Axillary vein thrombosis as the first clinical manifestation of inflammatory breast cancer: report of a case

Inflammatory breast cancer is a rare and aggressive form of breast cancer. Venous thromboembolism is often related to cancer conditions but this report presents a case in which the thromboembolic event predicted the diagnosis of cancer. A 48-year-old female was admitted with the evidence of acute right axillary vein thrombosis. There was also erythema and edema of the skin of the right breast. Further evidence revealed a case of inflammatory breast cancer. The patient underwent anticoagulant therapy, and neoadjuvant systemic chemotherapy was initiated. The patient underwent extensive unilateral mastectomy following neoadjuvant chemotherapy. Follow-up (after 2 months of anticoagulation therapy for deep vein thrombosis) revealed recanalization of the right axillary vein, without evidence of residual thrombus. A case of acute vein thrombosis as the first manifestation of breast cancer may delay the diagnosis and subsequent appropriate treatment.     

Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap

Background: The management of stage III breast cancer is challenging; it often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate transverse rectus abdominis musculocutaneous (TRAM) flap in 21 patients treated for stage III breast cancer. Methods: Data have been collected retrospectively on 21 patients diagnosed with stage III breast cancer between 1987 and 1994. All patients had mastectomy and immediate TRAM reconstruction. Thirteen patients received primary systemic therapy, 10 patients received postoperative consolidation radiotherapy to the operative site, and 3 patients received preoperative radiation. Results: Mean follow-up for the group was 26 months. Two patients died with disseminated disease: neither of them developed local disease recurrence in the operative site; 82% of the patients followed for at least two years are free of disease. Sixty-two percent of the patients received preoperative chemotherapy, the remaining patients received postoperative multiagent chemotherapy and/or radiation therapy. Two of the patients received autologous bone marrow transplants after their adjuvant therapy. Ten patients had postoperative radiotherapy for consolidation; three patients received preoperative radiation. Conclusions: Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of local relapse. It facilitates wide resection of involved skin without skin grafting. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of stage III breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.Results of this study were presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

Acute Toxicity of High-Dose-Rate Intracavitary Brachytherapy With the MammoSite Applicator in Patients With Early-Stage Breast Cancer

Background: Intracavitary brachytherapy with the MammoSite applicator as the sole radiation treatment in breast-conserving therapy is an option for women with early-stage breast cancer; we evaluated the acute toxicities associated with this treatment method.Methods: Thirty-one patients with 32 stage I or II breast carcinomas underwent breast-conserving therapy, which included lumpectomy with negative margins, sentinel node biopsy, or axillary dissection, followed by brachytherapy with the MammoSite applicator. Acute radiation skin complications were graded on the day of radiotherapy completion and at weeks 2, 4, 6, and 12 after radiation treatment. Cosmesis was graded on the Harvard Scale at all follow-ups.Results: The median follow-up was 11 months (range, 4–15 months). Twenty-seven of the 31 patients were treated with the device as the sole method of radiotherapy. No acute toxicities occurred during the 5 days of treatment. Nineteen patients (68%) had no to mild acute skin reactions, and 25% developed bright erythema and patchy moist desquamation. Two patients (7%) developed confluent moist desquamation within the first 4 weeks (grade 3); this healed by week 12. All skin reactions were localized to the area overlying the balloon. Sixteen percent (5 of 32) of all breasts with implants developed infection. Cosmesis was good to excellent in 86% of cases.Conclusions: Most acute skin toxicities were mild. Our infection rate was higher than in prior studies that used interstitial brachytherapy. Cosmesis was good to excellent in most patients. Breast brachytherapy with the MammoSite catheter was well tolerated; further investigations of breast brachytherapy with this system are warranted.     

A case of post-radiation therapy patient with difficulty in intubation unexpected preoperatively

We experienced a post-radiation therapy patient who had a narrow trachea, and presented with unexpected difficulty for intubation. His trachea was narrowest at 2 cm below the glottis. The fiberscope barely could pass the narrowest part of the trachea. We speculate that the radiation therapy induced his tracheal constriction. Careful attention is necessary when examining the post-radiation therapy patients. Multiple cervical radiographs are necessary in such a case.     

