Postoperative Breast Cancer Patients Research Articles

A randomized trial of early cardiotoxicity in breast cancer patients receiving postoperative IMRT with or without serial cardiac dose constraints.

Optimal cardiac dose constraints in breast cancer (BC) patients undergoing postoperative intensity-modulated radiation therapy (IMRT) are unclear, although as low as possible is recommended. This trial proposes serial cardiac dose constraint to optimize cardiac safety. Postoperative BC patients eligible for anthracycline/taxanes-based chemotherapy or HER2-targeted therapy were randomized to cardiac safety arm with prespecified mean heart dose (MHD) (≤6 Gy), V30 (≤20%), and V10 (≤50%) constraints, or to a control arm with in-house protocol (mainly MHD ≤8 Gy). The primary endpoint was cumulative incidence of newly onset cardiac events within 1-year post-RT. An exploratory analysis examined the relationship between whole heart dose metrics and those of substructures. Of 199 participants, 93 were in the cardiac safety and 106 in the control arm. The cardiac safety group showed lower MHD, V10, and V30. The 1-year cardiac event incidence was slightly lower in the cardiac safety group (19.4%) compared to controls (24.9%). The LVEF and diastolic dysfunction rates were 0% and 5.4% in the study arm, and 1.9% and 8.8% in the control arm, respectively. The LAD, LV, and RV received the highest doses for left-sided patients. For right-sided patients, RA, RCA, and RV were most irradiated. The MHD, V10, and Dmax of heart significantly correlated with all substructure doses in either laterality. Our study supports the early cardiac safety profile using IMRT in BC patients receiving cardiac-toxic systemic therapy, with serial cardiac dose constraints. Combined constraints on MHD and dose-volume parameters are representative of the cardiac substructure dose.

Improvement of quality of life on breast cancer-related lymphedema patients through a postmastectomy care program in Mexico: a prospective study.

To assess whether health-related quality of life (HRQOL) improved through a postmastectomy care program focused on breast cancer-related lymphedema (BCRL) protection/awareness. Postoperative breast cancer patients were enrolled prospectively (February-2018 to September-2019) at Nursing and Obstetrics Faculty, Durango, Mexico. Sociodemographic/clinical characteristics, arm measurements, and HRQOL evaluation with Functional Assessment Cancer Therapy-Breast Cancer were collected at baseline and after six follow-up assessments between six-to-twelve-month postmastectomy. Lymphedema was verified through circometry. Descriptive analysis and McNemar-Bowker test were used to evaluate paired differences in HRQOL. Subgroup analysis was conducted to assess sociodemographic/clinical characteristics of BCRL using Pearson's chi-squared or Fisher exact test along with odds ratios (OR) and 95% confidence intervals (CI). All tests were two-sided with P-values < 0.05 considered statistically significant. One-hundred-two patients developed BCRL (incidence 66.2%, n = 154). All dimensions of HRQOL improved after the postmastectomy care program (P < 0.05). The subgroup analysis indicated that elementary academic degree (OR = 2.40, 95%CI: 1.01-5.69), laborer (OR = 9.85, 95%CI: 3.30-29.3), and total mastectomy (OR = 4.23, 95%CI: 1.20-14.9) were more associated with BCRL (P < 0.05). Conversely, high school academic degree (OR = 0.46, 95%CI: 0.22-0.94), married status (OR = 0.42, 95%CI: 0.21-0.86), housewife (OR = 0.27, 95%CI: 0.12-0.61), professional occupation (OR = 0.10, 95%CI: 0.01-0.64), and having no comorbidities (OR = 0.31, 95%CI: 0.15-0.63) were less associated with BCRL (P < 0.05). Although HRQOL improved through the postmastectomy care program, our findings suggest that lower education, working as a laborer, and total mastectomy may be more associated with BCRL. Continuing research may uncover liabilities among BCRL patients within limited-resources settings.

Correlation between symptom experience and fear of cancer recurrence in postoperative breast cancer patients undergoing chemotherapy in China: A cross-sectional study.

