Radical Mastectomy In Patients Research Articles

Comparison between electrocautry and ligasure in terms of preoperative blood loss in modified radical mastectomy in carcinoma breast.

Objective: To compare mean intra operative blood loss using ligasure and electrocautery in modified radical mastectomy in patients of breast malignancy. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: June 2020 to December 2020. Material & Methods: After fulling inclusion criteria, 60 Patients from surgical OPD of Allied Hospital Faisalabad were enrolled for the study. Informed consent was taken. Two groups of patients were made on random basis. Group A patients underwent modified radical mastectomy using ligasure while in Group B electrocautery was used to secure bleeding. In both groups, surgery was performed by senior consultant surgeon. Intra operative blood loss was measured. Results: In this research, mean intra operative blood loss was 17.63+1.22 ml in Group-A while 21.76+1.41 ml in Group-B, p value was 0.001. Conclusion: Mean intra operative blood loss using LigaSure is significantly lower when compared with electrocautery in modified radical mastectomy in patients of breast cancer.

Latissimus dorsi flap in breast reconstruction following radical mastectomy and prophylactic subcutaneous mastectomy in the same patient: Case report

One of the most common surgical treatment options for breast cancer is radical mastectomy, which affects the quality of life of patients in remission and their psychological state. One of the solutions to this problem is the use of skin and muscle flaps from other anatomical areas, in particular the back, for plastic reconstruction of the breast after radical mastectomy. The study aimed to present the practical implementation of reconstruction of both breasts in the remote period of radical mastectomy in a patient in remission of breast cancer using a skin and muscle flap of the broadest back muscle in combination with an implant. The patient, who met the criteria for participation in the study, had previously undergone a radical mastectomy of the right breast for direct indications along with radiotherapy. Delayed breast reconstruction within the study was performed 6 years after the planned right-sided mastectomy. The first surgical intervention included marking the back and breast area, excision and harvesting of the flap, preparation of the implantation site and its placement with the implant. Three months after the operation, she underwent a prophylactic mastectomy of the left breast based on molecular genetic testing with immediate reconstruction using the second flap of the broadest back muscle. The surgery was performed using a perimammary approach. Due to the available dissection, various anatomical configurations of the flap, and low-variability vascular anatomy, the latissimus dorsi flap is an adequate choice of material for the reconstruction of radical postmastectomy interventions. The final result of bilateral use of the flap for breast reconstruction after mastectomy is in favour of restoration of the anatomical tissue defect and a satisfactory aesthetic option, without complications in the form of seromas, haematomas, or pain. The result has a positive impact on the quality of life of a patient in remission of breast cancer

The Role of Fibrin Glue in Reducing Seroma Formation after Modified Radical Mastectomy in Patients with Breast Cancer: A Prospective Randomized Study

The Role of Fibrin Glue in Reducing Seroma Formation after Modified Radical Mastectomy in Patients with Breast Cancer: A Prospective Randomized Study

Early Outcome of Superomedial Pedicle as Extreme Oncoplastic Procedure versus Modified Radical Mastectomy in Patients with Stage T3 Breast Cancer Not Responding to Neoadjuvant Chemotherapy

Abstract Background Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women. Aim of the Work To assess the feasibility of extreme oncoplasty (achieving negative margins) for T3 breast cancer patients not responding to neoadjuvant chemotherapy by using a superomedial pedicle flap. Patients and Methods This study was conducted on 30 female patients with stage T3 breast cancer not responding to neoadjuvant chemotherapy with no skin involvement or upper medial quadrant tumor, with large breast size (cup D), accepting both intervention modalities and fit for both anesthesia and radiotherapy. It was performed at the (General Surgery Department) at Ain Shams University Hospitals and El Haram specialized Hospital starting from March 2020. Approval of the Ethical Committee and written informed consent from all participants were obtained. Patients were divided into two groups. Group A includes 15 patients underwent Modified radical mastectomy with axillary clearance. Group B includes 15 patients underwent Superomedial pedicle mammoplasty and axillary clearance. Results Superomedial pedicle mammoplasty is equivalent to modified radical mastectomy in terms of oncological safety, with advantages over mastectomy in terms of quality of life and esthetic outcomes. Thus, Extreme oncoplasty provides an alternative to Modified radical mastectomy, extends the scope of breast conservation, provides better clinical outcomes, and improves quality of life. Conclusion This study showed that superomedial pedicle mammoplasty technique is a feasible extreme oncoplastic approach for patients with large tumors and not responsive to neoadjuvant chemotherapy considered for Modified radical mastectomy with acceptable complication rates, negligible rates of reexcision and no early recurrence in 3 months period.

