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1.
Sriram Venigalla David M. Guttmann Varsha Jain Sonam Sharma Gary M. Freedman Jacob E. Shabason 《Clinical breast cancer》2018,18(5):e899-e908
Background
The acceptance of hypofractionated radiotherapy in treating breast cancer in the breast conservation therapy setting has stimulated interest in hypofractionated postmastectomy radiotherapy (PMRT). We assessed national trends and patterns of utilization of hypofractionated PMRT.Patients and Methods
Women 18 years of age or older with breast cancer treated with mastectomy and PMRT to the chest wall with or without regional lymph nodes from 2004 to 2014 were identified from the National Cancer Database. A standard fractionation cohort was defined as patients receiving 180 to 200 cGy per fraction to a total dose of 4500 to 7000 cGy over 5 to 7 weeks, and a hypofractionation cohort was defined as those receiving 250 to 400 cGy per fraction to a total dose of 3000 to 6000 cGy over 2 to 5 weeks. Multivariable logistic regression was used to determine factors associated with hypofractionated PMRT use.Results
We identified 113,981 patients who met study criteria. Overall, hypofractionated PMRT use was low (1.1%) although utilization increased over time (P ≤ .001). Older age, greater comorbidity, further distance from treatment facility, treatment at academic facilities, less extensive disease, and recent treatment year were statistically significant predictors of hypofractionation use compared with standard fractionation. Conversely, breast reconstruction and receipt of chemotherapy were negative predictors.Conclusion
Because of the absence of high-level evidence to support its use, hypofractionated PMRT was uncommonly utilized in the United States from 2004 to 2014, although a small increase in use was noted over time. Findings from this study might be useful in designing future studies, and might serve as a baseline for evaluation of future changes in practice patterns. 相似文献2.
Purpose
In this proof-of-concept study, we proposed 3-D–printed mold–guided breast-conserving surgery (BCS) in breast cancer patients.Patients and Methods
Pathologically confirmed and eligible breast cancer patients received magnetic resonance imaging examinations before BCS. The information on the shape, size, and location of the tumor relative to the nipple was extracted and analyzed. We used a 3-D printing technique to produce a mold to guide BCS for breast cancer patients.Results
We performed 3-D–printed mold–guided BCS in 8 breast cancer patients. All of the patients had negative surgical margins, confirmed by intraoperative and postoperative pathologic examinations.Conclusion
The 3-D–printed mold–guided BCS approach is a feasible way to achieve negative surgical margins. A prospective designed cohort study, with more patients included and a longer follow-up, is needed to further confirm its long-term oncologic safety. 相似文献3.
Jae Hoon Jeong Bomi Choi Sam Yeol Chang Eun-Kyu Kim Eunyoung Kang Chan Yeong Heo Yujin Myung 《Clinical breast cancer》2018,18(3):214-219
Background
Long-term posture change after unilateral mastectomy in breast cancer patients can affect spinal alignment during the postoperative period. We evaluated the effect of immediate breast reconstruction on body posture after surgery by analyzing spinal alignment with radiographic studies.Materials and Methods
Preoperative and 2-year postoperative chest radiographs of 116 patients who received immediate breast reconstruction with unilateral mastectomy and 250 patients who underwent unilateral mastectomy without reconstruction were retrospectively reviewed. Cobb angle, the direction of spinal curvature, upper and lower ends of the thoracic curve, and curve length were measured and compared between both groups. Additional patient information including age, height, weight, body mass index, and side of surgery were collected via chart review.Results
There was a significant difference in the Cobb angle between the preoperative and 2-year postoperative chest radiographs between the immediate breast reconstruction group and mastectomy group. Without considering curvature change, the difference was ?0.593° in the reconstruction group and 2.698° in the mastectomy-alone group (P = .02), and considering curvature change, the difference was 0.335° and 3.972° in the reconstruction and mastectomy-alone group, respectively (P < .01).Conclusion
The amount of change in postoperative spinal alignment was significantly smaller in the immediate breast reconstruction group compared with patients who received only unilateral mastectomy without reconstruction. We suggest that immediate breast reconstruction positively affects spinal alignment, leading to better posture and physical function. 相似文献4.