To analyze the relationship between experience of symptoms (e.g., pain, fatigue) and fear of cancer recurrence (FCR) in Chinese postoperative patients with breast cancer undergoing chemotherapy. A total of 225 patients were recruited using convenience sampling. The Fear of Cancer Recurrence Inventory-Chinese Version and the Symptom Experience Index were used to collect data. The Mann-Whitney U test, Spearman's correlation, and multivariate analysis were employed to explore the relationships between symptom experience and FCR. The total Fear of Cancer Recurrence Inventory score in postoperative patients with breast cancer undergoing chemotherapy was 43.19±22.83, and >64.0% of participants exhibited significant fear of cancer recurrence. The total score of symptom experience was 27.41±16.77, including scores of symptom severity (16.91±8.70) and symptom distress (10.50±8.89). Participants' symptom experience was positively correlated with fear of cancer recurrence (r = 0.353, P < 0.001). Patients with clinically relevant FCR had higher scores for total symptom experience (Z = -3.911, P<0.001), symptom severity (Z = -3.245, P = 0.001), and symptom distress (Z = -4.185, P<0.001), compared to patients without clinically relevant FCR. Symptom experience (b = 0.511, t = 6.474, P<0.001), age (b = -0.591, t = -4.201, P<0.001), and educational level (b = 4.147, t = 3.955, P<0.001) were statistically correlated with FCR, accounting for 27.0% of the variance. Among these variables, symptom experience demonstrated the strongest correlation, with a beta value of 0.371. This study followed others in identifying a cross-sectional relationship between symptom experience and FCR. Further prospective research is required to better understand the nature of this relationship.

Perceived social support mediates cancer and living meaningfully intervention effects on quality of life after breast cancer surgery.

Aim: To explore the role of perceived social support in enhancing psychological resilience and quality of life in postoperative breast cancer patients.Materials & methods: The Managing Cancer and Living Meaningfully (CALM) intervention was used to improve indicators such as psychological resilience in breast cancer patients, while the role of perceived social support in this was assessed.Results: The intervention group exhibited significant improvements compared with the control group in psychological resilience (F=9.059, p<0.01). The analysis showed that increased social support in the control group partly mediated the link between psychological resilience and quality of life.Conclusion: CALM improves overall well-being, indicating that incorporating it into standard care for post-mastectomy patients can positively impact their mental health.

Trajectories and influencing factors of social anxiety in postoperative breast cancer patients

BackgroundSocial anxiety among postoperative breast cancer patients is a prevalent concern, with its intensity fluctuating throughout the course of treatment. The study aims to describe the trajectory of social anxiety in postoperative breast cancer patients, explore the influencing factors, and provide theoretical support for the construction of future intervention programs.MethodsThis study was conducted from June 2022 to January 2023, encompassing 213 breast cancer patients from three first-class hospitals in China. Data collection occurred at four distinct time points. A growth mixture model was employed to identify latent categories representing the trajectories of social anxiety changes among patients. A multiple regression analysis was utilized to explore predictive factors associated with different latent trajectory categories.ResultsThe trajectory of social anxiety changes in postoperative breast cancer patients includes five potential categories: maintaining mild social anxiety group, changing from mild to moderate social anxiety group, maintaining moderate social anxiety group, changing from moderate to severe social anxiety group, and maintaining severe social anxiety group. Cluster analysis results indicated three types: positive, negative, and low. Logistic regression analysis revealed that younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination were factors that influenced patients’ social anxiety (P < 0.05).ConclusionThe trajectory of social anxiety in postoperative breast cancer patients comprises five potential categories. In clinical practice, it is essential to strengthen the management of high-risk populations susceptible to experiencing social anxiety emotions, including younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination.

Lidocaine effects on neutrophil extracellular trapping and angiogenesis biomarkers in postoperative breast cancer patients with different anesthesia methods: a prospective, randomized trial