Early complications following modified radical mastectomy in patients with breast.

Objective: To investigate the early complications, associated comorbidities and risk factors associated with modified radical mastectomy in patients suffering from breast cancer. Study Design: Prospective Cohort study. Setting: Department of Surgery, Khyber Medical University, Institute of Medical Sciences, District Headquarter Hospital, Kohat. Period: January 2021 to December 2022. Material & Methods: A total of 65 patients diagnosed with breast cancer who were planned to undergone through radical mastectomy during the study period were analyzed. Demographical and clinical characteristics of all patients were noted. Early complications, associated comorbidities and related risk factors were recorded. Results: In a total of 65 patients, the mean age was 47±13 years (ranging 50-65 years). At the time of enrollment, 25 (38.5%) patients had painful lump in their breasts while remaining 40 (47.7%) patients reported that they were had swelling in their axillary region. There were 30 (46.2%) patients who had had stage-III breast cancer whereas other 34 (52.3%) were suffering from stage-II breast cancer. Formation of seroma was most commonly associated complication reported in 30 (46.2%) patients whereas 10 (15.4%) patients reported infections of wound. Twenty (30.8%) patients reported that they were having pain on the site of surgery along with paresthesia on the medial side of arm. Five (7.7%) patients had associated diabetes while 8 (12.3%) patients were overweight with their body mass index (BMI) value between 25-29.9 kg/m2. Nine 9 (13.8%) patients were hypertensive. Conclusion: Most common early complications associated with modified radical mastectomy included infection of the surgical site, paresthesia and pain.

Analgesic efficacy of ultrasound-guided PECS II and transeversus thoracic plane blocks compared to serratus anterior plane block for modified radical mastectomy: A randomized prospective study

ABSTRACT Background Chronic pain and discomfort after breast cancer surgery could be reduced by improving acute postoperative pain management. Aim The aim is to compare the analgesic effectiveness of ultrasonography (US) guided serratus anterior plane (SAP) block vs combined modified pectoral nerve (PECS II) and transeversus thoracic plane (TTP) blocks by for modified radical mastectomy patients. The study was registered on Clinicaltrials.gov with registration code: NCT04908878 Patients and methods 70 patients were divided into two equal groups (35 each). After induction of general anesthesia, Group I got unilateral us-guided PECS II-TTP blocks on the procedure side. Group II: received unilateral us-guided SAP block on the operation side. The 24 hours’ postoperative morphine consumption (mg) was the primary outcome. Secondary outcomes were VAS score, time to first need for rescue analgesia, patient satisfaction and complications. Results In combined PECS II-TTP blocks there was a significant decrease in the 24 hours’ postoperative morphine consumption [median (IQR); 3 (3, 6) and 9 (9, 12) mg], VAS scores [median (IQR); 3 (2, 3), 3 (3, 4) at 4 hrs. and 3 (3, 3), 3 (3, 5) at 6 hrs. in group I and II respectively] and prolonged time for 1st rescue analgesia [median (IQR); 8 (6, 12) and 6 (4, 8) hrs in group I and II respectively]. While, there were no significant differences between the two groups in intra-operative fentanyl consumption, hemodynamics or complication. Conclusion The PECS II-TTP blocks provide effective and long-lasting postoperative analgesia than SAP block in modified radical mastectomy.

