Conservative Treatment Of Breast Cancer Research Articles

Risk Factors for Positive Resection Margins in Breast-Conserving Surgery for Breast Cancer-Retrospective Analysis.

The primary objective of this study was to identify preoperative factors that could be associated with positive resection margins. We also tried to analyze the local recurrence and overall survival in patients who received conservative treatment for early-stage breast cancer and correlate these parameters with preoperative factors. A retrospective examination was conducted on the medical records and pathological reports of 143 patients who underwent breast-conserving surgery (BCS) for breast cancer in our department from 2009 to 2017. Postoperative outcomes were assessed through phone contact and statistical analyses, including GraphPad Prism, and Fisher's exact test, the Chi-square test, and the log-rank test were employed. The results revealed positive resection margins in 7.69% (11 cases) of the 143 patients, with an overall mortality rate of 16.66% for those with positive margins and 6.59% for those with negative margins. Statistical analysis indicated no significant differences in the overall (p = 0.5) or specific (p = 0.53) survival between the positive and negative margin groups. The positive margins were significantly associated with neoadjuvant chemotherapy (p < 0.0001) and the presence of ductal carcinoma in situ (DCIS) (p = 0.01). Among the analyzed factors, two out of sixteen were significantly linked to positive resection margins in BCS, emphasizing their importance in surgical management planning for early-stage breast cancer.

Association of childhood trauma with choice of bilateral mastectomy for the treatment of unilateral breast cancer.

e24096 Background: Patients are increasingly choosing bilateral mastectomy (BMX) for the treatment of primary breast cancer (BC) despite minimal survival benefits and potential for adverse medical and psychosocial consequences. Exposure to childhood trauma is associated with dysregulation of stress response systems, threat perception alterations, increased risk-taking behaviors, and body dissatisfaction. We examined childhood trauma in relation to treatment decision-making in adulthood within a sample of breast cancer patients undergoing either BMX or more conservative BC treatment. Methods: Secondary analyses of a case-control study of the neurobiological and affective determinants of BMX choice were conducted. Cross-sectional data from the baseline survey were analyzed. Participants were recruited via institutional clinic practices, social media, and patient advocacy groups. Patients completed a medical status questionnaire and the Childhood Trauma Questionnaire (CTQ). Chi-square and Mann-Whitney U tests examined differences in treatment decision-making by childhood trauma exposure and type. Results: The sample included 137 patients with unilateral stages 0-III BC (mean age 49.2; SD = 11.2; 76.6% White; 10.9% Hispanic/Latina; 68.6% married). Seven tested positive for a BRCA gene mutation. Patients were divided between BMX (n = 66) and non-BMX (n = 71) treatment groups. On average, patients in the non-BMX group reported higher levels of childhood trauma severity (Median = 7; IQR = 0-12.5) compared to patients in the BMX group (Median = 4; IQR = 0-11.75; Mann Whitney U = 4728; small effect size; SRD = -0.11; p = .26). Patients who reported a major parental upheaval (e.g., divorce, separation) were significantly more likely to pursue non-BMX compared to BMX (small effect size; SRD = -.16; p = .047). Patients who reported any uncategorized major upheaval were more likely to choose non-BMX than BMX (small effect size; SRD = -.14), but group differences did not reach significance (p = .093) . No other statistically significant relationships were observed. Conclusions: Contrary to hypotheses, preliminary results suggest BC patients who were exposed to traumatic events in childhood may be more likely to elect conservative BC surgical treatments. Trauma-related hypervigilance to threats may cause patients to exercise more caution regarding treatment choice. More research exploring the effects of adverse childhood experiences in the BC population is warranted. [Table: see text]

Outcomes of reconstructive techniques in breast cancer using BCCT. core software

BackgroundSurgery remains a priority for breast cancer treatment. This study aimed to compare the cosmetic outcomes of oncoplastic patients who had undergone breast-conserving surgery, mini-LDF (latissimus dorsi flap), and immediate implant reconstruction using both the Japanese scale and the BCCT.core (The Breast Cancer Conservative Treatment cosmetic results software) program and to validate this program.Patients and methodsPatients who underwent surgery for breast cancer between 1997 and 2021 were retrospectively studied. Patients were divided into three groups: 1-those who had undergone breast-conserving surgery (245 patients, 71.3%), 2-those who had undergone mini-LDF after lumpectomy (38 patients, 11.02%), and 3- those who underwent reconstruction with implants after nipple-sparing mastectomy (61 patients, 17.68%). The patients were called for a follow-up examination, and their photos were taken. The photographs were shown to an independent breast surgeon and a plastic surgeon who was not included in the surgeries, and they were asked to evaluate and rate them according to the Japanese cosmetic evaluation scale. The same images were transferred to the computer and scored using BCCT.core.ResultsThe plastic and breast surgeon evaluation results showed no significant difference between the three cosmetic techniques (p = 0.99, 0.98).The results of BCCT.core software measurements were similar to the results of plastic and breast surgeons (p: 0.43).ConclusionPatients are more knowledgeable about cosmetic outcomes and expect more objective data. In this study, we used 3 different cosmetic evaluation scales. We found that these techniques give results that are compatible with each other in terms of evaluating the work done in a more concrete way. For this reason, we recommend the use of such software, which offers objective results in a subjective field such as aesthetics and is very easy to apply.