BackgroundAnesthesia techniques and drug selection may influence tumor recurrence and metastasis. Neutrophil extracellular trapping (NETosis), an immunological process, has been linked to an increased susceptibility to metastasis in individuals with tumors. Furthermore, recurrence may be associated with vascular endothelial growth factor A (VEGF-A), a mediator of angiogenesis. This study investigates the impact of lidocaine (combined with sevoflurane or propofol anesthesia ) during breast cancer surgery inhibits the expression of biomarkers associated with metastasis and recurrence (specifically H3Cit, NE, MPO, MMP-9 and VEGF-A).MethodsWe randomly assigned 120 women undergoing primary or invasive breast tumor resection to receive one of four anesthetics: sevoflurane (S), sevoflurane plus i.v. lidocaine (SL), propofol (P), and propofol plus i.v. lidocaine (PL). Blood samples were collected before induction and 3 h after the operation. Biomarkers associated with NETosis (citrullinated histone H3 [H3Cit], myeloperoxidase [MPO], and neutrophil elastase [NE]) and angiogenesis were quantified using enzyme-linked immunosorbent assays.ResultsPatient and breast tumor characteristics, along with perioperative management, did not differ between study groups. In intra-group comparisons, S and P groups demonstrated a statistically significant increase in post-operative MPO (S group: 10.39[6.89–17.22] vs. 14.31[8.55–20.87] ng ml-1, P = 0.032; P group: 9.45[6.73–17.37] vs. 14.34[9.87–19.75] ng ml-1, P = 0.035)and NE(S group: 182.70[85.66-285.85] vs. 226.20[91.85-391.65] ng ml-1, P = 0.045; P group: 154.22[97.31–325.30] vs. 308.66[132.36-483.57] ng ml-1, P = 0.037) concentrations compared to pre-operative measurements, whereas SL and PL groups did not display a similar increase. H3Cit, MMP-9, and VEGF-A concentrations were not significantly influenced by the anesthesia techniques and drugs.ConclusionsRegardless of the specific technique employed for general anesthesia, there was no increase in the postoperative serum concentrations of MPO and NE after perioperative lidocaine infusion compared to preoperative serum concentrations. This supports the hypothesis that intravenous lidocaine during cancer surgery aimed at achieving a cure may potentially decrease the likelihood of recurrence. Further interpretation and discussion of clinical implications are warranted, emphasizing the significance of these findings in the context of cancer surgery and recurrence prevention.Clinical trial registrationChiCTR2300068563.

Abstract LB418: Time to adjuvant chemotherapy and its predictors among postoperative breast cancer patients at Cancer Treatment Center of Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia in 2022: A retrospective follow-up study

Abstract Background The incidence of breast cancer is rising and is becoming a major public health problem in Ethiopia, posing a substantial threat to countries with limited oncology centers. Adjuvant chemotherapy is the most important treatment option for breast cancer initiated after definitive surgical management. Adjuvant chemotherapy decreases the risk of breast cancer mortality, reduces the recurrence rate, and improves the long-term overall survival. The time between surgery and the first adjuvant chemotherapy appears to have an impact on the overall survival (OS) and disease-free survival (DFS) in patients with breast cancer. Objective This study aimed to determine the time to start adjuvant chemotherapy and its predictors in post-operative breast cancer patients at oncology center of Hawassa University Comprehensive Specialized Hospital between September 2020 and March 2022. Method This institution based retrospective follow-up study was conducted at the Hawassa University Comprehensive Hospital Cancer Treatment Center between September 2020 and March 2022, among all women with breast cancer. All eligible patients whose medical records were available and accessed in the hospital during the study period were enrolled. The checklists were prepared using Google Forms. The data were then exported to Excel and sent to SPSS software version 26 for data analysis. A stratified Cox regression model was used to identify potential predictors. The adjusted hazard ratio (AHR) with 95% confidence interval (CI) was reported to indicate the strength of the association. This study was conducted between February 22 and April 8, 2022. Result In this study, the median time to adjuvant chemotherapy was 69 days Interquantile range (IQR)=26) with a range of 28-157 days. Twenty (12.9%) patients started chemotherapy in less than 30 days, 36 (23.2%) patients waited for 31-60 days, 68 (43.9%) patients initiated chemotherapy within 61-90 days while 31 (20%) patients took more than 90 days to start their adjuvant chemotherapy. Patients who experienced surgical complications were 1.5 times more likely to initiate adjuvant chemotherapy earlier than those without such complications, with an adjusted hazard ratio (AHR) of 1.512 (95% CI: 1.287-3.140). Patients with a BMI classified as underweight were1.5 times high likely to receive adjuvant chemotherapy earlier (AHR 1.569, 95% CI: (1.336-3.887)). Post-operative breast cancer patients with co-morbidity had a 25% lower likelihood of receiving adjuvant chemotherapy earlier than those without comorbidity (AHR=0.751,95%CI: 0.474-0.817), and illiteracy (AHR=0.829, 95% CI: (0.458-0.950)) was also a significant predictor of time to adjuvant chemotherapy. Conclusion The duration of initiation of the adjuvant chemotherapy was longer than the recommended initiation time. Body Mass Index, presence of surgical complications, presence of comorbidity, and educational status were predictors of delayed time to adjuvant chemotherapy Citation Format: Adugna Getahun Deboch. Time to adjuvant chemotherapy and its predictors among postoperative breast cancer patients at Cancer Treatment Center of Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia in 2022: A retrospective follow-up study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB418.

