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Ugeskrift For Laeger Dec 2018
Topics: Axilla; Humans; Hyperhidrosis; Microwaves
PubMed: 30520716
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Sep 2023
Topics: Humans; Axilla; Exanthema
PubMed: 37753761
DOI: 10.4045/tidsskr.23.0287 -
Ugeskrift For Laeger Mar 2024Surgical treatment of breast cancer has changed towards less invasive procedures as summarised in this review. Breast conserving surgery (BCS) and radiotherapy (RT) are... (Review)
Review
Surgical treatment of breast cancer has changed towards less invasive procedures as summarised in this review. Breast conserving surgery (BCS) and radiotherapy (RT) are now recommended as standard of care. Several flexible marking methods for removal of non-palpable tumours have gradually replaced wire-guided localisation. Neoadjuvant systemic treatment increases tumour shrinkage and BCS and may lead to omission of axillary clearance (AC). The prognostic significance of AC in patients with metastases to 1-2 sentinel nodes at primary surgery is questioned. Results from the SENOMAC trial are expected to change guidelines from AC to axillary RT.
Topics: Female; Humans; Axilla; Breast Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mastectomy, Segmental; Sentinel Lymph Node Biopsy
PubMed: 38533870
DOI: 10.61409/V01230033 -
Lancet (London, England) Nov 2023Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Radiotherapy has become much better targeted since the 1980s, improving both safety and efficacy. In breast cancer, radiotherapy to regional lymph nodes aims to reduce risks of recurrence and death. Its effects have been studied in randomised trials, some before the 1980s and some after. We aimed to assess the effects of regional node radiotherapy in these two eras.
METHODS
In this meta-analysis of individual patient data, we sought data from all randomised trials of regional lymph node radiotherapy versus no regional lymph node radiotherapy in women with early breast cancer (including one study that irradiated lymph nodes only if the cancer was right-sided). Trials were identified through the EBCTCG's regular systematic searches of databases including MEDLINE, Embase, the Cochrane Library, and meeting abstracts. Trials were eligible if they began before Jan 1, 2009. The only systematic difference between treatment groups was in regional node radiotherapy (to the internal mammary chain, supraclavicular fossa, or axilla, or any combinations of these). Primary outcomes were recurrence at any site, breast cancer mortality, non-breast-cancer mortality, and all-cause mortality. Data were supplied by trialists and standardised into a format suitable for analysis. A summary of the formatted data was returned to trialists for verification. Log-rank analyses yielded first-event rate ratios (RRs) and confidence intervals.
FINDINGS
We found 17 eligible trials, 16 of which had available data (for 14 324 participants), and one of which (henceforth excluded), had unavailable data (for 165 participants). In the eight newer trials (12 167 patients), which started during 1989-2008, regional node radiotherapy significantly reduced recurrence (rate ratio 0·88, 95% CI 0·81-0·95; p=0·0008). The main effect was on distant recurrence as few regional node recurrences were reported. Radiotherapy significantly reduced breast cancer mortality (RR 0·87, 95% CI 0·80-0·94; p=0·0010), with no significant effect on non-breast-cancer mortality (0·97, 0·84-1·11; p=0·63), leading to significantly reduced all-cause mortality (0·90, 0·84-0·96; p=0·0022). In an illustrative calculation, estimated absolute reductions in 15-year breast cancer mortality were 1·6% for women with no positive axillary nodes, 2·7% for those with one to three positive axillary nodes, and 4·5% for those with four or more positive axillary nodes. In the eight older trials (2157 patients), which started during 1961-78, regional node radiotherapy had little effect on breast cancer mortality (RR 1·04, 95% CI 0·91-1·20; p=0·55), but significantly increased non-breast-cancer mortality (1·42, 1·18-1·71; p=0·00023), with risk mainly after year 20, and all-cause mortality (1·17, 1·04-1·31; p=0·0067).
INTERPRETATION
Regional node radiotherapy significantly reduced breast cancer mortality and all-cause mortality in trials done after the 1980s, but not in older trials. These contrasting findings could reflect radiotherapy improvements since the 1980s.
FUNDING
Cancer Research UK, Medical Research Council.
