Radical Mastectomy For Breast Cancer Research Articles

Hyperbaric oxygen therapy for a refractory skin ulcer after radical mastectomy and radiation therapy: a case report

BackgroundRadiation therapy is performed as an adjuvant therapy when indicated following surgical resection of malignant tumors. However, radiation exposure induces acute or chronic dermatitis, depending on the radiation dose, interval, tissue volume, or irradiated area of the body. Radiation-induced skin ulcers and osteomyelitis of the underlying bone are intractable late-stage complications of radiation therapy, and often require reconstructive surgery to cover exposed tissue. Hyperbaric oxygen therapy has been suggested as a treatment for delayed radiation injury with soft tissue and bony necrosis.Case presentationA 74-year-old Japanese female underwent left radical mastectomy for breast cancer (T3N3M0, stage IIIB) in 1987. Radiation therapy was initiated 6 weeks after the surgery. She received telecobalt-60 in a total dose of 50 Gy with 25 fractions to the left supraclavicular, parasternal and left axillary regions, and electron treatment (9 MeV) in a total dose of 50 Gy in 25 fractions to the left chest wall. After irradiation, her skin became thinner and more fragile on the left chest wall, but no severe infections were observed. She noticed a small ulcer that repeatedly healed and recurred in 2000. She visited the hospital where she received radiation therapy and was treated for a skin ulcer on the left chest wall in December 2012. A fistula developed and then pus was discharged in January 2013. She was referred to the hyperbaric medical center in February 2013, and the fistula (1.5 × 3 cm) with pus discharge was observed. She was diagnosed with a late-onset radiation-induced skin ulcer that developed 25 years after radical mastectomy. HBO2 (2.5 atmospheres absolute with 100% oxygen for 60 minutes) was indicated for the refractory ulcer and osteomyelitis of the ribs. The patient was treated with HBO2 a total of 101 times over the course of 1 year and completely recovered.ConclusionsHyperbaric oxygen therapy can be performed safely for even more than 100 sessions in patients with radiation-induced skin ulcers and osteomyelitis. Hyperbaric oxygen therapy can be considered as an alternative, conservative treatment when surgical resection for late-onset, radiation-induced skin ulcers is not indicated because of fragile skin in the irradiated areas.

Effect of intercostobrachial nerve preserving in axillary lymph node dissection on sensory disturbance for breast cancer

Objective To explore the effect of preserving intercostobrachial nerve (ICBN) in axillary lymph node dissection on sensory disturbance for breast cancer. Methods Clinical data of 146 cases of stageⅠ, Ⅱ and Ⅲa breast cancer patients treated by modified radical mastectomy was analyzed. The patients were randomly divided into two groups. Retention group included 67 patients who were performed axillary lymph node dissection preserving ICBN, and 79 cases undergoing axillary lymph node dissection were taken as control group. Data of the two groups were assessed to compare the operation time, number of lymph nodes dissection and sensory abnormalities of upper arms. Results In the follow-up of 1, 3 and 6 months, the incidence rate of the lateral upper arm sensory disturbance were 17.9% and 74.9%, 11.9% and 60.7%, 7.4% and 59.5% respectively in the retention and control group, and the difference was statistically significant (χ2=46.78, P 0.05). No local recurrence after operation occurred in the follow-up of 8 months to 5 years. Conclusions For stage Ⅰ, Ⅱ and Ⅲa breast cancer patients undergoing axillary lymph node dissection, retaining ICBN can significantly reduce the chance of the postoperative medial upper arm sensory disturbance, improve the quality of life with no increase of local recurrence rate. Key words: Modified radical mastectomy of breast cancer; Axillary lymph node excision; Intercosto-brachial nerve

Clinical study of one-stage lymphatics-venous anastomosis to prevent upper extremity lymphedema of breast cancer after radical resection

