Introduction: Symptomatic calcifications of the breast or skin after breast cancer surgery and adjuvant radiotherapy are a rare entity, with only a few case reports published worldwide, reducing the patient's quality of life, whilst asymptomatic calcifications are a common finding on imaging methods. Case presentation: Herein, we present a rare case report of calcifications after mastectomy and post-mastectomy radiation therapy causing chronic inflammation with ulceration and fistula formation, with a two-step surgical approach consisting of excision with linear suture and excision with the reconstruction using a thoraco-epigastric flap. Conclusions: To our knowledge, this is the first publication proving the feasibility of this therapy in patients with symptomatic dystrophic calcifications of the skin or the breast. Moreover, the article provides an up-to-date review of published studies about symptomatic calcifications after breast cancer surgery and radiotherapy with a focus on the time of the clinical manifestation from the radiotherapy and the used radiotherapy scheme.
- MeSH
- adjuvantní radioterapie MeSH
- kalcinóza * etiologie chirurgie MeSH
- kvalita života MeSH
- lidé MeSH
- mamoplastika * metody MeSH
- mastektomie škodlivé účinky metody MeSH
- nádory prsu * radioterapie chirurgie MeSH
- prsy chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
BACKGROUND: Accelerated partial breast irradiation (APBI) is an alternative breast-conserving therapy approach where radiation is delivered in less time compared to whole breast irradiation (WBI), resulting in improved patient convenience, less toxicity, and cost savings. This prospective randomized study compares the external beam APBI with commonly used moderate hypofractionated WBI in terms of feasibility, safety, tolerance, and cosmetic effects. METHODS: Early breast cancer patients after partial mastectomy were equally randomized into two arms- external APBI and moderate hypofractionated WBI. External beam technique using available technical innovations commonly used in targeted hypofractionated radiotherapy to minimize irradiated volumes was used (cone beam computed tomography navigation to clips in the tumor bed, deep inspiration breath hold technique, volumetric modulated arc therapy dose application, using flattening filter free beams and the six degrees of freedom robotic treatment couch). Cosmetics results and toxicity were evaluated using questionnaires, CTCAE criteria, and photo documentation. RESULTS: The analysis of 84 patients with a median age of 64 years showed significantly fewer acute adverse events in the APBI arm regarding skin reactions, local and general symptoms during a median follow-up of 37 months (range 21-45 months). A significant difference in favor of the APBI arm in grade ≥ 2 late skin toxicity was observed (p = 0.026). Late toxicity in the breast area (deformation, edema, fibrosis, and pain), affecting the quality of life and cosmetic effect, occurred in 61% and 17% of patients in WBI and APBI arms, respectively. The cosmetic effect was more favorable in the APBI arm, especially 6 to 12 months after the radiotherapy. CONCLUSION: External APBI demonstrated better feasibility and less toxicity than the standard regimen in the adjuvant setting for treating early breast cancer patients. The presented study confirmed the level of evidence for establishing the external APBI in daily clinical practice. TRIAL REGISTRATION: NCT06007118.
- MeSH
- kojenec MeSH
- kombinovaná terapie MeSH
- kvalita života MeSH
- lidé MeSH
- mastektomie MeSH
- nádory prsu * radioterapie chirurgie patologie MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- segmentální mastektomie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Klíčová slova
- trastuzumab, pertuzumab, pembrolizumab, studie FeDeriCa, studie PHeanceSCa, studie KEYNOTE-522,
- MeSH
- antitumorózní látky farmakologie terapeutické užití MeSH
- doba přežití bez progrese choroby MeSH
- klinická studie jako téma MeSH
- kombinovaná protilátková terapie farmakologie terapeutické užití MeSH
- lidé MeSH
- nádory prsu * chirurgie diagnóza farmakoterapie radioterapie MeSH
- neoadjuvantní terapie * metody MeSH
- patologická kompletní odpověď MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
Standardem léčby časných stadií karcinomu prsu je prs šetřící chirurgická léčba, kombinovaná s perioperační léčbou systémovou a pooperační radioterapií. Mastektomie se nadále provádí u pacientek, kterým nelze záchovnou operaci z léčebného či kosmetického hlediska doporučit. Jedná se často o lokálně či regionálně pokročilá onemocnění, kde po mastektomii prakticky vždy následuje adjuvantní radioterapie. S rekonstrukcí prsu po mastektomii se setkáváme stále častěji a tento trend bude dále narůstat i v budoucnosti. S pokroky v medicíně dochází k rozvoji jak chirurgických postupů samotné rekonstrukce, tak i technických možností radioterapie. Otázka správné kombinace a načasování rekonstrukce a adjuvantní radioterapie nadále vyvolává četné otázky, na které se snaží odpovědět následující přehledový článek.
