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Purpose
This study aimed to prospectively characterize toxicity and cosmesis after accelerated partial breast irradiation (APBI) with 3-dimensional conformal radiation therapy (CRT) or single-entry, multilumen, intracavitary brachytherapy.Methods and materials
A total of 281 patients with pTis, pT1N0, or pT2N0 (≤3.0 cm) breast cancer treated with segmental mastectomy were prospectively enrolled from December 2008 through August 2014. APBI was delivered using 3-dimensional CRT (n = 29) or with SAVI (n = 176), Contura (n = 56), or MammoSite (n = 20) brachytherapy catheters. Patients were evaluated at protocol-specified intervals, at which time the radiation oncologist scored cosmetic outcome, toxicities, and recurrence status using a standardized template.Results
The median follow-up time is 41 months. Grade 1 seroma and fibrosis were more common with brachytherapy than with 3-dimensional CRT (50.4% vs 3.4% for seroma; P < .0001 and 66.3% vs 44.8% for fibrosis; P = .02), but grade 1 edema was more common with 3-dimensional CRT than with brachytherapy (17.2% vs 5.6%; P = .04). Grade 2 to 3 pain was more common with 3-dimensional CRT (17.2% vs 5.2%; P = .03). Actuarial 5-year rates of fair or poor radiation oncologist-reported cosmetic outcome were 9% for 3-dimensional CRT and 24% for brachytherapy (P = .13). Brachytherapy was significantly associated with inferior cosmesis on mixed model analysis (P = .003). Significant predictors of reduced risk of adverse cosmetic outcome after brachytherapy were D0.1cc (skin) ≤102%, minimum skin distance >5.1 mm, dose homogeneity index >0.54, and volume of nonconformance ≤0.89 cc. The 5-year ipsilateral breast recurrence was 4.3% for brachytherapy and 4.2% for 3-dimensional CRT APBI patients (P = .95).Conclusions
Brachytherapy APBI is associated with higher rates of grade 1 fibrosis and seroma than 3-dimensional CRT but lower rates of grade 1 edema and grade 2 to 3 pain than 3-dimensional CRT. Rates of radiation oncologist-reported fair or poor cosmetic outcomes are higher with brachytherapy. We identified dosimetric parameters that predict reduced risk of adverse cosmetic outcome after brachytherapy-based APBI. Ipsilateral breast recurrence was equivalent for brachytherapy and 3-dimensional CRT. 相似文献Metabolic surgery dramatically improves type 2 diabetes mellitus (T2DM). In 2017, the American Diabetes Association (ADA) recommended metabolic surgery as the optimal treatment for patients with T2DM and Body Mass Index (BMI) > 40. We sought to evaluate whether or not that recommendation is being implemented. The purpose of this study was to evaluate the trend of bariatric surgery 2 years prior and 2 years following the ADA statement.
Materials and MethodsA retrospective analysis of primary bariatric procedures on patients with class III obesity (BMI > 40 kg/m2) and T2DM performed between 2015 and 2018, using the Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database.
ResultsFrom 2015 to 2018, 164,535 patients with T2DM underwent bariatric surgery. The majority had a BMI > 40 kg/m2 (n = 117,422, 71.4%) and most were not using insulin. Majority of the patients with T2D and class III obesity were female (72.1%), Caucasian (71.5%), and mean age (SD) 48.5 (11.5). Although the numbers of patients with T2DM and class III obesity increased during this time period, there was not a significant change in the overall percentage of patients who were treated with surgery: from 25.99% in 2015 to 24.96% in 2018. In addition, this group is associated with higher rates of complications and mortality compared to patients with BMI > 40 kg/m2 without T2DM.
ConclusionUtilization of metabolic surgery in patients with obesity and T2DM has not improved following the updated 2017 ADA guidelines. There is a clear need for more awareness of these guidelines among providers, patients, and the public.
Graphical abstract 相似文献