Minoru Miyashita Hiroshi Tada Akihiko Suzuki Gou Watanabe Hisashi Hirakawa Masakazu Amari Yoichiro Kakugawa Masaaki Kawai Akihiko Furuta Kaoru Sato Ryuichi Yoshida Akiko Ebata Hironobu Sasano Keiichi Jingu Noriaki Ohuchi Takanori Ishida 《Surgical oncology》2017,26(2):163-170
Introduction
Given modern treatment strategies, controversy remains regarding whether postmastectomy radiation therapy (PMRT) is necessary for breast cancer patients with 1–3 positive axillary lymph nodes (ALN). Our aim was to assess the significance of PMRT in the modern treatment era for these patients.Material and methods
We have conducted the retrospective multicenter study and identified 658 patients with 1–3 positive ALN who were treated with mastectomy and ALN dissection between 1999 and 2012. Propensity score weighting was used to minimize the influence of confounding factors between the PMRT and no-PMRT groups. The variables including tumor size, lymph nodes status, skin and/or muscle invasion, histological grade, lymphovascular invasion and ER positivity which were statistically unbalanced between the groups were used to define the propensity scores.Results
The median follow-up time was 7.3 years. In the modern era (2006–2012), no significant difference in locoregional recurrence (LRR)-free survival was noted between the PMRT and no-PMRT groups (P = 0.3625). The 8-year LRR-free survival rates of the PMRT and no-PMRT groups were 98.2% and 95.3%, respectively. After matching patients by propensity scores, the PMRT group, compared to the no-PMRT group, exhibited significantly better locoregional control (P = 0.0366) in the entire cohort. The 10-year LRR-free survival rates were 97.8% and 88.4% in the PMRT and no-PMRT groups, respectively. In contrast, no significant difference in LRR-free survival was noted between the PMRT and no-PMRT groups in the modern era (P = 0.5298). The 8-year LRR-free survival rates of patients treated in the modern era were approximately the same between the groups (98.0% and 95.7% in the PMRT and no-PMRT groups, respectively).Particularly, LRR-free survival of HER2 positive breast cancer significantly improved in the modern treatment era, compared with that of the old treatment era (P = 0.0349).Conclusion
PMRT had minimal impact on LRR for breast cancer patients with 1–3 positive ALN in the modern treatment era. 相似文献5.
Jianyang Wang Shulian Wang Yu Tang Hao Jing Guangyi Sun Jing Jin Yueping Liu Yongwen Song Weihu Wang Hui Fang Hua Ren Zihao Yu Yexiong Li 《Clinical breast cancer》2018,18(5):e975-e984
Background
To investigate the superiority of breast-conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy alone for patients with stage I breast cancer in a real-world setting.Patients and Methods
The data from patients with histologically confirmed stage I breast cancer treated from 1999 to 2014 were retrospectively reviewed. The association of outcomes with the choice of treatment (BCS plus RT vs. mastectomy) was evaluated using multivariable proportional hazards regression and further confirmed using propensity score matching methods.Results
Of 6137 eligible patients in the present study, 1296 underwent BCS plus RT and 4841 underwent mastectomy plus axillary lymph node dissection without RT (mastectomy group). Multivariate analysis revealed that BCS plus RT was related to similar locoregional recurrence-free survival but greater distant metastasis-free survival (P = .003) and overall survival (P = .036) compared with mastectomy. For the 1252 pairs of patients matched using propensity score matching, the BCS plus RT groups enjoyed significantly greater 5-year overall survival (99.1% vs. 96.1%; P = .001), distant metastasis-free survival (97.0% vs. 92.2%; P < .001), and disease-free survival (95.3% vs. 90.2%; P = .001) compared with the mastectomy group.Conclusion
BCS plus RT provided better outcomes than mastectomy for eligible patients with stage I breast cancer and should be offered as a preferred treatment option. 相似文献6.
Rati Chkheidze Mary Ann G. Sanders Barbara Haley A. Marilyn Leitch Sunati Sahoo 《Clinical breast cancer》2018,18(4):298-304
Background
Breast cancer metastases to an ipsilateral supraclavicular lymph node is assigned a N3 status in the TNM system and thus classified as stage III disease in the American Joint Commission on Cancer staging manual. Breast cancer metastatic to contralateral axillary lymph node (CAM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III).Patients and Methods
We retrospectively reviewed the medical records of breast cancer patients diagnosed with CAM for their clinical presentation, pathologic diagnoses, treatment, and follow-up data. Patients who had distant metastases at the time of CAM diagnosis were excluded from the study.Results
We report 12 breast cancer patients who developed CAM but no evidence of metastases in any other distant organ documented with extensive imaging workup. Imaging studies and thorough pathologic evaluation of the prophylactic total mastectomy specimen did not reveal a primary in the breast to account for the metastases in the axillary node.Conclusion
Findings of our study as well as previous studies support that lymph node metastases in the contralateral axilla represents a locoregional spread of the tumor from the index breast via lymphatics rather than hematogenous spread. Therefore, isolated CAM in breast cancer patients should not be classified as stage IV disease. 相似文献7.
