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https://www.readbyqxmd.com/read/28928852/dcis-margins-and-breast-conservation-md-anderson-cancer-center-multidisciplinary-practice-guidelines-and-outcomes
#1
REVIEW
Henry M Kuerer, Benjamin D Smith, Mariana Chavez-MacGregor, Constance Albarracin, Carlos H Barcenas, Lumarie Santiago, Mary E Edgerton, Gaiane M Rauch, Sharon H Giordano, Aysegul Sahin, Savitri Krishnamurthy, Wendy Woodward, Debasish Tripathy, Wei T Yang, Kelly K Hunt
Recent published guidelines suggest that adequate margins for DCIS should be ≥ 2 mm after breast conserving surgery followed by radiotherapy (RT). Many groups now use this guideline as an absolute indication for additional surgery. This article describes detailed multidisciplinary practices including extensive preoperative/intraoperative pathologic/histologic image-guided assessment of margins, offering some patients with small low/intermediate grade DCIS no RT, the use/magnitude of radiation boost tailoring to margin width, and endocrine therapy for ER-positive DCIS...
2017: Journal of Cancer
https://www.readbyqxmd.com/read/28927756/recent-time-trends-and-predictors-of-heart-dose-from-breast-radiation-therapy-in-a-large-quality-consortium-of-radiation-oncology-practices
#2
Lori J Pierce, Mary Feng, Kent A Griffith, Reshma Jagsi, Thomas Boike, Daniel Dryden, Gregory S Gustafson, Lisa Benedetti, Martha M Matuszak, Teamour S Nurushev, Joe Haywood, Jeffrey D Radawski, Corey Speers, Eleanor M Walker, James A Hayman, Jean M Moran
PURPOSE: Limited data exist regarding the range of heart doses received in routine practice with radiation therapy (RT) for breast cancer in the United States today and the potential effect of the continual assessment of the cardiac dose on practice patterns. METHODS AND MATERIALS: From 2012 to 2015, 4688 patients with breast cancer treated with whole breast RT at 20 sites participating in a state-wide consortium were enrolled into a registry. The importance of limiting the cardiac dose has been emphasized in the consortium since 2012, and the mean heart dose (MHD) has been reported by each institution since 2014...
July 22, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28918848/a-multi-institutional-analysis-of-intraoperative-radiotherapy-for-early-breast-cancer-does-age-matter
#3
A M Abbott, S A Valente, L Loftus, R D Tendulkar, J M Greif, K P Bethke, E D Donnelly, C Lottich, D L Ross, N B Friedman, C G Bedi, J E Joh, P Kelemen, R A Hoefer, S K Kang, J Ruffer, A Police, A Fyles, G M Graves, S C Willey, E A Tousimis, W Small, J Lyons, S Grobmyer, C Laronga
BACKGROUND: Single-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited. METHODS: A multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. RESULTS: We evaluated 686 patients (<70 = 424; ≥70 = 262) who were margin and lymph node negative...
October 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28894737/fmeca-application-to-intraoperative-electron-beam-radiotherapy-procedure-as-a-quality-method-to-prevent-and-reduce-patient-s-risk-in-conservative-surgery-for-breast-cancer
#4
Cristiana Vidali, Mara Severgnini, Monica Urbani, Licia Toscano, Alfredo Perulli, Marina Bortul
INTRODUCTION: Failure Mode Effects and Criticalities Analysis (FMECA) represents a prospective method for risk assessment in complex medical practices. Our objective was to describe the application of FMECA approach to intraoperative electron beam radiotherapy (IOERT), delivered using a mobile linear accelerator, for the treatment of early breast cancer as an anticipated boost. MATERIALS AND METHODS: A multidisciplinary Working Group, including several different professional profiles, was created before the beginning of clinical practice in 2012, with the purpose of writing the Flow Chart and applying the FMECA methodology to IOERT procedure...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28874627/iort-in-breast-cancer-our-experience-of-the-first-patients-treated
#5
Andrea Morlino, Giuseppe La Torre, Loredana Lapadula, Aldo Cammarota
AIM: The aim of this study was to assess the therapeutic effect of intraoperative radiotherapy, describe the method and examine the results of our experience. BACKGROUND: Breast conserving therapy has recently become a standard treatment modality in patients with early invasive cancer. Radiotherapy, along with surgery, is an integral part of such treatment. The important thing of radiotherapy is to deliver a high dose to the tumour bed. One of the methods is the intraoperative radiotherapy...