Objective To investigate the value of one-stage lymphatics-venous anastomosis in radical mastectomy of breast cancer to prevent post-mastectomy upper limb lymphedema. Methods Ninety patients requiring radical mastectomy of breast cancer in Tangshan Tumor Hospital Affiliated to North China University of Science and Technology from March 2010 to May 2013 were collected as the objects. They were divided into the control group (45 cases) and the treatment group (45 cases) using block randomized grouping (concealment of allocation). Both groups underwent radical mastectomy of breast cancer, and the treatment group was treated with one-stage lymphatics-venous anastomosis on the basis of radical mastectomy. The operation times, amount of bleeding, hospitalization times, postoperative complications and the numbers of axillary lymph node dissection of the patients in the two groups were compared, and the postoperative upper limb lymphedema incidence rates of the patients in the two groups were compared. Results The operative times of the patients in the treatment group and the control group were (152.82±18.76)min and (78.92±10.33)min respectively, and amount of bleeding were (416.64±94.65)ml and (250.84±63.17)ml, with statistical significances (t=-20.39, P=0.00; t=-4.48, P=0.00). The average hospitalization times of the patients in the treatment group and the control group were (14.91±5.44)d and (13.45±2.36)d respectively, the numbers of axillary lymph node dissection were 14.63±3.37 and 14.37±3.18, the numbers of postoperative complications occurred were 9 cases (20.00%) and 5 cases (11.11%), with no statistical significances (t=-0.47, P=0.64; t=0.75, P=0.46; χ2=1.35, P=0.38). Compared with the control group, the treatment group has lower incidence of upper extremity lymphedema (13.95% vs. 40.91%) and lower swelling degree, with statistical significance (χ2=8.48, P=0.03). Conclusion One-stage lymphatics-venous anastomosis in radical mastectomy of breast cancer can effectively transfer lymph diversion to the venous circulation and reduce the incidence of limb lymphedema, which has significant preventive effect. Key words: Breast neoplasms; Lymphedema; Mastectomy, radical; Anastomosis, surgical

Effects of the combination of intercostal nerve block and general anesthesia on analgesia after radical mastectomy for breast cancer

Effects of the combination of intercostal nerve block and general anesthesia on analgesia after radical mastectomy for breast cancer

Lymphedema After Radical Mastectomy for Breast Cancer in Chinese Women: A 2 Year Follow-up Study of Incidence and Risk Factors

Lymphedema After Radical Mastectomy for Breast Cancer in Chinese Women: A 2 Year Follow-up Study of Incidence and Risk Factors

Design of intensity modulated radiotherapy plan in chest wall and supraclavicular region for patients with breast cancer after radical mastectomy

Objective To study how to design the treatment plan to reduce the influence of respiratory movement and the dose of heart and lung as few as possible, to improve the dosage distribution in the target area after radical mastectomy of breast cancer. Methods Twelve patients with breast cancer after radical mastectomy were selected. A dose of 50 Gy with 2 Gy every day and 5 times per week was prescribed. Based on the treatment planning system (TPS), 4-field intensity modulated radiotherapy (4FIMRT) and hybrid intensity modulated treatment planning 2-field conformal radiotherapy (2FCRT) + 4FIMRT were designed respectively. The two plans were compared from the aspects of target conformity index (CI), the homogeneity index (HI) and exposure dose volume delivered to organ at risk. Results According to the hybrid plan of 2FCRT + 4FIMRT, HI was 1.08±0.01, which was superior to that from 4FIMRT (1.11±0.01, t = 9.587, P 0.05). Conclusion Hybrid radiotherapy theoretically reduces the influence of respiratory movement, improves the uniformity of target dose and lowers the risk of complications of radiation therapy on breast cancer. Key words: Breast neoplasms; Mastectomy, radical; Radiotherapy, intensity-modulated; Radiotherapy dosage

Difficult diagnosis: The Stewart-Treves syndrome vs. Kaposi sarcoma following mastectomy for breast cancer - A case report

The Stewart-Treves syndrome is defined as lymphangiosarcoma of an extremity appearing due to chronic lymphedema, classically following radical mastectomy for breast cancer. We report the case of a 67 years old women admitted for an angiosarcoma of the right forearm occurring 14 years after a modified radical mastectomy and adjuvant chemotherapy for carcinoma of the right breast. A wide excision of the lesion and split-thickness skin graft was performed with uneventful recovery and satisfactory healing of the graft tissue and functional aspect of the arm. The pathological examination showed conventional high-grade angiosarcoma with a mixture of vasoformative features, whereas the immunohistochemical tests showed Ki67 positive expression in 70% of tumor, CD31 and CD34 intense positive, Factor 8 positive and HHV8 intense diffuse at nuclear level which advocates for nodular Kaposi sarcoma. Further on, the D2-40 and Flt-4 (VEGF-R3) detection were positive on lymphatic endothelium. Lymphangiosarcoma is a rare and aggressive tumor with a very poor prognosis. Early clinical diagnosis and histological confirmation may pose extreme difficulties. Moreover, the clinician should be aware of this rare pathological entity and regard it in the diagnosis algorithm of the patients with nodules linked to chronic lymphedema. It is worth mentioning that in our experience of more than 1100 cases of breast cancer – diagnosed, operated and followed by the same surgical team in the last 10 years, this is the first Stewart- Treves syndrome versus Kaposi sarcoma case we encountered.

Effect of the brake type pillow on preventing the postoperative complication in breast cancer patients

Objective To explore the effect of the brake type pillow on preventing the postoperative complication in breast cancer patients .Methods One hundred and sixty patients with modified radical mastectomy for breast cancer were divided into the control group and the observation group according to the random number table, each with 80 cases.The observation group received the brake type pillow , and the control group received the routine nursing .The incidence of postoperative subcutaneous drainage , the subcutaneous effusion , the skin flap necrosis and the paretic upper-limb edema were compared between two groups .Results The amount of postoperative subcutaneous drainage in the observation group was （276.59 ±163.10） ml, and was （431.72 ± 265.18） ml in the control group, and the difference was statistically significant （t=3.573,P〈0.01）.The incidence rate of subcutaneous effusion was 0.25%in the observation group , and was lower than 1.63%in the control group, and the difference was statistically significant （χ2 =8.901,P〈0.01）.The incidence rate of skin flap necrosis was 0.25% in the observation group, and was lower than 1.38% in the control group, and the difference was statistically significant （χ2 =6.782,P〈0.01）.No difference was found in the incidence of the paretic upper-limb edema between two groups （χ2 =0.592,P〉0.05）.Conclusions Application of the brake type pillow can reduce the subcutaneous drainage after the operation in breast cancer patients , and prevent the incidence of the subcutaneous effusion and the skin flap necrosis , and it is needed to further study to prevent the incidence of the paretic upper-limb edema . Key words: Breast cancer; Complication; Postoperative nursing; Brake type pillow

Manual lymphatic drainage versus exercise in the early postoperative period for breast cancer

Objective: To compare the effect of active exercise and manual lymphatic drainage (MLD) on postoperative wound healing complications, shoulder range of motion (ROM) and upper limb (UL) perimetry in women undergoing radical mastectomy for breast cancer. Methods: Controlled non-randomized clinical trial with 89 women undergoing breast cancer surgery with axillary lymph node dissection (Brazilian Registry of Clinical Trials: 906). Women were matched for staging, age and body mass index, with 46 women allocated to the exercise group and 43 in the MLD group, receiving 2 weekly sessions during one month. Assessments were performed in the preoperative and 60 d after surgery, including inspection, palpation, goniometry and perimetry. Results: No significant difference existed between groups relative to individual and clinical surgical characteristics. The incidence of seroma, number of punctures performed, dehiscence and infection was similar in both groups. A comparison of shoulder ROM and UL perimetry between groups, obtained in the preoperative and postoperative period, did not show any significant difference. Conclusion: The performance of active exercise or MLD did not demonstrate difference in wound healing complications, shoulder ROM and UL perimetry at 60 d after surgery, suggesting that these techniques may be employed, according to the complaints or symptoms of each woman and physical therapist experience.

Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer

This study aimed to provide additional anatomical information for axillary lymph node dissection (ALND) through in vivo anatomy studies of intercostobrachial nerve (ICBN) preservation in order to provide theoretical and practical experience for clinicians. A total of 156 patients with breast cancer underwent ALND at the Department of Gynecology of Baotou Tumor Hospital between June 2009 and March 2010. The origin, destination, main source, length, branch type, and direction of ICBN in axilla were observed, as well as its relationship with adjacent major blood vessels and nerves within the axilla. There were 120 cases of single trunk, 23 cases of double trunks, 9 cases of multiple trunks, and 4 cases without trunks in 156 patients with ICBN preservation. The transverse diameter at the origin of the ICBN was 1.89 ± 0.44 mm with a length of 94.45 ± 12.08 mm; the distances were 77.19 ± 21.04 mm, 29.34 ± 6.73 mm, 90.04 ± 13.13 mm, and 28.63 ± 13.01 mm from origin to the inferior margin at the midpoint of the clavicle, inferior margin of the axillary vein, the bottom of axilla, and branch point, respectively. The identification, dissection, and preservation of ICBN was simple and easy in a modified radical mastectomy for breast cancer and breast-conserving surgery, which only took 10-20 min, but effectively reduced the incidence of post-mastectomy pain syndrome and significantly improved the quality of life for patients after surgery.