Background
For clinical T1-2N0 breast cancer, sentinel lymph node biopsy (SLNB) has been shown in American College of Surgeons Oncology Group (ACOSOG) Z0011 to be sufficient for women with 1 to 2 positive sentinel lymph nodes with no added benefit for completion axillary lymph node dissection (ALND). Z0011 specified whole breast radiotherapy (RT) using standard tangential fields; however, later analysis showed variation in field design. We assessed nationwide practice patterns and examined factors associated with patients undergoing completion ALND and subsequent radiation field design.Patients and Methods
Women with clinical T1-2N0 breast cancer who underwent breast-conserving surgery, axillary staging, and whole breast RT in 2012 to 2013 were identified in the National Cancer Database. Multivariable logistic regression modeling was used to examine axillary management and RT, adjusting for demographic and clinicopathologic factors.Results
Among 83,555 patients meeting criteria, 9.3% underwent upfront ALND, 75.8% underwent SLNB only, and 14.9% underwent SLNB with completion ALND. From 2012 to 2013, upfront SLNB increased from 90.1% to 91.4% (odds ratio, 1.14; P < .001). Among 9474 patients that underwent SLNB with 1 to 2 positive sentinel nodes, 31.2% received completion ALND. Among patients with 1 to 2 positive sentinel nodes, SLNB increased from 65.8% to 72.1% from 2012 to 2013 (P < .001). For patients with 1 to 2 positive lymph nodes that underwent SLNB only, 63.4% underwent breast RT, whereas 36.6% received breast and nodal RT.Conclusions
Nationwide practice patterns of axillary management vary. Despite an increasing rate of SLNB, many patients still receive upfront and completion ALND. Furthermore, there is significant variation in RT field design, and modern treatment guidelines are warranted for this patient population. 相似文献8.
Robabeh Taheripanah Firoozeh Balash Robab Anbiaee Mohammedreza Mahmoodi Azadeh Akbari Sene 《Clinical breast cancer》2018,18(5):395-399
Background
This study was performed to determine whether the use of ovulation induction drugs in treatment of infertility have a significant effect on the risk of breast cancer.Patients and Methods
This case control study (928 cases, 928 controls), was performed in the gynecology and oncology clinics of Shahid Beheshti University of Medical Sciences between 2011 and 2013. Data were collected via in-person interviews using a questionnaire, which included demographic and gynecologic information. Statistical analysis was performed using SPSS statistics software version 20 (IBM Corp).Results
The use of ovulation induction drugs was not significantly associated with an increased risk of breast cancer (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.7-1.855) among women with infertility (OR, 1.28; 95% CI, 0.8-1.95).Conclusion
We observed no statistically significant relationship between infertility and ovulation induction drugs with the risk of breast cancer, except for significant increases in the risk of breast cancer among patients who had used fertility drugs for >6 months. 相似文献9.
Background
Despite the psychological benefits and oncologic safety of postmastectomy breast reconstruction, most breast cancer patients do not undergo reconstruction. To better understand the patterns of breast reconstruction usage, it is important to identify the clinicopathologic factors associated with immediate breast reconstruction (IBR), and whether modification of the reconstruction incidence when stratified by patient- or cancer-related factors exists in the breast cancer population. The primary objectives were to determine whether the incidence of immediate postmastectomy breast reconstruction varies across age, and whether the tumor grade or radiation therapy modify the effect of age on the incidence of immediate breast reconstruction.Materials and Methods
Using the Surveillance, Epidemiology, and End Results database, we identified women who had undergone mastectomy for breast cancer from 2000 to 2014. Inverse probability of treatment-weighted log-binomial regression was used to estimate the effect of age on IBR after accounting for potential confounding by patient demographic data and cancer characteristics. Potential effect measure modification by tumor grade and radiation therapy on the age–IBR relationship was also assessed.Results
Of 321,206 women, 77,798 (24.2%) had undergone IBR. Age was significantly associated with IBR prevalence (P < .0001), with younger women more likely to undergo IBR. Both tumor grade (P < .0001) and radiation therapy (P < .0001) modified the effect of age on IBR.Conclusion
Compared with their older counterparts, younger breast cancer patients were more likely to undergo IBR, and both tumor grade and radiation therapy were differentially associated with the likelihood of IBR across patient age. 相似文献10.