2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28854966/using-automated-texture-features-to-determine-the-probability-for-masking-of-a-tumor-on-mammography-but-not-ultrasound
#6
Lothar Häberle, Carolin C Hack, Katharina Heusinger, Florian Wagner, Sebastian M Jud, Michael Uder, Matthias W Beckmann, Rüdiger Schulz-Wendtland, Thomas Wittenberg, Peter A Fasching
BACKGROUND: Tumors in radiologically dense breast were overlooked on mammograms more often than tumors in low-density breasts. A fast reproducible and automated method of assessing percentage mammographic density (PMD) would be desirable to support decisions whether ultrasonography should be provided for women in addition to mammography in diagnostic mammography units. PMD assessment has still not been included in clinical routine work, as there are issues of interobserver variability and the procedure is quite time consuming...
August 30, 2017: European Journal of Medical Research
https://www.readbyqxmd.com/read/28841614/autologous-fat-grafting-as-a-novel-antiestrogen-vehicle-for-the-treatment-of-breast-cancer
#7
Scott Thomas, Stephanie Chen, Hani Sbitany, Edwin Kwon, Merisa Piper, Jeenah Park, Manuela Terranova Barberio, Nela Pawlowska, Pamela N Munster
BACKGROUND: Adipose fat transfer is increasingly used for contour corrections of the tumor bed after lumpectomy and breast reconstructions after mastectomy. The lipophilic nature of the fat tissue may render adipocytes an ideal vehicle with which to deliver a high boost of an antiestrogen to the tumor bed to serve as an adjunct systemic hormonal therapy. The authors therefore tested whether adipocytes could safely be loaded with an antiestrogen and allow for release at therapeutic concentrations to treat breast cancer...
September 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28838210/de-escalating-and-escalating-treatments-for-early-stage-breast-cancer-the-st-gallen-international-expert-consensus-conference-on-the-primary-therapy-of-early-breast-cancer-2017
#8
G Curigliano, H J Burstein, E P Winer, M Gnant, P Dubsky, S Loibl, M Colleoni, M M Regan, M Piccart-Gebhart, H-J Senn, B Thürlimann, F André, J Baselga, J Bergh, H Bonnefoi, S Y Brucker, F Cardoso, L Carey, E Ciruelos, J Cuzick, C Denkert, A Di Leo, B Ejlertsen, P Francis, V Galimberti, J Garber, B Gulluoglu, P Goodwin, N Harbeck, D F Hayes, C-S Huang, J Huober, K Hussein, J Jassem, Z Jiang, P Karlsson, M Morrow, R Orecchia, K C Osborne, O Pagani, A H Partridge, K Pritchard, J Ro, E J T Rutgers, F Sedlmayer, V Semiglazov, Z Shao, I Smith, M Toi, A Tutt, G Viale, T Watanabe, T J Whelan, B Xu
The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer...
August 1, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28834326/proposal-for-a-gold-standard-for-cosmetic-evaluation-after-breast-conserving-therapy-results-from-the-st-george-and-wollongong-breast-boost-trial
#9
Roya Merie, Lois Browne, Jaime S Cardoso, Maria J Cardoso, Yaw Chin, Catherine Clark, Peter Graham, Alison Szwajcer, Eric Hau
INTRODUCTION: Breast cosmesis is an important endpoint of breast conserving therapy (BCT), but a gold standard method of its evaluation is not yet established. The St. George and Wollongong Randomised Breast Boost trial used five different methods of cosmetic assessment, including both subjective and objective, to comprehensively evaluate the cosmetic outcome of the trial patients. This current study analyses the level of concordance between these methods in an attempt to determine a possible standard in the evaluation of breast cosmesis...
August 18, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/28827731/microrna-7641-is-a-regulator-of-ribosomal-proteins-and-a-promising-targeting-factor-to-improve-the-efficacy-of-cancer-therapy
#10
Abu Musa Md Talimur Reza, Yun-Jung Choi, Yu-Guo Yuan, Joydeep Das, Hideyo Yasuda, Jin-Hoi Kim
Many diseases, including myocardial infarction, autoimmune disease, viral diseases, neurodegenerative diseases, and cancers, are frequently diagnosed with aberrant expression of microRNAs (miRNAs) and their allied pathways. This indicates the crucial role of miRNAs in maintaining biological and physiological processes. miR-7641 is a miRNA whose role in disease has not been fully investigated. In the present study, we investigated the expression pattern of miR-7641 and its target genes in different cancer cells, as well as in clinical cancer patients...