Breast-conserving surgical treatment combined with perioperative systemic therapy and postoperative radiotherapy is the standard treatment for early-stage breast carcinoma. Mastectomy continues to be performed in patients in whom breast-conserving surgery cannot be recommended for therapeutic or cosmetic reasons. They often have locally or regionally advanced disease in which mastectomy is virtually always followed by adjuvant radiotherapy. Breast reconstruction following mastectomy is increasingly encountered, and this trend will continue to grow in the future. With advances in medicine, there has been progress in both the surgical procedures used in reconstruction and the technical aspects of radiotherapy. The issue of correct combination and timing of reconstruction and adjuvant radiotherapy continues to raise numerous questions which the present review article attempts to address.
- MeSH
- adjuvantní radioterapie MeSH
- celková dávka radioterapie MeSH
- klinické rozhodování MeSH
- lidé MeSH
- mamoplastika * klasifikace metody škodlivé účinky MeSH
- mastektomie MeSH
- nádory prsu chirurgie radioterapie MeSH
- radioterapie * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- ozařovací fixační podprsenka,
- MeSH
- fixace tkání * metody MeSH
- kožní manifestace MeSH
- lidé MeSH
- nádory prsu radioterapie MeSH
- pronační poloha fyziologie MeSH
- prsy * anatomie a histologie účinky záření MeSH
- radioterapie přístrojové vybavení škodlivé účinky MeSH
- zdravotnické prostředky MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
BACKGROUND: Radiation-induced secondary breast cancer (BC) may be a concern after radiation therapy (RT) for primary breast cancer (PBC), especially in young patients with germline (g)BRCA-associated BC who already have high contralateral BC (CBC) risk and potentially increased genetic susceptibility to radiation. We sought to investigate whether adjuvant RT for PBC increases the risk of CBC in patients with gBRCA1/2-associated BC. METHODS: The gBRCA1/2 pathogenic variant carriers diagnosed with PBC were selected from the prospective International BRCA1/2 Carrier Cohort Study. We used multivariable Cox proportional hazards models to investigate the association between RT (yes vs no) and CBC risk. We further stratified for BRCA status and age at PBC diagnosis (<40 and >40 years). Statistical significance tests were 2-sided. RESULTS: Of 3602 eligible patients, 2297 (64%) received adjuvant RT. Median follow-up was 9.6 years. The RT group had more patients with stage III PBC than the non-RT group (15% vs 3%, P < .001), received chemotherapy more often (81% vs 70%, P < .001), and received endocrine therapy more often (50% vs 35%, P < .001). The RT group had an increased CBC risk compared with the non-RT group (adjusted hazard ratio [HR] = 1.44; 95% confidence interval [CI] = 1.12 to 1.86). Statistical significance was observed in gBRCA2 (HR = 1.77; 95% CI = 1.13 to 2.77) but not in gBRCA1 pathogenic variant carriers (HR = 1.29; 95% CI = 0.93 to 1.77; P = .39 for interaction). In the combined gBRCA1/2 group, patients irradiated when they were younger than or older than 40 years of age at PBC diagnosis showed similar risks (HR = 1.38; 95% CI = 0.93 to 2.04 and HR = 1.56; 95% CI = 1.11 to 2.19, respectively). CONCLUSIONS: RT regimens minimizing contralateral breast dose should be considered in gBRCA1/2 pathogenic variant carriers.
- MeSH
- kohortové studie MeSH
- lidé MeSH
- nádory prsu * genetika radioterapie farmakoterapie MeSH
- prospektivní studie MeSH
- protein BRCA1 genetika MeSH
- protein BRCA2 genetika MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Primární synchronně zjištěný bilaterální karcinom prsu (PSBBC) je relativně vzácná klinická entita. Adjuvantní radioterapie je standardní součástí léčby nepokročilého nádoru prsu. Přestože je tato léčba nenahraditelná, je zatížena nežádoucími účinky, které u části pacientek mohou vést k neakceptovatelnému zvýšení kardiovaskulárního rizika a rizika rozvoje sekundární malignity. Kardiovaskulární komplikace prokazatelně snižují přežití pacientek s karcinomem prsu, a proto je nutná snaha o co největší redukci dávek na srdce a srdeční struktury. Protonová radioterapie, díky svým dozimetrickým výhodám, přináší možnost snížení dávky na rizikové orgány a současně umožňuje zachovat optimální pokrytí cílového objemu. Tato výhoda stoupá se zvětšujícím se rozsahem a rostoucí náročností cílového objemu, mezi které synchronně zjištěný bilaterální karcinom prsu jednoznačně patří.
