Accelerated partial breast irradiation in early breast cancer: focus on intraoperative treatment with electrons (ELIOT)

Wide tumor resection plus postoperative whole breast irradiation is standard treatment for early breast cancer. Irradiation decreases recurrence rates, but may cause poor cosmesis, breast pain, and cardiac and lung toxicity. Accelerated partial breast irradiation is increasingly used in the hope of increasing convenience, decreasing sequelae and maintaining cure rates. Intraoperative radiotherapy with electrons is an attractive accelerated partial breast irradiation technique because collimator placement is under the direct control of the surgeon who removes the tumor, the skin is spared, shielding protects the chest wall and complete irradiation can be given in a single intraoperative session (avoiding 5-7 weeks of whole breast irradiation). Intraoperative radiotherapy with electrons seems as safe as whole breast irradiation; however, long-term results on local control and survival are not available yet.     

Synergism between radiation and other risk factors for breast cancer

The question of whether the risk of radiation-induced breast cancer is additive or multiplicative (synergistic) with other risk factors for breast cancer has important implications for determining optimal guidelines for mammographic screening. Data from a follow-up study of 571 women given X-ray therapy for acute postpartum mastitis in Rochester, New York, and 993 control women were analyzed to examine this question. No synergism was found between breast irradiation and family history of breast cancer, late parity, oral contraceptive use, menopausal hormone use, or a composite of ovarian-related factors. Results indicated that women with a history of breast irradiation who develop benign breast disease, particularly cystic disease, are at high risk for breast cancer and should be carefully monitored. Women who were irradiated at the time of their first childbirth are also at especially high risk for breast cancer.     

HER-2/neu与乳腺癌放射治疗后照射野内复发的相关性

目的　探讨HER - 2 /neu高表达与乳腺癌术后辅助放射治疗后放射野内复发的相关性。方法　回顾性分析 2 4例乳腺癌术后辅助放射治疗后放射野内复发的病例 (复发组 ) ,同时设对照组 4 8例 ,采用免疫组织化学的方法测定肿瘤组织的Cer-bB - 2表达情况 ,将 ++,+++定义为高表达 ,比较复发组和对照组的HER - 2 /neu高表达率。结果　复发组的Cer-bB - 2高表达率明显高于对照组 ,分别为 6 2 5 % (15 / 2 4 )和 18 7% (9/ 4 8) ,二者比较差异有显著意义 (P <0 0 0 1)。结论　本研究结果初步表明了HER - 2 /neu高表达与乳腺癌术后辅助放射治疗后复发的相关性 ;提示HER - 2 /neu高表达可能与乳腺癌细胞的放射抗拒有关。     

40例早期乳癌保乳术后放射治疗的临床观察

目的：观察早期乳腺癌保乳手术后放射治疗的疗效、美容效果及并发症。方法：对40例早期乳腺癌患者行保乳手术,术后联合放射治疗,采用全乳切线野照射50Gy／25Fx,后瘤床补量14or／7Fx。腋窝淋巴结阳性者,患侧锁骨上x线和电子线混合照射50G弘结果：随访12～62个月,1年生存率100％,3年生存率95％,5年生存率92．5％。近期美容效果患者自评满意度佳、良者92．5％。无局部复发。3例远处转移,3例放射性肺炎,9例急性放射性皮肤反应,无Ⅲ-Ⅳ度骨髓抑制。结论：放射治疗可使早期乳腺癌保乳患者术后获得满意的生存率和美容效果,提高了患者的生活质量。     

Evidence-based radiotherapy in the treatment of operable breast cancer: results in the 1990-ies