Short-term effects of a new resistance exercise approach on physical function during chemotherapy after radical breast cancer surgery: a randomized controlled trial

BackgroundApproximately 30% of post-operative breast cancer patients develop shoulder joint movement disorders affecting routine upper limb movement. This study discusses the impact of a neuromuscular joint facilitation (NJF) method on the physical function of breast cancer patients experiencing shoulder dysfunction during chemotherapy after radical surgery.MethodsThis study included 162 female patients who have unilateral breast cancer in a cancer hospital in China. They developed shoulder joint mobility disorders during chemotherapy within 1–3 months postoperatively. These patients were divided into three groups: NJF, conventional rehabilitation (conventional group), and control groups. The clinical examination included the maximum passive and active range of motion (ROM) of the shoulder (flexion, extension, abduction, adduction, and external and internal rotation). Other evaluations included a pain score using a visual analog scale (VAS), grip strength, and supraspinatus muscle thickness. All tests were evaluated pre-and post-intervention.ResultsThe NJF group showed a significant increase in all shoulder ROM angles post-intervention. In the conventional group, all other ROM values increased significantly, except passive external rotation ROM. In the control group, all other ROM values increased significantly, except passive and active external rotation ROM. All three groups had decreased VAS scores, increased grip strength, and supraspinatus muscle thickness post-intervention during active abduction. In the control group, the supraspinatus contraction rate decreased significantly at 60° and 90° abduction post-intervention compared to that at pre-intervention.ConclusionThis study revealed that NJF during chemotherapy had positive clinical intervention effects, improving shoulder joint mobility disorders, pain, grip strength, and external rotation following radical breast cancer surgery.Clinical trial registrationChinese Clinical Trial Registry; https://www.chictr.org.cn/ (ChiCTR2300073170), registered (03/07/2023).

Prediction of Radiation-induced Lung Injury in Postoperative Breast Cancer Patients with Intensity-modulated Radiotherapy based on Radiomics and Dosiomics

Prediction of Radiation-induced Lung Injury in Postoperative Breast Cancer Patients with Intensity-modulated Radiotherapy based on Radiomics and Dosiomics

Efficacy and safety analysis of hypofractionated and conventional fractionated radiotherapy in postoperative breast cancer patients

ObjectivesIn this meta-analysis, we conducted a comparative analysis of the safety and efficacy of hypofractionated and conventional fractionated radiotherapy in individuals who had undergone surgery for breast cancer.MethodsThis study involved a systematic and independent review of relevant research articles published in reputable databases such as PubMed, Embase, Cochrane Library, and Web of Science. Two investigators conducted the review, which included studies published up to January 3, 2023. The quality of the eligible studies was evaluated and data were extracted using Review Manager software 5.4 (RevMan 5.4) to calculate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe analysis comprised 35 studies and encompassed a collective sample of 18,246 individuals diagnosed with breast cancer. We did not find a statistically significant disparity in efficacy between conventional fractionated (CF) radiotherapy and hypofractionated (HF) radiotherapy regarding local recurrence (LR; OR = 0.91, 95% CI: 0.76–1.09, P = 0.30), disease-free survival (DFS; OR = 1.20, 95% CI: 1.01–1.42, P = 0.03), and overall survival (OS; OR = 1.08, 95% CI: 0.93–1.26, P = 0.28). Concerning safety, there was no significant difference between the HF and CF regimens in terms of breast pain, breast atrophy, lymphedema, pneumonia, pulmonary fibrosis, telangiectasia, and cardiotoxicity. However, the HF regimen resulted in lower skin toxicity (OR = 0.43, 95% CI: 0.33—0.55, P < 0.01) and improved patient fatigue outcomes (OR = 0.73, 95% CI: 0.60 – 0.88, P < 0.01).ConclusionsAlthough there is no substantial difference in LR, DFS, OS, or many other side effects between the HF and CF regimens, the HF regimen reduces skin toxicity and relieves patient fatigue. If these two issues need to be addressed in clinical situations, the HF regimen may be a superior alternative to conventional radiotherapy in postoperative breast cancer patients.