Hui-Yu Chang Yu-Kai Tseng Yu-Chia Chen Chih-Wen Shu Miaw-I. Lin Huei-Han Liou Ting-Ying Fu Yun-Chung Lin Luo-Ping Ger Ming-Hsin Yeh Pei-Feng Liu 《Surgical oncology》2018,27(2):314-320
Background
High Snail expression is known as a poor prognostic factor in breast cancer. However, its prognostic impact for breast cancer with different molecular subtypes is still controversial.Methods
Snail expression was examined by immunohistochemistry in tissue microarray slides of 85 corresponding tumor-adjacent normal (CTAN) and 247 breast invasive ductal carcinoma (IDC) tissues. Multivariable Cox regression analysis was used to assess the impact of Snail expression on survival rate by different molecular subtypes of breast IDC patients.Results
The level of Snail expression in IDC tumor tissues was significantly higher than that in CTAN tissues. Moreover, high Snail expression had direct impacts on poor disease specific survival (DSS) and disease-free survival (DFS) in breast IDC patients with human epidermal growth factor receptor 2 (HER2)-positive and human epidermal growth factor receptor (EGFR)-positive statuses as well as the HER2 intrinsic subtype. Additionally, breast IDC patients with a combination of three prognostic factors, including high Snail expression and HER2-positive and EGFR-positive statuses, had much poor DSS and DFS with a statistically significant linear trend.Conclusion
High Snail expression could predict a poor prognosis for breast IDC patients with HER2/EGFR-positive subtypes. 相似文献11.
M.L. Yap M. Tieu J. Sappiatzer T. Panzarella J. Cuartero D. McCready A. Fyles 《Clinical oncology (Royal College of Radiologists (Great Britain))》2018,30(7):427-432
Aims
The use of bolus in post-mastectomy radiotherapy (PMRT) varies significantly between institutions. We report on chest wall recurrence and acute toxicity rates for PMRT patients treated with selective use of bolus.Materials and methods
We analysed PMRT patients who received adjuvant chest wall radiotherapy for invasive breast cancer between 2004 and 2009. Patient, tumour and cancer outcomes were collected from a prospective database, with additional radiotherapy and acute toxicity details supplemented retrospectively. Chest wall bolus was reserved for patients considered at high risk of local recurrence.Results
There were 314 patients suitable for analysis: 52 received bolus, 262 did not. The mean age was 53.2 years. The median follow-up was 4.2 years. The most common T stage was T2 (37%), followed by T3/T4 (33%). There were 229 patients (73%) who had N+ disease; 213 (68%) patients had grade 3 cancer. Oestrogen receptor was positive in 176 (56%) cases, progesterone receptor was positive in 134 (43%) and HER2 receptor was positive in 24 (8%). Lymphovascular space invasion was present in 146 patients (46%), dermal invasion in 30 patients (10%) and positive margin in 14 patients (4%). The 4 year chest wall recurrence rate was 14% (95% confidence interval 5.4–26.8%) in the bolus group and only 3.5% (95% confidence interval 1.6–6.4%) in the non-bolus group. On univariate analysis, use of bolus was associated with a significant difference in chest wall recurrence (hazard ratio 3.09; 1.15–8.33; P = 0.025). However, when taking into account margin status, this significance was lost (hazard ratio = 2.45; 95% confidence interval 0.80–7.50, P = 0.12). There was a higher rate of acute grade 2 skin toxicity in patients receiving bolus compared with those without, 40% versus 21% (P = 0.01).Conclusions
The selective use of bolus resulted in a small risk of chest wall recurrence rates for low-risk patients. This suggests that the routine use of bolus in PMRT patients may be unnecessary. 相似文献12.