Lymphedema After Radical Mastectomy for Breast Cancer in Chinese Women

Lymphedema After Radical Mastectomy for Breast Cancer in Chinese Women

Effect of early nursing intervention on duration of tube indwelling after modified radical mastectomy for breast cancer

Objective To investigate the effect of early nursing intervention on duration of tube indwelling in modified radical mastectomy for breast cancer.Methods 100 patients with breast cancer in our hospital underwent modified radical mastectomy for breast cancer and were randomly divided into two groups.Postoperative routine nursing,nursing intervention,duration of tube indwelling,and complications were analyzed between the two groups after surgery.Results The mean duration of tube indwelling was significantly shorter in the study group than in the control group (P＜0.05); the incidence rate of postoperative complications was significantly lower in the study group than in the control group (P＜0.05).Conclusions Early nursing intervention can shorten duration of tube indwelling after modified radical mastectomy for breast cancer,reduce the cost of hospitalization and treatment,and improve quality of life in patients,with a higher clinical value. Key words: Early nursing intervention; Modified radical mastectomy for breast cancer; Postoperative drainage; Duration of tube indwelling

Effect of evidence based nursing on preventing deep vein thrombosis of lower extremity after unilateral modified radical mastectomy for breast cancer

Objective To investigate the significance of evidence-based nursing in the prevention ofdeep venous thrombosis after unilateral modified radical mastectomy for breast cancer.Methods Evidencebased nursing group:totals of 315 unilateral modified radical mastectomy hospitalization cases who had been treated in Beijing Chaoyang Hospital,Capital Medical University from April 2010 to November 2011,which received evidence-based nursing intervention.Tradition nursing group:totals of 300 unilateral modified radical mastectomy hospitalization cases from January 2008 to December 2009,which received traditional routine nursing intervention.Results The rate of deep vein thrombosis was 0.417％ in evidence-based nursing group,and 1.667％ in traditional care group.There was a significant difference between the two groups (x2 =4.595,P ＜ 0.05).Conclusions Evidence-based nursing can effectively find the risk factor of deep venous thrombosis,therefore it can prevent the occurrence of deep venous thrombosis effectively. Key words: Breast neoplasms ; Deep venous thrombosis; Postoperative care; Evidence-based nursing

Prevention of complications of radical mastectomy for breast cancer

The paper analyzes the immediate and early results of surgical treatment in 266 patients with breast cancer. To prevent postoperative complications, new intraoperative methods were used. These include air plasma currents; plasty of the axillary region with a flap from the broadest spinal muscle; lymph vessel ligation in the axillary-subclavian-subscapular region, by using microsurgical magnifiers; plasty of the axillary-subclavian-subcapular region with a composition of anterior pectoral muscles. The application of the new methods reduces postoperative lymphorrhea from 43.8 to 98.5%; a drain-free procedure of radical mastectomy accelerates and improves rehabilitation in patients with breast cancer and contributes to reductions in postoperative bed-days and in the financial cost of health care facilities.