MR-contrast enhanced mammography (CEM) for follow-up of breast cancer patients: a "pros and cons" debate.

Women with a personal history of breast cancer (PHBC) are at an increased risk of either a local recurrence or a new primary breast cancer. Thus, surveillance is essential for the detection of recurrent disease at the earliest possible stage, allowing for prompt treatment, and potentially improving overall survival. Nowadays, mammography follow-up is the only surveillance imaging technique recommended by international guidelines. Nevertheless, sensitivity of mammography is lower after breast cancer treatment, particularly during the first 5 years, due to increased density or post-treatment changes. Contrast-enhanced breast imaging techniques, such as MRI or contrast-enhanced mammography (CEM), are very sensitive to detect malignant enhancement, especially in dense breasts. This Special Report will provide arguments in favor of and against breast cancer follow-up with MRI or CEM, in a debate style between experts in Breast Imaging. Finally, the scientific points of pros and cons arguments will be summarized to help objectively decide the best follow-up strategy for women with a personal history of breast cancer. CLINICAL RELEVANCE STATEMENT: A personalized approach to follow-up imaging after conservative breast cancer treatment could optimize patient outcomes, using mammography as a baseline for most patients, and MRI or CEM selectively in patients with higher risks for a recurrence. KEY POINTS: • Women with a personal history of breast cancer are at an increased risk of either a local recurrence or a new primary breast cancer. • Breast cancer survivors may benefit from additional imaging with MRI/CEM, in case of increased risk of a second breast cancer, with dense breasts or a cancer diagnosis before age 50 years. • As survival after local recurrence seems to depend on the initial stage at diagnosis, imaging should be more focused on detecting tumors in the earliest stages.

Cardiological Safety of 5-Fraction Whole Breast Irradiation

Our study aims to assess heart toxic effect using a reliable cardiac assessment with standard and 3-dimensional (3D) echocardiography and left ventricular (LV) global longitudinal strain (GLS) in patients receiving a 5-fraction (total dose 26 Gy) postoperative radiation therapy (RT) for breast cancer (BC). SAFE-FORWARD is an observational prospective cohort study (NCT04842409). Inclusion criteria were: (1) patients with invasive BC receiving ultra-hypofractionated whole breast irradiation (WBI) (26 Gy in 5 fractions) after breast conserving surgery (BCS) (2) without cardiovascular comorbidity and (3) previous thoracic irradiation. All enrolled patients are prospectively monitored for 12 months, receiving a complex cardiological assessment before RT start (baseline), and at 2-, 6-, and 12-month after RT end of treatment. Both acute and early-late toxicity are evaluated according to CTCAE (v.5) scales. The primary endpoint is defined as detection of any subclinical impairment in myocardial function and deformation (decrease ≥10%) measured with standard and 3D echocardiography and LV GLS. Overall, 40 women (median age 66 years; range, 48-84) were enrolled in the study. We analyzed patients who had completed the cardiological assessment at 12 months. Baseline patient's characteristics are summarized in Table 1. All patients received ultra-hypofractionated WBI (26 Gy in 5 fractions), 25 patients also received adjuvant endocrine therapy. GLS worsened 4% or less, both for the left- and right-side treated breast, and remained in normal range for all the time points. The only exception was for RVGLS at 6 months for right-sided treatment where it reached a borderline value (-17.4±4.9 SE). 3D-LVEF remains stable during observation, both for the left- and right-side treated breast CONCLUSION: The 5-fraction schedule after BCS is well tolerated and the intensive 1-year cardiological monitoring showed no significant differences overtime in cardiac functioning. DIBH, deep inspiration breath hold; AI, aromatase inhibitors; BCCT, Breast Cancer Conservation Treatment.

Tumor Bed Boost Radiotherapy in the Conservative Treatment of Breast Cancer: A Review of Intra-Operative Techniques and Outcomes.

