reduced mortality rates over the past decades. Patients with breast cancer represent a heterogeneous population. Differences in the severity of the disease require diverse treatment options. Women have distinct individual risk patterns for

  10. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review

    NARCIS (Netherlands)

    Penha, T.R.; Ijsbrandy, C.; Hendrix, N.A.; Heuts, E.M.; Voogd, A.C.; Meyenfeldt, M.F. von; Hulst, R.R. van der

    2013-01-01

    BACKGROUND: Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related lymphedem

  11. 保乳手术和改良根治术治疗乳腺癌对比分析%Analysis and comparison of breast-conserving surgery and modified radical mastectomy to treat breast cancer

    Institute of Scientific and Technical Information of China (English)

    陈先志

    2014-01-01

    目的:对比保乳手术、改良根治术在乳腺癌治疗中的疗效。方法选取2011年5月至2013年4月在我院就诊的乳腺癌患者97例,并随机分为观察组(49例)和对照组(48例)。观察组患者接受保留乳房的乳腺癌切除术,对照组患者接受乳腺癌改良根治术。对比两组术中平均出血量、平均住院时间、术后平均引流量、患者的术后恢复及复发情况,以及对美容效果是否满意等。结果两组患者术后随访12个月,术区皮肤均恢复良好,暂无复发患者。观察组患者对于术后美容效果满意率为87.8%,而对照组患者的满意率为20.8%,两组之间差异有统计学意义(P<0.05)。观察组在术中平均出血量、平均住院时间、术后平均引流量等指标均低于对照组(P<0.05)。结论乳腺癌早期患者在满足手术适应症的前提下,应在临床上推广选择保留乳房的乳腺癌切除术作为首选。%Objective To compare the treatment efifcacy of breast-conserving surgery and modiifed radical mastectomy in breast cancer.Methods 97 cases of breast cancer patients admitted in our hospital from May 2011 to april 2013 were randomly divided into observation group (49 cases) and control group (48 cases). observation group patients underwent breast-conserving surgery, while the control group patients received modiifed radical mastectomy. The mean intraoperative blood loss, length of stay, the average postoperative drainage volume, postoperative recovery and recurrence, as well as the cosmetic results whether be satisfactory and so on were compared between two groupsResults the two groups of patients were followed up for 12 months. The surgical skin recovered well, no relapse. The observation group patients were satisifed with the cosmetic results after surgery and the satisfaction rate was 87.8%, while this rate of the control group patients was 20.8%, the difference between the two groups was statistically

  12. Feasibility and acute toxicity of 3-dimensional conformal external-beam accelerated partial-breast irradiation for early-stage breast cancer after breast-conserving surgery in Chinese female patients

    Institute of Scientific and Technical Information of China (English)

    LI Feng-yan; HE Zhen-yu; XUE Ming; CHEN Li-xin; WU San-gang; GUAN Xun-xing

    2011-01-01

    Background A growing number of studies worldwide have advocated the replacement of whole-breast irradiation with accelerated partial breast irradiation using three-dimensional conformal external-beam radiation (APBI-3DCRr) for early-stage breast cancer. But APBI can be only used in selected population of patients with early-staged breast cancer. It is not replacing the whole breast radiotherapy. This study aimed to examine the feasibility and acute normal tissue toxicity of the APBI-3DCRT technique in Chinese female patients who generally have smaller breasts compared to their Western counterparts.Methods From May 2006 to December 2009, a total of 48 Chinese female patients (with early-stage breast cancer who met the inclusion criteria) received APBI-3DCRT after breast-conserving surgery at Sun Yat-sen University Cancer Center. The total dosage from APBI-3DCRT was 34 Gy, delivered in 3.4 Gy per fractions, twice per day at intervals of at least six hours. The radiation dose, volume of the target area and volume of irradiated normal tissues were calculated.Acute toxicity was evaluated according to the Common Toxicity Criteria (CTC) 3.0.Results Among the 48 patients, the planning target volume for evaluation (PTVE) was (90.42±9.26) cm3, the ipsilateral breast volume (IBV) was (421.74±28.53) cm3, and the ratio between the two was (20.74±5.86)%. Evaluation of the dosimetric characteristics of the PTVE revealed excellent dosimetric results in 14 patients and acceptable results in 34 patients. The dose delivered to the PTVE ranged from 93% to 110% of the prescribed dose. The average ratio of the volume of PTVE receiving 95% of the prescription dose (V95) was (99.26±0.37)%. The habituation index (HI) and the conformity index (CI) were 1.08±0.01 and 0.72±0.02, respectively, suggesting good homogeneity and conformity of the dose delivered to the target field. The radiation dose to normal tissues and organs was within the dose limitation.Subjects experienced mild acute

  13. Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast

    Institute of Scientific and Technical Information of China (English)

    Koji Yamashita; Kazuo Shimizu

    2008-01-01

    Background The endoscopic surgery for inner-side cancer of the breast is usually performed by periareolar approach,but it often makes deformation or malposition of nipple and areola. The trans-axillary approach is favorable without making any injuries on breast skin. Furthermore, we devised a new approach of retro-mammary route without subcutaneous exfoliation, from axillary skin incision, to preserve skin touch sensation.Methods We have performed video-assisted breast surgery (VABS) on 200 patients since December 2001. The newly devised trans-axillary retromammary-route approach (TARM) was performed on 12 patients of early breast cancer. After endoscopic sentinel lymph node biopsy, we lengthened the axillary skin incision to 2.5 cm, and dissected retromammary tissue from superficial pectoral fascia onto major pectoral muscle below the tumor. The working space was made by lifting traction sutures through the gland. We cut the gland vertically at free margin 2 cm apart from the tumor edge, and dissect skin flap over the tumor. The breast reconstruction was done by filling absorbable fiber cotton.Results Traction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like bum. All surgical margins were negative. The operation time was needed longer but the blood loss was not different.The postoperative esthetic results were good. The sensory disturbance was minimal. All patients were satisfied with this operation.Conclusion This newly devised TARM approach need no injury on whole breast, and can become a single standard method for breast conserving surgery wherever the cancer situated.

  14. What's New in Breast Cancer Research and Treatment?

    Science.gov (United States)

    ... Evolving Trends in Breast Surgery: Oncoplastic to Onco-Aesthetic Surgery. Arch Plast Surg . 2016;43(2):222- ... LR, Wilkinson D. The role of general nuclear medicine in breast cancer. J Med Radiat Sci . 2015; ...

  15. Colorado Plateau Rapid Ecoregion Assessment Conservation Elements - Terrestrial Species: Yellow-Breasted Chat

    Data.gov (United States)

    Bureau of Land Management, Department of the Interior — This map shows the potential current distribution of yellow-breasted chat, in the context of current and near-term terrestrial intactness and long-term potential for...

  16. Patterns of Care and Disparities in the Treatment of Early Breast Cancer

    Science.gov (United States)

    2010-09-01

    breast cancer care across the United States.   33 REFERENCES    1. Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL. Results of the...McMasters KM, Scoggins CR, Martin RC Jr, Thoene C, Edwards MJ. The use of radiation therapy after breast-conserving surgery in hormonally treated breast...G. Haffty, Frank A. Vicini, Julia R. White, Douglas W. Arthur, Jay R. Harris, and Ya-Chen T. Shih From The University of Texas MD Anderson Cancer

  17. Early-Stage Breast Cancer Treatment Fact Sheet

    Science.gov (United States)

    ... same breast is low. Yet, even if breast cancer does recur in the same breast, that does not reduce a woman's chances for a healthy recovery. As was already noted, the chance of survival is not affected by the choice of surgery. ...

  18. 乳腺癌保乳术后加速部分乳腺照射研究进展%Accelerated partial breast irradiation after breast conserving surgery:a review of techniques and progress

    Institute of Scientific and Technical Information of China (English)

    张勇乾; 王雅棣

    2013-01-01

    Breast-conserving surgery with postoperative whole-breast irradiation (WBI) has become one of the standard treat-ments for early breast cancer. However, traditional WBI has a large radiation field and lengthy course of treatment. Accelerated par-tial-breast irradiation (APBI) has been recognized as an alternative treatment to WBI. Three main techniques constitute APBI: intraoper-ative radiation therapy, external radiation therapy, and brachytherapy. Intraoperative radiation therapy involves the application of thera-peutic levels of radiation during surgery. This technique allows for the exact delivery of radiation beams to the tumor bed; strict preci-sion is observed for equipment in this technique. External radiation therapy is performed by radiotherapists and physicists. This tech-nique is easy to implement. Furthermore, the target dose distribution can be achieved because of the implementation of a treatment plan-ning system. Brachytherapy includes multi-catheter interstitial brachytherapy and mammosite therapy. Presently, mammosite therapy is widely used because of its facile procedure. However, clinical follow-up data are limited because of the short duration of APBI therapy. The selection of appropriate patients and optimal dosimetric distribution is needed before APBI application to reduce the risk of breast cancer recurrence.%  保乳手术加术后全乳腺放疗(whole breast irradiation,WBI)已成为早期乳腺癌的标准治疗模式之一,但是传统的WBI照射范围大,疗程长.近年来,缩小照射范围、缩短总疗程的加速部分乳腺照射(accelerated partial breast irradiation,APBI)作为保乳术后WBI的替代治疗方法,得到了广泛的认同.APBI常用的治疗方式有术中放疗、外照射和近距离放疗三种.术中放疗为保乳手术中给予一次性照射,照射范围准确,但是对设备的要求较高.外照射由专业的放疗科医师和物理师执行,相对容易实现,而且可以通过治疗计划系

  19. Concurrent chemo-radiotherapy in the treatment of early breast cancer: Current status

    OpenAIRE

    Nabil Ismaili

    2013-01-01

    Concurrent chemo-radiotherapy (CCRT) in early breast cancer was investigated by few authors and remains controversial. This treatment is more commonly used for locally advanced breast cancer and showed high rate of complete pathological response. A search of articles published in English literature, between 1980 and November 2012, was conducted on Medline using the following terms: "breast cancer", "chemotherapy", "concurrent radiotherapy", and "Trastuzumab". We identified five phase I/II tri...

  20. A Research Agenda for Appearance Changes Due to Breast Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Mia K. Markey

    2008-01-01

    Full Text Available Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor’s appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women’s perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor’s appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor’s breasts to match her preferences as much as possible.

  1. Research Progress on the Serratus Anterior Muscle Flap in the Reconstruction of Partial Breast Defects after Breast Conserving Surgery for Patients with Breast Cancer%前锯肌肌瓣修补保乳手术后乳房局部缺损的应用

    Institute of Scientific and Technical Information of China (English)

    陈朝华(综述); 韦兴中(审校)

    2014-01-01

    Traditional operation treatment for patients with breast cancer will destroy the graceful female sexuality and the figure,which causes great psychological trauma to the patients,and severely impacts on the postoperative quality of life.The treatment for early breast cancer has been developed from the traditional rad-ical surgery to the breast-conserving surgery,application of serratus anterior muscle flap in repairing breast defects is not only safe, but also have satisfactory aesthetic outcomes.Moreover,it can not only alleviate the mental stress and mood disorders of the patients due to the loss of breast ,but also recover the patients confi-dence and social participation awareness,and greatly improve the postoperative quality of life of the patients.%传统的乳腺癌手术在治疗的同时破坏了女性优美的性征和曲线,给患者造成极大的心理创伤,严重影响患者术后生存质量。早期乳腺癌治疗手段已经由传统的根治手术发展到现在的保乳术,应用前锯肌肌瓣修复保乳术后局部的缺损,可明显改善美容效果。其不仅可以缓解患者因失去乳房而导致的心理压力和情绪障碍,恢复患者的自信与社会参与意识,而且可以极大地提高乳腺癌患者术后的生活质量。

  2. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears : a randomized controlled trial

    NARCIS (Netherlands)

    Lambers Heerspink, Okke; van Raay, Jos J. A. M.; Koorevaar, Rinco C. T.; van Eerden, Pepijn J. M.; Westerbeek, Robin E.; van 't Riet, Esther; van den Akker-Scheek, Inge; Diercks, Ronald L.

    2015-01-01

    Background: Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears. The primary aim of this randomized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tea

  3. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Fastner, Gerd; Zehentmayr, Franz; Kopp, Peter; Fussl, Christoph; Sedlmayer, Felix [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Hauser-Kronberger, Cornelia [Landeskrankenhaus, Paracelsus Medical University, Department of Pathology, Salzburg (Austria); Moder, Angelika [Landeskrankenhaus, Paracelsus Medical University, Institute of Inborn Errors in Metabolism, Salzburg (Austria); Reitsamer, Roland; Fischer, Thorsten [Landeskrankenhaus, Paracelsus Medical University, Department of Special Gynecology, Salzburg (Austria); Landeskrankenhaus, Paracelsus Medical University, Department of Gynecology, Salzburg (Austria); Deutschmann, Heinrich [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Paracelsus Medical University, Institute for Research and Development of Advanced Radiation Technologies (radART), Salzburg (Austria)

    2016-01-15

    The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation. A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median D{sub max}) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %). After a median follow-up of 97 months (range 4-170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03). Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3. (orig.) [German] Ziel der Studie war es, im Rahmen einer retrospektiven Analyse Ueberlebens- und Lokalkontrollraten bei triple-negativen Mammakarzinomen zu untersuchen. Die Tumoren waren in 5NP(5-Marker-negative)- und CB(core basal)-Subtypen klassifiziert und die Patientinnen hatten nach brusterhaltender Operation und

  4. Note: Utilization of polymer gel as a bolus compensator and a dosimeter in the near-surface buildup region for breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fuse, Hiraku, E-mail: fuseh@ipu.ac.jp; Inohira, Masaya; Kawamura, Hiraku; Fujisaki, Tatsuya [Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Inashiki-gun, Ibaraki 300-0331 (Japan); Shinoda, Kazuya [Graduate School of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki (Japan); Department of Radiological Technology, Tsukuba Medical Center Hospital, Tsukuba (Japan); Miyamoto, Katsumi [Department of Radiological Technology, Tsukuba Medical Center Hospital, Tsukuba (Japan); Sakae, Takeji [Faculty of Medicine, University of Tsukuba, Tsukuba (Japan)

    2015-09-15

    Tangential beam radiotherapy is routinely used for radiation therapy after breast conserving surgery. A tissue-equivalent bolus placed on the irradiated area shifts the depth of the dose distribution; this bolus provides uniform dose distribution to the breast. The gel bolus made by the BANG-Pro{sup ®} polymer gel and in an oxygen non-transmission pack was applicable as a dosimeter to measure dose distribution in near-surface buildup region. We validated the use of the gel bolus to improve in the whole-breast/chest wall, including the near-surface buildup region.

  5. Treatment of breast cancer with different antiprogestins: Preclinical and clinical studies

    OpenAIRE

    Bakker, Gerard; Setyono-Han, Buddy; Portengen, Henk; Jong, Frank de; Foekens, John; Klijn, Jan

    1990-01-01

    markdownabstractAbstract Treatment with antiprogestins in a new treatment modality for breast cancer. Previously, in rats with DMBA-induced mammary tumors we observed significant growth inhibitory effects of chronic treatment with the antiprogestin mifepristone (RU486). In addition, in 11 postmenopausal breast cancer patients, we observed one objective response, six instances of short-term stable disease, and four instances of progressive disease. Side-effects appeared mainly due to antigluco...

  6. Neutropenic event risk and impaired chemotherapy delivery in six European audits of breast cancer treatment

    NARCIS (Netherlands)

    Schwenkglenks, Matthias; Jackisch, Christian; Constenla, Manuel; Kerger, Joseph N.; Paridaens, Robert; Auerbach, Leo; Bosly, Andre; Pettengell, Ruth; Szucs, Thomas D.; Leonard, Robert

    2006-01-01

    Goals of work: The aims of this study were to assess chemotherapy treatment characteristics, neutropenic event (NE) occurrence and related risk factors in breast cancer patients in Western Europe. Material and methods: Six retrospective audits of breast cancer chemotherapy were combined into a datas

  7. Endometrial cancer survival after breast cancer in relation to tamoxifen treatment : Pooled results from three countries

    NARCIS (Netherlands)

    Jones, Michael E.; van Leeuwen, Flora E.; Hoogendoorn, Wilhelmina E.; Mourits, Marian J. E.; Hollema, Harry; van Boven, Hester; Press, Michael F.; Bernstein, Leslie; Swerdlow, Anthony J.

    2012-01-01

    Introduction: Tamoxifen is an effective treatment for breast cancer but an undesirable side-effect is an increased risk of endometrial cancer, particularly rare tumor types associated with poor prognosis. We investigated whether tamoxifen therapy increases mortality among breast cancer patients subs

  8. Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast-conserving therapy.

    Science.gov (United States)

    Jobsen, Jan J; Van Der Palen, Job; Ong, Francisca; Meerwaldt, Jacobus H

    2007-01-01

    A study of the possible difference in outcome for positive margins for invasive carcinoma (IC) versus ductal carcinoma in situ (DCIS), and with regard to different age categories in a large prospective cohort of patients with invasive breast cancer. A total of 2 291 BCT were analyzed. Margins were positive for IC in 8.7% and for DCIS in 4.6%. The median follow-up was 83 months. The 10-year local recurrence-free survival for negative margins vs. positive margins for IC vs. positive for DCIS for women 40 years 94.7% vs. 92.6% vs. 82.6% (HR4.2). The 10-year distant disease-free survival for negative margins vs. positive margins for IC vs. positive for DCIS women 40 years.

  9. The surgical treatment of 18 cases of primary breast tumor effect observation%18例原发性乳腺肿瘤的手术治疗效果观察

    Institute of Scientific and Technical Information of China (English)

    周建宇; 郭峰宇

    2013-01-01

    Objective To investigate the clinical effect of primary breast cancer operation and early treatment of breast. Methods 18 cases of primary breast cancer I, I patients with breast conserving treatment standard operation, underwent breast conserving operation treatment, radiotherapy, chemotherapy and regular fol ow-up after operation, evaluation of breast shape the situation. Results 36 months fol ow-up, patients with breast cancer recurrence and distant metastasis, no patients died. With contralateral breast evaluation optimal 10 cases, 7 cases, and poor in 1 case, was 94.44%. Conclusion patients with primary breast cancer early clinical surgical treatment effect is good, the breast cosmetic effect is good, can be popularized in clinical application.%目的:探讨原发性乳腺癌早期保乳手术治疗的临床效果。方法对18例原发性乳腺癌I、I 期患者符合保乳手术治疗标准,均行保乳手术治疗,术后给予放疗、化疗并定期随访,评定乳房外形情况。结果随访时间36个月,无乳腺癌复发及远处转移患者,无死亡患者。患侧乳房评估优10例,良7例,差1例,优良率94.44%。结论原发性乳腺癌患者早期保乳手术治疗临床效果较好,乳房美容效果良好,可在临床推广应用。

  10. Molecular clonality determination of ipsilateral recurrence of invasive breast carcinomas after breast-conserving therapy: comparison with clinical and biologic factors.