背阔肌肌皮瓣修复新辅助化疗后局部晚期乳腺癌组织缺损的疗效观察

目的:探讨我科12例局部晚期伴有皮肤侵犯导致溃疡形成的乳腺癌患者,术前行新辅助化疗后行改良根治术,即刻应用背阔肌肌皮瓣即时修复组织缺损的疗效观察。方法:12例患者均于术前行4~6周期新辅助化疗TEC方案,后达到临床部分缓解(PR)、创面缩小后,行乳腺癌改良根治术、即刻背阔肌肌皮瓣转移修复胸壁组织缺损。结果:12例患者手术均成功,接受新辅助化疗和术后放疗。随访l0~24个月,术后远处转移l例,无局部复发和死亡病例。结论:局部晚期乳腺癌新辅助化疗后,应用背阔肌肌皮瓣转移至胸壁修复组织缺损切实可行。     

Prospective evaluation of concomitant tumour bed boost with whole breast irradiation in patients with locally advanced breast cancer undergoing breast-conserving therapy

BACKGROUND AND PURPOSE: To evaluate prospectively the feasibility of concomitant weekly tumour bed electron boost along with whole breast radiotherapy (RT) following breast-conserving therapy (BCT) in patients with locally advanced breast cancer (LABC) with the aim of reducing overall treatment time. MATERIALS AND METHODS: Thirty patients with LABC suitable for BCT following neoadjuvant chemotherapy (CAF/CEF) were accrued in the study. Conventional RT (CRT) to the whole breast was delivered 5 days a week to a dose of 50Gy using 6-10MV photons. In addition, an electron boost to the tumour bed was delivered every Saturday, eventually delivering 5 such weekly fractions to a boost dose of 12.5Gy. Patients were evaluated for acute reactions during the treatment and cosmetic evaluation was done before, at the end of radiation therapy and at follow up by 2 independent observers blinded to each other. The study population (concomitant boost (CB) group) was compared with a similar cohort of 32 patients treated conventionally with tumour bed boost of 15Gy in 6 fractions delivered after the completion of whole breast irradiation (CRT group). RESULTS: All patients completed RT within the stipulated time with no grade IV skin toxicity in either group. At conclusion of RT, in the CB group, confluent moist desquamation (grade III) developed within the tumour bed region in 1 patient (3.3%) and outside tumour bed region in 3 patients (10%). In the CRT group, 3 and 4 patients (9.4% and 12%) developed moist desquamation within and outside the tumour bed regions, respectively. CB did not affect the global cosmesis as compared with CRT group (p=0.23) at the end of 3 years. CONCLUSION: Concomitant tumour bed boost along with whole breast RT appears to be safe and feasible in a select group of patients. As the treatment is completed earlier by 6-10 days than conventional practice, it has favourable time and resource implications, particularly attractive for patients travelling long distances for treatment. Based on these encouraging results, we are planning to confirm the results in an appropriately designed and powered randomised trial.     

Effect of intravenous hyperalimentation on established delayed hypersensitivity in the cancer patient.

Forty-seven cancer patients were selected for study based on their candidacy for hyperalimentation. Each patient received selected skin test antigens intradermally in the forearm prior to the initiation of hyperalimentation, and at 7-day intervals throughout treatment with either chemotherapy, radiation therapy or surgery. Of 23 patients who received chemotherapy, 17 initially had negative skin tests. Thirteen of these patients had positive skin tests after an average of 11.4 +/- 5.5 days of hyperalimentation. Response to chemotherapy occurred only in hyperalimentation. Response to chemotherapy occurred only in those patients whose skin tests were positive, and conversion of skin test reactivity to positive occurred before clinical regression of metastatic disease. No patient who received radiation therapy developed or retained positive skin test reactivity, although nutritional repletion was considered satisfactory in each patient. Surgical patients whose skin tests converted to positive or remained positive preoperatively had an uncomplicated postoperative recovery, whereas 2 of 4 patients whose skin tests remained negative expired postoperatively. Absence of established delayed hypersensitivity in the cancer patient who is treated with chemotherapy or surgery is probably secondary to generalized malnutrition, and established cell-mediated immunity can be restored by proper nutritional repletion.     