Conservative surgery is the preferred treatment in the management of breast cancer followed by adjuvant whole-breast irradiation. Since the tumor bed is the main site of relapse, boost doses are conveniently administered according to risk factors for local relapse to increase the efficacy of the treatment. The benefit of a radiation boost is well established and it can be performed by several techniques like brachytherapy, external radiation or intraoperative radiotherapy. Greater precision in localizing the tumor cavity, immediacy and increased biological response are the main advantages of intraoperative boost irradiation. This modality of treatment can be performed by means of mobile electron accelerators or low-photon X-ray devices. There is a lot of research and some published series analyzing the results of the use of an intraoperative boost as an adjuvant treatment, after neoadjuvant systemic therapy and in combination with some reconstructive surgeries. This review discusses advantages of intraoperative radiotherapy and presents the main results of a boost in terms of local control, survival, tolerance and cosmesis.

Second Conservative Treatment for Local Recurrence Breast Cancer: A GEC-ESTRO Oncological Outcome and Prognostic Factor Analysis

For second ipsilateral breast tumor event (2nd IBTE), second conservative treatment (2nd CT) combining lumpectomy plus accelerated partial breast reirradiation (APBrI) represents a curative option. The aim of this study was to analyze oncological prognostic factors for patients with a 2nd IBTE treated with 2nd CT. An analysis of clinical practices was conducted across 7 academic hospitals/cancer centers in 6 European countries based on the GEC-ESTRO database. Patients presenting a 2nd IBTE occurring after conservative surgery (lumpectomy+axillary evaluation) and irradiation performed for the primary tumor underwent a 2nd CT with brachytherapy-based APBrI. The main outcome was 5-year cumulative incidence (CI) rate of second local relapse. All analyzed patients were classified according to risk groups for Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) accelerated partial breast irradiation (APBI) and molecular classification and time interval between first and second breast surgery (TIS1S2). Finally, we combined GEC-ESTRO APBI, molecular, and TIS1S2 risk groups, leading to the definition of a new score (named TAM: score based on the combination of time interval [T] between first and second surgery and APBI [A] and molecular [M] classifications) specifically designed for 2nd IBTE oncological outcome analysis. From July 1994 to January 2021, a total of 508 patients received a 2nd CT. At the time of 2nd IBTE, median age was 64.6 years (range, 56.2-72.6). With a median follow-up of 60.9 months (56.2-72.6), the 5-year second local relapse CI rate was 4% (95% confidence interval [95% CI], 2%-6%). The 5-year distant metastasis disease CI rate was 7% (95% CI, 4%-10%). Five-year disease-free and overall survival rates were 89% (95% CI, 86%-93%) and 91% (95% CI, 88%-94%), respectively. In multivariate analysis, TAM score was an independent prognostic factor for all the oncological items (P < .001) except disease-specific survival (P=.07) and overall survival (P=.09). The grade ≥3 late toxicity rate was 12.1%. This analysis of 2nd CT combining lumpectomy with APBrI for 2nd IBTE confirmed the excellent oncological results obtained after 2nd CT. Furthermore, the GEC-ESTRO TAM score appears to be an important prognostic factor, assisting patients and physicians in the decision-making process.

Outcomes of Different Quality of Life Assessment Modalities After Breast Cancer Therapy

Improvement in clinical understanding of the priorities of patients with breast cancer (BC) regarding postoperative aesthetic outcomes (AOs) is needed. To assess expert panel and computerized evaluation modalities against patient-reported outcome measures (PROMs), the gold standard of AO assessment, in patients after surgical management of BC. Embase, MEDLINE, PsycINFO, PubMed, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov were interrogated from inception through August 5, 2022. Search terms included breast conserving AND aesthetic outcome AND breast cancer. Ten observational studies were eligible for inclusion, with the earliest date of database collection on December 15, 2022. Studies with at least 1 pairwise comparison (PROM vs expert panel or PROM vs computerized evaluation with Breast Cancer Conservation Treatment cosmetic results [BCCT.core] software) were considered eligible if they included patients who received BC treatment with curative intent. Studies reporting solely on risk reduction or benign surgical procedures were excluded to ensure transitivity. Two independent reviewers extracted study data with an independent cross-check from a third reviewer. The quality of included observational studies was assessed using the Newcastle-Ottawa Scale, and the level of evidence quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Confidence in network meta-analysis results was analyzed with the Confidence in Network Meta-analysis semiautomated tool. Effect size was reported using random-effects odds ratios (ORs) and cumulative ratios of ORs with 95% credibility intervals (CrIs). The primary outcome of this network meta-analysis was modality (expert panel or computer software) discordance from PROMs. Four-point Likert responses across PROMs, expert panel assessment, and BCCT.core evaluation of AOs were assessed. A total of 10 observational studies including 3083 patients (median [IQR] age, 59 [50-60] years; median [range] follow-up, 39.0 [22.5-80.5] months) with reported AOs were assessed and homogenized in 4 distinct Likert response groups (excellent, very good, satisfactory, and bad). Overall network incoherence was low (χ22 = 0.35; P = .83). Overall, panel and software modalities graded AO outcomes worse than PROMs. Specifically, for excellent vs all other responses, the panel to PROM ratio of ORs was 0.30 (95% CrI, 0.17-0.53; I2 = 86%) and the BCCT.core to PROM ratio of ORs was 0.28 (95% CrI, 0.13-0.59; I2 = 95%), while the BCCT.core to panel ratio of ORs was 0.93 (95% CrI, 0.46-1.88; I2 = 88%). In this study, patients scored AOs higher than both expert panels and computer software. Standardization and supplementation of expert panel and software AO tools with racially, ethnically, and culturally inclusive PROMs is needed to improve clinical evaluation of the journey of patients with BC and to prioritize components of therapeutic outcomes.

