Effect of individualized physical rehabilitation programs on respiratory function in women with post-mastectomy syndrome

Purpose: The purpose of this study was to determine the effectiveness of an individualized physical rehabilitation programs aimed at improving respiratory function in women with post-mastectomy syndrome. Methods: In a randomized controlled trial 50 women with post-mastectomy syndrome were enrolled in the experimental group (EG, n = 25) or the comparison group (CG, n = 25). The program for the EG included: aqua aerobics (i.e. aqua jogging, aqua building, and aqua stretching); conditional swimming; and recreational aerobics. The program for the CG included: conditional swimming and Pilates exercises. Both intervention groups attended individualized physical rehabilitation programs three times per week for 48 weeks. The primary outcome measure was spirometry of the patients measured before, 6 and 12 months after the intervention. Results: This study demonstrated that most of the respiratory function parameters increased significantly in both groups over the year of exercise training. After the year of training the individualized physical rehabilitation program for the EG was significantly better (p < 0.01) as compared with the CG, except for inspiratory reserve volume and maximal voluntary ventilation, which were not statistically different. Conclusions: The results of the study suggest that individual programs of physical rehabilitation could be considered effective for the improvement of respiratory function of the patients with post-mastectomy syndrome. The results obtained could serve as a basis for more widespread clinical program development.     

Psychological intervention with couples after mastectomy

Cancer is a family affair. Clinical work and research studies have shown that cancer does indeed invade the entire family, and that family members, especially spouses, are often highly distressed individuals. The familiy in general and the spouse in particular cannot, therefore, be looked on as natural supporters for cancer patients, but rather as a system that is itself in need of help and support.Presented at the Symposium Psychotherapeutic Interventions in Cancer Patients, Flims, Switzerland, 12–14 January 1995     

左侧乳腺癌患者根治术后靶区分割式计划和常规调强计划的剂量学比较研究

目的 比较左侧乳腺癌患者根治术后靶区分割式放射治疗计划（target segmented plan,TSP）、与TSP优化参数相同但未分割靶区计划（Non-TSP）与常规8野调强计划（8fields IMRT,8F-IMRT）的剂量学差异。方法 选择2017年6月至2018年11月于武汉大学人民医院放疗科收治的30例左侧乳腺癌根治术后患者资料,所有胸壁靶区两侧后界连线切肺最大深度均>2 cm。将连线切肺最大深度按照<3 cm、3~4 cm、>4 cm分组。所有患者均采用美国Varian Eclipse治疗计划系统设计3种（TSP、Non-TSP和8F-IMRT）治疗计划,然后对比分析3种方式计划的剂量学参数差异。结果 所有患者的治疗计划都达到了处方剂量要求。TSP的D_98%明显低于Non-TSP和8F-IMRT （Z=-3.294,-3.266,P<0.05）;3种计划的均匀指数（HI）和适形指数（CI）比较,差异均无统计学意义（P>0.05）;Non-TSP的加速器治疗的跳数（monitor unit,MU）明显高于TSP和8F-IMRT （Z=-3.04,-2.669,P<0.05）。TSP的D_mean高于8F-IMRT （Z=-3.181,P<0.05）。对于危及器官（Organs at risk,OARs）,TSP较Non-TSP和8F-IMRT计划明显降低了所有患者患侧肺和心脏的V_{5 Gy}、V_{10 Gy}、V_{20 Gy}和D_mean（肺：V_{5 Gy}：Z=-3.408、-3.408,V_{10 Gy}：Z=-3.408、-3.408,V_{20 Gy}：Z=-3.408、-3.124,D_mean：Z=-3.408、-3.408,P<0.05;心脏：V_{5 Gy}：Z=-3.408、-3.408,V_{10 Gy}：Z=-3.408、-3.408,V_{20 Gy}：Z=-2.499、-3.067,D_mean：Z=-3.408、-3.408,P<0.05）。Non-TSP健侧乳腺的D_mean明显高于TSP和8F-IMRT （Z=-2.954、-2.215,P<0.05）,但D_max的比较差异无统计学意义（P>0.05）。3种计划的脊髓D_max差异无统计学意义（P>0.05）;8F-IMRT肱骨头D_mean明显高于TSP和Non-TSP （Z=-3.01、-2.442,P<0.05）。分组的患侧肺V_{5 Gy}、V_{10 Gy}、V_{20 Gy}和心脏的V_{5 Gy}、V_{10 Gy}、D_mean的Non-TSP和8F-IMRT计划与TSP的幅度差均值均满足D （N-T,A）< D （N-T,B）< D （N-T,C）和D （8F-T,A）< D （8F-T,B）< D （8F-T,C）。结论 TSP能在保持原有靶区剂量充分的同时,在不增加高剂量照射体积的前提下,有效地减小左侧乳腺癌患者根治术后放疗患侧肺和心脏的低剂量区照射体积;随着靶区后界连线切肺最大深度的增加,TSP对患侧肺和心脏的低剂量保护优势愈明显。     

The Assisi Think Tank Meeting and Survey of post MAstectomy Radiation Therapy after breast reconstruction: The ATTM-SMART report

Purpose

To describe the current European practise on post-mastectomy radiation therapy (PMRT) in relation to breast reconstruction.

早期(T1-2N1)三阴型乳腺癌根治术后辅助放疗的疗效评估

目的:评估乳腺癌根治术后放疗(post-mastectomy radiation therapy,PMRT)在早期(T1-2N1)三阴型乳腺癌(triple negative breast cancer,TNBC)患者中的治疗价值.方法:回顾性分析SEER数据库中根治术后早期(pT1-2N1)TNBC患者的临床数据.将...     

成人尸体肋间臂神经解剖学特点及其临床意义

目的:为乳腺癌腋清扫术中保留肋间臂神经(JCBN)提供解剖学基础。方法:对5具成人尸体(2男3女)的10侧腋区进行了解剖,进行肋间臂神经观察和准确测量。并且对肋间臂神经周围组织结构及毗邻关系(血管、神经等)进行了仔细研究。结果:1)成人尸体的肋间臂神经直径较患者活体术中肋间臂神经直径为粗。2)成人尸体肋间臂神经的起止点以及与周围组织结构的距离和乳腺癌患者术中测量值基本相同。3)成人尸体肋间臂神经的形态学特点比较单一,均为单干分二支型,考虑原因是解剖尸体例数较少。4)由于解剖较彻底,比活体肋间臂神经分支复杂。结论:明确成人尸体JCBN解剖特点可指导乳腺癌腋清扫术中对肋间臂神经的保留,减少乳腺癌术后疼痛综合征(PMPS)的发生。     

超声引导下肋间臂神经阻滞治疗乳房切除术后疼痛综合征的临床效果

目的观察及评价超声引导下肋间臂神经(ICBN)阻滞治疗保留ICBN的乳腺癌根治术术后顽固性疼痛的效果。方法选择2014年1月至2016年2月于我院行保留ICBN的乳腺癌根治术术后随访的女性患者53例,年龄18~55岁,ASAⅠ或Ⅱ级,其中术后出现术侧侧胸壁、腋窝和/或上臂顽固性疼痛,且持续超过3个月的患者有19例,经超声引导在第2肋间隙前锯肌浅面和胸小肌深面形成的潜在间隙内注入0.5%罗哌卡因10ml行ICBN阻滞,记录阻滞前、阻滞后30min和阻滞后1~7d患者静息(VAS_(静息))、运动(肩外展,VAS_(运动))及接受von Frey痛觉测试纤维丝100kPa压力刺激(VAS_(压力))时的VAS评分,并计算疼痛评分总和(SPI,SPI=VAS_(静息)+VAS_(运动)+VAS_(压力)),同时观察阻滞后1~7dSPI降低≥5分的患者例数。记录局麻药过敏、中枢神经系统和心血管系统毒性反应等阻滞相关不良反应。所有患者均接受7d疼痛评估随访。结果 19例患者均完成超声引导下ICBN阻滞,其中17例完成阻滞后7d的随访。患者阻滞前后SPI平均数差值为-9.19分(95%CI-11.24~-7.14,P0.01)。与阻滞前比较,阻滞后30 min、阻滞后1~6d VAS_(静息)、VAS_(运动)、VAS_(压力)和SPI评分均明显降低(P0.01或P0.05)。阻滞后1~4dSPI降低≥5分的患者分别有14例(82.4%)、13例(76.5%)、7例(41.2%)和3例(17.6%)。所有患者均未出现局麻药过敏、中枢神经系统和心血管系统毒性反应等阻滞相关不良反应。结论超声引导下ICBN阻滞可安全有效地改善行保留ICBN的乳腺癌根治术患者术后顽固性疼痛。     

男性乳腺癌术后放疗疗效分析

 目的探讨男性乳腺癌的临床特征、预后和术后放疗的疗效。方法对22例男性乳腺癌患者进行了随访分析。Ⅰ期3例,Ⅱ期6例,Ⅲ期13例。其中13例手术后未放疗,9例行术后放疗。设胸壁野和区域淋巴结野,每个野肿瘤剂量平均为50Gy左右。11例行辅助化疗。5例接受了内分泌治疗。结果经过72个月中位随访期,5年总生存率为70.1%,无瘤生存率为57.9%。其中IIB+III期患者的5年复发率,手术组为61.31%,术后放疗组为18.75%,差异有显著性意义(P=0.0319)。COX模型多因素分析,腋窝淋巴结转移为唯一的临床预后指标。结论男性乳腺癌术后放疗可减少局部区域的复发。腋窝淋巴结转移为唯一的临床预后指标。     

Ultrasonography of the chest wall

Ultrasonography of the chest wall has been used to aid in radiation therapy treatment planning. The sonogram reveals the lung surface and the sternum in relation to the skin surface. Tumor tissue tends to be more sonolucent than normal breast tissue. This technique has been used to detect post-mastectomy recurrent tumor.     

Low locoregional recurrence rates in patients treated after 2000 with doxorubicin based chemotherapy, modified radical mastectomy, and post-mastectomy radiation

Purpose

To determine the rate of locoregional recurrence (LRR) associated with modern tri-modality therapy.

Methods

We retrospectively reviewed data from 291 consecutive PMRT patients treated from 1999 to 2001. These patients were compared to an historical group of 313 patients treated from 1979 to 1988 who had fluoroscopic simulation and contour-generated 2D planning. 1999-2001 spans the adoption of CT simulators for breast radiation therapy and a comparison was made between patients simulated before and after the implementation of CT simulation. Five-year actuarial rates for LRR, distal metastasis (DM), and overall survival (OS) between the pre and post CT simulation cohorts were compared as well.

Results

Compared to a 2D planned historic control, the combined contemporary patients had improved outcomes at 5 years for all endpoints studied; LRR 3.0% vs. 11.5%, DM 29.2% vs. 39.2%, and OS 79.2% vs. 70.6% (p = 0.0004, 0.0052, 0.0012, respectively). Significant factors in a multivariate analysis for LRR were: advanced T-stage (RR = 2.14, CI = 1.11-4.11, p = 0.023), and percent positive nodes (RR = 1.01, CI = 1.00-1.02, p = 0.012). The comparison of the pre and post CT-simulated PMRT patients (1999-2001) found no significant difference in any endpoint.

Conclusions

The rate of locoregional control for PMRT patients treated with modern radiotherapy is outstanding and has improved significantly compared to historical controls.