    Science.gov (United States)

    Goldstein, Neal S; Vicini, Frank A; Hunter, Susan; Odish, Eva; Forbes, Suzy; Kraus, Daniel; Kestin, Larry L

    2005-05-01

    We established clonality relationships between invasive ipsilateral breast failures (IBFs; local recurrences) and initial invasive carcinomas using a molecular polymerase chain reaction loss of heterozygosity (LOH) assay for 26 patients treated with breast-conserving therapy for invasive carcinoma with no distant metastases (DMs) before the IBE LOH was +/- 50% allelic loss. Eighteen IBFs (69%) were related clonally to initial carcinomas; 8 (31%) were clonally distinct, second primary carcinomas. IBFs and initial invasive carcinomas were morphologically similar in 6 (75%) of 8 clonally different cases. Clinical IBF classification and molecular assay results differed in 11 cases (42%). The mean intervals to IBF were 4.7 years in related and 8.7 years in different cases (P = .013). In 6 patients, DMs developed; 5 had related IBFs. In related IBF cases, the mean increase in fractional allelic loss (FAL) of IBFs associated with DMs was 18.9% compared with 7.6% in cases unassociated with DMs (P = .004). Molecular assays can accurately establish the clonality of most IBFs. Morphologic comparison and clinical IBF classification are unreliable methods of determining clonality. Clonally related IBFs occurred sooner than clonally different IBFs. Patients with clonally related IBFs are the main pool in which DMs occur Not all clonally related IBFs have the same DM association; those with large FAL gains were associated with DMs. Molecular clonality assays may provide a reliable means of identifying patients who might benefit from systemic chemotherapy at the time of IBF.

  11. Comprehensive therapy of early breast cancer after breast-conserving surgery%早期乳腺癌保乳术后综合治疗

    Institute of Scientific and Technical Information of China (English)

    董亚勤; 杨林

    2015-01-01

    For the patients with early breast cancer,the effects of breast-conserving surgery combined with radiotherapy and radical resection are equal,and the former shows less adverse reactions and better aes-thetic outcome. Because of individual differences and the inherent complexity of tumor,to obtain optimal effects,it is an inevitable trend of making an individual comprehensive therapy,which is a combination of radiotherapy,chemotherapy,endocrine therapy and targeted therapy.%早期乳腺癌保乳术结合放疗与根治术效果相当,并且较根治术有着更少的不良反应和更好的美容效果。由于个体差异及肿瘤的内在复杂性,为获得最优疗效,制定结合放疗、化疗、内分泌及靶向治疗的个体化综合治疗方案是早期乳癌保乳术后治疗的必然趋势。

  12. Improved fertility following conservative surgical treatment of ectopic pregnancy

    DEFF Research Database (Denmark)

    Bangsgaard, Nannie; Lund, Claus Otto; Ottesen, Bent

    2003-01-01

    OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic...... pathology, the chance of pregnancy was poor (hazard ratio 0.463) and the risk of recurrence was high (hazard ratio 2.25), assessed with Cox regression. The rate of persistent ectopic pregnancy was 8%. CONCLUSION: Conservative surgery is superior to radical surgery at preserving fertility. Conservative...

  13. Understanding a Breast Cancer Diagnosis

    Science.gov (United States)

    ... Cancer A-Z Breast Cancer Understanding a Breast Cancer Diagnosis If you’ve been diagnosed with breast cancer, ... Prevention Early Detection and Diagnosis Understanding a Breast Cancer Diagnosis Treatment Breast Reconstruction Surgery Living as a Breast ...

  14. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial

    OpenAIRE

    Mann, Eleanor; Smith, Melanie J; Hellier, Jennifer; Balabanovic, Janet A; Hamed, Hisham; Grunfeld, Elizabeth A; Hunter, Myra S.

    2012-01-01

    Summary Background Hot flushes and night sweats (HFNS) affect 65–85% of women after breast cancer treatment; they are distressing, causing sleep problems and decreased quality of life. Hormone replacement therapy is often either undesirable or contraindicated. Safe, effective non-hormonal treatments are needed. We investigated whether cognitive behavioural therapy (CBT) can help breast cancer survivors to effectively manage HFNS. Methods In this randomised controlled trial, we recruited women...

  15. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conservative surgery enhances late toxicities; La chimiotherapie concomitante de la radiotherapie augmente la toxicite tardive apres chirurgie conservatrice du cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Toledano, A. [Hopital Tenon, Service d' oncologie-radiotherapie 75 - Paris (France); Garaud, P.; Body, G.; Le Floch, O.; Calais, G. [Centre Hospitalier Universitaire Bretonneau, 37 - Tours (France); Serin, D. [Institut Sainte-Catherine, 84 - Avignon (France); Fourquet, A. [Institut Curie, 75 - Paris (France); Bosset, J.F.; Miny-Buffet, J. [Centre Hospitalier Universitaire Minjoz, 25 - Besancon (France); Favre, A. [Centre Hospitalier Universitaire La Source, 45 - Orleans (France); Azria, D. [Centre de Lutte Contre le Cancer Val d' Aurelle, 34 Montpellier (France)

    2006-06-15

    In 1996, a multicenter randomized study comparing after breast-conservative surgery. sequential vs concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) was initiated (ARCOSEIN study). Seven hundred sixteen patients were included in this trial. After a median follow-up of 6.7 (4.3 -9) years, we decided to prospectively evaluate the late effects of these two strategies. Patients and methods - A total of 297 patients were asked to follow-up from the five larger including institutions. Seventy-two percent (214 patients) were eligible for late toxicity. After breast-conserving surgery with axillary dissection, patients were treated either with sequential treatment with CT first followed by RT (arm A) or CT administered concurrently with RT (arm B). In all patients, CT regimen combined mitoxantrone (12 mg/m{sup 2}). 5-FU (500 mg/m{sup 2}), and cyclophosphamide (500 mg/m{sup 2}), 6 cycles (day 1-day 21). In arm B, patients received concurrently the first 3 cycles of CT with RT. In arm A, RT started 3 to 5 weeks after the 6. cycle of CT. Conventional RT was delivered to the whole breast using a 2 Gy-fraction protocol to a total dose of 50 Gy ({+-} boost to the primary tumour bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist according to the LENT-SOMA scale. Skin pigmentation was also evaluated using a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results - Among the 214 evaluated patients, 107 were treated in each arm. The two populations were homogeneous for patients', tumors' and treatment characteristics. Subcutaneous fibrosis (SF), telangiectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in arm B. Twenty patients experienced grade superior or equal to 2 (SF) in arm B vs five in arm A (P 0.003). Twenty-five and seven patients showed grade superior or equal to 2 (T) in ann B and A, respectively (P = 0.001). Forty-four and

  16. EARLY-STAGE YOUNG BREAST CANCER PATIENTS : IMPACT OF LOCAL TREATMENT ON SURVIVAL

    NARCIS (Netherlands)

    Bantema-Joppe, Enja J.; de Munck, Linda; Visser, Otto; Willemse, Pax H. B.; Langendijk, Johannes A.; Siesling, Sabine; Maduro, John H.

    2011-01-01

    Purpose: In young women, breast-conserving therapy (BCT), i.e., lumpectomy followed by radiotherapy, has been associated with an increased risk of local recurrence. Still, there is insufficient evidence that BCT impairs survival. The aim of our study was to compare the effect of BCT with mastectomy

  17. Is Ki-67 Expression Prognostic for Local Relapse in Early-Stage Breast Cancer Patients Treated With Breast Conservation Therapy (BCT)?

    Energy Technology Data Exchange (ETDEWEB)

    Hafeez, Farhaan [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Neboori, Hanmanth J. [Drexel Medical College, Philadelphia, Pennsylvania (United States); Harigopal, Malini [Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (United States); Wu, Hao; Haffty, Bruce G. [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (United States); Yang, Qifeng [Department of Breast Surgery, Shandong University School of Medicine, Shanghai (China); Schiff, Devora [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (United States); Moran, Meena S., E-mail: meena.moran@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2013-10-01

    Purpose: Ki-67 is a human nuclear protein whose expression is strongly up-regulated in proliferating cells and can be used to determine the growth fraction in clonal cell populations. Although there are some data to suggest that Ki-67 overexpression may be prognostic for endpoints such as survival or postmastectomy recurrence, further elucidation of its prognostic significance is warranted. Specifically after breast conservation therapy (BCT) (defined in this setting as breast-conserving surgery and adjuvant radiation therapy), whether Ki-67 predicts for locoregional recurrence has not been investigated. The purpose of this study was to assess Ki-67 expression in a cohort of early-stage breast cancer patients to determine whether a significant independent association between Ki-67 and locoregional relapse exists. Methods and Materials: Ki-67 staining was conducted on a tissue microarray of 438 patients previously treated with BCT, and expression was analyzed with clinicopathologic features and outcomes from our database. Results: Ki-67 expression was more prevalent in black patients (37% of black patients vs 17% of white patients, P<.01), younger patients (27% of patients aged ≤50 years vs 15% of patients aged >50 years, P<.01), estrogen receptor (ER)–negative tumors (25% of ER-negative tumors vs 17% of ER-positive tumors, P=.04), human epidermal growth factor receptor 2 (HER2)/neu–positive tumors (35% of HER2-positive tumors vs 18% of HER2-negative tumors, P=.01), and larger tumors (26% of T2 tumors vs 16% of T1 tumors, P=.03). On univariate/multivariate analysis, Ki-67 did not predict for overall survival (74.4% vs 72.6%), cause-specific survival (82.9% vs 82.1%), local relapse-free survival (83.6% vs 88.5%), distant metastasis-free survival (76.1% vs 81.4%), recurrence-free survival (65.5% vs 74.6%), and locoregional recurrence-free survival (81.6% vs 84.7%): P>.05 for all. Conclusions: Ki-67 appears to be a surrogate marker for aggressive disease and

  18. Interventions to Enhance Breast Cancer Screening, Diagnosis, and Treatment among Racial and Ethnic Minority Women

    Science.gov (United States)

    Masi, Christopher M.; Blackman, Dionne J.; Peek, Monica E.

    2009-01-01

    The authors conduct a systematic review of the literature to identify interventions designed to enhance breast cancer screening, diagnosis, and treatment among minority women. Most trials in this area have focused on breast cancer screening, while relatively few have addressed diagnostic testing or breast cancer treatment. Among patient-targeted screening interventions, those that are culturally tailored or addressed financial or logistical barriers are generally more effective than reminder-based interventions, especially among women with fewer financial resources and those without previous mammography. Chart-based reminders increase physician adherence to mammography guidelines but are less effective at increasing clinical breast examination. Several trials demonstrate that case management is an effective strategy for expediting diagnostic testing after screening abnormalities have been found. Additional support for these and other proven health care organization-based interventions appears justified and may be necessary to eliminate racial and ethnic breast cancer disparities. PMID:17881627

  19. Changes in brain activation in breast cancer patients depend on cognitive domain and treatment type

    Science.gov (United States)

    Menning, Sanne; de Ruiter, Michiel B.; Veltman, Dick J.; Boogerd, Willem; Oldenburg, Hester S. A.; Reneman, Liesbeth

    2017-01-01

    Background Cognitive problems in breast cancer patients are common after systemic treatment, particularly chemotherapy. An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment, suggestive of neurotoxicity. Previous prospective fMRI studies administered a single cognitive task. The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain. Methods Participants were breast cancer patients scheduled to receive systemic treatment (anthracycline-based chemotherapy +/- endocrine treatment, n = 28), or no systemic treatment (n = 24) and no-cancer controls (n = 31). Assessment took place before adjuvant treatment and six months after chemotherapy, or at similar intervals. Blood oxygen level dependent (BOLD) activation and performance were measured during an executive functioning task and an episodic memory task. Group-by-time interactions were analyzed using a flexible factorial design. Results Task performance did not differ between patient groups and did not change over time. Breast cancer patients who received systemic treatment, however, showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment. This hyperactivation was accompanied by worse physical functioning, higher levels of fatigue and more cognitive complaints. In contrast, in breast cancer patients who did not receive systemic treatment, parietal activation normalized over time compared to the other two groups. Conclusions Parietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels. This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural

  20. Development of Intraductal Technique for Breast Cancer Prevention, Diagnosis and Treatment (97 Breast)

    Science.gov (United States)

    1999-10-01

    Surgeons 2. Presentations: (1) Istituto Europeo di Oncologia ( Milan) Grand Rounds, "Intraductal approach to the breast," July 7, 1999. (2) Yale...in nipple aspirate fluid (NAF) using manual breast pumps (Petrakis et al and Sartorius et al), nipple aspiration is a relatively inefficient technique

  1. 早期老年乳腺癌保乳手术的临床疗效观察%The Therapy Discussion of Breast Cancer by Conserving Surgery in the Aged Women

    Institute of Scientific and Technical Information of China (English)

    何志刚; 欧阳立志; 尹宏

    2013-01-01

    objective:To compare the therapeutic effect of breast-conserving surgery and modified radical mastectomy in the treatment of elderly patients with early-stage breast cancer.Methods:According to their surgical method,48 elderly patients with early-stage breast cancer were divided into 2 groups.The observation group included 24 patients and received breast-conserving surgery,and the control group included 24 patients and received modified radical mastectomy.After being dischargde,al patients were fol owde up for 3 years.Results:The postoperative breast cosmetic efficacy of the observation group was bet er than that of the control group(P0.05).Conclusion:It shows the advantages of little pain,good cosmetic results and good functions of the breast conserving surgery for early stage breast cancer in the aged women.With the strictly handling of the indication,it does not increase the risk of recurrence and metastasis.%目的:比较早期老年乳腺癌患者保乳术与改良根治术的疗效。方法:将48例早期乳腺癌患者按治疗方式分为2组:观察组24例,接受保乳术治疗;对照组24例,接受改良根治术治疗。在患者出院后,再对其进行长达3年的随访。结果:观察组术后乳房美容效果显著优于对照组,两组比较差异有统计学意义(P<0.01)。两组患者的局部复发率,远处转移率,3年生存率差异无统计学意义(P>0.05)。结论:早期老年乳腺癌行保乳治疗具有机体创伤小、组织器官破坏少、美容效果好和保存功能的优点,在严格掌握手术适应证的前提下,并不增加复发及远处转移的风险。

  2. Exercise, Behavioral Therapy Reduce Menopausal Symptoms Caused by Breast Cancer Treatment

    Science.gov (United States)

    Women with breast cancer who were suffering from treatment-related menopausal symptoms experienced symptom relief with cognitive behavioral therapy, physical exercise, or both, according to a Dutch study.

  3. Meta-analysis of breast cancer microarray studies in conjunction with conserved cis-elements suggest patterns for coordinate regulation

    Directory of Open Access Journals (Sweden)

    Lundberg Cathryn

    2008-01-01

    Full Text Available Abstract Background Gene expression measurements from breast cancer (BrCa tumors are established clinical predictive tools to identify tumor subtypes, identify patients showing poor/good prognosis, and identify patients likely to have disease recurrence. However, diverse breast cancer datasets in conjunction with diagnostic clinical arrays show little overlap in the sets of genes identified. One approach to identify a set of consistently dysregulated candidate genes in these tumors is to employ meta-analysis of multiple independent microarray datasets. This allows one to compare expression data from a diverse collection of breast tumor array datasets generated on either cDNA or oligonucleotide arrays. Results We gathered expression data from 9 published microarray studies examining estrogen receptor positive (ER+ and estrogen receptor negative (ER- BrCa tumor cases from the Oncomine database. We performed a meta-analysis and identified genes that were universally up or down regulated with respect to ER+ versus ER- tumor status. We surveyed both the proximal promoter and 3' untranslated regions (3'UTR of our top-ranking genes in each expression group to test whether common sequence elements may contribute to the observed expression patterns. Utilizing a combination of known transcription factor binding sites (TFBS, evolutionarily conserved mammalian promoter and 3'UTR motifs, and microRNA (miRNA seed sequences, we identified numerous motifs that were disproportionately represented between the two gene classes suggesting a common regulatory network for the observed gene expression patterns. Conclusion Some of the genes we identified distinguish key transcripts previously seen in array studies, while others are newly defined. Many of the genes identified as overexpressed in ER- tumors were previously identified as expression markers for neoplastic transformation in multiple human cancers. Moreover, our motif analysis identified a collection of

  4. Treatment with insulin (analogues) and breast cancer risk in diabetics

    DEFF Research Database (Denmark)

    Bronsveld, Heleen K; Ter Braak, Bas; Karlstad, Øystein

    2015-01-01

    : A systematic literature search was performed on breast cell-line, animal and human studies using the key words 'insulin analogue' and 'breast neoplasia' in MEDLINE at PubMed, EMBASE, and ISI Web of Science databases. A quantitative and qualitative review was performed on the epidemiological data; due...

  5. Nonpalpable breast lesions : challenges in diagnosis and treatment

    NARCIS (Netherlands)

    Hoorntje, L.E.

    2003-01-01

    The aim of this thesis was to address pitfalls and concerns of the diagnostic evaluation of nonpalpable breast lesions, in an attempt to further improve preoperative diagnostic assessment, as well as surgical strategies of nonpalpable breast lesions. Chapter 1 presents an overview of current methods

  6. Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment

    Directory of Open Access Journals (Sweden)

    Jennifer M. Hulett

    2015-05-01

    Full Text Available This study explored breast cancer survivors’ perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379 with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants’ comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction.

  7. The molecular portraits of breast tumors are conserved across microarray platforms

    Directory of Open Access Journals (Sweden)

    Perreard Laurent

    2006-04-01

    Full Text Available Abstract Background Validation of a novel gene expression signature in independent data sets is a critical step in the development of a clinically useful test for cancer patient risk-stratification. However, validation is often unconvincing because the size of the test set is typically small. To overcome this problem we used publicly available breast cancer gene expression data sets and a novel approach to data fusion, in order to validate a new breast tumor intrinsic list. Results A 105-tumor training set containing 26 sample pairs was used to derive a new breast tumor intrinsic gene list. This intrinsic list contained 1300 genes and a proliferation signature that was not present in previous breast intrinsic gene sets. We tested this list as a survival predictor on a data set of 311 tumors compiled from three independent microarray studies that were fused into a single data set using Distance Weighted Discrimination. When the new intrinsic gene set was used to hierarchically cluster this combined test set, tumors were grouped into LumA, LumB, Basal-like, HER2+/ER-, and Normal Breast-like tumor subtypes that we demonstrated in previous datasets. These subtypes were associated with significant differences in Relapse-Free and Overall Survival. Multivariate Cox analysis of the combined test set showed that the intrinsic subtype classifications added significant prognostic information that was independent of standard clinical predictors. From the combined test set, we developed an objective and unchanging classifier based upon five intrinsic subtype mean expression profiles (i.e. centroids, which is designed for single sample predictions (SSP. The SSP approach was applied to two additional independent data sets and consistently predicted survival in both systemically treated and untreated patient groups. Conclusion This study validates the "breast tumor intrinsic" subtype classification as an objective means of tumor classification that should be

  8. Behavioral Symptoms after Breast Cancer Treatment: A Biobehavioral Approach

    Directory of Open Access Journals (Sweden)

    Christopher Fagundes

    2015-08-01

    Full Text Available Being diagnosed and treated for breast cancer is emotionally and physically challenging. Breast cancer is the most commonly diagnosed cancer and the second leading cause of death for women in the United States. Accordingly, women with a breast cancer history are the largest group of female cancer survivors. Psychological stress substantially augments adverse autonomic, endocrine, and immune discharge, including enhanced production of proinflammatory cytokines. Importantly, inflammation is a key biological mechanism underlying the symptom cluster of pain, depression, fatigue, and sleep disturbances; there is also good evidence that inflammation contributes to breast cancer recurrence. Stress may exert direct effects on psychological and physiological risk processes. In this review, we take a biobehavioral approach to understanding predictors and mechanisms underlying somatic symptoms in breast cancer survivors.