August 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28814388/the-impact-of-poxvirus-vector-priming-protein-co-administration-and-vaccine-intervals-on-hiv-gp120-vaccine-elicited-antibody-magnitude-and-function-in-infant-macaques
#11
Bonnie Phillips, Genevieve G Fouda, Josh Eudailey, Justin Pollara, Alan D Curtis, Erika Kunz, Maria Dennis, Xiaoying Shen, Camden Bay, Michael Hudgens, David Pickup, S Munir Alam, Amir Ardeshir, Pamela A Kozlowski, Koen K A Van Rompay, Guido Ferrari, M Anthony Moody, Sallie Permar, Kristina De Paris
Despite success in reducing vertical HIV transmission by maternal antiretroviral therapy, several obstacles limit its efficacy during breastfeeding, and breast-milk transmission is now the dominant mode of mother-to-child transmission (MTCT) of HIV in infants. Thus, a pediatric vaccine is needed to eradicate oral HIV infections in newborns and infants. Utilizing the infant rhesus macaque model, we compared 3 different vaccine regimens: (i) HIV Env protein only; (ii) a poxvirus vector (MVA)-HIV Env prime/HIV Env protein boost, and (iii) co-administration of HIV Env protein and MVA-HIV Env at all time points...
August 16, 2017: Clinical and Vaccine Immunology: CVI
https://www.readbyqxmd.com/read/28797765/patterns-of-fractionation-and-boost-usage-in-adjuvant-external-beam-radiotherapy-for-ductal-carcinoma-in-situ-in-the-united-states
#12
William A Stokes, Arya Amini, Matthew W Jackson, S Reed Plimpton, Nicole Kounalakis, Peter Kabos, Rachel A Rabinovitch, Chad G Rusthoven, Christine M Fisher
BACKGROUND: While the roles of hypofractionated (HFxn) radiotherapy and lumpectomy boost in the adjuvant management of invasive breast cancer are supported by the results of clinical trials, randomized data supporting their use for ductal carcinoma in situ (DCIS) are forthcoming. We sought to evaluate current national trends and identify factors associated with HFxn and boost usage using the National Cancer Database. PATIENTS AND METHODS: We queried the National Cancer Database for women diagnosed with DCIS from 2004 to 2014 undergoing external beam radiotherapy after breast conservation surgery...
June 29, 2017: Clinical Breast Cancer
https://www.readbyqxmd.com/read/28794640/volumetric-modulated-arc-therapy-for-treatment-of-solid-tumors-current-insights
#13
REVIEW
Gabriella Macchia, Francesco Deodato, Savino Cilla, Silvia Cammelli, Alessandra Guido, Martina Ferioli, Giambattista Siepe, Vincenzo Valentini, Alessio Giuseppe Morganti, Gabriella Ferrandina
AIM: This article discusses the current use of volumetric modulated arc therapy (VMAT) techniques in clinical practice and reviews the available data from clinical outcome studies in different clinical settings. An overview of available literature about clinical outcomes with VMAT stereotactic/radiosurgical treatment is also reported. MATERIALS AND METHODS: All published manuscripts reporting the use of VMAT in a clinical setting from 2009 to November 2016 were identified...
2017: OncoTargets and Therapy
https://www.readbyqxmd.com/read/28776318/ten-year-results-of-accelerated-hypofractionated-adjuvant-whole-breast-radiation-with-concomitant-boost-to-the-lumpectomy-cavity-after-conserving-surgery-for-early-breast-cancer
#14
Domenico Cante, Edoardo Petrucci, Piera Sciacero, Cristina Piva, Silvia Ferrario, Silvia Bagnera, Sebastiano Patania, Guido Mondini, Massimo Pasquino, Valeria Casanova Borca, Giorgio Vellani, Maria Rosa La Porta, Pierfrancesco Franco
Accelerated hypofractionated whole-breast radiotherapy (WBRT) is considered a standard therapeutic option for early breast cancer (EBC) in the postoperative setting after breast conservation (BCS). A boost to the lumpectomy cavity may further increase local control. We herein report on the 10-year results of a series of EBC patients treated after BCS with hypofractionated WBRT with a concomitant photon boost to the surgical bed over 4 weeks. Between 2005 and 2007, 178 EBC patients were treated with a basic course of radiotherapy consisting of 45 Gy to the whole breast in 20 fractions (2...
September 2017: Medical Oncology
https://www.readbyqxmd.com/read/28766200/keynote-address-at-the-american-society-of-breast-surgeons-18th-annual-meeting-current-and-future-application-of-intraoperative-radiotherapy-iort-in-the-curative-and-palliative-treatment-of-breast-cancer
#15
Frederik Wenz
Intraoperative radiotherapy (IORT) is increasingly used worldwide. Breast cancer is the most rapidly growing indication for IORT, approaching 70-80% of cases in most centers. This report reviews the theoretical background and clinical use of IORT for primary and metastasized breast cancer. There are established applications such as tumor bed boost during breast-conserving surgery followed by whole breast radiotherapy or IORT as a form of accelerated partial-breast irradiation (APBI) for selected patients. Novel applications such as IORT for vertebral or brain metastases are presented as well as technological developments, widening the spectrum of potential clinical applications for IORT...
August 1, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/28756536/therapeutic-blockade-of-foxp3-in-experimental-breast-cancer-models
#16
Mariela A Moreno Ayala, María Florencia Gottardo, Mercedes Imsen, Antonela S Asad, Elisa Bal de Kier Joffé, Noelia Casares, Juan José Lasarte, Adriana Seilicovich, Marianela Candolfi
PURPOSE: Regulatory T cells (Tregs) impair the clinical benefit of cancer immunotherapy. To optimize the antitumor efficacy of therapeutic dendritic cell (DC) vaccines, we aimed to inhibit Foxp3, a transcription factor required for Treg function. METHODS: Mice bearing established syngeneic LM3 and 4T1 breast tumors were treated with antitumor DC vaccines and a synthetic peptide (P60) that has been shown to inhibit Foxp3. RESULTS: Treatment with P60 improved the therapeutic efficacy of DC vaccines in these experimental models...
July 29, 2017: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/28755327/comorbidities-and-intensity-modulated-radiotherapy-with-simultaneous-integrated-boost-in-elderly-breast-cancer-patients
#17
Alba Fiorentino, Rosario Mazzola, Niccolò Giaj Levra, Sergio Fersino, Francesco Ricchetti, Gioacchino Di Paola, Stefania Gori, Alberto Massocco, Filippo Alongi
PURPOSE: To evaluate the impact of comorbidity assessment on compliance to intensity modulated radiotherapy with simultaneous integrated boost (SIB-IMRT) in elderly patients affected by early stage breast cancer (BC). MATERIALS AND METHODS: 40 consecutive patients were treated with SIB-IMRT (50 Gy in 25 fractions to the whole breast, and simultaneously 60 Gy to the surgical bed) for invasive BC after conserving surgery. Inclusion criteria were: age ≥ 70 years, pT1-2 disease, pN0-1, no neoadjuvant chemotherapy, non-metastatic disease...
July 28, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28752645/effect-of-pumping-pressure-on-onset-of-lactation-after-caesarean-section-a-randomized-controlled-study
#18
Feng Zhang, Yahui Yang, Ting Bai, Lele Sun, Mingzhu Sun, Xueling Shi, Meng Zhu, Meijuan Ge, Haiou Xia
Caesarean section is associated with weaker newborn suction pressure. This nonblinded, randomized trial explored the effect of suction pressures generating by a breast pump on mothers' onset of lactation and milk supply after caesarean section. A high pressure group (-150 mmHg), a low pressure group (-100 mmHg), and a control group (none) were generated under computer random assignment with concealed allocation in 2 tertiary hospitals. The breast pumping began within 2 hr after caesarean operation (6 times a day and 30 min per time) until onset of lactation...
July 27, 2017: Maternal & Child Nutrition
https://www.readbyqxmd.com/read/28740908/preplanning-prediction-of-the-left-anterior-descending-artery-maximum-dose-based-on-patient-dosimetric-and-treatment-planning-parameters
#19
Benjamin T Cooper, Xiaochun Li, Samuel M Shin, Aram S Modrek, Howard C Hsu, J K DeWyngaert, Gabor Jozsef, Stella C Lymberis, Judith D Goldberg, Silvia C Formenti
PURPOSE: Maximum dose to the left anterior descending artery (LADmax) is an important physical constraint to reduce the risk of cardiovascular toxicity. We generated a simple algorithm to guide the positioning of the tangent fields to reliably maintain LADmax <10 Gy. METHODS AND MATERIALS: Dosimetric plans from 146 consecutive women treated prone to the left breast enrolled in prospective protocols of accelerated whole breast radiation therapy, with a concomitant daily boost to the tumor bed (40...
October 2016: Advances in Radiation Oncology
https://www.readbyqxmd.com/read/28740451/mri-reduces-variation-of-contouring-for-boost-clinical-target-volume-in-breast-cancer-patients-without-surgical-clips-in-the-tumour-bed
#20
Noora Al-Hammadi, Palmira Caparrotti, Saju Divakar, Mohamed Riyas, Suparna Halsnad Chandramouli, Rabih Hammoud, Jillian Hayes, Maeve Mc Garry, Satheesh Prasad Paloor, Primoz Petric
BACKGROUND: Omitting the placement of clips inside tumour bed during breast cancer surgery poses a challenge for delineation of lumpectomy cavity clinical target volume (CTVLC). We aimed to quantify inter-observer variation and accuracy for CT- and MRI-based segmentation of CTVLC in patients without clips. PATIENTS AND METHODS: CT- and MRI-simulator images of 12 breast cancer patients, treated by breast conserving surgery and radiotherapy, were included in this study...
June 2017: Radiology and Oncology
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