The aim of this study was to give information about the evidence based radiation oncology in the treatment of operable breast cancer for specialists involved in the national public health. It was performed a review of the English language clinical studies published in the nineties, in which specific radiotherapy questions of operable breast cancer were debated. Clinical studies were classified according to the level of obtained evidence: randomized study (level I.), cohort study (level II.), retrospective study (level III.) and meta-analysis (mathematical synthesis of results). 1. Findings of one large randomized study indicate that lumpectomy plus irradiation is more beneficial than lumpectomy alone for women with ductal carcinoma in situ. Findings are supported by retrospective studies. 2. There are four complete published randomized studies comparing the outcome of conservative surgery alone to that of conservative surgery plus radiation for patients with stage I-II. breast cancer. The local recurrence rate is unacceptably high when random patients are treated without radiotherapy. Meta-analysis of these studies conferred statistically significant survival advantages on women receiving irradiation. In one randomized clinical trial the delivery of a 10 Gy boost to the tumor bed after 50 Gy to the whole breast significantly reduces the risk of early local recurrence. Additional follow-up evaluation and more evidence will be required to define the indications for boost irradiation. In one randomized trial with unselected patients there was a significant superiority in local control for whole breast irradiation compared to partial breast irradiation, but interim results of prospective studies with carefully selected women appear promising. 3. Findings of three randomized controlled clinical trials indicate that postmastectomy radiotherapy reduces mortality from breast cancer by preventing locoregional recurrences in node positive patients. One study examined the effect of radiation on overall survival by meta-analysis of earlier published randomized studies and demonstrated the reduction of breast cancer deaths in irradiated patients. 4. The value of irradiation of parasternal lymph nodes is uncertain by retrospective studies and is currently being studied in a large European randomized trial. After an adequate axillary lymphadenectomy the incidence of axillary recurrence is low and there is no indication for irradiation. Results of two retrospective studies indicate that irradiation of supraclavicular lymph nodes is beneficial in patients with four or more positive axillary lymph nodes. In summary, thank to the intensive clinical research in radiotherapy, the irradiation of patients with operable breast cancer is based on level I. scientific evidences in the majority of the cases. Results of randomized controlled clinical trials and meta-analyses indicate that radiotherapy is more than locoregional control: breast cancer deaths are reduced among irradiated patients.     

超声检查在乳腺癌临床诊断的应用研究

目的：探讨超声检查在乳腺癌临床诊断的价值。方法：回顾分析某医院超声科检查提示为乳腺癌可能的36例患者,经手术切除或者活检取得手术病理,比较两者分析超声诊断乳腺癌的准确率。结果：36例超声检查提示乳腺癌的资料中,术后病理证实为乳腺癌为33例,纤维瘤3例,诊断符合率为91.7%,误诊率为8.3%。结论：超声检查对于乳腺癌的诊断符合率高,临床上具有实用价值。     

Malignant tumors associated with thyroid cancer in an autopsy material

In the Department of Pathology of Albert Szent-Gy?rgyi Medical University at Szeged in Hungary 37,504 autopsies were performed in the last 30 years and double multiple primary malignant tumours were found in 385 cases (4.2%). In thyroid cancer cases the tumours of other organs were more frequent (22.7%), and these tumour-associations were observed mainly simultaneously, there were no important sex differences. In the most of cases the thyroid cancer was only a side diagnosis beside other malignancies, in the more rare metachronous cases the thyroid cancer was secondary following postoperative irradiation of the first tumour (4 cases of 5). We have seen thyroid cancers most frequently together with lung, breast and digestive system tumours.     

Was Breast Conserving Surgery Underutilized for Early Stage Breast Cancer? Instrumental Variables Evidence for Stage II Patients from Iowa

Objective. To estimate the average survival effects of breast conserving surgery plus irradiation relative to mastectomy for marginal stage II breast cancer patients in Iowa from 1989–1994.
Data Sources/Data Setting. Secondary linked Iowa SEER Cancer Registry—Iowa Hospital Association discharge abstract data for women in Iowa with stage II breast cancer from 1989–1994.
Study Design. Observational instrumental variables (IV) analysis.
Data Collection/Extraction Methods. Women with stage II breast cancer from the Iowa SEER Cancer Registry 1989–1994 who received all of their inpatient care in Iowa were linked with their respective hospital discharge abstracts.
Principal Findings. Breast conserving surgery plus irradiation decreased survival relative to mastectomy for marginal stage II breast cancer patients in Iowa during the early 1990s. In this study marginal patients were those whose surgery choices were affected by differences in area treatment rates and access to radiation facilities.
Conclusions. If marginal patients are representative of patients whose treatment choices would be affected by changes in treatment rates, an increase in the breast conserving surgery plus irradiation rate for stage II early stage breast cancer patients would have decreased survival in Iowa during the early 1990s. Further research with newer data and broader samples is needed to make more current and specific assessments.     