A comparative study of boost dose delivery techniques in breast cancer radiotherapy optimising efficacy and minimising toxicity.

The present study aims to compare three techniques for delivering a boost absorbed dose: conventional reduced tangential (3D), volumetric modulated arc therapy (VMAT) and fields forward-planned technique boost (3DF). The study included 15 postoperative breast cancer patients who received a boost absorbed dose following breast-conserving surgery. The conformity index and homogeneity index were used to evaluate treatment outcomes, along with the average absorbed dose received by organs at risk (OAR). All the calculated dosimetric plans are carried out using Monaco Treatment Planning System (TPS). VMAT offers superior conformity, dose homogeneity and target coverage, it is associated with higher absorbed doses to OAR such as the heart and lung. In contrast, the 3D and 3DF techniques exhibit advantages in reducing absorbed doses to critical structures, potentially minimising the risk of cardiac and pulmonary complications. Each technique has its advantages and disadvantages. The choice of technique should be individualised, taking into account patient-specific factors and treatment goals and involves a multidisciplinary approach.

Xiaoyaosan formula augments adjuvant therapy and enhances postoperative breast cancer care.

Xiaoyaosan (XYS), a traditional Chinese formula, not only has good antitumor effects but also attenuates distress, anorexia, and quality of life (QoL) by regulating neurology, the microbiota, immunology, and oxidative stress. This study aimed to assess the effect of XYS on QoL, psychological pressure, and spiritual well-being in breast cancer patients undergoing adjuvant chemotherapy. This prospective cohort study enrolled 176 postoperative breast cancer patients who received adjuvant chemotherapy combined with (n = 81) or without (n = 95) XYS for comparison. The Quality-of-Life Questionnaire Core-30 (QLQ-C30), Hospital Anxiety and Depression Scale (HADS), University of California Los Angeles (UCLA-LS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-Sp) scores were evaluated before adjuvant chemotherapy (T0) and after the first (T1), second (T2), third (T3), and fourth cycles (T4) of adjuvant chemotherapy. XYS improved the QLQ-C30 score at T2 (p = 0.043), T3 (p = 0.021), and T4 (p = 0.040) and the QLQ-C30 score at T4 (p = 0.027); moreover, XYS attenuated the QLQ-C30 score at T2 (p = 0.040), T3 (p = 0.023), and T4 (p = 0.027). Regarding distress, XYS reduced the HADS-anxiety score at T2 (p = 0.010), T3 (p = 0.025), and T4 (p = 0.019) and the HADS-defined anxiety score at T3 (p = 0.038). XYS also decreased the HADS-depression score at T2 (p = 0.016), T3 (p = 0.018), and T4 (p = 0.017) and the HADS-defined depression rate at T2 (p = 0.047), T3 (p = 0.012), and T4 (p = 0.013). In addition, XYS decreased the UCLA-LS at T2 (p = 0.023) but enhanced the FACIT-Sp at T2 (p = 0.029) and T4 (p = 0.026). Furthermore, after adjustment via propensity score matching, most of the significant findings remained. The addition of XYS to adjuvant chemotherapy improved QoL, psychological health, and spiritual well-being in breast cancer patients.

Effectiveness of Thoracic Mobility Exercises and Chest Proprioceptive Neuromuscular Facilitation Technique on Pulmonary Function in Postoperative Breast Cancer Patients: A Randomised Controlled Trial

Effectiveness of Thoracic Mobility Exercises and Chest Proprioceptive Neuromuscular Facilitation Technique on Pulmonary Function in Postoperative Breast Cancer Patients: A Randomised Controlled Trial

A Comprehensive Deep Learning Framework for Automatic Target Volumes Segmentation in Post-Operative Stereotactic Partial Breast Irradiation (S-PBI)

In S-PBI, accurate delineation of post-surgical tumor bed volume (TBV) and clinical target volume (CTV) are crucial tasks to achieve effective radiotherapy outcomes. However, manual contouring is labor intensive, time consuming, and largely relies on the experience of clinicians. We aimed to propose a deep learning (DL) approach which mimics physicians' contouring practice to accurately segment target volumes in post-operative breast CT images. Our approach incorporated domain knowledge into a 3D U-Net based DL model for breast target volumes (TBV and CTV) delineation. Our TBV segmentation approach was inspired by the marker-guidance procedure in manual delineation, where the visual clues provided by the markers assist physicians in defining TBV. For this purpose, a distance-transformation coupled with a Gaussian filter was adopted to convert markers' locations on the CT images to saliency maps. Subsequently, the CT images and the corresponding saliency maps formed a two-channel input for the segmentation model. For CTV segmentation, TBV was incorporated as an input in addition to the CT images, guiding the model to encode the location-related image features. The architecture allowed the network to emulate the oncologist's manual delineation where CTV is derived from TBV via a margin expansion, followed by correcting the extensions for anatomical barriers of tumor invasion (e.g., skin, chest wall). We retrospectively collected 175 prone CT images from 35 post-operative breast cancer patients who received 5-fraction partial breast irradiation (PBI) regimen on a Co-60 prone based S-PBI unit. The 35 patients were randomly split into 25, 5, and 5 for model training, validation, and testing respectively. We evaluated the performance of the developed DL model on the testing dataset by comparing the predicted volumes with the manually delineated contours (ground truth) using Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (HD95), and average symmetric surface distance (ASD). For TBV segmentation, our model achieved mean (standard deviation) of 0.76 (±2.7), 6.76 (±1.83) mm, and 1.9 (±0.66) mm for DSC, HD95, and ASD respectively. For CTV segmentation, our model achieved 0.94 (±0.02), 2.46 (±0.5) mm, and 0.53 (±0.14) mm for DSC, HD95, and ASD respectively. The proposed auto-segmentation approach generated TBV and CTV masks in ∼11 seconds per CT volume, implying significantly improved efficiency compared to manual contouring. We developed a comprehensive DL framework mimicking clinical contouring practice for auto-segmentation of target volumes in S-PBI. The results demonstrated high levels of agreement between the predicted contours and physicians' manual contours. The approach is promising for improving the efficiency and accuracy of the on-line treatment planning workflow, such as adaptive based S-PBI.

Comparative Different Interventions to Improve Exercise Adherence in Patients in the Postoperative Breast Cancer Phase of Care: A Network Meta-analysis.

Global Cancer Statistics 2020 reported that breast cancer had exceeded lung cancer as the most frequently diagnosed cancer. Surgery is the primary treatment modality for breast cancer, but postoperative upper limb dysfunction often occurs; functional exercise can alleviate this and restore upper limb function. However, exercise compliance is low in postoperative breast cancer patients; thus, many studies have been conducted in recent years to improve patient compliance with exercise. The aim of this study was to compare the effectiveness of different interventions to improve exercise adherence in postoperative breast cancer patients. We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, CNKI, VIP, and CBM databases for eligible studies. Exercise adherence rate and quality-of-life difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. Risk of bias was assessed using the risk-of-bias table in RevMan 5.4. Surface under the cumulative ranking was used to estimate the rankings among different interventions. Twenty-five randomized controlled trials involving 9 interventions were included, and the network meta-analysis results showed that patients in the pedometer + counseling group had the best exercise adherence. Pedometer + counseling care measures are recommended to improve exercise adherence in postoperative breast cancer patients. Oncology nurses can improve patients' exercise compliance through counseling and by giving them pedometers to wear.

Effects of a lymphedema prevention program based on the theory of knowledge-attitude-practice on postoperative breast cancer patients: A randomized clinical trial.