  9. Newer therapies for the treatment of metastatic breast cancer: A clinical update

    Directory of Open Access Journals (Sweden)

    Anjana Mohan

    2013-01-01

    Full Text Available Breast cancer is the foremost common malignancy among the female population around the world. Female breast cancer incidence rates have increased since 1980, slowed in 1990, the rate of increase have leveled off since 2001. In spite of the advances in the early detection, treatment, surgery and radiation support, almost 70% of the patients develop metastasis and die of the disease. Around 10% of the patients when diagnosed with breast cancer have metastases. Survival among the breast cancer patients have increased due to the introduction of novel single agent, combination of chemotherapeutic agents and targeted biologic agents, which is breast cancer specific. The staging of tumor-node-metastasis is significant for the prognosis and treatment. Predominantly the combination of chemotherapeutic regimen is given to improve the rate of clinical benefit and the overall survival rate. Novel mono-therapeutic options are being used often in metastatic setting as they will not be able to endure the toxicity of the combination regimen. Usually, endocrine therapy is recommended for hormone-responsive breast cancer due to efficacy and favorable side effect profile but chemotherapy becomes an option when endocrine therapy fails. This review summarizes the newer therapeutic options for early breast cancer and advanced breast cancer that are pretreated heavily on other chemotherapeutic agents. Further it provides monotherapies and other emerging novel combination regime which can be opted for first line or second line setting.

  10. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Risk-modifying factors

    Energy Technology Data Exchange (ETDEWEB)

    Hille-Betz, Ursula; Soergel, Philipp; Kundu, Sudip; Klapdor, Ruediger; Hillemanns, Peter [Hannover Medical School, Department of Obstetrics and Gynaecology, Hannover (Germany); Vaske, Bernhard [Hannover Medical School, Institute of Medical Biometry and Informatics, Hannover (Germany); Bremer, Michael; Henkenberens, Christoph [Hannover Medical School, Department of Radiation Oncology and Special Oncology, Hannover (Germany)

    2016-01-15

    The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis. LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5). Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters. (orig.) [German] Ziel dieser Arbeit war es, Parameter zu identifizieren, die Spaetschaeden nach Radiotherapie, ein unguenstiges

  11. Outcomes of Low-Risk Ductal Carcinoma In Situ in Southeast Asian Women Treated With Breast Conservation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Fuh Yong, E-mail: fuhyong@yahoo.com [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Wang, Fuqiang [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Chen, John Ju [Department of Cancer Informatics, National Cancer Centre Singapore (Singapore); Tan, Chiew Har [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Tan, Puay Hoon [Department of Pathology, Singapore General Hospital (Singapore)

    2014-04-01

    Purpose: To examine the outcomes of Southeast Asian (SEA) women with low-risk ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and adjuvant radiation therapy. Methods and Materials: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 were performed. Patients meeting the selection criteria from Eastern Cooperative Oncology Group 5194 were included. Most patients received adjuvant radiation therapy (RT) consisting of whole-breast RT delivered to 50 Gy followed by a 10-Gy boost to the tumor bed. Results: Of 744 patients with pathologic diagnosis of pure DCIS identified, 273 met the selection criteria: low-intermediate grade (LIG), n=219; high grade (HG), n=54. Median follow-up for these patients was 60 months. There were 8 ipsilateral breast tumor recurrences (IBTRs) in total, 7 of which were DCIS. The estimated actuarial IBTR rates at 5 and 10 years for the entire cohort are 1.8% and 4.3%, respectively. Of the 219 patients with LIG DCIS, 210 received RT and 9 did not. There were 7 IBTRs in LIG DCIS, 2 among the 9 patients who did not receive RT. The IBTR rates in LIG DCIS at 5 and 10 years are 2.3% and 4.2%, respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years, giving an estimated IBTR rate of 4.5% at 10 years. Conclusions: SEA women with screen-detected DCIS have exceedingly low rates of IBTR after BCS, comparable to that observed in reports of similar patients with low-risk DCIS treated with adjuvant radiation.

  12. [Breast carcinoma: state of the art].

    Science.gov (United States)

    Pestalozzi, B C

    1996-11-30

    Diagnosis and therapy of breast cancer are briefly reviewed for the general internist. He should know what triple diagnosis, breast-conserving surgery, radiotherapy and adjuvant systemic therapy involve. He should know when to perform a screening mammography, what follow-up examinations after breast cancer are indicated and what dangers loom in metastatic breast cancer. He should know of new therapeutic avenues such as bisphosphonates, new aromatase inhibitors, taxanes, and high-dose chemotherapy with stem cell support. Since advances in the treatment of breast cancer have been achieved mostly through randomized studies, a positive attitude toward such studies and a willingness to take part in them are desirable.

  13. Interaction of green tea catechins with breast cancer endocrine treatment: a systematic review.

    Science.gov (United States)

    Yiannakopoulou, Eugenia C

    2014-01-01

    Recent data have shown strong chemopreventive and possibly cancer chemotherapeutic effects of green tea polyphenols and EGCG against breast cancer. This systematic review aims to synthesize data on the possible interaction of green tea catechins with breast cancer endocrine treatment. Electronic databases were searched with the appropriate search terms. Experimental trials suggest a synergistic interaction of green tea catechins with tamoxifen or raloxifene in the treatment of estrogen receptor-positive and estrogen receptor-negative breast cancer through estrogen receptor-dependent and -independent mechanisms. No evidence of an interaction of green tea catechins with aromatase inhibitors or fulvestrant has been reported. As green tea catechins are natural compounds with a rather favorable safety profile, the strategy of co-administrating green tea catechins with tamoxifen seems to be a rational approach in chemoprevention, adjuvant and metastatic breast cancer treatment that needs further investigation.

  14. Cell-specific biomarkers and targeted biopharmaceuticals for breast cancer treatment.

    Science.gov (United States)

    Liu, Mei; Li, Zhiyang; Yang, Jingjing; Jiang, Yanyun; Chen, Zhongsi; Ali, Zeeshan; He, Nongyue; Wang, Zhifei

    2016-08-01

    Breast cancer is the second leading cause of cancer death among women, and its related treatment has been attracting significant attention over the past decades. Among the various treatments, targeted therapy has shown great promise as a precision treatment, by binding to cancer cell-specific biomarkers. So far, great achievements have been made in targeted therapy of breast cancer. In this review, we first discuss cell-specific biomarkers, which are not only useful for classification of breast cancer subtyping but also can be utilized as goals for targeted therapy. Then, the innovative and generic-targeted biopharmaceuticals for breast cancer, including monoclonal antibodies, non-antibody proteins and small molecule drugs, are reviewed. Finally, we provide our outlook on future developments of biopharmaceuticals, and provide solutions to problems in this field.

  15. Eribulin for the treatment of metastatic breast cancer: an update on its safety and efficacy

    Directory of Open Access Journals (Sweden)

    Doherty MK

    2015-01-01

    Full Text Available Mark K Doherty, Patrick G Morris Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland Abstract: Breast cancer remains a leading cause of cancer-related death internationally. Treatment approaches for metastatic breast cancer have evolved in recent years; however chemotherapy remains a core component for the majority of patients. Agents such as anthracyclines and taxanes have been extensively studied and form standard treatment. Eribulin mesylate is a novel synthetic microtubule-directed chemotherapy, based on a naturally-occurring compound. Through phase I studies, eribulin was found to be tolerable and activity was seen in patients with metastatic breast cancer. Phase II studies in metastatic breast cancer further demonstrated its efficacy, with responses and survival which compare favorably with other studied chemotherapy agents. The phase III EMBRACE study showed superior survival for patients treated with eribulin compared with those who received a physician’s choice control. This led to its approval for use in many countries in this setting. Its toxicity profile is well established and manageable for the most part, with the commonest reported toxicities being alopecia, fatigue, neutropenia and peripheral neuropathy. A second reported phase III study comparing eribulin to capecitabine failed to show an improvement in survival in pretreated patients. This article reviews the clinical pharmacology and mechanism of action of eribulin, and summarizes the results of the major preclinical and clinical studies of eribulin in metastatic breast cancer. Keywords: eribulin, breast cancer, metastatic breast cancer, review, new treatments, chemotherapy

  16. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  17. Inorganic and hybrid inorganic-organic systems for conservative treatments of stone and wood materials

    OpenAIRE

    Bergamonti, Laura

    2015-01-01

    Inorganic and hybrid inorganic-organic systems for conservative treatments of stone and wood materials The research has focused on the synthesis, characterization and application of inorganic and hybrid inorganic-organic systems for conservative treatments of stone and wood. The wood preservatives synthesized and tested for biocidal activity are polyamidoamines functionalized with hydroxyl and siloxane groups, while the coatings applied on the stones are water based TiO2 nanosols with ...

  18. Current medical treatment of estrogen receptor-positive breast cancer

    Institute of Scientific and Technical Information of China (English)

    Franco; Lumachi; Davide; A; Santeufemia; Stefano; MM; Basso

    2015-01-01

    Approximately 80% of breast cancers(BC) are estrogen receptor(ER)-positive and thus endocrine therapy(ET) should be considered complementary to surgery in the majority of patients. The advantages of oophorectomy, adrenalectomy and hypophysectomy in women with advanced BC have been demonstrated many years ago, and currently ET consist of(1) ovarian function suppression(OFS), usually obtained using gonadotropinreleasing hormone agonists(Gn RHa);(2) selective estrogen receptor modulators or down-regulators(SERMs or SERDs); and(3) aromatase inhibitors(AIs), or a combination of two or more drugs. For patients aged less than 50 years and ER+ BC, there is no conclusive evidence that the combination of OFS and SERMs(i.e., tamoxifen) or chemotherapy is superior to OFS alone. Tamoxifen users exhibit a reduced risk of BC, both invasive and in situ, especially during the first 5 years of therapy, and extending the treatment to 10 years further reduced the risk of recurrences. SERDs(i.e., fulvestrant) are especially useful in the neoadjuvant treatment of advanced BC, alone or in combination with either cytotoxic agents or AIs. There are two types of AIs: type Ⅰ are permanent steroidal inhibitors of aromatase, while type Ⅱ are reversible nonsteroidal inhibitors. Several studies demonstrated the superiority of the third-generation AIs(i.e., anastrozole and letrozole) compared with tamoxifen, and adjuvant therapy with AIs reduces the recurrence risk especially in patients with advanced BC. Unfortunately, some cancers are or became ET-resistant, and thus other drugs have been suggested in combination with SERMs or AIs, including cyclin-dependent kinase 4/6 inhibitors(palbociclib) and mammalian target of rapamycin(m TOR) inhibitors, such as everolimus. Further studies are required to confirm their real usefulness.

  19. Pregnancy-associated breast cancer in Taiwanese women: potential treatment delay and impact on survival.

    Science.gov (United States)

    Yang, Ya-Ling; Chan, K Arnold; Hsieh, Fon-Jou; Chang, Li-Yun; Wang, Ming-Yang

    2014-01-01

    This study investigated the clinicopathologic characteristics and survival of women diagnosed with pregnancy-associated breast cancer (PABC) in Taiwan. PABC is defined as breast cancer diagnosed during pregnancy or within 1 year after obstetric delivery. Our sample of PABC patients (N = 26) included all patients diagnosed at a major medical center in northern Taiwan from 1984 through 2009. Among these patients, 15 were diagnosed during pregnancy and 11 were diagnosed within 1 year after delivery. The comparison group included 104 patients within the same age range as the PABC patients and diagnosed with breast cancer not associated with pregnancy from 2004 through 2009 at the same hospital. Patients' initiating treatment delayed, 5-year and 10-year overall survival were delineated by stratified Kaplan-Meier estimates. Patients' characteristics were associated with initiating treatment delayed was evaluated with multivariate proportional hazards modeling. Antepartum PABC patients were younger and had longer time between diagnosis and treatment initiation than postpartum PABC patients. The predictor of treatment delayed was including birth parity, cancer stage, and pregnancy. The PABC group had larger tumors, more advanced cancer stage, and tumors with less progesterone receptor than the comparison group. The antepartum PABC patients had higher mortality than postpartum PABC and comparison groups within 5 years after diagnosis. Based on these results, we confirmed that pregnant women with breast cancer were more likely to delay treatment. Therefore, we recommend that breast cancer screening should be integrated into the prenatal and postnatal routine visits for early detection of the women's breast problems.

  20. Reducing the Human Burden of Breast Cancer: Advanced Radiation Therapy Yields Improved Treatment Outcomes.

    Science.gov (United States)

    Currey, Adam D; Bergom, Carmen; Kelly, Tracy R; Wilson, J Frank

    2015-01-01

    Radiation therapy is an important modality in the treatment of patients with breast cancer. While its efficacy in the treatment of breast cancer was known shortly after the discovery of x-rays, significant advances in radiation delivery over the past 20 years have resulted in improved patient outcomes. With the development of improved systemic therapy, optimizing local control has become increasingly important and has been shown to improve survival. Better understanding of the magnitude of treatment benefit, as well as patient and biological factors that confer an increased recurrence risk, have allowed radiation oncologists to better tailor treatment decisions to individual patients. Furthermore, significant technological advances have occurred that have reduced the acute and long-term toxicity of radiation treatment. These advances continue to reduce the human burden of breast cancer. It is important for radiation oncologists and nonradiation oncologists to understand these advances, so that patients are appropriately educated about the risks and benefits of this important treatment modality.

  1. Minimally invasive porcelain veneers: indications for a conservative esthetic dentistry treatment modality.

    Science.gov (United States)

    Strassler, Howard E

    2007-11-01

    Patients have many restorative options for changing the appearance of their teeth. The most conservative restorative treatments for changing the appearance of teeth include tooth bleaching, direct composite resin veneers, and porcelain veneers. Patients seeking esthetic treatment should undergo a comprehensive clinical examination that includes an esthetic evaluation. When selecting a conservative treatment modality, the use of minimally invasive or no-preparation porcelain veneers should be considered. As with any treatment decision, the indications and contraindications must be considered before a definitive treatment plan is made. Long-term research has demonstrated a 94% survival rate for minimally invasive porcelain veneers. While conservation of tooth structure is important, so is selecting the right treatment modality for each patient based on clinical findings.

  2. Breast reshaping with displacement of residual gland following breast conserving surgery%残留腺体转位整形法在乳腺癌保乳手术中的应用

    Institute of Scientific and Technical Information of China (English)

    周围; 王泽强; 郭琼; 胡壹; 廖妮

    2012-01-01

    目的:探讨乳腺癌保乳手术中采用残留腺体转位整形法应用的可行性,并评估其美学效果.方法:对2009年10月-2011年11月收治的47例肿瘤直径≤3 cm的乳腺癌患者行保乳手术,其中36例采用残留腺体转位整形法(观察组),11例仅直接缝合皮肤(对照组),分别评估两组患者的术后及放疗后的美学效果.结果:全部患者随访9~33个月,中位随访时间21个月,无1例复发及转移.术后3个月,观察组与对照组达到优或良美学效果的分别为31例(86.1%)和8例(72.7%),两组差异无统计学意义(P>0.05);放疗后3个月,观察组与对照组在放疗后达到优或良美学效果的分别为30例(83.3%)和6例(54.5%),观察组的美学效果优于对照组,差异有统计学意义(x2=3.895,P<0.05).结论:对于肿瘤直径≤3cm的乳腺癌患者,采用残留腺体转位整形法是一种简单、有效、创伤小、术后乳房美学效果满意的方法.%Objective: To investigate the feasibility and assess the cosmetic effect of mammaplasty with displacement of residual glandular tissue following breast conserving surgery. Methods: Breast conserving surgery was performed in 47 patients whose lesion size was less than 3 cm and admitted between October 2009 and November 2011. Of the patients, 36 cases received oncoplastic volume displacement (observation group) and 11 cases had only direct skin closure without treatment of the post-resection defect (control group) following breast conserving surgery. The cosmetic results of the two groups were evaluated after operation and radiotherapy, respectively. Results: All patients were followed up for 9-33 months with median follow-up of 21 months, and no recurrence or metastasis occurred in any of the patients. Three months after surgery, the excellent or good cosmetic outcome was achieved in 31 cases (86.1%) in observation group and 8 cases (72.7%) in control group respectively, and there was no statistical difference

  3. Concerns about Breast Cancer, Pain, and Fatigue in Non-Metastatic Breast Cancer Patients Undergoing Primary Treatment

    Directory of Open Access Journals (Sweden)

    Chelsea R. Amiel

    2016-08-01

    Full Text Available Women diagnosed with breast cancer often endorse psychosocial concerns prior to treatment, which may influence symptom experiences. Among these, low perceived social support relates to elevated fatigue. Those with low social support perceptions may also experience a greater sense of rejection. We sought to determine if social rejection concerns post-surgery predict fatigue interference 12 months later in women with non-metastatic breast cancer. Depressive symptoms and pain severity after completion of adjuvant therapy (six months post-surgery were examined as potential mediators. Women (N = 240 with non-metastatic breast cancer were recruited 2–10 weeks post-surgery. Multiple regression analyses examined relationships among variables adjusting for relevant covariates. Greater rejection concerns at study entry predicted greater fatigue interference 12 months later (p < 0.01. Pain severity after adjuvant therapy partially mediated the relationship between social rejection concerns and fatigue interference, with significant indirect (β = 0.06, 95% CI (0.009, 0.176 and direct effects (β = 0.18, SE = 0.07, t(146 = 2.78, p < 0.01, 95% CI (0.053, 0.311. Therefore, pain levels post-treatment may affect how concerns of social rejection relate to subsequent fatigue interference. Interventions targeting fears of social rejection and interpersonal skills early in treatment may reduce physical symptom burden during treatment and into survivorship.

  4. Right breast conservation operation%右乳癌保乳根治术

    Institute of Scientific and Technical Information of China (English)

    陶思丰

    2016-01-01

    对于临床腋窝阴性的乳腺癌患者,进行前哨淋巴结活检已经成为标准的术式。以亚甲兰和纳米碳作为淋巴管显影剂,术前10 min在乳晕旁皮下注射,在腋窝以胸大肌外侧缘处沿皮纹切口,寻找显色的淋巴管和淋巴结,送术中快速冰冻病理检查。在等待冰冻期间,对肿块行保乳切除,取切缘送术中快速冰冻病理检查。此时冰冻报告:1枚前哨淋巴结阳性,故行腋窝淋巴结清扫术。肿块切缘均阴性,遂以钛夹标记残腔,缝合残腔。%For patients with clinically negative axillary nodes , sentinel lymph node biopsy has become a standard operation method in treating breast cancer .Methylene blue and nano carbon could be employed as lymphatic developers , which were injected subcutaneously into the para areola of the breast 10 minutes before operation .In the armpit , an incision was made along the skin texture at the lateral margin of the pectoralis major , searching for the blue stained lymphatic vessels and lymph nodes , which were harvested and sent for rapid pathological examination .During the waiting period , the breast tumor was excised , Pathological examination of the resection margin was performed .There was one positive sentinel lymph node , therefore the axillary lymph node was cleansed .Since the tumor margins were negative , titanium clips were used as markers of residual cavity margin .

  5. [Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment--report of two cases].

    Science.gov (United States)

    Yamamoto, Hiromichi; Kurimoto, Masanori; Hayashi, Nakamasa; Ohmori, Tomoaki; Hirashima, Yutaka; Endo, Shunro

    2002-09-01

    Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.

  6. Radiotherapy in the management of early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Wei [Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales (Australia); Department of Radiation Oncology, Westmead Hospital, New South Wales (Australia)

    2013-03-15

    Radiotherapy is an indispensible part of the management of all stages of breast cancer. In this article, the common indications for radiotherapy in the management of early breast cancer (stages 0, I, and II) are reviewed, including whole-breast radiotherapy as part of breast-conserving treatment for early invasive breast cancer and pre-invasive disease of ductal carcinoma in situ, post-mastectomy radiotherapy, locoregional radiotherapy, and partial breast irradiation. Key clinical studies that underpin our current practice are discussed briefly.

  7. Targeted treatment of advanced and metastatic breast cancer with lapatinib

    Directory of Open Access Journals (Sweden)

    Brendan Corkery

    2008-09-01

    Full Text Available Brendan Corkery1,2, Norma O’Donovan2, John Crown1,21St. Vincent’s University Hospital, Dublin, Ireland; 2National Institute for Cellular Biotechnology, Dublin City University, Dublin, IrelandAbstract: Improved molecular understanding of breast cancer in recent years has led to the discovery of important drug targets such as HER-2 and EGFR. Lapatinib is a potent dual inhibitor of HER-2 and EGFR. Preclinical and phase I studies have shown activity with lapatinib in a number of cancers, including breast cancer, and the drug is well tolerated. The main known drug interactions are with paclitaxel and irinotecan. The most significant side-effects of lapatinib are diarrhea and adverse skin events. Rates of cardiotoxicity compare favorably with trastuzumab, a monoclonal antibody against HER-2. This paper focuses on lapatinib in advanced and metastatic breast cancer, which remains an important therapeutic challenge. Phase II and III studies show activity as monotherapy, and in combination with chemotherapy or hormonal agents. Results from these studies suggest that the main benefit from lapatinib is in the HER-2 positive breast cancer population. Combinations of lapatinib and trastuzumab are also being studied and show encouraging results, particularly in trastuzumab-refractory metastatic breast cancer. Lapatinib may have a specific role in treating HER-2 positive CNS metastases. The role of lapatinib as neoadjuvant therapy and in early breast cancer is also being evaluated.Keywords: HER-2, EGFR, erbB, lapatinib, Tykerb®, tyrosine kinase

  8. Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race

    Directory of Open Access Journals (Sweden)

    Yu Xue

    2009-10-01

    Full Text Available Abstract Background Previous studies have documented lower breast cancer survival among women with lower socioeconomic status (SES in the United States. In this study, I examined the extent to which socioeconomic disparity in breast cancer survival was explained by stage at diagnosis, treatment, race and rural/urban residence using the Surveillance, Epidemiology, and End Results (SEER data. Methods Women diagnosed with breast cancer during 1998-2002 in the 13 SEER cancer registry areas were followed-up to the end of 2005. The association between an area-based measure of SES and cause-specific five-year survival was estimated using Cox regression models. Six models were used to assess the extent to which SES differences in survival were explained by clinical and demographical factors. The base model estimated the hazard ratio (HR by SES only and then additional adjustments were made sequentially for: 1 age and year of diagnosis; 2 stage at diagnosis; 3 first course treatment; 4 race; and 5 rural/urban residence. Results An inverse association was found between SES and risk of dying from breast cancer (p Conclusion Stage at diagnosis, first course treatment and race explained most of the socioeconomic disparity in breast cancer survival. Targeted interventions to increase breast cancer screening and treatment coverage in patients with lower SES could reduce much of socioeconomic disparity.

  9. Clinical features and treatment of squamous cell carcinoma of the breast

    Directory of Open Access Journals (Sweden)

    Zhang XM

    2016-05-01

    Full Text Available Ximei Zhang,1 Baozhong Zhang,1 Fenglin Zang,2 Lujun Zhao,1 Zhiyong Yuan,1 Ping Wang1 1Department of Radiation Oncology, 2Department of Pathology, Cancer Institute and Hospital, Tianjin Medical University, Tianjin, People’s Republic of China Objectives: Data on breast squamous cell carcinoma (SCC are rare. The aim of this study was to analyze the clinical characteristics and to explore the rational treatment of patients with breast SCC. Patients and methods: We conducted a retrospective review of breast SCC cases treated at our center from 1966 to 2014. The majority of these patients received primary surgery followed by adjuvant chemoradiotherapy, whilst four elderly patients had lumpectomy only. Results: Patients with breast SCC were usually women, and large masses, large proportion of early stage disease, low levels of estrogen receptor expression, less frequent axillary lymph nodes involvement, and unfavorable prognosis were common. The 5-year overall survival and progression-free survival of all patients were 67.2% and 57.8%, respectively. Axillary nodal involvement was a significant prognostic factor for survival. Conclusion: The current results indicated that breast SCC is clinically aggressive and the outcomes were poor. Distant metastasis was the main failure pattern. New strategies will be needed because of the poor outcomes. Keywords: breast metaplastic carcinoma, breast SCC, treatment, surgery, prognosis

  10. Evaluation of treatment response for breast cancer: are we entering the era of "biological complete remission"?

    Institute of Scientific and Technical Information of China (English)

    Li Bian; Tao Wang; Yi Liu; Hui-Qiang Zhang; Jin-Jie Song; Shao-Hua Zhang; Shi-Kai Wu; San-Tai Song; Ze-Fei Jiang

    2012-01-01

    Breast cancer is one of the most common malignancies in women.The post-operative recurrence and metastasis are the leading causes of breast cancer-related mortality.In this study,we tried to explore the role of circulating tumor cell (CTC) detection combination PET/CT technology evaluating the prognosis and treatment response of patients with breast cancer; meanwhile,we attempted to assess the concept of "biological complete remission" (bCR) in this regard.A 56-year-old patient with breast cancer (T2N1M1,stage Ⅳ left breast cancer,with metastasis to axillary lymph nodes and lungs) received 6 cycles of salvage treatment with albumin-bound paclitaxel plus capecitabine and trastuzumab.Then,she underwent CTC detection and PET/CT for efficacy evaluation.CTC detection combination PET/CT is useful for the evaluation of the biological efficacy of therapies for breast cancer.The bCR of the patient appeared earlier than the conventional clinical imaging complete remission and promised the histological (pathological) complete remission.The integrated application of the concepts including bCR,imageological CR,and histological CR can achieve the early and accurate assessment of biological therapeutic reponse and prognosis of breast cancer.

  11. Posttraumatic stress symptoms in breast cancer: Prevalence, predictors, consequences, and treatment

    DEFF Research Database (Denmark)

    O Connor, Maja; Zachariae, Robert

    2015-01-01

    This chapter focuses on posttraumatic stress reactions after being diagnosed with and treated for breast cancer. Posttraumatic stress symptoms (PTSS) are evident in a significant proportion of women after having experienced diagnosis and treatment of breast cancer. Several risk factors...... for developing long-term PTSS after breast cancer have been identified. Younger age, low education and income, pre-cancer previous psychiatric history, cancer disease severity, poor physical functioning, and acute symptoms of PTSS are predictors of long-term post-cancer PTSS, with poor physical functioning...

  12. Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

    Energy Technology Data Exchange (ETDEWEB)

    Purdie, Thomas G., E-mail: Tom.Purdie@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Techna Institute, University Health Network, Toronto, Ontario (Canada); Dinniwell, Robert E.; Fyles, Anthony [Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Sharpe, Michael B. [Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Techna Institute, University Health Network, Toronto, Ontario (Canada)

    2014-11-01

    Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented

  13. Microwave radiothermometry in the diagnosis and evaluation of the neoadjuvant treatment of patients with breast cancer

    Directory of Open Access Journals (Sweden)

    O. A. Sinelnikova

    2011-01-01

    Full Text Available Microwave mammography permits thermal changes to be estimated both within the breast and onto its surface. It is obvious that ireplace X-ray mammography or ultrasonography (USG since it gives no information on breast structural changes, which is very nefor a physician.At the same time microwave mammography can yield additional information on the magnitude of proliferative processes and on the thermal activity of tissue. In many cases, this information may be decisive in elaborating treatment policy.Due to its simplicity , non-invasiveness, and safety , decimetric microw ave radiothermometry may be a promising method for diagno sing breast cancer and evaluating the efficiency of its treatment. When used in combination with X-ray study and USG, this technique provides incomparable assistance in defining the management of patients. The concurrent use of mammography , USG, and radiothermometric d iag- nosis of the breast assists in reducing the level of diagnostic errors to 1-3%.

  14. 乳腺癌保乳手术38例临床分析%Analysis of breast conserving surgery 38 cases

    Institute of Scientific and Technical Information of China (English)

    朱昱

    2011-01-01

    Objective To evaluate the clinical efficacy of line - conserving surgery for early breast cancer and cosmetic results were evaluated. Methods The hospital from January 2008 to December 2010 were treated 38 cases of breast cancer clinical data were retrospectively analyzed, according to Rose standards, the acceptance of breast - conserving surgery in patients with cosmetic results assessment. Results All patients recovered well without complications, postoperative patient satisfaction with breast appearance and quality of life. Conclusions Early breast cancer patients receiving breast - conserving surgery can lead to satisfactory clinical effect and cosmetic results.%目的 探讨早期乳腺癌行保乳手术的临床疗效并对美容效果进行评价.方法 对永煤集团总医院普外科2008年1月-2010年12月收治的38例乳腺癌患者的临床资料及治疗体会进行回顾性分析,并按Rose标准,对接受保乳手术的患者进行美容效果评价.结果 所有病例术后恢复良好,无1例出现并发症,患者对术后乳房外形及生活质量满意.结论 早期乳腺癌患者接受保乳手术治疗可取得满意的临床和美容效果,但术前应严格选择适应证和禁忌症.

  15. 放射治疗在浸润性乳腺癌保乳术中的进展和争议%Progress and Controversies:radiation therapy for invasive breast cancer of breast-conserving surgery

    Institute of Scientific and Technical Information of China (English)

    李学波; 陈湘磊; 张士义

    2015-01-01

    Radiation therapy is a critical component of the multidisciplinary management of invasive breast cancer . In appropriately selected patients ,radiation not only improves local control and distress of local recurrence ,but also improves survival by preventing seeding and reseeding .This article reviews the role of radiation therapy in invasive breast cancer management after breast‐conserving surgery .It focuses on emerging evidence that helps to define the clinical situations in which radiotherapy is indicated ,the appropriate targets of treatment ,and optimal approaches for minimizing the toxicity . It includes a discussion of new approaches ,including hypofractionation and intensity modulation ,as well as a discussion of promising avenues for future research .%放射治疗是浸润性乳腺癌保乳术综合治疗的重要组成部分之一,选取恰当的患者术后给予局部放疗,不但可以有效降低局部复发率,而且可以降低远处转移率和提高生存率。本综述回顾性探讨放射治疗在浸润性乳腺癌保乳术中的应用,选择合适的放疗方法,降低毒副作用,获得最佳的治疗目的,并总结了新的放疗方法:低分割放疗和调强放疗,对不同病例的治疗情况,同时还探讨了保乳术后放疗的争议。希望本综述能为以后的临床工作和研究指引方向。

  16. Technology as a force for improved diagnosis and treatment of breast disease

    Science.gov (United States)

    Holloway, Claire M.B.; Easson, Alexandra; Escallon, Jaime; Leong, Wey Liang; Quan, May Lynn; Reedjik, Michael; Wright, Frances C.; McCready, David R.

    2010-01-01

    Increasing numbers of women are seeking evaluation of screen-detected breast abnormalities, and more women with breast cancer are living with the consequences of treatment. Improved technologies have helped to individualize diagnostic evaluation and treatment, improve efficacy and minimize morbidity. This article highlights some of these technologies. Superior imaging techniques have improved breast cancer screening and show promise for intraoperative surgical guidance and postoperative specimen evaluation. Digital mammography improves the sensitivity of mammography for women younger than 50 years with dense breasts, and tomosynthesis may improve specificity. Magnetic resonance imaging provides sensitive delineation of the extent of the disease and superior screening for women with a greater than 25% lifetime risk of breast cancer Minimally invasive techniques have been developed for the assessment of intraductal lesions, biopsy of imaging abnormalities, staging of the axilla and breast radiotherapy. Ductoscopy facilitates intraductal biopsy and localization of lesions for excision, sentinel lymph node biopsy is becoming standard for axillary staging, and intraoperative radiotherapy has the potential to reduce treatment time and morbidity. Three-dimensional imaging allows correlation of final histology with preoperative imaging for superior margin assessment. Related techniques show promise for translation to the intraoperative setting for surgical guidance. New classifications of breast cancers based on gene expression, rather than morphology, describe subtypes with different prognoses and treatment implications, and new targeted therapies are emerging. Genetic fingerprints that predict treatment response and outcomes are being developed to assign targeted treatments to individual patients likely to benefit. Surgeons play a vital role in the successful integration of new technologies into practice. PMID:20646402

  17. Conservative approach for esthetic treatment of enamel hypoplasia.

    Science.gov (United States)

    Reston, E G; Corba, D V; Ruschel, K; Tovo, M F; Barbosa, A N

    2011-01-01

    This article describes a minimally invasive technique for removal of intrinsic enamel stains and discoloration. The technique is based on enamel microabrasion with application of an acid-abrasive gel. Treatment may be complemented with composite resin to compensate for the effects of acid or to finish the masking effect.

  18. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention

    DEFF Research Database (Denmark)

    Andersen, Kenneth Geving; Kehlet, Henrik

    2011-01-01

    Chronic pain after breast cancer treatment is a major clinical problem, affecting 25 to 60% of patients. Development of chronic pain after breast cancer treatment, as well as other surgical procedures, involves a complex pathophysiology that involves pre-, intra- and post-operative factors....... This review is a systematic analysis on methodology and evidence in research into persistent pain after breast cancer treatment during the period 1995 to 2010, in order to clarify the significance and relative role of potential risk factors. Literature was identified by a search in PubMed and OVID, as well...... principles of surgical and adjuvant therapy. In summary, the data show inconsistencies in definition of chronic pain and treatment groups, as well as in the collection of pre- intra- and post-operative data, precluding conclusions with regard to pathophysiologic mechanisms as well as rational strategies...

  19. The Diagnosis and Treatment Progress of Early Breast Cancer%早期乳腺癌的诊断及治疗进展

    Institute of Scientific and Technical Information of China (English)

    杨阳; 张健; 李爱东

    2012-01-01

    Breast cancer is the worldwide most common malignancy in women and also is the leading cause of cancer-related mortality. Early breast cancer is one of the attentions that mammary gland oncologists focus on. The long-term cure rate of early breast cancer is more than 90%, the improvement of diagnosis rate can increase patients' survival rate, decrease mortality. The risk factors of breast cancer include way of life, the environment factors, genetic and so on. In resent years early breast cancer incidence keeps rising, and tend to be younger. The key of treating early breast cancer is early prevention, early detection and early treatment The treatment of early breast cancer has been improved from traditional surgery to comprehensive therapy, which is conserving surgery combined with adjuvant radiotherapy and chemotherapy. Along with the progress of the society and the development of economy, the treatment of early breast cancer tend to be perfect gradually. In order to guide clinical, now I summarize the diagnosis and treatment progress of early breast cancer.%乳腺癌是全球女性最常见的恶性肿瘤.多年来早期乳腺癌是乳腺肿瘤学家积极关注的焦点之一.早期乳腺癌的长期治愈率达90%以上,其诊断率的提高将大大提高病人的生存率和生存年限,降低病死率.生活方式、环境因素、遗传基因等都是乳腺癌的危险因素.近年来早期乳腺癌发生率不断上升,并趋于年轻化,所以早期预防、早期发现、早期治疗成了治疗早期乳腺癌的关键.早期乳腺癌的治疗从传统的手术治疗发展到以手术为主,放化疗为辅的综合疗法.随着社会的进步和经济的发展,早期乳腺癌的治疗方案渐渐趋于完整.现对早期乳腺癌的诊断和治疗研究进展进行概述,以指导临床.

  20. Evaluation of the conservative treatment of Trigger finger by local instillation of corticosteroids

    Directory of Open Access Journals (Sweden)

    Muris Pecar

    2011-12-01

    Full Text Available Introduction: Trigger Finger (tenosynovitis stenosans is a specific, named disease from a group of repetitive strain injury (RSI diseases, caused by inflammation which results in difficulties during muscle contraction and weakened and painful tendon movement. It is common in the outpatient physical medicine and rehabilitation practice. The aim of our study was to evaluate the success of conservative treatment of Trigger Finger by local instillation of corticosteroids.Methods: The study was designed as an observational and open analysis of the results of conservative treatment of 45 patients. We used precise instillation of steroid anti-inflammatory antirheumatic drugs in the area of patho-anatomic, microtraumatic injuries of tendon and its sheath. Patients were evaluated before and after the treatment with 0 to 5 evaluation score scale. The data were analyzed using X2 test.Results: Most of the patients had evaluation score of 2, 3 and 4, before the treatment. After the treatment 10 (29% patients had achieved score 4 and 35 (71% patients had achieved score 5. All of the patients with score 5 had excellent working ability with full working capacity. Other patients had well-preserved working ability, which improved to excellent in maximum of 7 days.Conclusions: Conservative treatment of Trigger finger shows good therapeutic effects and taking into account the benefits, convenience and generally lower cost of conservative treatment for the patient, should be considered as an effective alternative to surgical treatment.

  1. Conservative treatment of Malgaigne fracture in young female - case report

    OpenAIRE

    Vukašinović Zoran; Spasovski Duško; Šešlija Igor; Živković Zorica; Stevanović Milan

    2013-01-01

    Introduction. Pelvic ring injuries usually result from high­energy trauma, and cranial and abdominal multiple injuries are frequently present. Malgaigne fracture is referred to pelvic ring disruption at two sites, and is often treated surgically for its instability. We present a case of nonoperative treatment of Malgaigne pelvic fracture. Case Outline. A 17­year­old girl sustained a Malgaigne fracture falling off a horse. After ruling out urgent multiple tr...

  2. Conservative treatment of a comminuted cervical fracture in a racehorse

    OpenAIRE

    Vos NJ

    2008-01-01

    Abstract The 'classical' or 'Hangman' neck fracture involves the odontoid peg (process) of the second cervical vertebra (C2), and is described as an axial, dens or odontoid peg fracture in both the veterinary and human literature. Possible surgical treatment in both foals and adult horses requires a technique that allows decompression, anatomical alignment and stabilisation of the odontoid fracture. A limited number of surgical cases in foals have been reported in literature, but never in an ...

  3. Receipt of Standard Breast Cancer Treatment by African American and White Women

    Directory of Open Access Journals (Sweden)

    Julie Worthington, John W. Waterbor, Ellen Funkhouser, Carla Falkson, Stacey Cofield, Mona Fouad

    2008-01-01

    Full Text Available Objectives: Breast cancer mortality is higher among African Americans than for Whites, though their breast cancer incidence is lower. This study examines whether this disparity may be due to differential receipt of treatment defined as “standard of care” or “addition to standard of care” by the National Comprehensive Cancer Network (NCCN. Design: Incident, female breast cancer cases, 2,203 African American and 7,518 White, diagnosed during 1996-2002 were identified from the Alabama Statewide Cancer Registry. Breast cancer treatment was characterized as whether or not a woman received standard of care as defined by the NCCN. For cases characterized as receiving standard of care, addition to standard of care was also evaluated, defined as receiving at least one additional treatment modality according to NCCN guidelines. Logistic models were used to evaluate racial differences in standard and addition to standard of care and to adjust for age, stage at diagnosis, year of diagnosis and area of residence. Results: No racial differences were found for standard (Prevalence Ratio (PR=1.00 or for addition to standard of care (PR=1.00 after adjustment for confounders. When the adjusted models were examined separately by age, stage, and area of residence, overall no racial differences were found. Conclusion: No racial differences in standard of care and addition to standard of care for breast cancer treatment were found. Therefore, both African Americans and Whites received comparable treatment according to NCCN guidelines.

  4. Delay in Presentation, Diagnosis, and Treatment for Breast Cancer Patients in Jordan.

    Science.gov (United States)

    Abu-Helalah, Ahmad Munir; Alshraideh, Ahmad Hussam; Al-Hanaqtah, Mo'tasem; Da'na, Moh'd; Al-Omari, Asim; Mubaidin, Rasmi

    2016-01-01

    Breast cancer is the most common cancer, and one of the leading causes of death for females in Jordan and many countries in the world. Studies have shown that delay in symptoms presentation, diagnosis or treatment would result in poor prognosis. There has been no published study from Jordan on delays in patient presentation, delays in diagnosis, or delays in treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for breast cancer patients in Jordan. This project was a cross-sectional study on female breast cancer patients in Jordan. The total number of participants was 327. The proportion of patients with presentation delay, diagnosis delay, and treatment delay was 32.2%, 49.1%, or 32.4%, respectively. The main reported reasons for delay in presentation were ignorance of the nature of the problem (65.6%), limited/lack of knowledge that symptoms were suggestive of cancer diagnosis (16.7%), and misdiagnosis (16.7%). Predictors of delay and mean time for presentation, diagnosis, and treatment were identified. Our results reveal that breast cancer patients in Jordan are experiencing delays in presentation, diagnosis, and treatment. This could justify the advanced stages at diagnosis and poor outcomes for breast cancer patients in Jordan. We recommend revising the current early detection and down-staging programs in Jordan.

  5. Taking CHARGE: A self-management program for women following breast cancer treatment.

    Science.gov (United States)

    Cimprich, Bernadine; Janz, Nancy K; Northouse, Laurel; Wren, Patricia A; Given, Barbara; Given, Charles W

    2005-09-01

    The purpose of the study was to develop and evaluate Taking CHARGE, a self-management intervention designed to facilitate successful transitions to survivorship after breast cancer treatment. The Taking CHARGE intervention involves a two-pronged approach building on self-regulation principles to (1) equip women with self-management skills to address concerns following breast cancer treatment, and (2) provide information about common survivorship topics. The program involved four intervention contacts, two small group meetings and two individualized telephone sessions, delivered by nurse/health educators. This paper focuses on the process evaluation findings from a preliminary test of the Taking CHARGE intervention conducted with 25 women, aged 34-66 years, completing breast cancer treatment, who were randomly assigned to the intervention group. The process evaluation was conducted to obtain systematic information about the relevance and usefulness of the self-regulation approach, informational aspects, and program delivery. The findings indicated that intervention group participants found the Taking CHARGE program to be timely, relevant, and to have high utility in dealing with concerns that exist following breast cancer treatment. The process evaluation findings provide early evidence of the usefulness of the Taking CHARGE intervention for successful transition to survivorship following breast cancer treatment.

  6. Dosimetric evaluation of CR, 3DCRT and two types of IMRT for breast cancer after conservative surgery

    Institute of Scientific and Technical Information of China (English)

    Fuli Zhang; Yongqian Zhang; Yadi Wang

    2013-01-01

    Objective: The purpose of this study was to compare the dose distribution and dose volume histogram (DVH) of the planning target volume (PTV) and organs at risk (OARs) among conventional radiation therapy (CR), three-dimensional conformal radiation therapy (3DCRT), two-step intensity-modulated radiation therapy (TS-IMRT) and direct machine parameter optimization intensity-modulated radiation therapy (DMPO-IMRT) after breast-conserving surgery. Methods: For each of 20 randomly chosen patients, 4 plans were designed using 4 irradiation techniques. The prescribed dose was 50 Gy/2 Gy/25 f, 95% of the planning target volume received this dose. The cumulated DVHs and 3D dose distributions of CR, 3DCRT, TSIMRT and DMPO-IMRT plans were compared. Results: For the homogeneity indices, no statistically significant difference was observed among CR, 3DCRT, TS-IMRT and DMPO-IMRT while the difference of the conformality indices were statistically significant. With regard to the organs at risk, IMRT and 3DCRT showed a significantly fewer exposure dose to the ipsilateral lung than CR in the high-dose area while in the low-dose area, IMRT demonstrated a significant increase of exposure dose to ipsilateral lung, heart and contralateral breast compared with 3DCRT and CR. In addition, the monitor units (MUs) for DMPOIMRT were approximately 26% more than those of TS-IMRT and the segments of the former were approximately 24% less than those of the latter. Conclusion: Compared with CR, 3DCRT and IMRT improved the homogeneity and conformity of PTV, reduced the irradiated volume of OARs in high dose area but IMRT increased the irradiated volume of OARs in low dose area. DMPO-IMRT plan has fewer delivery time but more MUs than TS-IMRT.

  7. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap

    Science.gov (United States)

    Alço, Gül; Igdem, Sefik; Okkan, Sait; Dincer, Maktav; Sarsenov, Dauren; Ilgun, Ahmet Serkan; Agacayak, Filiz; Elbüken, Filiz; Ercan, Tulay; Selamoglu, Derya; Ozmen, Vahit

    2016-01-01

    The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4–4.43 cm) in the x, 1.07 cm (range, 0.05–5.67 cm) in the y, and 1.12 cm (range, 0–3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction. PMID:27699027

  8. New developments in the treatment of HER2-positive breast cancer

    Directory of Open Access Journals (Sweden)

    Nahta R

    2012-05-01

    Full Text Available Rita NahtaDepartments of Pharmacology and Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USAAbstract: Approximately 20%–30% of metastatic breast cancers show increased expression of the human epidermal growth factor receptor-2 (HER2 tyrosine kinase. Two HER2-specific therapies are currently approved for clinical treatment of patients with HER2-overexpressing metastatic breast cancer. Trastuzumab is a monoclonal antibody against HER2 and is approved for first-line treatment of HER2-positive metastatic breast cancer. Lapatinib is a small molecule dual inhibitor of epidermal growth factor receptor and HER2 tyrosine kinases, and is approved for trastuzumab-refractory disease. Although trastuzumab is a highly effective therapy for patients with HER2-overexpressing metastatic breast cancer, a significant number of patients in the initial clinical trials of trastuzumab monotherapy showed resistance to trastuzumab-based therapy. Further, among those who did respond, the initial trials indicated that the median time to progression was less than 1 year. Similarly, lapatinib is effective in a subset of trastuzumab-refractory cases, but the majority of patients display resistance. This review discusses the multiple molecular mechanisms of resistance that have been proposed in the literature. In addition, novel agents that are being tested for efficacy against HER2-positive breast cancer, including the antibodies pertuzumab and trastuzumab-DM1 and the immunotoxin affitoxin, are reviewed. The introduction of trastuzumab has revolutionized the clinical care of patients with HER2-positive metastatic breast cancer and has resulted in dramatic reductions in recurrences of early-stage HER2-positive breast cancer. The development and implementation of gene- and protein-based assays that measure potential molecular predictors of trastuzumab resistance will allow individualization of HER2-targeted therapeutic approaches

  9. Presentation of Axillary Metastases from Occult Breast Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Xin Wang

    2007-01-01

    Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians.Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confirmed,a preoperative workup should be done.The current experience is based on several relatively small retrospective reviews and case reports.It is difficult to determine the best management of occult breast cancer.However,treatmenl of axillary Iymph node dissection is recommended for local control and complete staging information.Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy.Adjuvant systemic treatment should be offered.

  10. Current approaches in treatment of triple-negative breast cancer

    Institute of Scientific and Technical Information of China (English)

    Hanan Ahmed Wahba; Hend Ahmed El-Hadaad

    2015-01-01

    Triple-negative breast cancer (TNBC) is diagnosed more frequently in younger and premenopausal women and is highly prevalent in African American women. TNBC is a term derived from tumors that are characterized by the absence of ER, PgR, and HER2. So patients with TNBC do not beneift from hormonal or trastuzumab-based therapies. TNBCs are biologically aggressive, although some reports suggest that they respond to chemotherapy better than other types of breast cancer, prognosis remains poor. hTis is due to:shortened disease-free interval in the adjuvant and neoadjuvant setting and a more aggressive course in the metastatic setting.

  11. Clinical utility of exemestane in the treatment of breast cancer 

    Directory of Open Access Journals (Sweden)

    Zucchini G

    2015-05-01

    Full Text Available Giorgia Zucchini,1 Elena Geuna,1 Andrea Milani,1 Caterina Aversa,2 Rossella Martinello,2 Filippo Montemurro1 1Investigative Clinical Oncology, Fondazione del Piemonte per l’Oncologia-Candiolo Cancer Institute (IRCCs, Candiolo, 2University of Turin Medical School, Turin, Italy Abstract: Breast cancer is the most prevalent cancer in women, causing a significant mortality worldwide. Different endocrine strategies are available for the treatment of hormone-sensitive breast cancer, including antiestrogen tamoxifen and fulvestrant, as well as third-generation aromatase inhibitors (AIs, such as letrozole, anastrozole, and exemestane. In this review, we will focus on exemestane, its clinical use, and its side effects. Exemestane is a steroidal third-generation AI now used in all treatment settings for breast cancer. In the metastatic disease, it has been extensively investigated as the first-, second-, and further-line treatment and it is now registered for the treatment of postmenopausal women with advanced estrogen-receptor-positive breast cancer whose disease has progressed following antiestrogen therapy. A potential lack of cross-resistance with nonsteroidal AIs has been described, giving additional therapeutic opportunities in sequences of endocrine agents. Exemestane is also approved for the adjuvant treatment of postmenopausal early breast cancer, either as upfront monotherapy for 5 years, as a switch following 2–3 years of tamoxifen, or as extended therapy beyond 5 years of adjuvant treatment. New promising data also showed a beneficial effect in young premenopausal early breast cancer patients, when administered together with ovarian suppression. Interesting results have also emerged when exemestane has been investigated as neodjuvant treatment as well as preventive agent in healthy women at high risk for breast cancer. Exemestane is generally well tolerated, with a side effect profile similar to that of other AIs, including menopausal

  12. Conservative Treatment of a Patient with Epidermolysis Bullosa Presenting as Bart Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Samet Vasfi Kuvat

    2010-01-01

    Full Text Available We presented a case of a newborn male with aplasia cutis congenita on the lower limb. The case was treated with conservative method. As for the conservative treatment, daily hydrodebridement with 1/200 diluted povidone-iodine and serum physiologic was performed, followed by closure of the wound with a dexpanthenol + chlorhexidine + fusidic acid-impregnated sterile gauze bandage. the followup that occured after three weeks, the wound was completely epithelialized, but a hypopigmented scar remained in the limb.

  13. Results of the conservative treatment in clubfoot using the French method

    Directory of Open Access Journals (Sweden)

    Dana VASILESCU

    2014-03-01

    Full Text Available The idiopathic clubfoot represents a congenital deformation incorporating four distinct alterations: the equinus, varus, cavus and adduction of the forefoot to the hindfoot. The meaning given to the conservative treatment of clubfoot by French method is that of mobilization-manipulation and serial plaster immobilizations. We followed the results of the early conservative orthopedic treatment in the congenital clubfoot in 52 patients (74 feet under the age of 1 year. These cases were treated in the Department of Pediatric Orthopedics of the Rehabilitation Clinical Hospital of Cluj-Napoca for a period of 5 years. The degree of deformation used DiMeglio’s clinical criteria. The conservative treatment began since the presentation of the cases with mobilizations – manipulations and continued up to the age of one month. After the age of one month, serial plaster immobilizations followed. When the conservative treatment failed consecutive to five or six successive plasters, the correction already obtained was followed by surgery. The percentage of the favorable results after the conservative treatment can reach 82.44 %. The results are not so good in cases of arthrogryposis multiplex congenita, myelomeningocele etc.

  14. Characteristics of breast cancer patients who experience menopausal transition due to treatment

    NARCIS (Netherlands)

    S.F.A. Duijts; A.C. Stolk-Vos; H.S.A. Oldenburg; M. van Beurden; N.K. Aaronson

    2011-01-01

    Objective To identify patient-related and treatment-related factors associated significantly with climacteric symptoms in young patients who experience menopausal transition due to adjuvant treatment for breast cancer. Methods This cross-sectional study used questionnaire data collected to screen br

  15. Conservative treatment of Angle Class III malocclusion with anterior crossbite

    Directory of Open Access Journals (Sweden)

    João Hélder Ferreira de Aguiar

    2015-08-01

    Full Text Available Angle Class III malocclusion is characterized by anteroposterior dental discrepancy which might be associated or not with skeletal changes. Class III molar relationship is associated with vertical or lingually tipped mandibular incisors and a usually concave profile. These characteristics seriously affect facial esthetics and most frequently are the reason why patients seek orthodontic treatment. This case was presented to the committee of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO as part of the requisites to become a BBO Diplomate.

  16. Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy.

    Science.gov (United States)

    Russo, Andrea L; Arvold, Nils D; Niemierko, Andrzej; Wong, Nathan; Wong, Julia S; Bellon, Jennifer R; Punglia, Rinaa S; Golshan, Mehra; Troyan, Susan L; Brock, Jane E; Harris, Jay R

    2013-07-01

    We sought to assess whether a close surgical margin (>0 and <2 mm) after breast-conserving therapy (BCT) confers an increased risk of local recurrence (LR) compared with a widely negative margin (≥2 mm). We studied 906 women with early-stage invasive breast cancer treated with BCT between January 1998 and October 2006; 91 % received adjuvant systemic therapy. Margins were coded as: (1) widely negative (n = 729), (2) close (n = 85), or (3) close (n = 84)/positive (n = 8) but having no additional tissue to remove according to the surgeon. Cumulative incidence of LR and distant failure (DF) were calculated using the Kaplan-Meier method. Gray's competing-risk regression assessed the effect of margin status on LR and Cox proportional hazards regression assessed the effect on DF, controlling for biologic subtype, age, and number of positive lymph nodes (LNs). Three hundred seventy-seven patients (41.6 %) underwent surgical re-excision, of which 63.5 % had no residual disease. With a median follow-up of 87.5 months, the 5-year cumulative incidence of LR was 2.5 %. The 5-year cumulative incidence of LR by margin status was 2.3 % (95 % CI 1.4-3.8 %) for widely negative, 0 % for close, and 6.4 % (95 % CI 2.7-14.6 %) for no additional tissue, p = 0.3. On multivariate analysis, margin status was not associated with LR; however, triple-negative subtype (AHR 3.7; 95 % CI 1.6-8.8; p = 0.003) and increasing number of positive LNs (AHR 1.6; 95 % CI 1.1-2.3; p = 0.025) were associated. In an era of routine adjuvant systemic therapy, close surgical margins and maximally resected close/positive margins were not associated with an increased risk of LR compared to widely negative margins. Additional studies are needed to confirm this finding.

  17. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review.

    Science.gov (United States)

    Luijsterburg, Pim A J; Verhagen, Arianne P; Ostelo, Raymond W J G; van Os, Ton A G; Peul, Wilco C; Koes, Bart W

    2007-07-01

    Patients with a lumbosacral radicular syndrome are mostly treated conservatively first. The effect of the conservative treatments remains controversial. To assess the effectiveness of conservative treatments of the lumbosacral radicular syndrome (sciatica). Relevant electronic databases and the reference lists of articles up to May 2004 were searched. Randomised clinical trials of all types of conservative treatments for patients with the lumbosacral radicular syndrome selected by two reviewers. Two reviewers independently assessed the methodological quality and the clinical relevance. Because the trials were considered heterogeneous we decided not to perform a meta-analysis but to summarise the results using the rating system of levels of evidence. Thirty trials were included that evaluated injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture as treatment for the lumbosacral radicular syndrome. Because several trials indicated no evidence of an effect it is not recommended to use corticosteroid injections and traction as treatment option. Whether clinicians should prescribe physical therapy, bed rest, manipulation or medication could not be concluded from this review. At present there is no evidence that one type of treatment is clearly superior to others, including no treatment, for patients with a lumbosacral radicular syndrome.

  18. Potential use of humanized antibodies in the treatment of breast cancer.

    Science.gov (United States)

    Schaefer, Niklaus G; Pestalozzi, Bernhard C; Knuth, Alexander; Renner, Christoph

    2006-07-01

    With the growing knowledge of key cellular pathways in tumor induction and evolution, targeted therapies make up an increasing proportion of new drugs entering clinical testing. In the treatment of breast cancer, humanized antibodies have become a major option. The humanized monoclonal antibody trastuzumab (Herceptin); Genentech, Inc., CA, USA) for HER2-overexpressing, metastatic breast cancer, represents a successful agent associated with impressive survival benefits when combined with chemotherapy. Based on impressive results, trastuzumab will become a standard in the adjuvant treatment of HER2-overexpressing breast cancer. The role of trastuzumab in the neoadjuvant setting is promising, but must be further evaluated in large prospective, randomized trials. However, there is still a large proportion of patients overexpressing HER2 that do not respond to trastuzumab. Regarding this patient cohort, the optimal combination of trastuzumab with other agents needs further evaluation. In breast cancer lacking HER2 amplification, the role of the new antibody pertuzumab remains to be defined. The role of antibodies interfering with angiogenesis, tumor stroma or glycoproteins is of a preliminary nature and warrants further investigation. Here, an overview of humanized antibodies in human breast cancer is provided, with emphasis on the recent advances and future prospects in treating malignant breast cancer.

  19. Diagnosis and Treatment Experience of 14 Cases of Breast Cancer Associated with Pregnancy or Lactation

    Institute of Scientific and Technical Information of China (English)

    ZHENG Zhixiang; WU Zhiyong

    2006-01-01

    Objective: To explore the diagnosis and treatment experience of breast cancer associated with pregnancy or lactation. Methods: From January 1990 to December 2005, 14 cases with breast cancer associated with pregnancy or lactation were analyzed retrospectively (TNM stage Ⅱ, 2 cases; stage Ⅲ, 11 cases; stage Ⅳ, 1 case). Diagnosis was established by fine needle aspiration biopsy primarily or routine pathological method if necessary. Abortion was used for discontinuation of pregnancy in 1 case with early pregnancy and 1 case with meddle pregnancy. 2 patients with late pregnancy received cesarean section,10patients of breast cancer associated with lactation received multidisciplinary and-tumor treatment after discontinuation of lactation. Results: Diagnosis was confirmed by fine noodle aspiration biopsy in 9 cases and by secondary routine pathological method in the other 5 cases, 12 cases were followed up, 1 case of stage Ⅳ died of metastasis 5 months after diagnosis. 3-, 5-year survival rates in 10 cases of stage Ⅲ were 66% and 30% respectively. One case remained alive without recurrence for 8 years up to now. Conclusion: A thorough breast examination is necessary at the first antenatal visit physicians should aggressively pursue work-up in women with a palpable breast tass. In the patients during the second and third trimness,the various modalities available for treatment inholding abortion and their risks and beneath modalities available for treatment including abortion and their risks and benefits must be discussed openly with patients and their families.

  20. A role for the androgen receptor in the treatment of male breast cancer.

    Science.gov (United States)

    Zhu, Jason; Davis, Carter T; Silberman, Sandra; Spector, Neil; Zhang, Tian

    2016-02-01

    Male breast cancer (BC) is relatively rare, making up less than 1% of all breast cancer cases in the United States. Treatment guidelines for male BC are derived from studies on the treatment of female BC, and are based molecular and clinical characteristics, such as hormone receptor positivity. For female estrogen receptor positive (ER+) breast cancers, the standard of care includes three classes of endocrine therapies: selective estrogen receptor modulators, aromatase inhibitors, and pure anti-estrogens. In contrast to female ER+ breast cancers, there is less known about the optimal treatment for male ER+ BC. Furthermore, in contrast to ER, less is known about the role of the androgen receptor (AR) in male and female BC. We report here the treatment of a 28-year-old man with metastatic AR+, ER+ breast cancer otherwise refractory to chemotherapy, who has had a durable clinical response to hormonal suppression with the combination of aromatase inhibition (Letrozole) in conjunction with a GnRH agonist (Leuprolide).

  1. Bolus electron conformal therapy for the treatment of recurrent inflammatory breast cancer: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Michelle M., E-mail: mmkim@mdanderson.org [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Kudchadker, Rajat J.; Kanke, James E.; Zhang, Sean; Perkins, George H. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

    2012-07-01

    The treatment of locoregionally recurrent breast cancer in patients who have previously undergone radiation therapy is challenging. Special techniques are often required that both eradicate the disease and minimize the risks of retreatment. We report the case of a patient with an early-stage left breast cancer who developed inflammatory-type recurrence requiring re-irradiation of the chest wall using bolus electron conformal therapy with image-guided treatment delivery. The patient was a 51-year-old woman who had undergone lumpectomy, axillary lymph node dissection, and adjuvant whole-breast radiation therapy for a stage I left breast cancer in June 1998. In March 2009, she presented at our institution with biopsy-proven recurrent inflammatory carcinoma and was aggressively treated with multi-agent chemotherapy followed by mastectomy that left a positive surgical margin. Given the patient's prior irradiation and irregular chest wall anatomy, bolus electron conformal therapy was used to treat her chest wall and draining lymphatics while sparing the underlying soft tissue. The patient still had no evidence of disease 21 months after treatment. Our results indicate that bolus electron conformal therapy is an accessible, effective radiation treatment approach for recurrent breast cancer in patients with irregular chest wall anatomy as a result of surgery. This approach may complement standard techniques used to reduce locoregional recurrence in the postmastectomy setting.

  2. Conservative treatment of Malgaigne fracture in young female - case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Pelvic ring injuries usually result from high­energy trauma, and cranial and abdominal multiple injuries are frequently present. Malgaigne fracture is referred to pelvic ring disruption at two sites, and is often treated surgically for its instability. We present a case of nonoperative treatment of Malgaigne pelvic fracture. Case Outline. A 17­year­old girl sustained a Malgaigne fracture falling off a horse. After ruling out urgent multiple trauma in local hospital, she was then transferred to Pediatric Orthopedic and Trauma Service at the Institute of Orthopedic Surgery «Banjica» Belgrade, with provisional cutaneous traction of 2 kg applied to her right leg. After the status evaluation, the supracondylar femoral traction was applied for three months, combined with pelvic cradle for first 73 days. Weight of traction was gradually adjusted according to x­ray check­up, ranging from 1­16 kg (1/4 of body weight. Antibiotic prophylaxis was administered for 10 days, and thromboprophylaxis for two months. After the removal of traction, physical therapy was applied and the patient achieved full weight bearing four months after the injury. Treatment outcome was a symmetric and stable pelvic ring, equal leg length, full range of motion in both hip joints and normal walking. Conclusion. Traction therapy, combined with gravitational suspension in pelvic cradle, resulted in excellent clinical result. Although significantly longer and more loaded than usual, normal weight bearing and walking were promptly achieved using intensive physical therapy. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

  3. Simulated Optimization of Brachytherapy for the Treatment of Breast Cancer

    Science.gov (United States)

    2014-03-01

    In: Biomechanics : Mechanical Properties of Living Tissues. Springer , New York, pp. 203– 212. Y C Fung, Biomechanics : Mechanical Properties of...Living Tissues, Springer , Jun 18, 1993. S Richardson, R Pino, Dosimetric Effects of an air cavity for the SAVITM partial breast irradiation applicator

  4. Preoperative distress predicts persistent pain after breast cancer treatment

    DEFF Research Database (Denmark)

    Mejdahl, Mathias Kvist; Mertz, Birgitte Goldschmidt; Bidstrup, Pernille Envold Hansen;

    2015-01-01

    at the Department of Breast Surgery, Rigshospitalet, Denmark, were invited to participate in the study. Patients filled out a questionnaire preoperatively, and 4 and 8 months after surgery. Preoperative distress was measured with the Distress Thermometer (DT; 11-point scale, 0-10). We examined the association...

  5. A software tool for determination of breast cancer treatment methods using data mining approach.

    Science.gov (United States)

    Cakır, Abdülkadir; Demirel, Burçin

    2011-12-01

    In this work, breast cancer treatment methods are determined using data mining. For this purpose, software is developed to help to oncology doctor for the suggestion of application of the treatment methods about breast cancer patients. 462 breast cancer patient data, obtained from Ankara Oncology Hospital, are used to determine treatment methods for new patients. This dataset is processed with Weka data mining tool. Classification algorithms are applied one by one for this dataset and results are compared to find proper treatment method. Developed software program called as "Treatment Assistant" uses different algorithms (IB1, Multilayer Perception and Decision Table) to find out which one is giving better result for each attribute to predict and by using Java Net beans interface. Treatment methods are determined for the post surgical operation of breast cancer patients using this developed software tool. At modeling step of data mining process, different Weka algorithms are used for output attributes. For hormonotherapy output IB1, for tamoxifen and radiotherapy outputs Multilayer Perceptron and for the chemotherapy output decision table algorithm shows best accuracy performance compare to each other. In conclusion, this work shows that data mining approach can be a useful tool for medical applications particularly at the treatment decision step. Data mining helps to the doctor to decide in a short time.

  6. Evaluation of Quality of Life and Efficacy of Breast Cancer Patients Treated with Breast-Conserving Surgery%保乳手术疗效及其患者生存质量评估

    Institute of Scientific and Technical Information of China (English)

    庞钊

    2014-01-01

    目的:探讨保乳手术对老年乳腺癌患者的疗效及其生存质量评估。方法180例早期乳腺癌患者,其中56例患者行保乳手术,63例患者行标准根治术,61例患者行改良根治术。结果保乳手术组具有住院时间较短、手术时间较短、术中出血量少等优势,与根治术组(标准根治术组+改良根治术组)相比有统计学差异( P<0.0001);三组患者生存率、远处转移、术后复发等方面比较均无统计学差异(P>0.05);保乳术组患者心理因子、躯体因子、精神因子和社会支持因子四个方面均显著优于标准根治术组和改良根治术组患者(P<0.05);术后乳房外观及美容效果保乳术组与标准根治术及改良根治术相比有显著统计学差异( P<0.05)。结论早期乳腺癌患者保乳手术近期疗效较满意,严格把握相关手术指征、规范切除和术后放化疗等是保乳手术成功的关键。%Objective To analyze the quality of life and efficacy of elderly breast cancer patients treated with breast -conserving surgery .Methods In the 180 early breast cancer patients ,56 cases received breast-conserving surgery ,63 cases re-ceived standard radical mastectomy and 61 cases received modified radical mastectomy .Results Hospitalization time,operative time and blood loss in breast-conserving surgery group were better than those of the radical surgery group ( standard radical sur-gery group +modified radical mastectomy group ) (P0.05);psychological factors,physical factors,mental factors and social support factors in breast-conserving surgery group were significantly superior to those of the radical surgery group (P<0.05);Compared with radical surgery group ,breast appearance and cosmetic results had significant differences in breast -conserving sur-gery group (P<0.05).Conclusion For early stage breast cancer patients ,breast-conservative surgery has good efficacy .Strict

  7. Functional Muscular Condition Dynamics at Osteoarthrosis Conservative Treatment of Major Joints of Lower Extremities

    Directory of Open Access Journals (Sweden)

    М.S. Sayfutdinov

    2009-06-01

    Full Text Available The method of global electromyography has been used for the evaluation of 231 patients aged from 16 to 74 (43,7±0,8 with bilateral osteoarthrosis of major joints of lower extremities I-III degrees before the course of conservative treatment, immediately after the end of conservative treatment and in three months. Conservative treatment of patients with osteoarthrosis of major joints of lower extremities has been shown to cause restructuring of EMG patterns of maximal voluntary muscle contraction in lower extremities accompanied by decreased asymmetry of activity levels in muscle pairs and less observations of pathologically changed EMG that results in improved functional condition of the locomotor system.

  8. Coracoid fractures in wild birds: a comparison of surgical repair versus conservative treatment.

    Science.gov (United States)

    Scheelings, T Franciscus

    2014-12-01

    Medical records of wild bird admissions to the Australian Wildlife Health Centre at Healesville Sanctuary were analyzed for cases of unilateral coracoid fractures with known final outcomes. Forty-seven birds, comprising 13 species, fit these criteria. Of those birds, 18 were treated conservatively with analgesia and cage rest without coaptation bandaging, and 29 were treated with surgical correction of the fracture. Of the conservatively managed birds, 89% (16 of 18) were released back into the wild. Conversely, 34% (10 of 29) of the surgically managed birds were released. Treatment success for release differed significantly between treatment groups (P birds were not released. Given the high risks associated with surgical treatment and the high success rate of conservative management, cage rest without surgery appears prudent when managing coracoid injuries in birds.

  9. 保乳术与改良根治术治疗早期乳腺癌疗效对比%Early breast cancer surgery and modiifed radical treatment efifcacy

    Institute of Scientific and Technical Information of China (English)

    程敏; 陈德志

    2016-01-01

    Objective To investigate the effect of breast conserving surgery and modiifed radical mastectomy for early stage breast cancer patients.Methods From March 2004 to March 2010,60 cases of early breast cancer patients admitted to our hospital were randomly divided into breast conserving surgery group and modiifed radical mastectomy group. The treatment effect of the two groups was compared.Results Patients with breast conserving surgery group were significantly better than the modified radical mastectomy group,and the two groups had no signiifcant difference in the ifve year follow-up results.Conclusion The two methods for the effect of early breast cancer patients are better, breast conserving surgery in reducing surgical trauma is better than the modiifed radical mastectomy.%目的:探讨保乳术与改良根治术对早期乳腺癌患者的治疗疗效。方法选取2014年3月~2015年3月我院收治的早期乳腺癌患者60例作为研究对象,将其随机分为保乳术组和改良根治术组,各30例。比较两组患者的治疗疗效。结果保乳术组的患者手术损伤等指标和乳房美观性方面显著优于改良根治术组,两组患者在五年随访结果上没有显著性差异。结论两种方法对于早期乳腺癌患者均有较好的疗效,保乳术在减少患者手术损伤方面优于改良根治术。

  10. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study

    Science.gov (United States)

    Gugliotta, Marinella; da Costa, Bruno R; Dabis, Essam; Theiler, Robert; Jüni, Peter; Reichenbach, Stephan; Landolt, Hans; Hasler, Paul

    2016-01-01

    Objectives Evidence comparing the effectiveness of surgical and conservative treatment of symptomatic lumbar disc herniation is controversial. We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. Methods A prospective cohort study of a routine clinical practice registry consisting of 370 patients. Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life. Primary outcomes were back pain at 6 and 12 weeks. Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks. We filled in missing outcome variable values with multiple imputation, accounted for repeated measures within patients with mixed-effects models and adjusted baseline group differences in relevant prognostic indicators by inverse probability of treatment weighting. Results Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy (−0.97; 95% CI −1.89 to −0.09), were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks (48% vs 17%, risk difference: 0.34; 95% CI 0.16 to 0.47) and reported less physical function disability at 52 weeks (−3.7; 95% CI −7.4 to −0.1). The other assessments showed minimal between-group differences with CIs, including the null effect. Conclusions Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. PMID:28003290

  11. Conserved Molecular and Epigenetic Determinants of Aromatase Gene Induction by the Herbicide Atrazine in Human and Rat Cellular Models Relevant to Breast Cancer Risk

    OpenAIRE

    2011-01-01

    AbstractConserved Molecular and Epigenetic Determinants of Aromatase Gene Induction by the Herbicide Atrazine in Human and Rat Cellular Models Relevant to Breast Cancer Risk ByTheresa Ryan StueveDoctor of Philosophy in Molecular ToxicologyUniversity of California, BerkeleyProfessor Gary Firestone, Co-ChairProfessor Dale Leitman, Co-ChairFall 2011The widely-applied herbicide atrazine (ATR) is a potent endocrine disruptor that elicits anti-androgenic and estrogenic effects, often at concentrat...

  12. Counterview: Pre-operative breast MRI (magnetic resonance imaging) is not recommended for all patients with newly diagnosed breast cancer.

    Science.gov (United States)

    Solin, Lawrence J

    2010-02-01

    For the woman with a newly diagnosed early stage breast cancer, the routine use of pre-operative breast MRI (magnetic resonance imaging) is not indicated beyond conventional breast imaging (i.e., mammography with correlation ultrasound as indicated). There is no consistent evidence that a pre-operative breast MRI confers a benefit to the patient by improving clinical outcomes or surgical procedures. In a meta-analysis of studies reporting on the use of pre-operative breast MRI for the patient with an established index cancer, multifocal or multicentric disease was found on breast MRI in 16% of the patients, a rate substantially higher than the rate of local recurrence after breast conserving surgery plus definitive radiation treatment. In the largest retrospective study of patients treated with breast conserving surgery plus radiation, no gain was found for adding a breast MRI to conventional breast imaging. No randomized clinical trial has been designed to evaluate long term clinical outcomes associated with adding a pre-operative breast MRI. Adding pre-operative breast MRI can alter clinical management in ways that are potentially harmful to patients, for example, increased ipsilateral mastectomies, increased contralateral prophylactic mastectomies, increased work-ups, and delay to definitive surgery. In summary, the routine use of pre-operative breast MRI is not warranted for the typical patient with a newly diagnosed early stage breast cancer.

  13. Effect of breast conserving surgery combined with postoperative chemotherapy on the prognosis of early breast cancer patients%保乳手术联合术后化疗对早期乳腺癌患者近期预后影响研究

    Institute of Scientific and Technical Information of China (English)

    李文斌

    2015-01-01

    目的:探讨保乳手术联合术后化疗对早期乳腺癌患者近期预后的影响。方法选择2009年1月至2013年12月运城市中心医院收治的早期乳腺癌患者89例作为研究对象,根据不同手术方式分为两组,观察组47例给予保乳手术联合术后化疗,对照组42例给予改良根治术联合术后化疗,比较两组患者的手术情况、乳房美容效果及术后生存率、复发率、远处转移率。结果观察组手术时间、住院时间均短于对照组,差异有统计学意义(P0.05)。结论保乳手术联合术后化疗、改良根治术联合术后化疗均是治疗早期乳腺癌的有效手段,但保乳手术对患者损伤较轻,且乳房美容效果优于改良根治术,值得临床重视。%Objective To investigate the effect of breast conserving surgery combined with postoperative chemotherapy on the prognosis of early breast cancer patients.Methods From January 2009 to December 2013,89 patients with early breast cancer treated as the research object,89 patients with early breast cancer were selected as the research object,according to different operation methods were divided into 2 groups,the observation group of 47 were gived the treatment of the breast conserving surgery combined with chemotherapy,the control group of 42 cases were gived the treatment of modified radical mastectomy combined with chemotherapy.The operation,breast beauty effect and survival rate, recurrence rate and distant metastasis rate were compared between the 2 groups.Results In the observation group the operative time,blood loss,hospitalization time were lower than the control group,the difference was statistically significant (P0.05).Conclusion Breast conserving surgery combined with postoperative chemotherapy and modified radical surgery combined with postoperative chemotherapy is effective in the treatment of early breast cancer,but Bao milk surgery on patients with injury lighter and breast cosmetic

  14. Breast operative technique for single-stage reconstruction after conservative skin sparing and nipple sparing mastectomies: a preliminary study

    Directory of Open Access Journals (Sweden)

    Egidio Riggio

    2012-02-01

    Full Text Available The Authors present a novel technique of immediate breast reconstruction with definite implants after mastectomy conserving the nipple- areola complex and, less frequently, in skin-sparing mastectomy. The increase of indications for both oncologic and prophylactic nipple-sparing mastectomy has induced the research for a single-stage technique that could replace the two-stage reconstruction with expanders and/or autogenous reconstructions with flaps. The new techniques introduce modifications of the pocket coverage for the implants occurring in two ways: i autologous adaptation of muscle-fascia-fat-skin layers, ii application of alloplastic materials as the meshes. A series of 124 immediate reconstructions were performed from 2008 to 2011 using a continuous composite pocket made of pectoralis maior and serratus anterior muscle above, and skin-fat flap below. The innovation is represented by an extended electrosurgical scoring of the lower pole of the mammary pocket at two levels. The first is the deep-fascia and muscle layer; the second is the superfiacial fascial system. This operative technique represents an advancement of a prior procedure described by the Authors in 1998. This preliminary study would primarily describe the technique step by step. Discussion debates about alternative techniques in terms of either surgical details of technique or cosmetic results are still to be reached.

  15. Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer

    DEFF Research Database (Denmark)

    Land, L H; Dalton, S O; Jensen, M-B;

    2012-01-01

    Prevalence of comorbidity at breast cancer diagnosis increases with age and is likely to influence the likelihood of receiving treatment according to guidelines. The aim of this study was to examine the effect of breast cancer treatment on mortality, taking age at diagnosis and comorbidity...

  16. Quality of Life determinants in women with breast cancer undergoing treatment with curative intent

    Directory of Open Access Journals (Sweden)

    Ratheesan Kuttan

    2005-09-01

    Full Text Available Abstract Background The diagnosis of breast cancer and its subsequent treatment has significant impact on the woman's physical functioning, mental health and her well-being, and thereby causes substantial disruption to quality of life (QOL. Factors like patient education, spousal support and employment status, financial stability etc., have been found to influence QOL in the breast cancer patient. The present study attempts to identify the determinants of QOL in a cohort of Indian breast cancer patients. Patients and methods Functional Assessment of Cancer Therapy-Breast (FACT-B Version 4 Malayalam was used to assess quality of life in 502 breast cancer patients undergoing treatment with curative intent. The data on social, demographic, disease, treatment, and follow-up were collected from case records. Data was analysed using Analysis of Variance (ANOVA and multinomial logistic regression. Results The mean age of the patients was 47.7 years with 44.6% of the women being pre-menopausal. The FACT-B mean score was 90.6 (Standard Deviation [SD] = 18.4. The mean scores of the subscales were – Physical well-being 19.6 (SD = 4.7, Social well-being 19.9 (SD = 5.3, Emotional well-being 14 (SD = 4.9, Functional well-being 13.0 (SD = 5.7, and the Breast subscale 23.8 (SD = 4.4. Younger women ( Conclusion QOL derangements are common in breast cancer patients necessitating the provisions for patient access to psychosocial services. However, because of the huge patient load, a screening process to identify those meriting intervention over the general population would be a viable solution.

  17. Regional radiotherapy in high-risk breast cancer: is the issue solved?

    DEFF Research Database (Denmark)

    Krause, M; Petersen, C; Offersen, B V;

    2015-01-01

    Adjuvant radiotherapy is the treatment standard for breast cancer with lymph node metastases after breast-conserving surgery or mastectomy. The inclusion of regional lymph nodes into the treatment volumes has been a question in recent clinical trials. Their impact on treatment standards and open...