乳腺癌根治术后放射治疗胸壁及腋窝的临床意义

目的研究乳腺癌根治术后放射治疗胸壁以及腋窝的临床价值。方法选取2010年1月—2011年4月入我院进行乳腺癌根治术后放射治疗患者118例,将其按照随机数字表分为甲组与乙组。甲乙两组均采用适行或传统放射治疗技术,甲组58例患者照射胸壁,乙组60例患者照射胸壁加锁腋野。两组患者照射剂量46-56GY,治疗时间为5-6周。在完成放射治疗后对比两组患者的生存率与复发率。结果乙组与甲组患者在接受放射治疗后近期总体缓解率不存在显著差异,无统计学意义,P〉0.05;甲组患者的生存率与复发率和乙组相比无显著差异,无统计学意义,P〉0.05。但乙组患者进行腋窝照射存在一定的副作用,降低了患者的生存质量。结论研究未得出乳腺癌根治术后采用适行或传统放射治疗照射胸壁或胸壁加锁腋野有利于提高局部控制率,降低复发率,但是照射胸壁加锁腋野存在一定的副作用,在实施时需要加以考虑。胸壁放射治疗的价值及术后放射治疗靶区的个体化确定需要更多的随机研究来证实。     

乳腺癌术后化疗患者生命质量现状及影响因素的研究

目的 了解乳腺癌术后化疗患者生命质量状况及其影响因素。方法 采用乳腺癌患者生命质量测定量表(Functional Assessment of Cancer Therapy-Breast,FACT-B),对徐州市153名乳腺癌术后化疗患者进行问卷调查,采用t检验、方差分析和多元线性回归分析方法探讨乳腺癌患者生命质量的影响因素。结果 乳腺癌术后化疗患者生命质量总分为(83.30±15.53)分。经单因素分析,不同年龄、体质指数(Body Mass Index,BMI)、化疗次数以及癌瘤是否有远处转移患者的生命质量比较,差异有统计学意义(P均＜0.05)。多重线性回归分析显示,癌瘤是否有远处转移、BMI、化疗次数对乳腺癌术后化疗患者生命质量影响最大。结论 乳腺癌术后化疗患者的生命质量较低,其影响因素是多方面的,应从临床干预、家庭关怀、社会支持等多方面提高患者的生命质量。     

乳腺癌术后放疗乳腺切线野的CT模拟定位研究

目的：通过对乳腺癌保乳术后根治性放疗CT模拟乳腺切线野定位技术的研究及与传统X线模拟机定位的比较,阐述CT模拟乳腺切线野定位技术的特点,讨论其临床应用价值。方法：以60例早期乳腺癌保乳术后根治性放疗的病例为研究对象,进行CT模拟乳腺切线野的定位,首先用头颈垫,进行体位固定,并做体表标记,然后用飞利浦CT模拟定位机进行定位,确定切线野等中心,最后做等中心体表标记。再用传统X线模拟机进行定位并作比较分析。结果：CT模拟乳腺癌保乳术后根治性放疗乳腺切线野的定位技术比较传统X线模拟机的定位,能观察所有的射束重叠的解剖学信息,能观察是否将靶区精确覆盖,从而提高布野和防护的精确性,有利于关键结构重要器官的保护,并缩短了定位时间,患者感觉更加舒适耐受。减少了医患压力,提高了工作效率和资源的利用率。结论：CT模拟技术的应用使得乳腺癌保乳术后根治性放疗乳腺切线野的定位更加精确,模拟计埘设计及剂量计算更加准确,并支持调强、加速部分乳腺照射及野中野等乳腺癌保乳术后根治性放疗新技术的临床应用,是提高放疗准确性和治疗效果的必要前提。     

托架坐高角度对乳腺癌锁上腋顶区放疗肺受量的影响

目的探讨乳腺托架坐高角度对乳腺癌术后锁上腋顶光子野照射肺受量的影响。方法选取广州医科大学附属肿瘤医院放疗科收治的12例Ⅱ^Ⅲ期女性乳腺癌改良根治术后放疗患者,将其CT定位图像传输至3D-TPS行锁上腋顶区垂直前切野设计,每例患者分别作50 Gy和26 Gy两种剂量模式,并对0°、10°、15°、20°、25°和30°六种乳腺托架坐高角度分别作不同计划。采用Spearman秩相关分析探讨乳腺托架坐高角度与锁上腋顶野肺受量的相关性。结果 Spearman秩相关分析显示,乳腺托架坐高角度与肺受照体积(V照)成正相关(r=0.841,p=0.000,具有统计学意义)。不论50 Gy或26 Gy照射,Spearman等级相关分析均发现,乳腺托架坐高角度与肺V5、V13、V20、V30、a V5、a V13、a V20、a V30均成正相关(均p=0.000,具有统计学意义)。结论乳腺癌术后锁上腋顶光子野的肺受量随乳腺托架坐高角度的增加而逐级加大;故锁上腋顶野设计应注意乳腺托架坐高角度与肺受量的关系,在不影响放疗设野的条件下应尽可能减少乳腺托架坐高角度。     