Active Drainage versus Passive Drainage after Modified Radical Mastectomy in Patients with Breast Carcinoma: A Randomised Controlled Trial

Introduction: Postoperative seroma formation is a common complication following Modified Radical Mastectomy (MRM), with an incidence ranging from 15-60%. There is a hypothesis that the negative pressure created by the suction drain used in MRM opens the damaged capillaries, preventing them from spontaneously closing and thereby increasing postoperative secretions. Aim: To compare active suction drains with passive drains in MRM in terms of postoperative outcomes. Materials and Methods: A randomised controlled trial with two arms, consisting of 15 patients in each arm, was conducted from November 2018 to March 2020 at the Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital in New Delhi. Patients diagnosed with localised breast carcinoma and scheduled for MRM were invited to participate. Pregnant females, patients with metastatic disease, those lost to follow-up, recurrent breast cancer patients, and those taking anticoagulants and antiplatelet agents were excluded from the study. The outcomes measured were drain output and duration of hospital stay, and postoperative morbidity, including flap necrosis, surgical site infection, seroma, and volume of seroma aspiration. The data acquired was analysed using the Statistical Package for Social Sciences (SPSS) version 21.0. Quantitative variables were compared using the Independent t-test and Mann-Whitney test as appropriate. Nominal categorical data was compared using the Chi-square or Fisher’s-exact test as appropriate. Results: Drain output was higher in the active group than in the passive group, but there was no significant difference in the average daily drain output and the average total output (652 mL versus 540 mL), except for the first two postoperative days. There was no statistically significant difference between the two groups in terms of hospital stay (6.67 days and 6.27 days), duration of drains in situ (6.67 days and 6.27 days), flap necrosis (13.3% vs. 13.3%), seroma formation (26.67% vs. 20%), and surgical site infection (26.67% vs. 20%). Conclusion: The use of suction in drains during MRM surgery is not compulsory and can save costs in resourcepoor settings. However, larger sample size studies with multicentre participation should be undertaken before making any recommendations.

Comparison of Analgesic Effect of Clonidine as an Adjuvant with Different Concentration of Ropivacaine (0.35% and 0.2%) in Thoracic Paravertebral Block among Modified Radical Mastectomy Patients: A Randomised Double Blinded Clinical Study

Introduction: Thoracic Paravertebral Block (TPVB) appears promising for reduction of postoperative pain in Modified Radical Mastectomy (MRM). Various combinations of local anaesthetics and adjuvants have been tried in TPVB but search for an ideal combination is still on. Aim: To evaluate analgesic efficacy of clonidine (1 µg/kg) as adjuvant with different concentrations of ropivacaine (0.35%, 0.2%) for TPVB in MRM surgery. Materials and Methods: This randomised double blind comparative clinical study was carried out in a tertiary care centre in Southern Rajasthan from January 2019 to March 2020, clinical study, 120 American Society of Anaesthesiologists (ASA) grade I, II patients aged 18-60 years female patients undergoing MRM surgery were randomised into three groupsRP, RC and LDRC to receive 0.35% Ropivacaine 19 mL, 0.35% Ropivacaine 19 ml+Clonidine (1 µg/kg) and 0.2% Ropivacaine 19 ml+Clonidine(1 µg/kg) diluted upto total 20 ml with normal saline, respectively. TPVB was performed at T4 level as single injection followed by administration of general endotracheal anaesthesia. The primary outcome measured was duration of analgesia. Secondary outcomes measured included consumption of rescue analgesic, Visual analog scale and perioperative haemodynamic parameters. Quantitative and qualitative data were analysed using Analysis of Variance (ANOVA) and Chi-square test respectively. p<0.05 was considered statistically significant. Results: Mean duration of analgesia was prolonged in clonidine groups RC and LDRC (811.5±110.99 and 753±119.76 min, respectively) as compared to group RP (400.125±108.13 min), although no statistically significant difference was noted between group RC and LDRC. Similar observations were noted when total dose of rescue analgesic in group RC (82.50±7.21 mg) and LDRC (99.38±35.57 mg) was compared to group RP (142.50±53.169 mg) as well as when total number of rescue analgesic doses in group RC (1.10±0.496) and group LDRC (1.32±0.474) were compared to group RP (1.92±0.694). Visual Analogue Scale (VAS) was noted at rest, cough, movement at 0, 4, 8, 12, 24 hours and showed a statistically significant difference between ropivacaine group RP and ropivacaine clonidine groups. Conclusion: Addition of clonidine to ropivacaine in TPVB during breast cancer surgery results in lower pain scores, prolong duration of analgesia and reduce postoperative requirement of rescue analgesics. Both lower (0.2%) and higher (0.35%) concentrations of ropivacaine provide equally effective postoperative analgesia.