Breast cancer-related lymphedema (BCRL) is one of the common postoperative complications that severely affects the functions of the arm and quality of life. Since lymphedema is difficult to treat and prone to recurrence, early prevention of lymphedema is crucial. Patient diagnosed with breast cancer (N = 108) were randomized to the intervention (n = 52) or control group (n = 56). In the intervention group, patients were provided the lymphedema prevention program based on the theory of knowledge-attitude-practice during the perioperative period and the first three chemotherapy sessions (mainly includes health education, seminars, knowledge manuals, sports guidance, peer education, and WeChat group).The limb volume, handgrip strength, arm function, and quality of life were measured in all patients at the baseline, 9 weeks (T1), and 18 weeks (T2) after surgery. The incidence of lymphedema in the Intervention group was numerically lower than in the control group after implementing the lymphedema prevention program, but the difference was not statistically significant (T1: 1.9% vs. 3.8%, p = 1.000; T2: 3.6% vs. 7.1%, p = 0.744). However, compared with the control group, the intervention group showed there was less deterioration in handgrip strength (T1 [t = -2.512, p < 0.05] and T2 [t = -2.538, p < 0.05]), improved postoperative upper limb dysfunction (T1 [t = 3.087, p < 0.05] and T2 [t = 5.399, p < 0.05]) and less deterioration in quality of life (T1 [p < 0.05] and T2 [p < 0.05]). Although the investigated lymphedema prevention program improved arm function and quality of life, it did not reduce the incidence of lymphedema in postoperative breast cancer patients.

A deep learning approach for automatic delineation of clinical target volume in stereotactic partial breast irradiation (S-PBI)

Accurate and efficient delineation of the clinical target volume (CTV) is of utmost significance in post-operative breast cancer radiotherapy. However, CTV delineation is challenging as the exact extent of microscopic disease encompassed by CTV is not visualizable in radiological images and remains uncertain. We proposed to mimic physicians’ contouring practice for CTV segmentation in stereotactic partial breast irradiation (S-PBI) where CTV is derived from tumor bed volume (TBV) via a margin expansion followed by correcting the extensions for anatomical barriers of tumor invasion (e.g. skin, chest wall). We proposed a deep-learning model, where CT images and the corresponding TBV masks formed a multi-channel input for a 3D U-Net based architecture. The design guided the model to encode the location-related image features and directed the network to focus on TBV to initiate CTV segmentation. Gradient weighted class activation map (Grad-CAM) visualizations of the model predictions revealed that the extension rules and geometric/anatomical boundaries were learnt during model training to assist the network to limit the expansion to a certain distance from the chest wall and the skin. We retrospectively collected 175 prone CT images from 35 post-operative breast cancer patients who received 5-fraction partial breast irradiation regimen on GammaPod. The 35 patients were randomly split into training (25), validation (5) and test (5) sets. Our model achieved mean (standard deviation) of 0.94 (±0.02), 2.46 (±0.5) mm, and 0.53 (±0.14) mm for Dice similarity coefficient, 95th percentile Hausdorff distance, and average symmetric surface distance respectively on the test set. The results are promising for improving the efficiency and accuracy of CTV delineation during on-line treatment planning procedure.

Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study.

Even though advanced radiotherapy techniques provide a better protective effect on surrounding normal tissues, the late sequelae from radiation exposure to the heart are still considerable in breast cancer patients. The present population-based study explored the role of cox-regression-based hazard risk grouping and intended to stratify patients with post-irradiation long-term heart diseases. The present study investigated the Taiwan National Health Insurance (TNHI) database. From 2000 to 2017, we identified 158,798 breast cancer patients. Using a propensity score match of 1:1, we included 21,123 patients in each left and right breast irradiation cohort. Heart diseases, including heart failure (HF), ischemic heart disease (IHD), and other heart diseases (OHD), and anticancer agents, including epirubicin, doxorubicin, and trastuzumab, were included for analysis. Patients received left breast irradiation demonstrated increased risks on IHD (aHR, 1.16; 95% CI, 1.06-1.26; p < 0.01) and OHD (aHR, 1.08; 95% CI, 1.01-1.15; p < 0.05), but not HF (aHR, 1.11; 95% CI, 0.96-1.28; p = 0.14), when compared with patients received right breast irradiation. In patients who received left breast irradiation dose of >6,040 cGy, subsequent epirubicin might have a trend to increase the risk of heart failure (aHR, 1.53; 95% CI, 0.98-2.39; p = 0.058), while doxorubicin (aHR, 0.59; 95% CI, 0.26-1.32; p = 0.19) and trastuzumab (aHR, 0.93; 95% CI, 0.33-2.62; p = 0.89) did not. Older age was the highest independent risk factor for post-irradiation long-term heart diseases. Generally, systemic anticancer agents are safe in conjunction with radiotherapy for managing post-operative breast cancer patients. Hazard-based risk grouping may help stratify breast cancer patients associated with post-irradiation long-term heart diseases. Notably, radiotherapy should be performed cautiously for elderly left breast cancer patients who received epirubicin. Limited irradiation dose to the heart should be critically considered. Regular monitoring of potential signs of heart failure may be conducted.