超声诊断在乳腺癌前哨淋巴结检查中的应用进展

乳腺癌疾病是当前发病率比较高的一种疾病,发病的人群也趋于年轻化。前哨淋巴结是原发肿瘤发生淋巴结转移所必经的第一批淋巴结,其可以作为阻止肿瘤细胞从淋巴道扩散的屏障,临床意义受到人们重视,腋窝淋巴结状态是衡量乳腺癌患者恢复情况的重要指标。随着当前乳腺癌手术方式的多样化,在处理乳腺癌患者腋窝淋巴结的相关问题过程中也有了新的认识。超声是当前临床上比较常见的用于检查乳腺癌前哨淋巴结的方法,本文针对其实际应用和研究情况进行综述,旨在为临床实践提供参考。     

Impact of axillary level I and II lymphnode dissection on the therapy of stage I and II breast cancer.

BACKGROUND: Routine performance of axillary node dissection (AND) in the treatment of stage I and II breast cancer has become controversial because of pretended morbidity of this procedure and progressing consent for sentinel lymphadenectomy. METHODS: Ninety-four consecutive patients who underwent AND for clinical stage I and II breast cancer were evaluated for a range of 48.3 months after surgery for movement and sensory alterations and arm swelling. Arm circumference was measured in all patients at the same four sites on both the operated and non operated sides preoperatively and in the immediate and late postoperative course. Capacity for movement was assessed pre- and postoperatively as active ranging at the shoulder joint. Postoperative numbness and paresthesias were assessed by standard questions. RESULTS: No patient had axillary recurrence. None of the detected differences between the preoperative and postoperative arm circumferences reached statistical significance. No persistent motion limitation was observed. Pain, numbness, paresthesia were detected in almost all patients in the immediate postoperative period but resolved spontaneously in all cases within 6 months. The obese body habit was detected on multivariate analysis as the only significant predictor of edema. CONCLUSIONS: No significant morbidity and no axillary recurrence were observed in current experience to follow AND. These findings suggest that axillary level I and II dissection remains an effective and safe tool for diagnostic, as well therapeutic, purposes in the treatment of stage I and II breast cancer. Further studies are necessary before it can safely be reported that axillary node dissection is an optional part of the treatment of stage I and II breast cancer.     

Radiotherapy and breast reconstruction: the issue of compatibility

BACKGROUND: Breast reconstruction after mastectomy represents an improvement in the quality of life of breast cancer patients. Radiotherapy is also suggested for many of them to prevent local relapse. However, irradiation increases the risk of complications require surgical procedures. PURPOSE: This study was undertaken to analyse the compatibility of breast reconstruction and irradiation in the treatment of breast cancer. METHODS: Computerised searches for publications debating this issue were done of MEDLINE data. Studies were grouped according to the techniques and types of reconstruction: reconstruction with silicone implant or autogenous skin-muscle flap, timing of reconstruction (immediate or delayed), and sequencing of treatments (pre- or post-reconstruction irradiation). The results of studies were assessed and compared in respect to reconstruction related chronic complications. RESULTS: The incidence of complications was significant even in the absence of irradiation, but radiotherapy increased the risk of complications to less or more extent. When reconstruction was done with implant, the most common type of complication was Grade III-IV capsular contracture. In patients subjected to immediate reconstruction, the complication rates with or without radiotherapy were from 0% to 64% and from 0% to 12%, respectively. In women who underwent delayed reconstruction, the incidence of complications with or without irradiation was from 22% to 55%, and from 17% to 34%, respectively. The negative effect of radiotherapy was more significant with immediate than with delayed reconstruction. In patients who underwent reconstruction with skin-muscle flaps, the most common type of complication was skin necrosis. The incidence of complications with or without radiotherapy was from 12% to 39% and from 5% to 25%, respectively. Cancer, developing after cosmetic augmentation mammaplasty in the breast, can be treated with lumpectomy and radiotherapy without removal of the implant. In series with this method of treatment the incidence of complications (mainly capsular contracture) was from 0% to 65%. The use of moderate dose (45-50 Gy), wedge filters, and no use of bolus application decreased the risk of complications. CONCLUSIONS: Radiotherapy and breast reconstruction are not incompatible, but careful consideration of their relative timing and technique is important. Plastic surgeons should counsel patients before starting their cancer disease treatment, and those who choose to have reconstruction need to be informed about risks for specific complications associated with the procedure. Results of the studies debating this issue are controversial. Longer follow-up time, larger patient material and better specified parameters are needed to validate results.     