SUBDERMAL PLEXUS AS A GUIDE FOR SKIN FLAP THICKNESS IN MODIFIED RADICAL MASTECTOMY IN BREAST CANCER

Introduction: Breast cancer is the most common invasive cancer to affect women in the world and is the second highest cause of cancer death in women after lung cancer. Different surgical options are available for treating breast cancer but Modified Radical Mastectomy is still the most common surgery performed worldwide for breast cancer and has the lowest incidence of loco-regional recurrence. Aim: The aim of this study to find out the role of sub-dermal plexus as a guide to achieve optimum skin flap thickness during modified radical mastectomy for breast cancer. Materialsandmethods: This prospective study was conducted in the Department of Surgery and Pathology, Zoram Medical College Hospital, Falkawn, Mizoram. A total of 40 patients with Breast carcinoma for which Modified Radical Mastectomy were included in this study. Results: All the patients were observed for skin flap necrosis. The overall incidence of Flap necrosis was 0% as observed on POD1, POD2, POD4 and POD6. Although after POD14, there were a total of 5 patients who had surgical site infection with wound gaping for whom debridement, dressings and secondary suturing were done. Conclusion: we concluded that there is minimal chance of skin flap necrosis and minimal chance of leaving behind breast tissue using subdermal plexus of vein as a guide for optimum skin flap thickness in modified radical mastectomy in patients with breast cancer.

DOSIMETRIC ANALYSIS OF INCIDENTALAXILLARY IRRADIATION IN BREAST CANCER USING TANGENTIAL FIELDS TREATED BY 3DCRT TECHNIQUE

Introduction Radiotherapy is an important aspect of treatment for multimodality approach in cancer breast. Inclusion of axillary nodes in radiotherapy tangential elds remains a long-standing controversial issue. It is considered that axillary nodes receive incidental radiation through tangential beams of chest-wall. The benet of decreasing regional recurrences with axillary nodal irradiation needs to be weighed against the risk of chronic lymphedema and its impact on quality of life. The following study was done to analyze the incidental dose received to axillary region and whether the addition of radiotherapy to axillary region will be useful. Material and methods Twenty post Modied Radical Mastectomy (MRM) patients who had received adjuvant radiotherapy from 2018-2021were retrospectively selected. Planning was a done with Field in Field–Forward planned–3DCRT with mono-isocentric technique. Dose prescribed was 50Gy/25 fractions. Axillary Lymph nodes were contoured according to RTOG guidelines. Various parameters of PTV(V95,D90, D95, Dmax, Dmean, Homogeneity Index(HI), Conformity Index (CI), Volume of PTV), Axillary Lymph nodes I, II, III and SCF (Dmean,V95, V90, Volume) and BMI were evaluated. Correlation was done among these parameters and Statistical analysis was done using Pearson-Correlation coefcient. Results The mean dose to axillary Lymph node level I, II, III were 45.75Gy, 31.80Gy and 25.83Gy respectively. The V90% and V95% of Axillary level–III also received a dose of 32.97Gy and 22.73Gy respectively. The combined volume of I and II received a mean dose of 40.85Gy and all three levels received 39.44.Gy. There is a weak correlation of SCF dosimetry with axillary nodal volumes although PTV volumes and BMI had positive correlation with axillary lymph nodal irradiation. ConclusionAxillary levels I and II received substantial amount of incidental radiation by the tangential eld 3DCRT technique. Our small sample size may have impacted a more detailed analysis of the correlation among variables. However more prospective clinical studies addressing this issue may help in understanding the risks versus benets of axillary lymph nodal irradiation.

