Radiotherapy For Breast Carcinoma Research Articles

Computed tomography or magnetic resonance imaging for axillary symptoms following treatment of breast carcinoma? A randomized trial

Fifty-eight patients presenting with axillary symptoms (pain, oedema, etc) following radiation therapy for breast carcinoma were randomized to be investigated by either computed tomography (CT: 29 patients) or magnetic resonance imaging (MRI: 28). The objectives of the study were to compare the efficacy of the two tests in identifying the presence of tumour and their effectiveness as judged by quality of life (QOL) outcome measurements. Both tests proved efficacious; the predictive values for a positive result (tumour present) were 100% for both tests; the predictive values for negative findings were in the range of 76 to 90% for CT and 81 to 100% for MRI. As regards outcome, complete QOL data were available in 37 patients (17 of these patients had CT, 20 MRI). Although the mean change in QOL over 6 months was slightly more favourable in the patients investigated by MRI than in the CT group, the difference did not reach statistical significance.

A RARE LATE COMPLICATION OF BREAST CANCER TREATMENT

SUMMARY In 1948 Stewart and Treeves recognised and described six cases of lymphangiosarcoma arising in the oedematous upper limb of patients who had previously undergone radical mastectomy and radiotherapy for breast carcinoma.1 The incidence of lymphangiosarcoma in such patients is 0.45%2 and is uniformly aggressive and fatal, with a 5‐year survival of less than 5% regardless of the treatment modality.3 We present a case report to increase the clinical awareness of this rare and fatal iatrogenic complication occurring subsequent to breast cancer treatment, and speculate on ways of improving survival.

Low-grade angiosarcoma of the skin of the breast: A complication of lumpectomy and radiation therapy for breast carcinoma

A case of low-grade angiosarcoma arising in the skin of a breast previously irradiated for breast carcinoma is reported. Initially, an asymptomatic breast mass was detected. Excisional biopsy and axillary lymph node dissection revealed a 1.5-cm infiltrating ductal carcinoma with 21 negative lymph nodes. The neoplasm was staged as T1, N0, M0. The patient was entered in a research protocol and was treated with high-dose external beam (4,860 rad) and iridium implant (1,860 rad) irradiation. Seven years later the patient developed low-grade angiosarcoma of the breast skin. The lesion recurred following excision and eventually was treated by simple mastectomy. The patient never and evidence of lymphedema. Cutaneous angiosarcomas occurring as a complication of lumpectomy and radiation therapy for breast carcinoma are rare. In some reported cases the patients have had lymphedema, a known factor predisposing to angiosarcoma. Furthermore, almost all cases previously reported have been high grade. This case suggests that radiation therapy for breast carcinoma may also be complicated by low-grade angiosarcoma.

Brown‐Sequard Syndrome Following Chemotherapy and Radiotherapy in Breast Carcinoma—A Case Report

Brown‐Sequard Syndrome Following Chemotherapy and Radiotherapy in Breast Carcinoma—A Case Report

Natural history of radiation-induced brachial plexopathy compared with surgically treated patients

Twelve patients who developed radiation-induced brachial plexopathy (RIBP) after receiving radiation therapy for breast carcinoma (7 patients) or Hodgkin's lymphoma (5 patients) were followed for 12 or more years, with a mean follow-up time of 20 years. Tingling and numbness of the fingers as well as weakness of the hand or arm were the most prominent presenting symptoms of RIBP. Whereas pain in most patients evolved only later in the course, it became a predominant feature in only 2. In 8 of the 12 patients, the plexopathy was surgically treated, either by neurolysis only or by neurolysis plus omental grafting in order to stop progression or paresis and/or pain. In 8 patients, including 6 of the operated group, there was slow and steady progression of RIBP over time, with the final outcome being almost complete paralysis of the arm (2 patients) or severe sensorimotor paresis rendering the hand useless (6 patients). In only 4 patients, including 2 of the non-operated group, was there absence of progression and stabilization of the paresis with only slight functional loss of the affected arm in 3 patients and severe palsy in 1. None of the 12 patients had any clear long-lasting improvement of their sensorimotor impairment. It is concluded from this study that RIBP, irrespective of surgery (neurolysis and/or omentum transplant), left two-thirds of the patients with severe or total paresis of the arm. However, the almost complete relief of severe pain (6 of 8 patients), both immediately and in follow-up patients treated with neurolysis and/or omental transplant, indicates that surgical treatment has a beneficial effect on pain relief.