Topics: Female; Humans; Breast Neoplasms; Lymph Nodes; Axilla; Neoplasm Recurrence, Local
PubMed: 37931633
DOI: 10.1016/S0140-6736(23)01082-6 -
BMJ (Clinical Research Ed.) Jan 2010To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer.
DESIGN
Randomised, single blinded, clinical trial.
SETTING
University hospital in Alcalá de Henares, Madrid, Spain.
PARTICIPANTS
120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007.
INTERVENTION
The early physiotherapy group was treated by a physiotherapist with a physiotherapy programme including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only.
MAIN OUTCOME MEASURE
Incidence of clinically significant secondary lymphoedema (>2 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm).
RESULTS
116 women completed the one year follow-up. Of these, 18 developed secondary lymphoedema (16%): 14 in the control group (25%) and four in the intervention group (7%). The difference was significant (P=0.01); risk ratio 0.28 (95% confidence interval 0.10 to 0.79). A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group (intervention/control, hazard ratio 0.26, 95% confidence interval 0.09 to 0.79).
CONCLUSION
Early physiotherapy could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes.
TRIAL REGISTRATION
Current controlled trials ISRCTN95870846.
Topics: Arm; Axilla; Breast Neoplasms; Female; Humans; Lymphatic Metastasis; Lymphedema; Middle Aged; Physical Therapy Modalities; Postoperative Complications; Single-Blind Method; Treatment Outcome
PubMed: 20068255
DOI: 10.1136/bmj.b5396 -
CMAJ : Canadian Medical Association... Dec 2021
Topics: Administration, Topical; Anti-Bacterial Agents; Axilla; Diagnosis, Differential; Erythrasma; Erythromycin; Groin; Humans; Male; Middle Aged
PubMed: 34903597
DOI: 10.1503/cmaj.210310-f -
Anais Brasileiros de Dermatologia 2018
Topics: Adult; Axilla; Biopsy; Dermis; Female; Fox-Fordyce Disease; Hair Follicle; Humans; Vulva
PubMed: 29641729
DOI: 10.1590/abd1806-4841.20187348 -
Chirurgia (Bucharest, Romania : 1990) 2014The present paper is a presentation of our technique of axillopexy, used after the excision of the axillary lymph nodes in 29 cases of breast cancer patients. We have...
The present paper is a presentation of our technique of axillopexy, used after the excision of the axillary lymph nodes in 29 cases of breast cancer patients. We have used this technique after Madden modified radical mastectomy or after quadrantectomy for tumors in the external quadrants of the mammary gland. We have studied and compared with a 30 case control group, the duration of the lymphorrhagia the moment of removing the drains, the presence absence of other local complications. We have also measured the time until the beginning of the oncological postoperative therapy. Every one of the aspects we have studied was improved in the axillopexy group.
Topics: Axilla; Breast Neoplasms; Case-Control Studies; Drainage; Female; Humans; Lymph Node Excision; Mastectomy, Modified Radical; Mastectomy, Segmental; Romania; Treatment Outcome
PubMed: 25149619
DOI: No ID Found -
The Journal of Thoracic and... Sep 2019
Topics: Arteries; Axilla; Axillary Artery; Catheterization; Dissection
PubMed: 30660410
DOI: 10.1016/j.jtcvs.2018.12.019 -
The British Journal of Radiology Oct 2020As tomosynthesis is rapidly adopted by breast imaging practices, tomosynthesis-guided procedures are increasingly being performed. Tomosynthesis-guided needle... (Review)
Review
As tomosynthesis is rapidly adopted by breast imaging practices, tomosynthesis-guided procedures are increasingly being performed. Tomosynthesis-guided needle localizations are feasible and efficient and allow for localization of tomosynthesis-only findings or one-view findings, which may be difficult to localize under standard digital mammography. In this review, we describe our step-by-step approach for performing tomosynthesis-guided localizations of the breast and axilla using a standard tomosynthesis unit.
Topics: Axilla; Breast Neoplasms; Female; Humans; Image-Guided Biopsy; Mammography; Radiographic Image Enhancement
PubMed: 32667855
DOI: 10.1259/bjr.20200495