The adoption of new technology in radiation oncology should rely on evidence-based medicine

The adoption of new technology in radiation oncology should rely on evidence-based medicine

A Clinical Research on the Effect of Levobupivacaine and Roplvacaine in Curing Seroma after Modified Radical Mastectomy

Objective To observe therapeutic effect of levobupivacaine and roplvacaine in curing seroma after modified radical mastectomy of breast cancer by satellite ganglion block. Methods A total of 90 patients were collected and randomly divided into three groups. L group (Levobupivacaine) included 30 patients. 30 patients were in R group(roplvacaine). The rest 30 patients in the control group were treated without satellite ganglion block. The amount of drainage, the condition of incision concrescence, the number of drainage tube pulled out before the treatment as well as on the seventh day and tenth day after the treatment were recorded respectively. Results Statistical significance was found between C group and L, R group in prior and post treatment, the amount of seroma decreased on each observation point (P ＜ 0.05), the number of drainage tube pulled out increased ( P ＜ 0.05 ). No significant differences were found between L and R group ( P ＞ 0.05). Conclusion The application of levobupivacaine and roplvacaine in curing seroma after modified radical mastectomy of breast cancer by satellite ganglion block was safe and effective, both of them could be used. Key words: Roplvacaine; Levobupivacaine; Satellite Ganglion Block; Breast neoplasms

Are Physical Therapists in West Virginia Prepared to Manage the Rehabilitation Needs of Women Following Modified Radical Mastectomy for Breast Cancer?

Breast cancer and its treatment are major health issues for women in West Virginia. Obtaining appropriate rehabilitation services following mastectomy may be difficult, due to lack of awareness of patients and/or health care providers of the need for such services or due to lack of knowledge of appropriate treatment by physical therapists. Purpose: To determine the knowledge level of physical therapists in West Virginia regarding appropriate rehabilitation for women with breast cancer who have undergone modified radical mastectomy. Methods: A systematic sample of 520 physical therapists licensed in West Virginia was mailed a multiple-choice format quiz and a demographic survey. Topics addressed in the quiz were impact of medical/surgical cancer treatment on mobility, precautions for physical therapy treatments, therapeutic exercise needs, and patient education needs. The quiz was created by the authors and face validated by oncology physical therapy experts. Demographic information included type of practice setting, population of practice, degree obtained, and years of practice. Initial and follow-up mailings were sent to the sample, resulting in 192 responses. Independent t-tests were used to determine differences in percent correct score based on sex, total years of experience, practice setting, population size, and experience with the patient population. Results: Mean correct score on the quiz was 82% (range 57-100%). Items most often answered correctly were in the areas of patient education and therapeutic exercise. Items most often answered incorrectly were in the areas of modality use, medication effects, and lymphedema. Significant differences in how well respondents scored were seen by sex, entry level degree, and practice setting. Conclusions: Physical therapists in West Virginia have the prerequisite knowledge to provide therapeutic exercise and patient education for women who have had modified radical mastectomy for breast cancer. However, knowledge is lacking regarding the medical and surgical treatment effects and how these impact the physical therapy plan of care. This information can be used in order to provide targeted education to physical therapists and improve patient access to appropriately knowledgeable providers.

Physical Therapistsʼ Knowledge Regarding Treatment of Women Following Modified Radical Mastectomy for Breast Cancer

Swisher, Anne1; Arose, Krystal1; Meckley, Anna1; Rymer, Megan1; Stickley, Samantha1; Erickson, Mia1 Author Information

Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study

This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.

Useful immunohistochemical markers for distinguishing Paget cells from Toker cells

Toker cells (TCs) are normal components of the nipple epidermis. Because of their morphological and immunohistochemical similarities to mammary Paget cells (PCs), their presence may lead to a mistaken diagnosis of Paget's disease. The objective of this study was to identify immunohistochemical markers that are able to distinguish TCs from mammary PCs. Nipple tissue, derived from surgical specimens following radical mastectomy for breast cancer, was obtained from 30 cases diagnosed with TCs and 30 cases of mammary Paget's disease (MPD). The tissue was examined by immunohistochemistry using antibodies to c-erbB-2, cytokeratin (CK)7, Ki-67 and oestrogen receptor (ER). TCs were consistently positive for CK7 and ER but negative for c-erbB-2. TCs either did not express Ki-67 or expressed very low levels with only 1-3 positive cells per high-power field. In contrast, MPD tended strongly to express both Ki-67 and c-erbB-2. Results suggested that TCs and mammary PCs differ substantially in their expression of ER, c-erbB-2 and Ki-67, although they share immunoreactivity to CK7. Both Ki-67 and c-erbB-2 were consistently positive in mammary PCs but almost always negative in TCs, while ER was consistently positive in TCs. Therefore, a combination of these markers may allow TCs to be distinguished from mammary PCs.