Xiao Zhu Jun-ming Huang Kun Zhang Long-jie Xia Lan Feng Ping Yang Meng-ya Zhang Wei Xiao Hui-xia Lin Ying-hua Yu 《Clinical breast cancer》2018,18(5):e985-e995
Background
Contrast-enhanced spectral mammography (CESM) is a new image examination technology that has developed over the past few years. As CESM technology keeps improving, a current meta-analysis review is needed to systematically evaluate the potential diagnostic value of CESM.Methods
A total of 18 studies were included in the review. Sensitivity, specificity, and other important parameters of CESM accuracy for breast cancer diagnosis were pooled and analyzed using random-effects models. Summary receiver operating characteristic curves were calculated for overall accuracy estimation.Results
The summary estimates for CESM in the diagnosis of breast cancer were as follows: the pooled sensitivity and specificity were 0.89 (95% confidence interval [CI], 0.88-0.91) and 0.84 (95% CI, 0.82-0.85), respectively. Positive likelihood ratio was 3.73 (95% CI, 2.68-5.20), negative likelihood ratio was 0.10 (95% CI, 0.06-0.15), and diagnostic odds ratio was 71.36 (95% CI, 36.28-140.39). The area under the curve was 0.96 (standard error = 0.011).Conclusion
CESM has a high diagnostic accuracy for evaluating breast cancer and can be considered as a useful test for initial assessment of breast lesions. 相似文献13.
Gustavo Nader Marta Philip Poortmans Alfredo C. de Barros José Roberto Filassi Ruffo Freitas Junior Riccardo A. Audisio Max Senna Mano Sarkis Meterissian Sarah M. DeSnyder Thomas A. Buchholz Tarek Hijal 《European journal of surgical oncology》2017,43(11):2036-2043
Purpose/Objective(s)
Skin sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have entered routine surgical practice for breast cancer, though their oncologic safety has not been established in randomized controlled trials. The aim of this study was to evaluate and compare radiation oncologists' and breast surgeons' opinions concerning the indications of post-operative radiation therapy (PORT) after SSM and NSM.Materials/Methods
Radiation oncologists and breast surgeons from North America, South America and Europe were invited to contribute in this study. A 22-question survey was used to evaluate their opinions.Results
A total of 550 physicians (298 radiation oncologists and 252 breast surgeons) answered the survey. The majority of responders affirmed that PORT should be performed in early-stage (stages I and II) breast cancer for patients who present with risk factors for relapse after SSM and NSM. They considered age, lymph node involvement, tumor size, extracapsular extension, involved surgical margins, lymphovascular invasion, triple negative receptor status and multicentric presentation as major risk factors. Considering that after SSM and NSM, residual breast tissue can be left behind, the residual tissue considered as acceptable in the context of an oncologic surgery were 1–5 mm for breast surgeons. There is no consensus for the necessity of evaluating residual breast tissue through breast imaging.Conclusion
Although the indications of PORT after SSM and NSM vary among practitioners, standard risk factors for relapse are considered as important by radiation oncologists and breast surgeons. 相似文献14.
Jonathan Chen Xian Wu Paul Christos Weisi Yan Akkamma Ravi 《Clinical breast cancer》2018,18(5):e967-e973
Introduction
Breast cancer patients with tumors > 5 cm but without nodal disease who undergo mastectomy present a clinical challenge regarding the appropriate adjuvant treatment. Traditionally, postmastectomy radiation therapy (PMRT) was the standard of care. However, recent studies have suggested local failure rates without PMRT might be low enough to omit RT. This might be especially true in the elderly.Patients and Methods
Women aged ≥ 75 years with a diagnosis of T3N0 breast cancer who had undergone mastectomy were identified from the Surveillance, Epidemiology, and End Results (SEER) 18 database. The study period was limited to 2006 to 2009 for more modern sampling. Multivariable proportional hazards modeling was used to examine the association of treatment and mortality, adjusting for demographic and clinicopathologic factors.Results
A total of 635 patients were identified. The median follow-up period was 43 months. PMRT was given to 31.2% of the patients aged 75 to 79 years, 21.5% of those aged 80 to 84 years, and 11.7% of the patients aged ≥ 85 years (P < .001). The receipt of PMRT showed a trend toward improved overall survival on bivariable analysis (hazard ratio [HR], 0.58; P < .001) and multivariable analysis (HR, 0.78; P = .14). The 5-year overall survival was 64.2% for those who had received PMRT and 44.8% for those who had not. A nonsignificant trend was seen toward improved breast cancer-specific survival at 5 years on bivariable analysis (HR, 0.63; P = .09) but not on multivariable analysis. The interaction of age and PMRT receipt could have confounded the results. Patient age and tumor grade were significant indicators of the survival prognosis in these patients.Conclusion
The results of the present analysis of the SEER database suggest that PMRT might still be beneficial in women aged > 75 years with T3N0 disease but also supports continuing efforts to confirm whether it could be safe to omit. It is likely that efforts to subdivide this population using other factors (eg, comorbidity) will be important. The search for refined inclusion and exclusion criteria for adjuvant RT remains an important field of research both clinically and economically. 相似文献15.
Marta D&#x;Alonzo Eleonora Piva Silvia Pecchio Viola Liberale Paola Modaffari Riccardo Ponzone Nicoletta Biglia 《Clinical breast cancer》2018,18(6):e1361-e1366
Introduction
BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic breast and ovarian surgery. These recommendations impact many aspects of their life. This study aims to evaluate the satisfaction with surveillance and prophylactic surgery and the impact of these procedures on the quality of life.Patients and Methods
An anonymous questionnaire was administered to 174 BRCA1-2 mutation carriers.Results
A total of 95% of women comply with the scheduled checks every 6 months. Periodic examinations are considered useful for early diagnosis of breast/ovarian cancer by 91.5% of responders. Among those women who received prophylactic breast surgery, 95% believe that this procedure can reduce cancer risk, but only 65% were completely satisfied by the cosmetic outcome. Among women who underwent prophylactic ovarian surgery, 90.5% would choose it again, mainly owing to a lower degree of concern about ovarian cancer risk. The early onset of menopausal symptoms was the most frequently reported side effects, but only 21% of patients use any treatment to relieve them.Conclusion
Women who follow a surveillance program show a good level of satisfaction, thanks to the lowering of concerns of cancer risk. The degree of satisfaction about the prophylactic surgery is generally high. Risk-reducing mastectomy is usually well-accepted, despite the fact that cosmetic results are not entirely satisfactory. Bilateral salpingo-oophorectomy may impact on quality of life because of the symptoms associated with early surgical menopause, even if it can be treated with hormonal replacement therapies. 相似文献16.
Background
Caveolae play a role in cell signal transduction, kinetic regulation of transport vesicles, and cellular physiology. In this study, we evaluated the role of caveolin-1 (CAV-1) genotypes in the risk of breast cancer.Patients and Methods
We evaluated 6 single nucleotide polymorphisms of the CAV-1 gene in a sample size of 406 participants. Six polymorphisms—G32124A (rs3807992), T29107A (rs7804372), T28608A (rs3757733), G21985A (rs12672038), G14713A (rs3807987), and C521A (rs1997623)—were assessed using restriction fragment length polymorphism polymerase chain reaction.Results
Regarding the distribution of genotypes, the relationship between cases and controls was significant for T29107A, G21985A, G14713A, and C521A polymorphisms, among which only C521A showed a significant difference in body mass index between the 2 groups. Moreover, the age of the 2 groups was significant in the case of G32124A and T28608A polymorphisms.Conclusion
Our results showed that genetic changes of CAV-1 might modify the risk for breast cancer and point out the importance of more studies for variants of this gene in breast cancer. 相似文献17.
Madelyn Mousa Yoav Barnea Udi Arad Amir Inbal Joseph Klausner Tehillah Menes 《Clinical breast cancer》2018,18(4):e699-e702
Introduction
Mastectomy with immediate reconstruction is associated with increased complications when compared with mastectomy without reconstruction. Postoperative complications have been associated with worse oncologic outcome in other cancers. We examined the association between postoperative complications after immediate reconstruction and oncologic outcome.Methods
This retrospective study included all women undergoing mastectomy and immediate alloplastic reconstruction for breast cancer between the years 2009 and 2016. Data collected included demographics, cancer and treatment characteristics, type of surgery, postoperative complications, and outcome. Association between postoperative complications and oncologic outcome was examined using Cox regression analysis.Results
Between January 2009 and December 2016, 227 women underwent mastectomy with immediate alloplastic reconstruction. One hundred eighty-six (82%) were done for breast cancer. Most (148; 80%) had infiltrating carcinoma. The mean age was 48.8 years (range, 21-77 years). Forty-seven (25%) had a previous history of radiation. Fifty-four (29%) had neoadjuvant treatment. Complications occurred in 83 (45%) of the women. Fifty-five (30%) needed revisional surgery (closure of wound, debridement, exchange or removal of implant, and evacuation of hematoma). Complications were associated with older age and previous radiation history (57% vs. 40% in women with no previous radiation; P = .04). The mean follow-up was 1138 days. Twenty-five (12%) women developed recurrence during follow-up. There was no association between presence of postoperative complications and recurrence of cancer.Conclusions
Postoperative complications were not associated with worse oncologic outcome in this study. The study may be limited by the relatively short follow-up. 相似文献18.
Ariffuddin Ishak Maya Mazuwin Yahya Ahmad Sukari Halim 《Clinical breast cancer》2018,18(5):e1011-e1021
Background
Breast reconstruction after mastectomy is important in breast cancer care.Materials and Methods
A cross-sectional study was designed to assess surgeons’ and patients’ perceptions toward breast reconstruction. Questionnaires were distributed to general and breast surgeons in East Coast Malaysian hospitals and Hospital Kuala Lumpur and to postmastectomy patients with and without breast reconstruction at the Hospital Universiti Sains Malaysia and Hospital Raja Perempuan Zainab II. The response rates were 82.5% for the surgeons (n = 33), 95.4% for the patients with reconstruction (n = 63), and 95.5% for the patients without reconstruction (n = 278).Results
The median surgeon age and experience was 42 and 6 years, respectively. Each surgeon saw an average of 20 new breast cancer cases annually. Most surgeons (86.7%) discussed reconstruction options with their patients but had only referred an average of 4 patients for reconstruction during a 3-year period. Surgeons’ concerns regarding the qualitative outcome increased the likelihood of a breast reconstruction discussion (β = 4.833; P = .044). The women who underwent breast reconstruction were younger (mean age, 42 vs. 50 years), were more often working (69.4% vs. 42.2%), and more often had previous awareness of the option (90.3% vs. 44.3%). The most common reasons for undergoing breast reconstruction were “to feel more balanced” (92.1%) and “surgeon’s strong recommendation” (92.1%). Previous knowledge of breast reconstruction increased the likelihood of reconstruction (odds ratio, 5.805; P = .026). Although 70% of surgeons thought that patients would not be interested in reconstruction, only 37.9% of patients with previous awareness reported having no interest.Conclusion
The low reconstruction rate (20.6%) can be attributed to the low referral rate. Patients’ likelihood to undergo reconstruction with their surgeon’s recommendation and with previous awareness were reflective of the surgeons’ strong influence on their patients. Thus, clarification of surgeons’ hypothetical criticisms could conceivably increase the reconstructive surgery rate. 相似文献19.
Colin E. Champ Nitin Ohri Rainer J. Klement Matthew Cantor Sushil Beriwal Scott M. Glaser Ryan P. Smith 《Clinical breast cancer》2018,18(1):e1-e6
Background
Radiation therapy (RT) is often delivered after lumpectomy for women with breast cancer. A common perceived side effect of RT is fatigue, yet its exact effect on activity levels and sleep is unknown. In this study we analyzed the change in activity levels and sleep using an activity tracking device before, during, and after RT for women with early stage breast cancer and ductal carcinoma in situ who underwent adjuvant RT.Patients and Methods
After institutional review board approval, activity levels were quantified before, during, and after RT with measurements of steps, miles walked, calories burned, and sleep metrics in 10 women fitted with activity trackers. All data were uploaded and tabulated on a secure database. Multivariable linear regressions were used to evaluate changes in these variables over time during the RT course.Results
Median step count was 5047 per day (range, 2741-15,508) and distance traveled was 1.6 miles per day (range, 0.9-5.3). Step count, distance, and calories decreased by an average of 54 steps per day, 0.02 miles per day, and 3 calories per day (median calories 1822; range, 1461-2712) during RT, respectively. These changes were statistically significant (P < .001), but not clinically relevant. There was no significant change in sleep (average 6.8 hours per night; range, 5.5-8.3).Conclusion
RT has a minimal effect on activity or sleep in women undergoing treatment for breast cancer. Activity levels varied greatly between patients in a population of women undergoing hypofractionated RT. Because increased activity levels correlate with improved outcomes, further studies evaluating attempts to increase physical activity during as well as after treatment with radiation are warranted. 相似文献20.
Leah Drost Nim Li Danny Vesprini Arneet Sangha Justin Lee Eric Leung Eileen Rakovitch Caitlin Yee Edward Chow Mark Ruschin 《Clinical breast cancer》2018,18(5):e789-e795