Evaluation of the immunomodulatory activity of Aronia in combination with apple pectin in patients with breast cancer undergoing postoperative radiation therapy

The aim of the present study was to evaluate the immunomodulatory activity of Aronia in combination with apple pectin in patients with breast cancer in the course of postoperative radiation therapy. Monoclonal antibodies were used to assay specific T cell subsets. Tests were performed prior to and after 26 and 50 Gy of irradiation. The study comprised 42 women (19 to 65 years of age) receiving 15 g of apple pectin in combination with 20 ml of Aronia concentrate (Bioactive Substance Laboratory--Plovdiv) twice daily during postoperative irradiation. Irradiation was performed by a 60Co-Rokus according to individualized treatment schedules. The following T lymphocyte populations were tested--CD3 total T lymphocytes, CD4 helper and inducer T cells, CD8 suppressor and cytotoxic T cells and NK cells. The levels of the polypeptide tissue antigen (TPA), an oncofetal protein, were tested in parallel. The TPA was used to assess treatment outcome in our patients. A group of 25 age-matched women with breast cancer served as controls. Immune status analysis of controls was performed prior to and following postoperative radiation. A total of 880 serum samples were tested. Assays of immunity parameters in the patients receiving Aronia in combination with apple pectin showed that CD4 and CD8 T cell counts increased significantly (P < 0.01 and P < 0.05 respectively). In control patients CD3 T cell levels lowered, the other T cell levels remained unchanged. Initially the number of NK cells was increased in both groups of patients. It remained constant throughout the course of the study. The normal levels of TPA in both groups of patients indicated a good treatment outcome due to the adequacy of surgery and in combination with radiation therapy.     

Modern radiotherapy after breast-conserving surgery

In the last four decades breast-conserving surgery followed by whole breast irradiation has become the standard of care for the treatment of early-stage (0-I-II) breast carcinoma. With the advent of breast-screening, incidence of breast carcinomas with more favorable prognostic characteristics has increased significantly. This change in the prognostic profile of newly diagnosed breast cancers opened a new horizon for clinical research seeking for individual risk-adapted protocols of breast cancer radiotherapy. Several groups have been tested the efficacy of accelerated (partial or whole) breast irradiation, which has become the new treatment paradigm in the radiotherapy of early-stage breast cancers. Furthermore, others have attempted to identify subgroups of patients for whom radiotherapy after breast-conserving surgery could be safely omitted. Recently molecular gene expression assays have emerged as promising prognostic and predictive markers for local recurrence. This article reviews the results of these studies focusing on individual risk-adapted radiotherapy after breast-conserving surgery for patients with early-stage breast carcinoma.     

彩色多普勒超声在乳腺癌诊断中的应用

目的:探讨彩色多普勒超声在乳腺癌疾病诊断中的诊断价值.方法:65例术后病理检查证实的乳腺癌患者,回顾性分析彩色多普勒超声的血流显像资料和诊断情况.结果:彩色多普勒超声显示,乳腺患者肿块形态多样、边界不清、肿块呈不均质低回声等.65例患者中有63例(96.9%)确诊为乳腺癌患者,与术后证实诊断准确率(100%)比较,差异无显著性(P>0.05).结论:在乳腺癌患者诊断中,彩色多普勒超声准确率高、操作简便、价格便宜,值得在临床推广应用.     

女性乳腺癌患者血清PSA含量测定

目的：探讨女性性乳腺癌患者血清PSA(前列腺特异性抗原)的含量及其临床意义。方法：应用微粒子化学发光酶免疫技术测定正常对照组、良性对照组及乳腺癌患者术前术后血清PSA的含量。结果：女性乳腺癌患者术前血清PSA的含量明显高于对照组(P＜0．05)，而术后明显下降，良性对照组比较差异无显著意义(P＞0．05)。结论：检测女性乳腺肿瘤疾病患者血清PSA的含量，有助于乳腺癌的诊断及治疗观察。     

Management of a woman with a family history of breast cancer

Recent media publicity about breast cancer has caused concern for many women. Most women with a relative with breast cancer are not at substantially increased risk. NICE released revised guidelines in 2004 classifying women into risk groups. When a woman presents with concerns, it is important to take a full family history. For those that fit into a high-risk group, referral to tertiary care may be appropriate. Genetic testing of BRCA1 and BRCA2 may be offered in families where there is a living affected family member to test first and can be offered to unaffected individuals when there is Ashkenazi Jewish background. Breast management options for those at high risk include breast screening from a young age. MRI screening also appears to be useful. The efficacy of ovarian screening is being studied although it is known that prophylactic oophrectomy before menopause reduces the risk of both breast and ovarian cancer. Prophylactic mastectomy is also an option for these women. Genetic counselling and psychosocial support are important.