Dermoglandular advancement-rotation flap for conservative treatment of breast cancer - description of technique, objective and subjective assessments.

to describe and evaluate the dermoglandular advancement-rotation flap with no contralateral surgery as a technique for the conservative treatment of breast cancer when skin or a large proportion of gland requires resection. 14 patients with breast tumors with a mean size of 4.2cm and need for skin resection. The resection area is included within an isosceles triangle, with its apex located on the areola, which is the pivot for rotation of a dermoglandular flap released through a lateral extension along that triangle base. Symmetry before and after radiotherapy was objectively assessed by authors using the BCCT.core software, as well as subjectively by three experts and patients themselves using the Harvard scale. Experts considered the breast symmetry results to be excellent/good for 85.7% of patients in the early post-operative period and 78.6% in the late post-operative period. Excellent/good ratings provided by BCCT.core software amounted to 78.6% of cases in the early post-operative period and 92.9% in the late post-operative period. Symmetry was rated as excellent/good by 100% of patients. Dermoglandular advancement-rotation flap technique with no contralateral surgery provides good symmetry when a large proportion of skin or gland requires resection on breast conservative cancer treatment.

Deep Edge Detection Methods for the Automatic Calculation of the Breast Contour.

Breast cancer conservative treatment (BCCT) is a form of treatment commonly used for patients with early breast cancer. This procedure consists of removing the cancer and a small margin of surrounding tissue, while leaving the healthy tissue intact. In recent years, this procedure has become increasingly common due to identical survival rates and better cosmetic outcomes than other alternatives. Although significant research has been conducted on BCCT, there is no gold-standard for evaluating the aesthetic results of the treatment. Recent works have proposed the automatic classification of cosmetic results based on breast features extracted from digital photographs. The computation of most of these features requires the representation of the breast contour, which becomes key to the aesthetic evaluation of BCCT. State-of-the-art methods use conventional image processing tools that automatically detect breast contours based on the shortest path applied to the Sobel filter result in a 2D digital photograph of the patient. However, because the Sobel filter is a general edge detector, it treats edges indistinguishably, i.e., it detects too many edges that are not relevant to breast contour detection and too few weak breast contours. In this paper, we propose an improvement to this method that replaces the Sobel filter with a novel neural network solution to improve breast contour detection based on the shortest path. The proposed solution learns effective representations for the edges between the breasts and the torso wall. We obtain state of the art results on a dataset that was used for developing previous models. Furthermore, we tested these models on a new dataset that contains more variable photographs and show that this new approach shows better generalization capabilities as the previously developed deep models do not perform so well when faced with a different dataset for testing. The main contribution of this paper is to further improve the capabilities of models that perform the objective classification of BCCT aesthetic results automatically by improving upon the current standard technique for detecting breast contours in digital photographs. To that end, the models introduced are simple to train and test on new datasets which makes this approach easily reproducible.