Negative regulation of CD44st by miR-138-5p affects the invasive ability of breast cancer cells and patient prognosis after breast cancer surgery

ObjectiveTo investigate how the negative regulation of CD44st by miR-138-5p affects the invasive ability of breast cancer cell lines and prognosis in postoperative breast cancer patients.MethodsRT-PCR, qRT-PCR, and western blot assays were used to detect the expression of CD44s, CD44v6, and CD44st at both mRNA and protein levels. The expression of miR-138-5p in breast cancer cell lines was also evaluated. The binding ability of miR-138-5p to CD44st was determined via a dual-luciferase assay. The CD44 protein expression in breast cancer tissues was detected using immunohistochemistry. A Transwell assay was used to detect the invasive ability of tumor cells. The correlation between CD44st and miR-138-5p mRNA expression in breast cancer tissues was evaluated using qRT-PCR, and the relationship between clinicopathological features was statistically analyzed.ResultsCD44s and CD44v6 were highly expressed in MDAMB-231 cell line, while CD44st was highly expressed in MCF-7/Adr and Skbr-3 cells. None of the CD44 isoforms were expressed in MCF-7 cells. The miR-138-5p was highly expressed in MCF-7 cells, but not in MCF-7/Adr, Skbr-3, and MDAMB-231 cells. The dual-luciferase assay suggested that miR-138-5p could bind to wild-type CD44st 3'-UTR, miR-138-5p overexpression significantly inhibited the expression level of CD44 protein in MCF-7/Adr cells, and miR-138-5p + CD44st (3'-UTR)-treated MCF-7/Adr and Skbr-3 cells were significantly less invasive than those in the control group (P < 0.05). RT-PCR results for 80 postoperative breast cancer patients showed that the mRNA expression rate for CD44st was higher in cancer tissues than in paracancerous tissues, and the expression rate of miR-138-5p was higher in paracancerous tissues than in cancerous tissues (P < 0.01). In cancer tissues, CD44st was negatively correlated with miR-138-5p expression, with correlation coefficient r = -0.76 (Pearson’s correlation), coefficient of determination R2 = 0.573, F = 106.89, and P < 0.001. The median overall survival value for patients in the low miR-138-5p expression group was 40.39 months [95% confidence interval (CI): 35.59–45.18 months] and 56.30 months (95% CI: 54.38–58.21 months) for patients in the high-expression group, with a log rank (Mantel-Cox) of 13.120, one degree of freedom, and P < 0.001.ConclusionIn breast cancer cell lines, miR-138-5p negatively regulated expression of CD44st and affected the invasive ability of tumor cells and patient prognosis after breast cancer surgery.

The effects of qigong intervention based on the Internet on quality of life and physical fitness in Chinese postoperative breast cancer patients: a protocol of randomized controlled trial

BackgroundThe purpose of this study is to verify the improvement of remote qigong intervention on the quality of life and physical fitness of breast cancer patients after surgery by means of a randomized controlled trial and to compare it with the conventional exercise combination of aerobic exercise and resistance training.Methods/designThe research approach applied in this study is a randomized controlled trial. After completing the baseline questionnaire and physical fitness test, participants were randomly assigned to either the qigong group or the combined exercise rehabilitation group. Patients in the qigong group performed Qigong-Baduanjin twice a week for 30 min each time under remote guidance and practiced Baduanjin by themselves at other times. Patients in the combined exercise rehabilitation group were given resistance training twice a week for 30 min under remote guidance, and walking the rest of the time. At the end of the 12-week intervention, outcomes testing and data collection were carried out. The primary outcomes are quality of life, measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Functional Assessment of Cancer Therapy-Breast (FATC-B). The secondary outcomes include cardiopulmonary endurance, upper limb strength, lower limb strength, and skinfold thickness.DiscussionThe importance of postoperative exercise rehabilitation for breast cancer has been gradually accepted by more and more doctors and patients, but further research and development of simple and practical means of exercise rehabilitation are necessary. Remote qigong intervention for breast cancer patients via the Internet will be a great alternative.Trial registrationChinese Clinical Trial Registry ChiCTR1900027989. Registered on December 7, 2019.