应用邻近扩张皮瓣修复T4期局部晚期乳腺癌术中大面积软组织缺损的临床研究

目的在皮肤累及较大的局部晚期乳腺癌根治术中应用邻近扩张皮瓣修复胸壁大面积缺损,减少术后并发症,降低局部复发率。方法 64例新辅助化疗完全缓解(complete remission,CR)、部分缓解(partial remission,PR)的患者,在新辅助化疗同期行患侧乳房周围皮下扩张器置入术,并持续液压扩张皮肤至化疗结束,行乳腺癌根治术同期取扩张器,推进扩张皮瓣修复创面。37例同期游离植皮修复患者为对照组。结果 64例采用扩张皮瓣的患者术后伤口全部一期愈合,术后放疗未出现皮肤放射性溃疡,随访3年局部复发率明显低于游离植皮组。结论对于新辅助化疗有效的T4期乳腺癌患者,根治术中应用邻近扩张皮瓣修复可减少皮瓣坏死和放射性溃疡的发生,降低局部复发率。     

Eribulin combined with radiation therapy in a young patient re-irradiated for a new lesion of breast cancer

Eribulin is widely used in the treatment of metastatic breast cancer, with a manageable toxicity profile. This aggressive disease often requires systemic and local treatments, comprising surgery or radiotherapy. However, eribulin is usually discontinued during radiation therapy due to the lack of data concerning the safety of this combination, especially in the setting of repeat locoregional radiation therapy. Our patient was diagnosed with ER positive invasive ductal carcinoma of the left breast initially treated by surgery, radiation therapy, chemotherapy, and hormone therapy. She then received various lines of chemotherapy for multiple triple-negative relapses in the left axillary region. Since October 2020, she has been treated by eribulin. In order to improve local control, it was decided to add local radiation therapy to the region of recurrence in addition to systemic therapy. She underwent radiation therapy concomitantly with eribulin from February to March 2021. Treatment was very well tolerated, and no acute toxicity was reported. This is the first published case of repeat locoregional radiation therapy in combination with eribulin.     

A Case of a Bilateral Inflammatory Breast Cancer: A Case Report

Cases of bilateral inflammatory breast cancer (IBC) are extremely rare. Our search criteria only found one other record of metachronous bilateral IBC (1). We present the case of a patient who was treated for IBC with neoadjuvant chemotherapy, modified radical mastectomy (MRM), and whole breast radiation. Less than 1 year later, the patient had a recurrence of IBC on the left chest wall with in the radiated field, as well as a new IBC on the contralateral side. Bilateral IBC is extremely rare. This entity can present challenges for the standard treatment of IBC with neoadjuvant chemotherapy, MRM, and whole breast radiation (2). Our case study shows the importance of scheduled routine imaging, screening with physical examination after IBC management, and good patient compliance in this aggressive disease (3).     

Radiation-induced angiosarcoma after mastectomy and TRAM flap breast reconstruction

Radiation-induced angiosarcoma of the breast is being reported with increasing frequency as a result of the increased use of radiation therapy in conjunction with breast conservation surgery. However, this entity has not been well documented in patients undergoing mastectomy. The authors present a case of angiosarcoma occurring in a patient 6 years after undergoing mastectomy for invasive duct carcinoma with immediate transverse rectus abdominis musculocutaneous flap reconstruction followed by postoperative radiation therapy. The diagnosis of angiosarcoma was made by skin biopsy performed by the patient's reconstructive surgeon on routine follow-up examination. This is the first reported case of postradiation angiosarcoma occurring in a postmastectomy breast reconstructed with autogenous tissue and it is unusual in that the cancer invaded the musculocutaneous flap. Diagnosis and management recommendations for radiation-induced angiosarcoma are discussed.     