Conservative Treatment of Breast Cancer and Oncoplasty at the Teaching Hospital Mother and Child of Jeanne Ebori Foundation in Libreville (Gabon)

Conservative Treatment of Breast Cancer and Oncoplasty at the Teaching Hospital Mother and Child of Jeanne Ebori Foundation in Libreville (Gabon)

Omission of Radiation in Conservative Treatment for Breast Cancer: Opportunity for De-escalation of Care

IntroductionDe-escalation of breast cancer treatment aims to reduce patient and financial toxicity without compromising outcomes. Level I evidence and National Comprehensive Cancer Network guidelines support omission of adjuvant radiation in patients aged >70 y with hormone-sensitive, pT1N0M0 invasive breast cancer treated with endocrine therapy. We evaluated radiation use in patients eligible for guideline concordant omission of radiation. MethodsSubgroup analysis of patients eligible for radiation omission from two pooled randomized controlled trials, which included stage 0-III breast cancer patients undergoing breast conserving surgery, was performed to evaluate factors associated with radiation use. ResultsOf 631 patients, 47 (7.4%) met radiation omission criteria and were treated by 14 surgeons at eight institutions. The mean age was 75.3 (standard deviation + 4.4) y. Majority of patients identified as White (n = 46; 97.9%) and non-Hispanic (n = 44; 93.6%). The mean tumor size was 1.0 cm; 37 patients (88.1%) had ductal, 4 patients (9.5%) had lobular, and 17 patients (40.5%) had low-grade disease. Among patients eligible for radiation omission, 34 (72.3%) patients received adjuvant radiation. Those who received radiation were significantly younger than those who did not (74 y, interquartile range = 4 y, versus 78 y, interquartile range = 11 y, P = 0.03). There was no difference in radiation use based on size (P = 0.4), histology (P = 0.5), grade (P = 0.7), race (P = 1), ethnicity (P = 0.6), institution (P = 0.1), gender of the surgeon (P = 0.7), or surgeon (P = 0.1). ConclusionsFewer than 10% of patients undergoing breast conservation met criteria for radiation omission. Nearly three-quarters received radiation therapy with younger age being a driver of radiation use, suggesting ample opportunity for de-escalation, particularly among younger eligible patients.

ASPECTS EVOLUTIFS APRES TRAITEMENT CONSERVATEUR DES CANCERS DU SEIN A L’INSTITUT DU CANCER DE DAKAR. A PROPOS DE 72 CAS

Conservative treatment has become the standard treatment for early-stage breast tumors. It accounts for more than 75% of breast cancer treatments in developed countries and in our institution 6%. We studied the evolutionary aspects of breast cancer treated in a conservative modality at the Aristide Le Dantec Hospital Cancer Institute between 2000 and 2009. Objectives Describe the epidemiological profile, their evolutionary and therapeutic aspects. Methodology This work is a descriptive retrospective study of breast cancer patients selected over a 10-year period from January 2000 to December 2009 and treated conservatively at the Joliot Curie Institute in Dakar. Results We selected 72 patients out of 1100 cases treated for histologically confirmed breast cancer who had an initial conservative treatment representing 6.54%. The average age of our patients was 44.4 years. Quadrantectomy associated with axillary dissection was performed in 64 patients, or 89% of cases. Radiotherapy was performed in 53 patients, or 73.6% of cases. Twentytwo percent had locoregional recurrence (n = 16). Of the 16 patients who had recurrence, (87.5%) (n = 14) had local recurrence and 2 (12.5%) had lymph node recurrence in the internal breast chain. The average time to onset of recurrence was 17.44 months. Twenty-six percent (n =) had developed metachronous metastasis. The average time to onset of metastases was 22.63 months. The recurrences were treated by mastectomy followed by chemotherapy and radiotherapy in 8 patients, 5 patients underwent mastectomy followed by chemotherapy, 1 patient received chemotherapy alone, 1 patient received chemotherapy and palliative radiotherapy for recurrence at the the internal mammary chain and 1 patient lost to follow-up without treatment after recurrence. Metastases were treated according to different therapeutic strategies. Overall survival was 80% at 5 years and 10 years for patients with no recurrence and 37% at 5 years and 10 years for patients with recurrence. Conclusion Conservative treatment of breast cancer is possible. The results need to be improved by the generalization of mammography to discover early stages. The choice of a conservative treatment must take into account local relapse factors and diagnostic, therapeutic and follow-up means to avoid the occurrence of recurrence in order to improve patient survival.

Conservative treatment of early hormone-dependent breast cancer in elderly patients (65 years and older)

Background.Standard treatment for hormone-dependent operable breast cancer includes surgery, hormone therapy (HT), and radiation therapy and chemotherapy (when necessary). Some elderly patients do not undergo surgery because of the high risk or refuse to be operated on. In such case, the only possible option is conservative treatment with hormones (± radiotherapy).Objective:to compare progression-free survival, local relapse-free survival, and metastasis-free survival between elderly patients with hormone-dependent breast cancer receiving different treatments (surgery + HT vs HT alone).Materials and methods.This study included 60 patients with stage I–II hormone-dependent breast cancer aged 65 years and older. Thirty patients in the experimental group received HT only, while 30 patients in the control group received surgery + adjuvant HT. All patients were treated at Saint Petersburg Clinical Oncology Dispensary. Patients were followed up for 3 years.Results.During 3 years of the study, three women from the experimental group (10 %) were found to have local tumor growth despite treatment. Three patients in the control group (10 %) also had disease progression, but it was associated with the development of bone metastases.Conclusion.The conservative approach to treatment of early hormone-dependent breast cancer in elderly patients is a possible option in routine clinical practice; however, it requires the analysis of indications and identification of patients who will benefit from this approach.