  18. Pregnancy-associated breast cancer in Taiwanese women: potential treatment delay and impact on survival.

    Directory of Open Access Journals (Sweden)

    Ya-Ling Yang

    Full Text Available This study investigated the clinicopathologic characteristics and survival of women diagnosed with pregnancy-associated breast cancer (PABC in Taiwan. PABC is defined as breast cancer diagnosed during pregnancy or within 1 year after obstetric delivery. Our sample of PABC patients (N = 26 included all patients diagnosed at a major medical center in northern Taiwan from 1984 through 2009. Among these patients, 15 were diagnosed during pregnancy and 11 were diagnosed within 1 year after delivery. The comparison group included 104 patients within the same age range as the PABC patients and diagnosed with breast cancer not associated with pregnancy from 2004 through 2009 at the same hospital. Patients' initiating treatment delayed, 5-year and 10-year overall survival were delineated by stratified Kaplan-Meier estimates. Patients' characteristics were associated with initiating treatment delayed was evaluated with multivariate proportional hazards modeling. Antepartum PABC patients were younger and had longer time between diagnosis and treatment initiation than postpartum PABC patients. The predictor of treatment delayed was including birth parity, cancer stage, and pregnancy. The PABC group had larger tumors, more advanced cancer stage, and tumors with less progesterone receptor than the comparison group. The antepartum PABC patients had higher mortality than postpartum PABC and comparison groups within 5 years after diagnosis. Based on these results, we confirmed that pregnant women with breast cancer were more likely to delay treatment. Therefore, we recommend that breast cancer screening should be integrated into the prenatal and postnatal routine visits for early detection of the women's breast problems.

  19. Role of Dynamic Magnetic Resonance Imaging in Preoperative Evaluation of Breast Conserving Surgery for Breast Cancer%动态磁共振成像在乳腺癌保乳术中的术前评估作用

    Institute of Scientific and Technical Information of China (English)

    范培芝; 张超杰; 刘鹏; 张志功; 唐梅徕; 顾晓文; 郑维; 李艳春

    2012-01-01

    [Objective] To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in prcopcrativc evaluation of breast-conserving surgery for breast cancer. [Methods! Totally 65 female breast cancer patients with the average age of 35. 8 years old took prcopcrativc mammography and MRI examination. Mammography and MRI examination were used to evaluate the feasibility of breast-conserving surgery. Pathological diagnosis was used to evaluate the accuracy of MRI in the assessment of breast cancer in cutting edge and with multi-center lesions. [Results! Among 65 patients with breast cancer, 64. 6% of the patients could undergo breast-conserving surgery by mammography prcopcrativc evaluation which was lower than that by MRI cvaluation(83. 1 %) , and there was significant difference between thcm( P breast cancer undergoing breast conserving surgery can more accurately determine multi-center lesion and incisal margin range than mammography, and is more helpful for deciding whether to adopt breast conserving surgery and more precisely determine surgical margin.%[目的]评价动态增强磁共振成像(MRI)在乳腺癌保乳根治术的术前评估作用.[方法]平均年龄35.8岁的65 例女性乳腺癌患者,术前均行钼靶及MRI检查,对钼靶、MRI评估是否可行保乳手术进行分析,通过病理诊断来评价MRI在评估乳腺癌多中心病灶以及切缘范围上的准确性.[结果]65例患者中,钼靶术前评估认为可保乳术患者64.6%,低于MRI评估的83.1%,且两者相比差异有显著性(P<0.05).对癌块切缘判断准确率MRI为80%,显著高于钼靶的53.8%(P<0.05).[结论]在中青年女性的I~IIb期乳腺癌保乳术的术前评估方法中,动态增强MRI成像较钼靶

  20. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, Adam A.; Prassopoulos, Panos; Petinarakis, Ioannis; Gourtsoyiannis, Nicholas C. [Department of Radiology, University Hospital of Heraklion, Medical School of Crete, Crete (Greece); Sanidas, Elias; Tsiftsis, Dimitrios [Department of Surgical Oncology, University Hospital of Heraklion, Medical School of Crete (Greece); Chrysos, Emmanuel; Chalkiadakis, Georgios [Department of General Surgery, University Hospital of Heraklion, Medical School of Crete (Greece)

    2002-07-01

    Our objective was to compare the effectiveness of percutaneous cholecystostomy (PC) vs conservative treatment (CO) in high-risk patients with acute cholecystitis. The study was randomized and comprised 123 high-risk patients with acute cholecystitis. All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score {>=}12. Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients (95.2%) who comprised the PC group. Sixty patients were conservatively treated (CO group). One patient died after unsuccessful PC (1.6%). Resolution of symptoms occurred in 54 of 63 patients (86%). Eleven patients (17.5%) died either of ongoing sepsis (n=6) or severe underlying disease (n=5) within 30 days. Seven patients (11%) were operated on because of persisting symptoms (n=3), catheter dislodgment (n=3), or unsuccessful PC (n=1). Cholecystolithotripsy was performed in 5 patients (8%). Elective surgery was performed in 9 cases (14%). No further treatment was needed in 32 patients (51%). In the CO group, 52 patients (87%) fully recovered and 8 patients (13%) died of ongoing sepsis within 30 days. All successfully treated patients showed clinical improvement during the first 3 days of treatment. Percutaneous cholecystostomy in high-risk patients with acute cholecystitis did not decrease mortality in relation to conservative treatment. Percutaneous cholecystostomy might be suggested to patients not presenting clinical improvement following 3 days of conservative treatment, to critically ill intensive care unit patients, or to candidates for percutaneous cholecystolithotripsy. (orig.)

  1. 磁共振成像在乳腺癌保乳术前评价中的应用%Application of preoperative MRI on breast cancer patients undergoing breast-conserving surgery

    Institute of Scientific and Technical Information of China (English)

    王文静; 洪庆山; 张嫣; 郭庆禄

    2014-01-01

    Objective To evaluate the influence of preoperative MRI on tumor-positive rate of resection margins in breast cancer patients eligible for breast-conserving surgery.Methods Study group consisted of 64 consecutive patients with breast cancer eligible for breast-conserving surgery,while 73 cases as history control group.For the two groups,a first plan for breast-conserving surgery was made on the basis of conventional imaging and clinical evaluation.Study group underwent preoperative breast MRI and re-evalu-ated before final surgical plan was made.Rates of tumor-positive resection margins were compared between the 2 groups.Surgical plan alteration was recorded in the study group.Results Study group had lower rate of tumor-positive resection margin compared with control group (9.6% vs 24.7%,P =0.04).Furthermore,18.8% of study group altered the finial surgical plan to mastectomy after breast MRI.Conclusion Preoperative breast MRI can more acurately evaluate the extent of breast cancer,therefore decrease rate of tumor-positive resection margin in breast cancer patients eligible for breast-conserving surgery.%目的:评价术前磁共振成像(MRI)对乳腺癌保乳术切缘阳性率的影响。方法收集乳腺癌患者64例为研究组,历史对照组73例乳腺癌患者,所有患者经常规检查及评估后均适合行保乳术。研究组患者术前行乳腺 MRI 检查,经评估后确定最终的手术计划。历史对照组未行 MRI 检查。比较2组患者的切缘阳性率差异,记录研究组的手术变更率。结果与对照组相比,研究组保乳术中的切缘阳性率降低(9.6% vs 24.7%;P =0.04)。术前 MRI 使18.8%的患者改变手术计划而行乳房全切术。结论术前乳腺 MRI 检查能更准确评估乳腺癌病灶的范围,从而有助于降低保乳术患者的术中切缘阳性率。

  2. Taxane therapy in the adjuvant treatment of breast cancer in Italy: economic evaluation

    Directory of Open Access Journals (Sweden)

    Simona Ravera

    2006-03-01

    Full Text Available Breast cancer (BC is one of the leading cause of death in developed Countries and every year more than a million new cases are diagnosed worldwide. In Italy the prevalence of BC was estimated to be 1,070 per 100,000 at 31 December 1992. Nevertheless, despite the increase in incidence, mortality rate for BC are decreased in the last decades probably due to several factors such as implementation of screening programs, early diagnosis and new adjuvant therapies. Important types of adjuvant chemotherapy include anthracyclines and taxanes and these treatments continue to be evaluated to determine optimal combinations and dosing regimens. The efficacy of paclitaxel and docetaxel in adjuvant setting for the treatment of early BC has been assessed in different trials where the two taxanes showed a significant increase in both Disease Free Survival (DFS and Overall Survival (OS in comparison with nontaxane therapy. In particular results from one of the last studies comparing paclitaxel and docetaxel show equivalent efficacy for both drugs. At the light of the recent findings, the objective of this work is to perform a cost minimization analysis of paclitaxel vs docetaxel in the adjuvant setting for treatment of early BC in Italy. The analysis was conducted from the National Health Service’s point of view, assuming equivalent efficacy in terms of DFS and OS for both taxanes. Costs were evaluated on the basis of therapeutic schemes used in the analyzed trials. Results show that paclitaxel, administered every 3 weeks for 4 cycles after doxorubicin and cyclophosphamide, represents the less costly therapy. This is a conservative costs estimate based on data from literature that does not take into account possible additional costs associated to the treatment of febrile neutropenia (FN as adverse event related to chemotherapy. Since, on the basis of scientific literature data, FN seems to be more related with docetaxel than with paclitaxel administration, it

  3. Comparison of Breast Conservation Therapy and Modified Radical Mastectomy for Early Breast Cancer%早期乳腺癌改良根治术与保乳手术的疗效比较

    Institute of Scientific and Technical Information of China (English)

    吴洁

    2014-01-01

    目的:比较改良根治术与保乳手术治疗对早期乳腺癌的临床疗效。方法按照手术方式将155例乳腺癌患者分为保乳组(40例)和改良组(115例),保乳组行保乳手术+术后放、化疗,改良组行改良根治术+术后化疗,比较两组患者1、3、5年生存率、局部复发率以及远处转移率。结果保乳组死亡1例,改良组死亡4例,死亡原因均为非乳腺癌原因;保乳组2例发生远处转移,其中1例为肺转移,1例为骨(脊柱)转移,术后生活质量未受明显影响;改良组6例发生远处转移,其中4例为肺转移,2例为骨转移,术后生活质量未受明显影响;两组患者1、3、5年生存率、局部复发率、远处转移率比较,差异无统计学意义(P>0.05)。结论保乳手术+术后放、化疗对早期乳腺癌的远期疗效与改良根治术+术后化疗相近,但保乳手术创伤小、术后恢复时间短、能够保留乳房的美观外形,临床应用价值更高。%Objective To compare the clinical efficacy of breast conservation therapy and modified radical mastectomy for early breast cancer .Methods 155 cases of patients with breast cancer were divided into breast conservation therapy group (40 cases) and modified radical mastectomy group (115 cases).The breast conservation therapy were treated by breast conservation and postoperative chemoradiotherapy ,the modified radical mastectomy group received modified radical mastectomy and postopera-tive radiotherapy.The 1-,3-and 5-year survival rate,local recurrence rate and distant metastasis rate of the 2 groups were com-pared.Results The breast conservation therapy group had 1 case of death,the modified radical mastectomy group had 4 cases of death,the reasons was not related with breast cancer;In the breast conservation therapy group ,distant metastasis had 2 cases( 1 case lung metastases,1 case bone metastasis ),there was no obvious impact on the

  4. Stereotactic Radiosurgery as Part of Multimodal Treatment in a Bulky Leptomeningeal Recurrence of Breast Cancer.

    Science.gov (United States)

    Bertke, Matthew H; Burton, Eric C; Shaughnessy, Joseph N

    2016-03-08

    Breast cancer metastatic to the brain and/or leptomeningeal spread of disease is a frequently encountered clinical situation, especially given the extended course of disease in these patients. Systemic therapies can often effectively prolong extracranial disease control, making effective strategies to control central nervous system-based disease even more critical. We present a case of bulky leptomeningeal relapse of breast cancer in the setting of prior whole brain radiation therapy. In order to treat the patient's bulky disease and leptomeningeal spread while avoiding the potential toxicities of repeat whole brain radiation, the patient was treated with frameless stereotactic radiosurgery and intrathecal chemotherapy. This is the first report of this treatment approach for leptomeningeal relapse of breast cancer. The patient had an excellent response to treatment and durable intracranial control.

  5. The effect of pain on physical functioning after breast cancer treatment

    DEFF Research Database (Denmark)

    Andersen, Kenneth Geving; Christensen, Karl Bang; Kehlet, Henrik

    2014-01-01

    OBJECTIVES:: Persistent postsurgical pain, musculoskeletal pain, sensory disturbances and lymphedema are major clinical problems after treatment for breast cancer. However, there is little evidence on how these sequelae affects physical function. The aim was to develop and validate a procedure...... specific tool for assessing the impact of pain and other sequelae on physical function after breast cancer treatment. METHODS:: Literature review, patient and expert interviews were used to identify dimensions of physical function and sequelae. A questionnaire was developed and tested using cognitive...... interviews, and field tested among 389 patients treated for primary breast cancer without recurrence (response rate 81%). Median follow-up was 14 months. Using item response theory we identified 5 cause scales of reduced physical functioning; pain after surgery, musculoskeletal pain, sensory disturbances...

  6. The effect of pain on physical functioning after breast cancer treatment

    DEFF Research Database (Denmark)

    Andersen, Kenneth G.; Christensen, Karl B.; Kehlet, Henrik

    2015-01-01

    Objectives: Persistent postsurgical pain, musculoskeletal pain, sensory disturbances, and lymphedema are major clinical problems after treatment for breast cancer. However, there is little evidence on how these sequelae affects physical function. The aim this study was to develop and validate...... a procedure-specific tool for assessing the impact of pain and other sequelae on physical function after breast cancer treatment. Methods: A literature review, patient and expert interviews were used to identify dimensions of physical function and sequelae. A questionnaire was developed and tested using...... cognitive interviews, and field tested among 389 patients treated for primary breast cancer without recurrence (response rate 81%). Median follow-up was 14 months. Using item response theory we identified 5 cause scales of reduced physical functioning: pain after surgery, musculoskeletal pain, sensory...

  7. Laser immunotherapy for the treatment of human breast cancer: one-year follow up results

    Science.gov (United States)

    Hode, Tomas; Adalsteinsson, Orn; Ferrel, Gabriela L.; Lunn, John A.; Guerra, Maria C.; Li, Xiaosong; Nordquist, Robert E.; Chen, Wei R.

    2011-03-01

    The immediate goal of the trial was to determine the breast cancer patient tolerance and the toxicity of Laser immunotherapy (LIT), the optimal dose for the alteration of the course of the disease, and the reduction of the tumor burden. Ten stage III and IV cancer patients were treated, all of which were considered to be out of all other options. No toxicity or significant adverse reactions were observed and the treatment was well tolerated by all patients. Almost all the treated patients have had positive responses: A majority of patients experienced large-scale reduction of primary breast tumors, and all the stage IV patients experienced either complete or significant reductions in distant metastases in the lungs, liver, bone, and the brain, indicating a strong systemic effect of the treatment. We also report two cases of triple negative breast cancer patients that showed limited or no response to LIT.

  8. Should inhomogeneity corrections be applied during treatment planning of tangential breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Mijnheer, B.J.; Heukelom, S.; Lanson, J.H. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands)); Battum, L.J. van; Bree, N.A.M. van (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands) Dr. Daniel Den Hoed Cancer Centre, Rotterdam (Netherlands). Department of Clinical Physics); Tienhoven, G. van (Amsterdam Univ. (Netherlands). Academisch Ziekenhuis)

    1991-12-01

    Due to the inclusion of lung tissue in the treatment volume, some parts of the breast will get a higher dose during tangential breast irradiation because of the lower lung density. Data on the accuracy of dose calculation algorithms, investigated by phantom measurements, determinations of the geometry and density of the actual lung in the patient and results of in vivo dose measurements, are presented. From this information it can be concluded that a lung correction varying between about 3 and 7% is needed but its magnitude is slightly overpredicted in a number of commercial treatment planning systems. Because this increase in dose is already in a high dose region, it is recommended that inhomogeneity corrections should be applied during tangential breast irradiation. (author). 20 refs.; 4 tabs.

  9. Current status of ultrasound-guided surgery in the treatment of breast cancer.

    Science.gov (United States)

    Volders, José H; Haloua, Max H; Krekel, Nicole Ma; Meijer, Sybren; van den Tol, Petrousjka M

    2016-02-10

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast

  10. Retrospective evaluation of conservative treatment for 140 ingrown toenails with a novel taping procedure.

    Science.gov (United States)

    Watabe, Akiko; Yamasaki, Kenshi; Hashimoto, Akira; Aiba, Setsuya

    2015-09-01

    The aim of this study is retrospectively to review the efficacy of a taping procedure for treating ingrown toe-nails or for supporting other conservative treatments of ingrown toenails. A total of 140 ingrown toenails treated at the Dermatology Clinic in Tohoku University Hospital were retrospectively reviewed for demographic characteristics, association with granulation tissue or infection, treatment modalities and their outcomes, and classified according the treatment modalities. All the ingrown toe-nails were treated with a novel taping procedure, "slit tape-strap procedure" alone or in conjunction with other conservative treatments. The mean?±?SD duration until pain relief and until cure of the ingrown toenail were 4.8?±?4.7 days, range 0-24 and 21.0?±?11.2 weeks, range 4-56, respectively. All of the treatments were all effective, although 18 cases recurred after treatment. The "slit tape-strap procedure" is effective in treating ingrown toenails, either as a monotherapy or as a supportive therapy for other conservative treatments.

  11. Association of single nucleotide polymorphisms in the genes ATM, GSTP1, SOD2, TGFB1, XPD and XRCC1 with risk of severe erythema after breast conserving radiotherapy

    Directory of Open Access Journals (Sweden)

    Raabe Annette

    2012-04-01

    Full Text Available Abstract Purpose To examine the association of polymorphisms in ATM (codon 158, GSTP1 (codon 105, SOD2 (codon 16, TGFB1 (position −509, XPD (codon 751, and XRCC1 (codon 399 with the risk of severe erythema after breast conserving radiotherapy. Methods and materials Retrospective analysis of 83 breast cancer patients treated with breast conserving radiotherapy. A total dose of 50.4 Gy was administered, applying 1.8 Gy/fraction within 42 days. Erythema was evaluated according to the Radiation Therapy Oncology Group (RTOG score. DNA was extracted from blood samples and polymorphisms were determined using either the Polymerase Chain Reaction based Restriction-Fragment-Length-Polymorphism (PCR-RFL technique or Matrix-Assisted-Laser-Desorption/Ionization –Time-Of-Flight-Mass-Spectrometry (MALDI-TOF. Relative excess heterozygosity (REH was investigated to check compatibility of genotype frequencies with Hardy-Weinberg equilibrium (HWE. In addition, p-values from the standard exact HWE lack of fit test were calculated using 100,000 permutations. HWE analyses were performed using R. Results Fifty-six percent (46/83 of all patients developed erythema of grade 2 or 3, with this risk being higher for patients with large breast volume (odds ratio, OR = 2.55, 95% confidence interval, CI: 1.03–6.31, p = 0.041. No significant association between SNPs and risk of erythema was found when all patients were considered. However, in patients with small breast volume the TGFB1 SNP was associated with erythema (p = 0.028, whereas the SNP in XPD showed an association in patients with large breast volume (p = 0.046. A risk score based on all risk alleles was neither significant in all patients nor in patients with small or large breast volume. Risk alleles of most SNPs were different compared to a previously identified risk profile for fibrosis. Conclusions The genetic risk profile for erythema appears to be different for patients with small

  12. Learning from social media: utilizing advanced data extraction techniques to understand barriers to breast cancer treatment.