Acute typhlitis associated with taxane-based chemotherapy

A rare case of acute typhlitis is reported. The patient had undergone chemotherapy for a breast cancer. Clinical and diagnostic tools as well as general and topical care are examined.     

经导管动脉栓塞治疗局部晚期乳腺癌伴皮肤破溃

目的 观察经导管动脉栓塞（TAE）用于改善经常规化学治疗（化疗）无效的局部晚期乳腺癌伴皮肤破溃的效果。方法 10例晚期乳腺癌经常规化疗及系统靶向治疗均无效,肿瘤增大伴皮肤破溃,伴恶臭、渗液、出血及感染等;于DSA引导下对其行TAE栓塞肿瘤供血动脉,术后观察症状改善情况。结果 10例均成功栓塞肿瘤供血动脉,技术成功率100%;术后均未出现栓塞相关皮肤坏死及神经损伤。术后7天皮肤症状均明显改善;术后30天9例皮肤破损面积减小、1例皮肤破溃加重;术后2个月内6例、术后3个月内10例皮肤破损面积增大并症状复发。结论 TAE用于治疗伴皮肤破溃的局部晚期乳腺癌能在短期内显著改善症状,但中长期效果有限。     

A patient with occult breast cancer presenting with an axillary lymph node metastasis and a synchronous contralateral breast cancer

Detection of a breast mass accompanied by a contralateral axillary lymphadenopathy presents a dilemma because of the possible presence of an occult breast cancer on the same side as the axillary lymphadenopathy. A patient presented with an axillary lymphadenopathy from an occult breast cancer and a synchronous contralateral breast cancer, for which the differential diagnosis was established through a significant difference in estrogen and progesterone receptor levels. The patient was treated with neoadjuvant chemotherapy followed by bilateral modified radical mastectomy, adjuvant chemotherapy, and adjuvant radiation therapy. She is alive and free of disease 1.5 years after the diagnosis.     

Effective Local Control and Long-Term Survival in Patients with T4 Locally Advanced Breast Cancer Treated with Breast Conservation Therapy

Background: The presence of skin involvement has been accepted as a relative contraindication to breast preservation because it is believed to be associated with an increased local failure rate. This study was conducted to assess the outcome of a carefully selected group of patients who presented with breast cancer involving the skin and who had breast conservation therapy (BCT) following neoadjuvant chemotherapy.Methods: Between 1987 and 1999, 33 patients with stage IIIB or IIIC breast cancer completed treatment consisting of four cycles of neoadjuvant chemotherapy, lumpectomy, radiation therapy, and consolidative chemotherapy. Clinicopathologic factors were analyzed and patients were followed for locoregional and distant recurrence.Results: Initial median tumor size was 7 cm. All patients had skin involvement, defined as erythema, skin edema, direct skin invasion, ulceration, or peau dorange. Following chemotherapy, median pathologic tumor size was 2 cm. Complete resolution of skin changes occurred in 29 patients (88%). At median follow-up time of 91 months in surviving patients, 26 patients (79%) were alive without evidence of disease. The 5-year, disease-free survival rate was 70%, and the 5-year overall survival rate was 78%. The actuarial ipsilateral breast cancer recurrence rate was 6% at 5 years.Conclusions: Patients who present with T4 breast cancer who experience tumor shrinkage and resolution of skin changes with neoadjuvant chemotherapy represent a select group of patients who can have BCT. These patients have favorable rates of long-term local control and survival. Mastectomy is not mandatory for all patients with breast cancer who present with skin involvement.Presented at the 57^th Annual Society for Surgical Oncology Cancer Symposium in New York City, New York, March 18–21, 2004     

The Use of Buflomedil in Reduction Mammaplasty for a Previously Irradiated Breast: A Case Report

In recent years, lumpectomy combined with breast irradiation and chemotherapy, as a part of conservation therapy for breast cancer, has well-established results. Little has been published on reduction mammoplasty for breast-irradiated patients. These patients have increased risks of nipple necrosis, wound complications, and delayed healing. Breast reduction techniques that rely on minimum skin undermining combined with the use of buflomedil may prevent major postoperative complications in breast-irradiated patients. Buflomedil was administered intraoperatively and for 14 days after the procedure. The use of buflomedil in reduction mammaplasty for a previously irradiated breast patient has not been heretofore described. The case of a 58-year-old woman who underwent bilateral breast reduction after breast conservation therapy is reported.     