Reliability of the BCCT.core software in evaluation of breast cosmesis – A systematic review

Breast cancer conservative treatment software (BCCT.core) has the potential to provide objective results using digital photographs, thus increasing the reliability, limiting the subjective interpretation and standardising the evaluation of breast cosmesis in patients. The aim of this systematic review was to summarise the empirical evidence regarding the agreement between the BCCT.core and other methods used by health professionals and patients to assess breast cosmesis. The Ovid MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases were systematically searched for studies comparing the agreement between BCCT.core and other methods used to assess breast cosmesis. A total of 14 studies involving 2703 patients were included in the review. In studies where patients undertook self-assessment, the percentage agreement ranged from 69.2% to 74.8% and the kappa values ranged from slight (k=0.12) to fair agreement. There was a low correlation between the BCCT.core and the Harvard scale when patients assessed cosmetic outcomes using photographs of their breasts (r=0.165). A 75% and 42.8% agreement was reported in studies where clinicians assessed breast cosmesis by directly visualising the patients' breasts and photographs, respectively. Assessment of breast cosmesis by the expert panel using patient photographs reported a percentage agreement ranging from 25% to 83%. The results of this systematic review demonstrated an overall agreement of fair to moderate between the BCCT.core and the subjective scales used to assess breast cosmesis. However, clinician experience and patient values should be considered in clinical decision-making.

Comparative study between laparoscopically harvested omental flap and glandular flap in immediate reconstruction after conservative surgery in breast cancer

AbstractAimOncoplastic breast surgery involves reconstruction of the resection defect by either volume displacement or volume replacement. Glandular flap insertion is an easy, quick, and acceptable method to correct breast defects after breast conserving surgery (BCS). The value of the omentum in extraperitoneal reconstruction was not appreciated until the mid‐20th century. The aim of this study was to assess the aesthetic outcome after immediate breast reconstruction with either glandular flap or laparoscopic‐harvested omental flap in early breast cancer after BCS.Patients and MethodsThis study was conducted on 44 patients with early breast cancer in the Surgical Oncology Unit, General Surgery Department, Tanta University Hospital during the period from October 2018 to May 2019. All patients underwent breast conserving surgery followed by immediate breast reconstruction by either glandular flap (group I; 20 patients) or omentoplasty (group II; 24 patients). The operative time, postoperative complications, the length of hospital stay, and aesthetic outcome were compared between the two groups.ResultsThe operative time in group I ranged from 90 to 120 minutes with a mean time of 113 minutes, whereas that in group II ranged from 110 to 160 minutes with a mean of 133 minutes. The hospital stay in group I ranged from 4 to 5 days with a mean of 4 days, whereas that in group II it ranged from 4 to 6 days with a mean of 5 days. In group I, two patients (10%) developed wound seroma and two patients (10%) developed fat necrosis, whereas in group II, eight patients (33.3%) developed fat necrosis and two patients (8.3%) developed epigastric incisional hernia with no wound seroma reported. Concerning the aesthetic outcome evaluated using patient's self‐evaluation, in group I, 70% of the patients were satisfied with the overall aesthetic results and 30% were dissatisfied, whereas in group II, 91.7% of the patients were satisfied and 8.3% were dissatisfied. With regard to the aesthetic outcome evaluated based on objective assessment with the Breast Cancer Conservation Treatment Cosmetic results software (BCCT.core), in group I, excellent results were obtained in 20% of cases, good results in 40% of cases, fair results in 20% of cases, and poor results in 20% of cases, whereas in group II, excellent results were obtained in 41.7% of cases, good results in 33.3% of cases, fair results in 16.7% of cases, and poor results in 8.3% of cases. No local recurrence or distant metastasis was reported.ConclusionThe glandular flap has shorter operative time and requires less extensive surgery than the omental flap. The omental flap has the potential to recreate a soft, naturally ptotic breast shape that is ideal for matching with the contralateral breast.

Correlation of the Oncoplastic Excision Volumes with the Aesthetic Outcomes for the Upper Outer Quadrant Breast Cancer

Background: Oncoplastic breast surgery (OBS) hasemerged as more advanced surgical approaches which combinethe principles of both the oncological and plastic surgeries toachieve those advanced results and to expand the tumour sizeindication in front of the conservative management.Methods: From July 2016 to March 2019, 200 patientspresented with UOQ primary breast cancer including multifocaland post neoadjuvant cases with predicted excision volume(PEV) less than 35% were operated and enrolled in thisprospective study. Aesthetic outcomes were objectively evaluated6 months after surgery by the semi-automated BreastCancer Conservative Treatment (BCCT) core software.Results: Total aesthetic results according to the objectiveBCCT core assessment were excellent in 41.5% (83 cases),good in 29.5% (59 cases), fair in 19.5% (39 cases), and poorin 9.5% (19 cases). More than 90% of the patients with EEVless than 10% have achieved excellent aesthetic results; EEVfrom 10 to 15% has achieved more than 60% good results;EEV from 15 to 20% has achieved around 50% fair resultswhich have been approached the 70% in the 20 to 25% group;more than 40% poor results were noticed in the 25 to 30%EEV which were raised up to 75% in the 30 to 35% EEV.Conclusion: Excision volume ratio has become one ofthe main determinants of the aesthetic results; its preoperativevalue can refer to the most suitable oncoplastic surgicaltechnique for each patient, expect the forthcoming discrepancyand the necessity for contralateral symmetrization. Currentstudy has revealed the necessity of discrepancy correctivesurgery or performing volume replacement reconstructionwith the EEV more than 20% in the UOQ and from 15 to 20%in the fair results according to the patients' preference.

Cosmetic Outcomes and Symmetry Comparison in Patients Undergoing Bilateral Therapeutic Mammoplasty for Breast Cancer

BackgroundBreast-reduction techniques are increasingly used in oncoplastic breast surgery. Bilateral therapeutic mammoplasty has the benefit of decreasing breast volume, enabling resection of larger tumors, and the potential to assure good postoperative symmetry. The aims of this study were to objectively asses the cosmetic outcomes of therapeutic mammoplasty in patients with breast cancer, using the breast cancer conservative treatment cosmetic results (BCCT.core) software, to compare this score with the surgeon’s score and the patient’s assessment, and to evaluate if other defined parameters have an impact on cosmetic outcomes. The secondary aim was to compare breast symmetry pre- and postoperatively.Materials and MethodsWe enrolled 146 consecutive patients with primary breast cancer who underwent therapeutic mammoplasty between 2011 and 2018 in Kristianstad Central Hospital, Sweden. We retrospectively collected data from patients’ records. We analyzed the BCCT.core score using postoperative photographs to objectively evaluate cosmetic outcomes on a four-grade scale and compared with preoperative photographs to evaluate symmetry. Cosmetic outcomes were also assessed subjectively by patients and surgeons, using a 10-point Likert scale.ResultsThe majority of patients (89%) had good or excellent BCCT.core scores, which correlated with surgeons’ scores, rs = − 0.22 (p < 0.001). Overall, patients were more satisfied with the cosmetic outcomes than the surgeons (p < 0.001). Evidence supporting an association between the defined clinicopathological variables, for example, tumor size, and cosmetic outcomes, was weak.ConclusionTherapeutic mammoplasty yields a very good cosmetic outcome, evaluated both by subjective and objective measurements. Importantly, symmetry can be improved in patients with asymmetry.

Verification and Evaluation of Radiation Doses received by organs at risk in (3D-CRT) and IMRT technique for breast cancer

External beam radiotherapy can be delivered more precisely by using three Dimensional Conformal Radiotherapy (3D-CRT) technique, which is a traditional method used for whole breast radiotherapy. 3D-CRT includes standard wedged tangents (two opposed wedged tangential photon beams), which is based on three Dimensional images (3D) from a special computed tomography (CT scan). Overseas notification form advent of CT scans and more powerful computers have improved dose calculation algorithms and Multi-leaf Collimators (MLCs). Consequently, 3D-CRT is able to shape the Radiotherapy Beam (RTB) closely to match the target shape and volume. Intensity Modulated Radiation Therapy (IMRT) technique has the ability to improve sparing of normal tissues and treatment results of radiotherapy (RT). RT is a standard adjuvant therapy in conservative treatment of breast cancer (BC). The IMRT technique is used for many treatment sites, allowing for improved normal tissue sparing, more conformal dose distributions and prevention of secondary cancer. The purpose of this study is to verify and evaluate between the outcome of Radiation Treatment Plans (RTP) of left-sided whole breast irradiation of IMRT technique, and 3D-CRT technique to organs at risk (OAR) that are proximal to the target volume during breast radiotherapy. These include left lung, right lung, heart, and spinal cord by different numbers of beam in left sided breast at Zhianawa cancer center (ZCC) – Sulaimany-KR-Iraq. A second aim is to establish a guideline for breast cancer radiotherapy planning at ZCC. Thirteen patients with left-sided, breast carcinoma who had received radiotherapy were selected for this study. The dose prescriptions for the patients were different according to each patient’s cancer stage, using 6, 18 MV photons. The clinical target volume [CTV] was contoured as a target volume and the contralateral breast, left lung, right lung, heart, and spinal cord tissues as OAR. The two different planning techniques were analyzed for 13 patients with left-sided breast conserving surgery. Plans were compared on the basis of planning target volume (PTV) dose conformity index (CI), homogeneity index (HI) and the volumes of normal tissues treated based on dose-volume histograms (DVHs). DVHs were calculated for the PTV, heart, left lung, right lung, spinal cord and soft tissue surrounding the breast PTV (VOB) volume. IMRT techniques slightly improved homogeneity ( HI) than 3D (0.16.04 vs. 0.22, p<0.068). However, there was no significant difference between IMRT and 3D-CRT plans regarding CI. No significant difference was noted in CI by 3D and IMRT as both showed similarity, p< 0.190 ); IMRT technique benefited patients more than 3D-CRT by reducing the high-dose (40.05 Gy) volume for the heart. The heart’s mean dose was significantly lower in 3D compared to IMRT (3.58 Gy vs. 10.07Gy, respectively; p < 0.0001). Both the mean dose of the left lung and right lung, were significantly lower for 3D compared to IMRT (10.18Gy vs. 14.26Gy and 0.34 vs. 4.17 respectively; p < 0.001), and p< 0.0001. Cord Max. Cord Max dose was significantly lower in 3D compared to IMRT (6.83Gy % vs. 20.89 Gy%, p < 0.0001). IMRT plans improved by increasing low-dose volume (Lift lung, and Spinal cord soft tissue surrounding the breast) compared with 3D-CRT plans (P<0.0001) but with Right lung P<0.575. However, 3D-CRT plans were improved by increasing low-dose volume (heart) compared with IMRT plans (P<0.230)

Comparison Between Accelerated Partial Breast Irradiation and Whole Breast Irradiation: APBI IMRT Florence Retrospective Analysis of Subjective, Objective and Patient-reported Cosmetic Outcomes

Accelerated partial breast irradiation (APBI) represents a valid alternative to whole breast irradiation (WBI) in selected low risk patients with early stage breast cancer. The long-term analysis of the APBI-IMRT Florence randomized phase 3 trial showed no significant difference in terms of both local and distant disease control and survival outcomes. Acute/late toxicity and cosmesis evaluations were significantly in favor of the APBI arm. The aim of this analysis is to compare the agreement between objective and subjective patient-reported outcome measures (PROMs) of cosmesis assessment. From June 2019 to January 2020, 95 women previously enrolled in the APBI-IMRT Florence trial accepted to undergo photographic assessment. Late skin toxicity was assessed following the RTOG/EORTC late Radiation Morbidity Scoring questionnaire. Digital photographs were assessed (objective method) using the BCCT.core software v.31 (Breast Cancer Conservative Treatment. Cosmetic Results). Breast cosmetic outcomes scored both by physician and patient (subjective methods) were recorded using the Harvard Breast Cosmesis Grading Scale. At median follow up of 11 years (IQR 10.5-11.6 years), we evaluated 95 patients (51 APBI, 44 WBI). Late skin toxicity rates (any grade) were significantly in favor of the APBI group of patients (36.4% vs 6%; p = 0.0003). Also, cosmetic assessment was significantly in favor of the APBI group both evaluated by physician (excellent-good [EG] 98% vs 90%, p<0.0001; fair-poor [FP] 2% vs 10%, p = 0.0455) and patient (EG 86% vs 70%, p<0.0001; FP 14% vs 30%, p<0.0001). The BCCT.core cosmetic assessment showed significantly improved outcomes in the APBI group (EG 65% vs FP 35%) as compared to WBI group (EG 52% vs FP 48%; p = 0.0001). We observed a good agreement between BCCT.core objective evaluation and both patients (p = 0.19) and physicians PROMs (p = 0.17). Patients treated with APBI showed significant improved late toxicity and cosmetic outcomes. There is a significative agreement between patients/physician PROMs and BCCT.core. This score has proven to be a feasible tool in breast cancer clinical practice.