Primary synchronously detected bilateral breast cancer (PSBBC) is a relatively rare clinical entity. The adjuvant radiotherapy is a standard part of non-metastatic breast cancer treatment. Despite the fact that this treatment is irreplaceable, it bears the burden of side effects, which may lead to an unacceptable increase of cardiovascular risk and risk of developing secondary malignancy in some patients. Cardiovascular complications have been shown to reduce the survival in breast cancer patients, and therefore efforts should be made to reduce the dose to the heart and cardiac structure as much as possible. Due to its dosimetric advantages, proton radiotherapy offers the possibility to reduce dose to organs at risk while maintaining optimal target volume coverage. This advantage grows with increasing extent and severity of the target volume, among which the synchronously detected bilateral breast cancer clearly belongs. We retrospectively attempted to evaluate the feasibility and safety of using proton radiotherapy in the treatment strategy of synchronously detected bilateral breast cancer.
Neoadjuvantní chemoterapie se dostává i do léčby méně pokročilých, operabilních tumorů, s nepříznivou biologickou charakteristikou. Její širší používání však otevírá nové otázky týkající se pooperační radioterapie. Nejvíce diskutabilní je indikace radioterapie u žen, které po neoadjuvantní chemoterapii dosáhnou patologické kompletní remise. Ty mají na jedné straně lepší prognózu, na druhé straně u nich vynechání radioterapie může vést k větší míře lokoregionálních recidiv. Indikace radioterapie se proto opírá stále o předoperační klasifikaci a data z retrospektivních studií. Vzhledem k tomu, že radioterapie může být zatížena pozdními ireverzibilními nežádoucími účinky, je snaha lépe identifikovat pacientky, které z ní budou mít největší prospěch. K tomu směřují prospektivní studie, na jejichž závěry ještě musíme počkat.
Neoadjuvant chemotherapy is also included in the treatment of less advanced, operable tumors with unfavorable biological characteristics. However, its wider use opens up new questions regarding postoperative radiotherapy. The most debatable is the indication for radiotherapy in women who achieve pathological complete remission after neoadjuvant chemotherapy. On the one hand, they have a better prognosis, on the other hand, skipping radiotherapy can lead to a greater rate of locoregional recurrences. The indication for radiotherapy is therefore still based on preoperative classification and data from retrospective studies. Since radiotherapy can be burdened with late irreversible side effects, the effort is to better identify the patients who will benefit the most from it. Prospective studies are leading to this, the conclusions of which we still have to wait for.
This study aims to identify key anatomic features that govern the individual variability of lung doses from breast-cancer radiotherapy. 3D conformal, intensity-modulated and hybrid techniques with 50.4 Gy whole-breast dose were planned for 128 patients. From their CT images, 17 anatomic measures were assessed and tested as predictors for lung dose-volume characteristics. Tangential techniques yielded mean ipsilateral lung doses in the range of 3-11 Gy. This inter-patient variability was explained to almost 40% by central lung distance, and to almost 60% if this measure was complemented by midplane lung width and maximum heart distance. Also the variability in further dose-volume metrics such as volume fractions receiving 5, 20 or 40 Gy could be largely explained by the anatomy. Multi-field intensity-modulated radiotherapy reduced high-exposed lung volumes, but resulted in higher mean ipsilateral lung doses and larger low-dose burden. Contralateral lung doses ranged from 0.3 to 1 Gy. The results highlight that there are large differences in lung doses among breast-cancer patients. Most of this inter-individual variability can be explained by a few anatomic features. The results will be implemented in a dedicated software tool to provide personalized estimates of long-term health risks related to breast-cancer radiotherapy. The results may also be used to identify favourable as well as problematic anatomies, and serve as a quick quantitative benchmark for individual treatment plans.
- MeSH
- konformní radioterapie * metody MeSH
- lidé MeSH
- nádory prsu * radioterapie MeSH
- plánování radioterapie pomocí počítače metody MeSH
- plíce diagnostické zobrazování MeSH
- prsy diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Klíčová slova
- pertuzumab,
- MeSH
- adjuvantní chemoterapie metody MeSH
- adjuvantní radioterapie metody MeSH
- geny erbB-2 MeSH
- humanizované monoklonální protilátky farmakologie terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prsu * chirurgie diagnóza farmakoterapie radioterapie MeSH
- neoadjuvantní terapie metody MeSH
- protokoly antitumorózní kombinované chemoterapie MeSH
- receptor erbB-2 účinky léků MeSH
- trastuzumab farmakologie terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH