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Frontiers in Oncology 2024Myofibroblastic sarcoma is a malignancy in which myofibroblasts are the main component, with a very low incidence. In this study, we report a case of low-grade...
Myofibroblastic sarcoma is a malignancy in which myofibroblasts are the main component, with a very low incidence. In this study, we report a case of low-grade myofibroblastic sarcoma (LGMS) in the breast. After the diagnosis of LGMS, the patient received a mastectomy. The patient showed no relapse or progression during the follow-up time of 3 months following the operation. LGMS in the breast is extremely rare, and the limited experience with its diagnosis and treatment brings obstacles to doctors. Therefore, this report summarizes the preoperative diagnosis, treatment, and prognosis of breast LGMS through a literature review.
PubMed: 38803530
DOI: 10.3389/fonc.2024.1366546 -
Technology in Cancer Research &... 2024Determining the impact of air gap errors on the skin dose in postoperative breast cancer radiotherapy under dynamic intensity-modulated radiation therapy (IMRT)...
Determining the impact of air gap errors on the skin dose in postoperative breast cancer radiotherapy under dynamic intensity-modulated radiation therapy (IMRT) techniques. This was a retrospective study that involved 55 patients who underwent postoperative radiotherapy following modified radical mastectomy. All plans employed tangential IMRT, with a prescription dose of 50 Gy, and bolus added solely to the chest wall. Simulated air gap depth errors of 2 mm, 3 mm, and 5 mm were introduced at depression or inframammary fold areas on the skin, resulting in the creation of air gaps named Air2, Air3, and Air5. Utilizing a multivariable GEE, the average dose () of the local skin was determined to evaluate its relationship with air gap volume and the lateral beam's average angle (AALB). Additionally, an analysis was conducted on the impact of gaps on local skin. When simulating an air gap depth error of 2 mm, the average in plan2 increased by 0.46 Gy compared to the initial plan (planO) ( < .001). For the 3-mm air gap, the average of plan3 was 0.51 Gy higher than that of planO ( < .001). When simulating the air gap as 5 mm, the average of plan5 significantly increased by 0.59 Gy compared to planO ( < .001). The TCP results showed a similar trend to those of . As the depth of air gap error increases, NTCP values also gradually rise. The linear regression of the multivariable GEE equation indicates that the volume of air gaps and the AALB are strong predictors of . With small irregular air gap errors simulated in 55 patients, the values of skin's , TCP, and NTCP increased. A multivariable linear GEE regression model may effectively explain the impact of air gap volume and AALB on the local skin.
Topics: Humans; Female; Breast Neoplasms; Radiotherapy Planning, Computer-Assisted; Skin; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Retrospective Studies; Middle Aged
PubMed: 38803305
DOI: 10.1177/15330338241258566 -
Breast Cancer Research : BCR May 2024We compared the survival rates of women with breast cancer (BC) detected within versus outside the mammography screening program (MSP) "donna".
STUDY GOAL
We compared the survival rates of women with breast cancer (BC) detected within versus outside the mammography screening program (MSP) "donna".
METHODS
We merged data from the MSP with the data from corresponding cancer registries to categorize BC cases as within MSP (screen-detected and interval carcinomas) and outside the MSP. We analyzed the tumor stage distribution, tumor characteristics and the survival of the women. We further estimated hazard ratios using Cox-regressions to account for different characteristics between groups and corrected the survival rates for lead-time bias.
RESULTS
We identified 1057 invasive (ICD-10: C50) and in-situ (D05) BC cases within the MSP and 1501 outside the MSP between 2010 and 2019 in the Swiss cantons of St. Gallen and Grisons. BC within the MSP had a higher share of stage I carcinoma (46.5% vs. 33.0%; p < 0.01), a smaller (mean) tumor size (19.1 mm vs. 24.9 mm, p < 0.01), and fewer recurrences and metastases in the follow-up period (6.7% vs. 15.6%, p < 0.01). The 10-year survival rates were 91.4% for women within and 72.1% for women outside the MSP (p < 0.05). Survival difference persisted but decreased when women within the same tumor stage were compared. Lead-time corrected hazard ratios for the MSP accounted for age, tumor size and Ki-67 proliferation index were 0.550 (95% CI 0.389, 0.778; p < 0.01) for overall survival and 0.469 (95% CI 0.294, 0.749; p < 0.01) for BC related survival.
CONCLUSION
Women participating in the "donna" MSP had a significantly higher overall and BC related survival rate than women outside the program. Detection of BC at an earlier tumor stage only partially explains the observed differences.
Topics: Humans; Female; Breast Neoplasms; Mammography; Switzerland; Middle Aged; Early Detection of Cancer; Aged; Survival Rate; Neoplasm Staging; Mass Screening; Registries
PubMed: 38802897
DOI: 10.1186/s13058-024-01841-6 -
Radiation Oncology (London, England) May 2024The effectiveness and safety of moderately hypofractionated radiotherapy (HFRT) in patients undergoing breast-conserving surgery (BCS) has been demonstrated in several... (Randomized Controlled Trial)
Randomized Controlled Trial
Hypofractionated radiotherapy with simultaneous tumor bed boost (Hi-RISE) in breast cancer patients receiving upfront breast-conserving surgery: study protocol for a phase III randomized controlled trial.
BACKGROUND
The effectiveness and safety of moderately hypofractionated radiotherapy (HFRT) in patients undergoing breast-conserving surgery (BCS) has been demonstrated in several pivotal randomized trials. However, the feasibility of applying simultaneous integrated boost (SIB) to the tumor bed and regional node irradiation (RNI) using modern radiotherapy techniques with HFRT needs further evaluation.
METHODS
This prospective, multi-center, randomized controlled, non-inferiority phase III trial aims to determine the non-inferiority of HFRT combined with SIB (HFRTsib) compared with conventional fractionated radiotherapy with sequential boost (CFRTseq) in terms of five-year locoregional control rate in breast cancer patients undergoing upfront BCS. A total of 2904 participants will be recruited and randomized in a 1:1 ratio into the HFRTsib and CFRTseq groups. All patients will receive whole breast irradiation, and those with positive axillary nodes will receive additional RNI, including internal mammary irradiation. The prescribed dose for the HFRTsib group will be 40 Gy in 15 fractions, combined with a SIB of 48 Gy in 15 fractions to the tumor bed. The CFRTseq group will receive 50 Gy in 25 fractions, with a sequential boost of 10 Gy in 5 fractions to the tumor bed.
DISCUSSION
This trial intends to assess the effectiveness and safety of SIB combined with HFRT in early breast cancer patients following BCS. The primary endpoint is locoregional control, and the results of this trial are expected to offer crucial evidence for utilizing HFRT in breast cancer patients after BCS.
TRIAL REGISTRATION
This trial was registered at ClincalTrials.gov (NCT04025164) on July 18, 2019.
Topics: Humans; Breast Neoplasms; Female; Mastectomy, Segmental; Radiation Dose Hypofractionation; Prospective Studies; Adult; Middle Aged; Aged; Radiotherapy, Intensity-Modulated; Radiotherapy, Adjuvant; Young Adult
PubMed: 38802888
DOI: 10.1186/s13014-024-02449-y -
Journal of Medical Internet Research May 2024Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear.
OBJECTIVE
We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR.
METHODS
This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
RESULTS
In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low.
CONCLUSIONS
The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR.
TRIAL REGISTRATION
PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.
Topics: Female; Humans; Decision Making; Decision Support Techniques; Internet; Mammaplasty; Mastectomy; Randomized Controlled Trials as Topic
PubMed: 38801766
DOI: 10.2196/53872 -
The British Journal of Surgery May 2024
Topics: Humans; Female; Breast Neoplasms; Diabetes Mellitus, Type 2; Postoperative Complications; Denmark; Cohort Studies; Mastectomy
PubMed: 38801440
DOI: 10.1093/bjs/znae127 -
The British Journal of Surgery May 2024
Topics: Humans; Breast Neoplasms; Female; Diabetes Mellitus, Type 2; Denmark; Postoperative Complications; Cohort Studies; Mastectomy
PubMed: 38801439
DOI: 10.1093/bjs/znae126 -
Cureus Apr 2024Introduction Erector spinae plane (ESP) block was first introduced for the management of thoracic pain but has become increasingly popular for the treatment of abdominal...
Introduction Erector spinae plane (ESP) block was first introduced for the management of thoracic pain but has become increasingly popular for the treatment of abdominal surgical pain. Previous studies have shown the ESP block can be easily adapted to abdominal procedures at the corresponding dermatome level and provide postoperative analgesia. Though the versatility, simplicity, and safety of the ESP block have been demonstrated, there is a gap in the literature regarding its comparison between thoracic and abdominal surgeries. This study aims to evaluate the efficacy of the ESP block in treating acute postoperative pain in patients undergoing thoracic and abdominal surgeries. Methods This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Data was obtained via the acute pain service records at a tertiary care center from 2018 to 2022. All patients received bilateral ESP blocks, performed under ultrasound guidance. Various parameters were evaluated including oral morphine equivalents (OMEs) and visual analog scale (VAS) scores during post-anesthesia care unit (PACU), 6, 12, and 24 hours postop. The use of abortive antiemetic medications within 24 hours was also measured to evaluate the incidence of nausea and vomiting. The results were analyzed and compared. No control group is included, as all patients at our institution receive a peripheral nerve block as a part of the institution's enhanced recovery pathway (ERP). Results This retrospective study included 50 patients in the non-cardiac thoracic surgery group (bilateral breast mastectomy with reconstruction) and 50 patients in the abdominal surgery group (robotic or laparoscopic sleeve gastrectomy). Compared to the thoracic group, the abdominal group had a statistically higher VAS score in PACU with mean difference (MD) 1.3 VAS, 95% confidence interval (CI) 0.03-2.56, p-value 0.0443, statistically higher OME consumption in the PACU (difference 13.35 OME, 95% CI 4.97-21.73, p-value 0.0003), and required significantly more antiemetic pharmacotherapy (mean 1.4 antiemetics administered, 95% CI 0.84-2.04, p-value <0.0001). Despite the abdominal group having more OME utilization in the PACU, there was no difference in cumulative OME use in the first 24 hours (95% CI -9.745-24.10, p-value 0.4021). Conclusion In this study, we demonstrated that ESP blocks are an effective regional anesthesia technique to reduce postoperative pain and opioid consumption. The ESP block can serve as a useful and safe alternative to either thoracic epidural or paravertebral block techniques in thoracic and upper abdominal surgeries for perioperative pain management.
PubMed: 38800304
DOI: 10.7759/cureus.58926 -
Cureus Apr 2024Platinum-based chemotherapeutic agents such as cisplatin, carboplatin, and oxaliplatin are used as adjuvant or neoadjuvant agents in malignancies of the ovary, cervix,...
Platinum-based chemotherapeutic agents such as cisplatin, carboplatin, and oxaliplatin are used as adjuvant or neoadjuvant agents in malignancies of the ovary, cervix, lymphoma, head and neck, and breast. Cisplatin is most commonly used until the carboplatin is approved by the Food and Drug Administration (FDA). Cisplatin is not tolerated in many patients due to severe nausea and renal tubular injury. Carboplatin is used in patients where side effects limit the uses of cisplatin. Although carboplatin is least commonly associated with hematuria, we report a case of carboplatin-induced hematuria with obstructive acute kidney injury (AKI). Our patient, a 63-year-old female diagnosed with triple-negative breast carcinoma and post-mastectomy, was started on adjuvant chemotherapy, with carboplatin 700 mg and paclitaxel 250 mg. She developed hematuria with ureter obstruction due to clots, resulting in obstructive AKI. The patient continued to have oliguria and worsening symptoms, and thus, the ureter was stented. The patient's renal function returned to the baseline. In this case, we highlight the fact that carboplatin can cause hematuria with ureter obstruction. Adequate hydration before infusing carboplatin as in cisplatin can reduce the complications.
PubMed: 38800179
DOI: 10.7759/cureus.58931 -
Plastic and Reconstructive Surgery.... May 2024Breast cancer is a leading cause of cancer among cisgender women worldwide, with an incidence that continues to rise. Breast reconstruction is increasingly recognized as...
Breast cancer is a leading cause of cancer among cisgender women worldwide, with an incidence that continues to rise. Breast reconstruction is increasingly recognized as an integral part of breast cancer management. In tandem, the population of trans women is also increasing. However, few studies have focused on the management of breast cancer in this population, given that estrogen therapy has the potential to increase the risk of breast cancer. We present the case of a 51-year-old trans woman diagnosed with right breast cancer following a 32-year history of estrogen therapy. She presented to our clinic for consultation and immediate breast reconstruction. She opted for bilateral skin-sparing mastectomies, sentinel lymph node biopsies, and immediate breast reconstruction using deep inferior epigastric perforator free flaps. There were no postoperative flap complications. Final pathology revealed invasive mucinous carcinoma, devoid of lymph node involvement. The patient was satisfied with her reconstruction and is currently planning for nipple reconstruction. To the authors' knowledge, this is the first reported case in the literature of bilateral deep inferior epigastric perforator free flap reconstruction in the trans female population after breast cancer diagnosis. This case underscores the need for a holistic treatment approach and heightened vigilance among trans women on estrogen therapy. It also highlights that breast reconstruction should be considered and offered to this patient population.
PubMed: 38798942
DOI: 10.1097/GOX.0000000000005834