(11) Lymphangiomata following surgery and radiotherapy for breast carcinoma

(11) Lymphangiomata following surgery and radiotherapy for breast carcinoma

Consequences of breast irradiation in patients with pre-existing collagen vascular diseases

Exaggerated acute and late effects were observed in three of four women with pre-existing collagen vascular disease (CVD) within 2 years after definitive megavoltage radiation therapy for breast carcinoma. Five women with breast carcinoma, who developed CVD 3 months to 10 years after radiation therapy, had no complications. An abnormally severe reaction was observed during treatment of one patient with discoid lupus. The patient developed moist desquamation that persisted for a month, requiring early termination of treatment. One year after treatment, the patient developed paresthesias in the ipsilateral arm. A planned reduction of the prescribed dose in a second patient with progressive systemic sclerosis did not prevent intense erythema at the end of treatment, followed 14 months later by chest wall necrosis, which eventually required multiple surgeries including chest wall resections. The third patient, who had systemic lupus erythematosis, developed necrosis 2 years after treatment, which progressed over 12 years to osteoradionecrosis of the clavicle, sternum and rib cage. Multiple surgeries to repair the defect were complicated by flap necrosis and pleurocutaneous fistulas. The fourth patient died 6 months after radiotherapy without apparent sequelae. None of the patients had evidence of recurrent carcinoma. A history of collagen vascular disease appears to be a contraindication to breast conservation or for elective irradiation for breast cancer.

Mammographic evaluation of the postsurgical and irradiated breast.

Mammography is important in women who elect lumpectomy and radiation therapy for breast carcinoma: to record the preoperative state, to assess the completeness of resection, and to detect recurrences and second primaries. Mammography of these patients, however, is difficult since surgery and irradiation may cause changes simulating carcinoma. This article describes the findings in the postsurgical and irradiated breast and the difficulty of differentiating the changes from recurrent carcinoma. It also illustrates the findings in recurrences and second primaries.

Post-radiotherapeutic left main coronary ostial stenosis: clinical and histological study

Pericardial abnormalities remain the most common manifestation of radiation-induced cardiac disease, but coronary artery lesions are not rare. In this report we describe a left coronary ostial stenosis which appeared five years after mediastinal irradiation for breast carcinoma in a 50-year-old woman. The patient underwent coronary angiography. A pressure drop was observed as the left catheter tip engaged the left coronary ostium; so, only nonselective coronary opacifications were performed showing an isolated, marked narrowing of the left coronary ostia. During surgery, a circumferential aortotomy allowed the examination of the left coronary ostium which appeared severely stenosed. The coronary tree was otherwise normal. A termino-terminal saphenous vein graft was anastomosed on the left stem and its proximal part was implanted on the ascending aorta. The coronary ostium and the proximal part of the left main stem were excised and the macroscopic examination of the proximal part of the left coronary artery confirmed the diagnosis of severe ostial stenosis. Microscopic examination of the coronary ostium showed a severe intimal thickening without any evident lesion of the media. This intimal thickening consisted of fibrous tissue without extracellular lipid deposit. Microscopic examination of the aorta near the coronary ostium also demonstrated an intimal thickening without any lesion of the media. Coronary ostial stenosis appears to be a rare lesion; its incidence has varied between 0.13 and 2.7% in angiographic studies and there is co-existing disease in multiple coronary vessels in the majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Sonographic findings following conservative surgery and irradiation for breast carcinoma

Postoperative care of patients who have received conservative surgery for breast cancer and subsequent radiotherapy is of ever greater significance. Both the clinical and the mammographic investigation are difficult in the post-irradiation phase. The present study was designed to appraise the value of real-time sonography in this group of patients. 106 patients were examined postoperatively with a high-resolution hand-held real-time scanner. The following alterations, found in the real-time sonogram, were compared to the normal sonographic appearance: (total echogenicity, feasibility of diagnosing the scar region, skin thickening, double contour of the skin, echogenicity of subcutaneous fat, Cooper's ligaments, striping, echogenicity of glandular tissue, architecture of glandular tissue). These alterations do not deter appraisal of the sonograms in the search for recurrences. Six out of seven recurrences, demonstrated histologically, were detected and correctly diagnosed by sonography. These results make real-time sonography the supplementary method of first choice in postoperative care of conservatively treated breast cancer patients.

The rapid onset of cutaneous angiosarcoma after radiotherapy for breast carcinoma

Malignant neoplasms known to develop following external beam radiation include squamous cell carcinoma, osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma, mixed mullerian tumors, malignant schwannoma, myelogenous leukemia and angiosarcoma. Latency periods of many years characterize the onset of these tumors following the exposure. Cutaneous angiosarcoma following radiotherapy for breast carcinoma has been rarely documented, occurring up to 13 years postirradiation. Two cases of this entity are reported occurring 37 months postradiotherapy at the site of mastectomy performed for mammary duct carcinoma.

The pathophysiologic and roentgenologic effects of chest irradiation in breast carcinoma

We studied the effects of radiation therapy on lung function in 21 patients who underwent modified radical mastectomy and radiotherapy for breast carcinoma. The patients had pulmonary function studies and chest X rays prior to radiation therapy and at six weeks, and three, six, and twelve months following radiation therapy. All pulmonary function studies showed a small but statistically significant decline within the first three months following radiation therapy. Changes in the moderate and large airways continued to occur after three months. None of the changes in pulmonary function were reversible. Radiographic changes occurred in 12 patients. These changes occurred later than the lung function changes (median time for the changes was twelve months) and were unrelated to changes in lung function.

Psychological aspects of primary radiation therapy for breast carcinoma*

Fifty-one patients who received primary radiation therapy as an alternative to radical mastectomy for the treatment of early breast cancer were studied in depth. They chose radiation therapy to avoid the disfigurement, difficulty with emotional adjustment, and adverse effects on their sexual lives they anticipated from mastectomy. Most of these women (median age 49) were leading active sexual lives in which their breasts play an important role. Their breasts also played an important role in enabling them to feel feminine, attractive, and sexually desirable. Forty-three percent of the patients who had had suicidal ideation because of feelings about breast cancer no longer were troubled by suicidal thoughts after learning about primary radiation therapy and the fact that they would not have to have a mastectomy. Recent reports that radiation therapy causes more psychic distress than other forms of cancer treatment appear to be incorrect in this particular population.

Psychological aspects of primary radiation therapy for breast carcinoma*

Psychological aspects of primary radiation therapy for breast carcinoma*

Bronchogenic carcinoma in breast carcinoma patients.

Forty-eight female patients who developed bronchogenic carcinoma synchronously with or after the occurrence of breast carcinoma are reported. The object of the study was to review the radiographic findings for possible clues to the diagnosis of bronchogenic carcinoma and to ascertain the histologic diagnoses observed. In 40 patients on whom films were available, the original radiographs before surgery for bronchogenic carcinoma were examined. The clinical records of the 48 patients were also reviewed. Histologic diagnosis of primary bronchogenic carcinoma was required. A solitary pulmonary lesion in a patient with breast carcinoma, a cavitated lesion, or a lesion that failed to respond to appropriate therapy for metastatic breast carcinoma suggested the diagnosis of bronchogenic carcinoma. An increase in the frequency of small cell carcinoma and a decrease in the frequency of adenocarcinoma was seen in bronchogenic carcinomas developing 5 years or more after radiation therapy for breast carcinoma. It was concluded that the benefits of radiation therapy in selected patients far outweighed the risk of bronchogenic carcinoma.

Utilization of parasternal lymphoscintigraphy in radiation therapy of breast carcinoma

In radiation therapy of patients with breast carcinoma, the ipsilateral internal mammary lymph nodes are either irradiated by a separate anterior field or included by isocentric opposing tangential fields, which also treat the breast and chest wall. To determine the acceptability of a particular treatment setup, the positions of the nodes must be determined with respect to the treatment fields. For the anterior field technique the problem is two-dimensional and is solved by simply superimposing the treatment field onto an anterior lymphoscintigram. For treatment by opposing tangential fields the problem is three-dimensional and more complex. The solution described in this note is to project the three-dimensional lymph node positions, obtained by a stereo-lymphoscintigraphic procedure, onto the tangential field radiographs. A mathematical expression is given to perform the required projection of the node positions onto the radiographs.

Radiation-Induced Soft-Tissue Fibrosarcoma: Surgical Therapy and Salvage

Soft-tissue fibrosarcomas of the chest wall that occur after radiation therapy for breast carcinoma are rare and usually lethal. The histories of the 10 previously reported patients emphasize the dismal prognosis for untreated patients and suggest that surgical intervention offers the only hope of reasonable palliation. We report another patient, now alive and free from disease 3½ years after radical resection. The cases of these 11 patients are reviewed, with emphasis on the clinical presentation, the difficulty of making the diagnosis, and the significant palliation that may be achieved with radical chest wall resection.

Elective radiotherapy in breast carcinoma

From March 1972 to November 1979 a total of 157 patients with stage I to III primary breast cancers have been irradiated after segmental resection (12 cases), tilectomy (89 cases) or biopsy (56 cases). Complete local control was achieved in all Stage I lesions, in 97% of Stage II lesions and in 68% of Stage III lesions. Non recurrence has been observed in patients previously operated by segmental resections, while local failures occurred in 6/89 and in 16/56 patients operated by tilectomy or biopsy, respectively. Of the 28 Stage I patients, 24 (86%) are alive, one with distant metastases. Four patients of this group are dead, 2 of intercurrent disease and 2 of breast cancer. Of the 61 (Stage II) patients, 38 (62%) are alive, 5 of these with distant metastases. Twenty-three patients are dead, 15 with active disease, and 8 suffered intercurrent death. Of the 68 Stage III patients, 21 (31%) are alive, 6 of these with distant metastases. Fourty-seven patients are dead, 43 of breast cancer and 4 of intercurrent disease. The high probability of initial subclinical deposits is evidenced by the fact that 49 of the 68 patients in this group developed distant metastases. The patients with T1 lesions appear to comprise the most favourable group with a relapse free survival at five years of 76%. The 5 years relapse free survival was 62% for T2 lesions and 25% for T3 and T4 lesions. N0 status does not confer the same favourable prognosis as T1 status. N+ status, however, resulted in a definitely negative prognostic factor. Cosmetic results after our treatment approach appear to be extremely good. A marked difference between the irradiated and controlateral breast occurred only in 10 of the 125 patients after a minimum of 2 years observation.

Changes in mixed lymphocyte culture (mlc) functions of peripheral lymphoid cells after radiation therapy for breast carcinoma

Peripheral lymphoid cells of patients with breast cancer were tested for their capacity to function as andstimulators in mixed lymphocyte culture (MLC before and after local radir local radiation therapy. Both of these MLC functions were decreased after therapy and returned to pretreatment levels within 3–4 months. Both the responder and stimulator capacities of the cell preparations obtained at completion of radiation therapy were increased by depleting phagocytic cells. These results are consistent with the view that immunosuppression observed shortly after radiation therapy results partly from the appearance of non-specific suppressor cells with monocyte characteristics.

Undifferentiated Sarcoma

SARCOMAS of the chest wall appearing after postoperative radiation therapy for breast carcinoma have recently been reviewed by Travis et al.1Less well documented are instances of such tumors developing in persons receiving nodal and mediastinal irradiation for Hodgkin's disease. We report such an occurrence. Report of a Case A 42-year-old woman, in 1969, had a history of fever, pruritis, and enlarged cervical lymph nodes, which were diagnosed by node biopsy as having nodular sclerosing Hodgkin's disease. Chest roentgenograms demonstrated a widened mediastinum and a large mediastinal mass consistent with Hodgkin's involvement. A lymphangiogram showed right periaortic nodes to be abnormal. Between March 11 and April 4, 1969, the patient was treated with a cobaltous chloride Co 60 mantle and received 3,550 R at the sternal notch, and 3,340 R at the xiphoid process. During this initial therapy, her systemic symptoms cleared and the mediastinal mass regressed to the