    Science.gov (United States)

    Freedman, Rachel A; Viswanath, Kasisomayajula; Vaz-Luis, Ines; Keating, Nancy L

    2016-07-01

    Past examinations of breast cancer treatment barriers have typically included registry, claims-based, and smaller survey studies. We examined treatment barriers using a novel, comprehensive, social media analysis of online, candid discussions about breast cancer. Using an innovative toolset to search postings on social networks, message boards, patient communities, and topical sites, we performed a large-scale qualitative analysis. We examined the sentiments and barriers expressed about breast cancer treatments by Internet users during 1 year (2/1/14-1/31/15). We categorized posts based on thematic patterns and examined trends in discussions by race/ethnicity (white/black/Hispanic) when this information was available. We identified 1,024,041 unique posts related to breast cancer treatment. Overall, 57 % of posts expressed negative sentiments. Using machine learning software, we assigned treatment barriers for 387,238 posts (38 %). Barriers included emotional (23 % of posts), preferences and spiritual/religious beliefs (21 %), physical (18 %), resource (15 %), healthcare perceptions (9 %), treatment processes/duration (7 %), and relationships (7 %). Black and Hispanic (vs. white) users more frequently reported barriers related to healthcare perceptions, beliefs, and pre-diagnosis/diagnosis organizational challenges and fewer emotional barriers. Using a novel analysis of diverse social media users, we observed numerous breast cancer treatment barriers that differed by race/ethnicity. Social media is a powerful tool, allowing use of real-world data for qualitative research, capitalizing on the rich discussions occurring spontaneously online. Future research should focus on how to further employ and learn from this type of social intelligence research across all medical disciplines.

  13. Early-breast cancer of conserving therapy controlled trials of long-term efficacy:Meta-analysis%早期乳腺癌保乳治疗对照试验远期疗效的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    冯惠; 赵瑛

    2014-01-01

    modified radical mastectomy surgery;(1)three-year survival rate index contrast,the difference was not statistically significant(P >0.05), prompt breast-conserving surgery group with modified radical mastectomy group of three years disease-free survival undifferentiated ;(2)three-year local recurrence rate,the difference was not statistically significant (P >0.05),namely that the three-year local recurrence of breast-conserving group of rate considerably modified radical mastectomy group;(3)three-year distant metastasis indicators to analyze the difference was not statistically significant (P>0.05),prompt breast conserving group and modified radical mastectomy group on a three-year distant metastasis rate was no significant difference. Conclusion breast-conserving surgery and modified radical mastectomy have the same efficacy of long-term,breast-conserving surgery with less trauma of small, rapid postoperative recovery,beautiful,effectively improve the quality of life,can be used as the treatment of choice for early breast cancer.

  14. Polymeric composite devices for localized treatment of early-stage breast cancer

    Science.gov (United States)

    Kan-Dapaah, Kwabena; Soboyejo, Wole

    2017-01-01

    For early-stage breast cancers mastectomy is an aggressive form of treatment. Therefore, there is a need for new treatment strategies that can enhance the use of lumpectomy by eliminating residual cancer cells with limited side effects to reduce local recurrence. Although, various radiotherapy-based methods have been developed, residual cells are found in 20–55% of the time at the first operation. Furthermore, some current treatment methods result in poor cosmesis. For the last decade, the authors have been exploring the use of polymeric composite materials in single and multi-modal implantable biomedical devices for post-operative treatment of breast cancer. In this paper, the concept and working principles of the devices, as well as selected results from experimental and numerical investigations, are presented. The results show the potential of the biomedical implants for cancer treatment. PMID:28245288

  15. Oncologic safety of conservative mastectomy in the therapeutic setting

    Science.gov (United States)

    Dumitru, Dorin; Malata, Charles M.

    2016-01-01

    Conservative mastectomy is a form of nipple-sparing mastectomy which is emerging as a surgical option for selected breast cancer patients. This technique differs from subcutaneous mastectomy which is well established as a technique for risk reduction but leaves behind a finite remnant of retro-areolar breast tissue. Clinical trials have confirmed the efficacy and safety of breast conservation therapy for smaller localised breast tumors whereby a variable amount of surrounding normal tissue is excised with administration of breast radiotherapy post-operatively. Conservative mastectomy aims to remove all breast tissue with dissection continued into the core of the nipple. However, the indication for conservative mastectomy remains to be defined but generally includes tumors of modest size located at least 2 cm away from the nipple. Patients undergoing conservative mastectomy do not necessarily receive adjuvant radiotherapy and this may only be intra-operative irradiation of the nipple-areola complex (NAC). Preservation of the NAC as part of a skin-sparing mastectomy in patients who might otherwise require standard mastectomy is of unproven safety from an oncologic perspective but is associated with enhanced cosmetic outcomes and quality-of-life. The advent of conservative mastectomy has coincided with a trend for “maximal surgery” with bilateral extirpation of all breast tissue in conjunction with immediate breast reconstruction. It is essential there is no compromise of local recurrence and survival in terms of ipsilateral breast cancer treatment. Further studies are required to clarify the indications for conservative mastectomy and confirm oncologic equivalence to either wide local excision and breast irradiation or conventional/skin-sparing mastectomy with sacrifice of the nipple areola complex. PMID:26855907

  16. Secretory breast cancer. Case report.

    Science.gov (United States)

    Lombardi, A; Maggi, S; Bersigotti, L; Lazzarin, G; Nuccetelli, E; Amanti, C

    2013-04-01

    Secretory carcinoma of the breast is a rare tumor initially described in children but occurring equally in adult population. This unusual breast cancer subtype has a generally favorable prognosis, although several cases have been described in adults with increased aggressiveness and a risk of metastases. However, surgery is still considered the most appropriate treatment for this pathology. We describe the case of a 50 -year-old woman who has undergone a breast conservative surgery for a little tumor, preoperatively diagnosticated by a fine needle aspiration biopsy (FNAB) as a well differentiated infiltrating carcinoma.

  17. Conservative treatment of shovel-shaped upper incisors and dens invaginatus: a case study

    OpenAIRE

    Maisa Oliveira Caliani Corral Morales; Luiz Evaristo Ricci Volpato; Fabio Luis Miranda Pedro; Cyntia Rodrigues de Araújo Estrela; Álvaro Henrique Borges

    2012-01-01

    The purpose of this paper was to describe the conservative treatment adopted in one nonsyndromic patient presenting with shovel-shaped upper incisors and dens invaginatus. A 13-yearold female patient sought treatment reporting pain in response to cold stimuli in the upper anterior teeth. Four upper incisors with shovel-shaped anatomical alterations in the palatal side of the crown were detected during intra-oral clinical examination; in addition, imaging exams revealed a type I dens invaginat...

  18. An overview of conservative treatment options for diabetic Charcot foot neuroarthropathy

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2011-05-01

    Full Text Available Conservative management of Charcot foot neuroarthropathy remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of the Charcot neuroarthopathy, site(s of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The authors present an overview of evidence-based non-operative treatment for diabetic Charcot neuroarthropathy with an emphasis on the most recent developments in therapy.

  19. Laparoscopic conservative treatment of colo-vesical fistula: a new surgical approach

    OpenAIRE

    2013-01-01

    Introduction The standard treatment of colo-vesical fistula is the exeresis of fistula, suture of bladder wall, colic resection with or without temporary colostomy. Usually the approach is open because conversion rates and morbidity are lower than laparoscopy. The aim of video is to show the steps of a new mini-invasive approach of colo-vesical fistula without colic resection. Materials and Methods A 69 years old male underwent laparoscopic conservative treatment of colo-vesical fistula due ...

  20. Breast cancer management: Past, present and evolving

    Directory of Open Access Journals (Sweden)

    M Akram

    2012-01-01

    Full Text Available Breast cancer is known from ancient time,and the treatment strategy evolved as our understanding of the disease changed with time. In 460 BC Hippocrates described breast cancer as a humoral disease and presently after a lot of studies breast cancer is considered as a local disease with systemic roots. For most of the twentieth century Halsted radical mastectomy was the "established and standardized operation for cancer of the breast in all stages, early or late". New information about tumor biology and its behavior suggested that less radical surgery might be just as effective as the more extensive one. Eventually, with the use of adjuvant therapy likeradiation and systemic therapy, the extent of surgical resection in the breast and axilla got reduced further and led to an era of breast conservation. The radiation treatment of breast cancer has evolved from 2D to 3D Conformal and to accelarated partial breast irradiation, aiming to reduce normal tissue toxicity and overall treatment time. Systemic therapy in the form of hormone therapy, chemotherapy and biological agents is now a well-established modality in treatment of breast cancer. The current perspective of breast cancer management is based on the rapidly evolving and increasingly integrated study on the genetic, molecular , biochemical and cellular basis of disease. The challenge for the future is to take advantage of this knowledge for the prediction of therapeutic outcome and develop therapies and rapidly apply more novel biologic therapeutics.

  1. Validated biomarkers: The key to precision treatment in patients with breast cancer.

    Science.gov (United States)

    Duffy, Michael J; O'Donovan, Norma; McDermott, Enda; Crown, John

    2016-10-01

    Recent DNA sequencing and gene expression studies have shown that at a molecular level, almost every case of breast cancer is unique and different from other breast cancers. For optimum management therefore, every patient should receive treatment that is guided by the molecular composition of their tumor, i.e., precision treatment. While such a scenario is still some distance into the future, biomarkers are beginning to play an important role in preparing the way for precision treatment. In particular, biomarkers are increasingly being used for predicting patient outcome and informing as to the most appropriate type of systemic therapy to be administered. Mandatory biomarkers for every newly diagnosed case of breast cancer are estrogen receptors and progesterone receptors in selecting patients for endocrine treatment and HER2 for identifying patients likely to benefit from anti-HER2 therapy. Amongst the best validated prognostic biomarker tests are uPA/PAI-1, MammaPrint and Oncotype DX. Although currently, there are no biomarkers available for predicting response to specific forms of chemotherapy, uPA/PAI-1 and Oncotype DX can aid the identification of lymph node-negative patients that are most likely to benefit from adjuvant chemotherapy, in general. In order to accelerate progress towards precision treatment for women with breast cancer, we need additional predictive biomarkers, especially for enhancing the positive predictive value for endocrine and anti-HER2 therapies, as well as biomarkers for predicting response to specific forms of chemotherapy. The ultimate biomarker test for achieving the goal of precision treatment for patients with breast cancer will likely require a combination of gene sequencing and transcriptomic analysis of every patient's tumor.

  2. The influence of endocrine treatments for breast cancer on health-related quality of life

    NARCIS (Netherlands)

    Buijs, Ciska; de Vries, Elisabeth G. E.; Mourits, Marian J. E.; Willemse, Pax H. B.

    2008-01-01

    Many hormonal modalities are available for breast cancer treatment, such as selective oestrogen receptor modulators (SERMs), aromatase inhibitors, progestins and luteinising hormone-releasing hormone (LHRH) agonists. The Long-term impact of these endocrine manipulations is an issue, because the dura

  3. Endocrine treatment options for advanced breast cancer--the role of fulvestrant.

    NARCIS (Netherlands)

    Robertson, J.F.; Come, S.E.; Jones, S.; Beex, L.V.A.M.; Kaufmann, Martin; Makris, A.; Nortier, J.W.; Possinger, K.; Rutqvist, L.E.

    2005-01-01

    For many years, tamoxifen has been the 'gold standard' amongst anti-oestrogen therapies for breast cancer. However, the selective aromatase inhibitors (AIs), anastrozole, letrozole and exemestane, have demonstrated advantages over tamoxifen as first-line treatments for advanced disease. Anastrozole

  4. Serum HER-2 predicts response and resistance to trastuzumab treatment in breast cancer

    DEFF Research Database (Denmark)

    Petersen, Eva Rabing Brix; Sørensen, Patricia Diana; Jakobsen, Erik Hugger;

    2013-01-01

    Serum HER2 (S-HER2) was approved in 2003 by the US Food and Drug Administration (FDA) for monitoring trastuzumab treatment in tissue HER2 positive breast cancer patients. Information of the value of S-HER2 is scarce. We hypothesised that S-HER2 would reflect the clinical effect of trastuzumab....

  5. Perceived Partner Reactions to Diagnosis and Treatment of Breast Cancer: Impact on Psychosocial and Psychosexual Adjustment

    Science.gov (United States)

    Wimberly, Sarah R.; Carver, Charles S.; Laurenceau, Jean-Philippe; Harris, Suzanne D.; Antoni, Michael H.

    2005-01-01

    Two studies examined breast cancer patients' perceptions of their partners' reactions to their diagnosis and treatment as influences on 3 aspects of patients' well-being: psychosexual adjustment, emotional distress, and marital satisfaction. Study 1, cross-sectional, indicated that partner initiation of sex, frequency of sex, a positive 1st sexual…

  6. Monte Carlo assessment of boron neutron capture therapy for the treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Mundy Daniel W.

    2005-01-01

    Full Text Available For a large number of women who are diagnosed with breast cancer every year the avail able treatment options are effective, though physically and mentally taxing. This work is a starting point of a study of the efficacy of boron neutron capture therapy as an alternative treatment for HER-2+ breast tumors. Using HER-2-specific monoclonal anti bodies coupled with a boron-rich oligomeric phosphate diester, it may be possible to deliver sufficient amounts of 10B to a tumor of the breast to al low for selective cell destruction via irradiation by thermal neutrons. A comprehensive computational model (MCNP for thermal neutron irradiation of the breast is described, as well as the results of calculations made using this model, in order to determine the optimum boron concentration within the tumor for an effective boron neutron capture therapy treatment, as compared with traditional X-ray radiotherapy. The results indicate that a boron concentration of 50-60 mg per gram of tumor tissue is optimal when considering treatment times, dose distributions and skin sparing. How ever these results are based upon best-guess assumptions that must be experimentally verified.

  7. Breast Cancer-Initiating Cells: Insights into Novel Treatment Strategies

    Directory of Open Access Journals (Sweden)

    Maria Grazia Daidone

    2011-03-01

    Full Text Available There is accumulating evidence that breast cancer may arise from mutated mammary stem/progenitor cells which have been termed breast cancer-initiating cells (BCIC. BCIC identified in clinical specimens based on membrane phenotype (CD44+/CD24−/low and/or CD133+ expression or enzymatic activity of aldehyde dehydrogenase 1 (ALDH1+, have been demonstrated to have stem/progenitor cell properties, and are tumorigenic when injected in immunocompromized mice at very low concentrations. BCIC have also been isolated and in vitro propagated as non-adherent spheres of undifferentiated cells, and stem cell patterns have been recognized even in cancer cell lines. Recent findings indicate that aberrant regulation of self renewal is central to cancer stem cell biology. Alterations in genes involved in self-renewal pathways, such as Wnt, Notch, sonic hedgehog, PTEN and BMI, proved to play a role in breast cancer progression. Hence, targeting key elements mediating the self renewal of BCIC represents an attractive option, with a solid rationale, clearly identifiable molecular targets, and adequate knowledge of the involved pathways. Possible concerns are related to the poor knowledge of tolerance and efficacy of inhibiting self-renewal mechanisms, because the latter are key pathways for a variety of biological functions and it is unknown whether their interference would kill BCIC or simply temporarily stop them. Thus, efforts to develop BCIC-targeted therapies should not only be focused on interfering on self-renewal, but could seek to identify additional molecular targets, like those involved in regulating EMT-related pathways, in reversing the MDR phenotype, in inducing differentiation and controlling cell survival pathways.

  8. Breast Cancer-Initiating Cells: Insights into Novel Treatment Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Santilli, Guido; Binda, Mara; Zaffaroni, Nadia; Daidone, Maria Grazia, E-mail: mariagrazia.daidone@istitutotumori.mi.it [Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS-Istituto Nazionale dei Tumori, Via Amadeo 42, Milan 20133 (Italy)

    2011-03-16

    There is accumulating evidence that breast cancer may arise from mutated mammary stem/progenitor cells which have been termed breast cancer-initiating cells (BCIC). BCIC identified in clinical specimens based on membrane phenotype (CD44{sup +}/CD24{sup −/low} and/or CD133{sup +} expression) or enzymatic activity of aldehyde dehydrogenase 1 (ALDH1{sup +}), have been demonstrated to have stem/progenitor cell properties, and are tumorigenic when injected in immunocompromized mice at very low concentrations. BCIC have also been isolated and in vitro propagated as non-adherent spheres of undifferentiated cells, and stem cell patterns have been recognized even in cancer cell lines. Recent findings indicate that aberrant regulation of self renewal is central to cancer stem cell biology. Alterations in genes involved in self-renewal pathways, such as Wnt, Notch, sonic hedgehog, PTEN and BMI, proved to play a role in breast cancer progression. Hence, targeting key elements mediating the self renewal of BCIC represents an attractive option, with a solid rationale, clearly identifiable molecular targets, and adequate knowledge of the involved pathways. Possible concerns are related to the poor knowledge of tolerance and efficacy of inhibiting self-renewal mechanisms, because the latter are key pathways for a variety of biological functions and it is unknown whether their interference would kill BCIC or simply temporarily stop them. Thus, efforts to develop BCIC-targeted therapies should not only be focused on interfering on self-renewal, but could seek to identify additional molecular targets, like those involved in regulating EMT-related pathways, in reversing the MDR phenotype, in inducing differentiation and controlling cell survival pathways.

  9. Growth Factor Receptors and Apoptosis Regulators: Signaling Pathways, Prognosis, Chemosensitivity and Treatment Outcomes of Breast Cancer

    Directory of Open Access Journals (Sweden)

    Siddik Sarkar

    2009-01-01

    Full Text Available Biomarkers of breast cancer are necessary for prognosis and prediction to chemotherapy. Prognostic biomarkers provide information regarding outcome irrespective of therapy, while predictive biomarkers provide information regarding response to therapy. Candidate prognostic biomarkers for breast cancers are growth factor receptors, steroid receptors, Ki-67, cyclins, urokinase plasminogen activator, p53, p21, pro- and anti-apoptotic factors, BRCA1 and BRCA2. But currently, the predictive markers are Estrogen and Progesterone receptors responding to endocrine therapy, and HER-2 responding to herceptin. But there are numerous breast cancer cases, where tamoxifen is ineffective even after estrogen receptor positivity. This lead to search of new prognostic and predictive markers and the number of potential markers is constantly increasing due to proteomics and genomics studies. However, most biomarkers individually have poor sensitivity or specificity, or other clinical value. It can be resolved by studying various biomarkers simultaneously, which will help in better prognosis and increasing sensitivity for chemotherapeutic agents. This review is focusing on growth factor receptors, apoptosis markers, signaling cascades, and their correlation with other associated biomarkers in breast cancers. As our knowledge regarding molecular biomarkers for breast cancer increases, prognostic indices will be developed that combine the predictive power of individual molecular biomarkers with specific clinical and pathologic factors. Rigorous comparison of these existing as well as emerging markers with current treatment selection is likely to see an escalation in an era of personalized medicines to ensure the breast cancer patients receive optimal treatment. This will also solve the treatment modalities and complications related to chemotherapeutic regimens.