Post-radiation Atypical Vascular Lesion/Angiosarcoma Arising in the Larynx

Atypical vascular lesions (AVL) and angiosarcomas (AS) are lesions known to arise after radiation therapy. These lesions can show overlap in both their gross and histologic pictures, and distinction between the two can be extremely challenging at times. They are known most commonly to arise in the breast region after radiation therapy. We present the first unique case of post-radiation AVL/AS arising in the larynx of a 51 year old woman, occurring 8 years after she received radiation for tonsillar squamous cell carcinoma.     

Radiotherapy-related axillary arteriopathy

Treatment of breast cancer involves surgery, then perhaps radiation, hormonal or chemotherapy. Radiation-induced arterial injury is a well-known entity that represents a rare cause of arterial occlusion. We present the case of a 76-year old woman who complained of a severe intermittent claudication of the right upper limb. Twenty years before, she underwent a right-sided radical mastectomy followed by intense radiation therapy for several weeks. The patient was found to suffer of a radiotherapy-related axillary artery thrombosis and was successfully treated by angioplasty and stenting.     

Impact of radiation dose on complications among women with breast cancer who underwent breast reconstruction and post-mastectomy radiotherapy: A multi-institutional validation study

PurposeEmerging data suggest that higher radiation doses in post-mastectomy radiotherapy may be associated with an increased risk of reconstruction complications. This study aimed to validate previous findings regarding the impact of radiation dose on complications among women with breast cancer using a multi-center dataset.MethodsFifteen institutions participated, and women with breast cancer who received radiotherapy after either autologous or prosthetic breast reconstruction were included. The primary endpoint was major post-radiation therapy complications requiring re-operation for explantation, flap failure, or bleeding control.ResultsIn total, 314 patients were included. Radiotherapy was performed using both conventional fractionation and hypofractionation in various schedules. The range of the radiation therapy dose in Equivalent Dose in 2 Gy fractions (EQD2; α/β = 3.5) varied from 43.4 to 71.0 Gy (median dose: 48.6 Gy). Boost radiation therapy was administered to 49 patients. Major post-radiation therapy complications were observed in 24 (7.6%) patients. In multivariate analysis, an increasing EQD2 per Gy (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.26–1.98; p < 0.001), current smoking status (OR: 25.48, 95% CI: 1.56–415.65; p = 0.023), and prosthetic breast reconstruction (OR: 9.28, 95% CI: 1.84–46.70; p = 0.007) were independently associated with an increased risk of major complications.ConclusionA dose-response relationship between radiation dose and the risk of complications was validated in this multi-center dataset. In this context, we hypothesize that the use of hypofractionated radiotherapy (40 Gy in 15 fractions) may improve breast reconstruction outcomes. Our multi-center prospective observational study (NCT03523078) is underway to further validate this hypothesis.     

Postirradiation malignant fibrous histiocytoma following mastectomy in breast cancer

A case is reported of a patient who developed a histological unusual sarcoma in the chest wall 5.3 years after postoperative radiation therapy (5,000 rads) for breast cancer. This sarcoma showed microscopic features of malignant fibrous histiocytoma (MFH). A review of the literature disclosed 16 other cases in which MFH developed under similar circumstances. An analysis of these 16 cases and the case reported here showed that the mean radiation dose was 5,623 rads, that the time period between irradiation and the development of MFH ranged from 2 to 27 years and that wide resection offered better prognosis than chemotherapy.