Ultrasound-guided serratus anterior block versus instillation of local anaesthetic through surgical drain in modified radical mastectomy: A randomized controlled study

ABSTRACT Background The primary outcome measure of this study was to compare ultrasound-guided serratus anterior block versus instillation of local anesthetic through the surgical drain in modified radical mastectomy patients as regards the duration of analgesia between the two techniques. Material and methods This prospective, randomized, double-blinded study was conducted on 162 female patients aged 25–50 years, ASA 1, ASA 2, selected for elective unilateral modified radical mastectomy in the Main University Hospital. Group SABP (n = 81) received 20 ml bupivacaine 0.5% in the plan between serratus anterior and latissimus dorsi muscles. Group LA (n = 81) received 40 ml bupivacaine 0.25%, 20 ml in each surgical drain (axillary and chest wall drain). Results The results of the study revealed that the duration of analgesia lasted for 20.8 hr in the SAPB group, while it was 8.14 hourshr in the LA group (P-value ˂0.001). In most postoperative periods, the SAPB group had lower VAS scores at rest and with movement of the ipsilateral arm compared to the LA group. The overall dose and frequency of the consumed rescue analgesic over the first 24 hr in the postoperative period were significantly lower in the SAPB group than in the second group (P-value <0.001). The SAPB group had higher satisfaction scores than the LA group (P-value <0.001). Conclusion It was concluded that the SAPB technique showed superiority over the anesthetic instillation method in controlling acute post-mastectomy pain with a longer duration of analgesia, more patient satisfaction, and less rescue analgesics were consumed.

Comparison of Efficacy and Psychology of Breast-Conserving Surgery and Modified Radical Mastectomy on Patients with Early Breast Cancer under Graded Nursing.

Objective To compare the efficacy and psychology of breast-conserving surgery and modified radical mastectomy in patients with early breast cancer (BC) under graded nursing. Methods Forty-one early breast-conserving surgery BC patients admitted to our hospital from April 2020 to March 2022 were regarded as group A, and 52 with modified radical surgery were seen as group B. The operating time, intraoperative bleeding, postoperative drainage, and hospital stay were compared, and the postoperative adverse effects were counted. In addition, patients' psychology and quality of life were assessed using the HAMD, HAMA, and QLSBC rating scales. At the time of discharge, a treatment satisfaction survey was conducted. Results The operative time, intraoperative bleeding, postoperative drainage, and hospital stay of patients in group A were lower than those in group B (P < 0.05). After treatment, the HAMD and HAMA scores were lower in group A than in group B, while the QLSBC scores and treatment satisfaction were higher (P < 0.05). Conclusion Breast-conserving surgery under graded nursing is less damaging to early BC patients. It can effectively shorten the postoperative recovery process and improve the psychology and quality of life, so it has higher clinical applicability.

The formation of lateral conical defects after radical mastectomy in patients with breast cancer

Aim to find the main causes of the lateral conical defects formation in obese patients after radical mastectomy for breast cancer.&#x0D; Material and methods. We analysed prospectively 82 breast cancer patients with various degrees of obesity. The patients were randomized into two groups. In the main group (43 patients), the original RME method (RU patent No. 2748639, dated May 28, 2021) was used; in the control group (39 patients), the standard RME method was applied.&#x0D; Results. The use of a standard elliptical incision for RME in obese patients leads to the formation of lateral conical defects, the frequency of which reaches 74%. There is a high correlation between the frequency of formation of lateral conical defects in radical mastectomy with expansion of the breast base (Spearman index 0.85 (p0.05), chest circumference (Spearman index 0.92(p0.05), fat pedicle thickness (Spearman index 0.94 (p 0.05) and degree of mammoptosis (Spearman index 0.98 (p 0.05).

Frequency of Seroma Formation after Modified Radical Mastectomy in Patients who receive Neo-adjuvant Chemotherapy

Background: Breast cancer is among the commonest of causes of the death caused due to cancer in the females throughout the world. Objective: To determine the frequency of Seroma formation in patients undergoing Modified Radical Mastectomy after neoadjuvant therapy. Methodology: Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Surgery, Chandka Medical College Hospital, Larkana from November 2019 to January 2022. A total of 217 diagnosed cases of breast carcinoma patients who underwent a modified radical mastectomy after initially receiving neoadjuvant chemotherapy were selected for this study. Pre-designed proforma was used to collect information related to different variables. Results: The average age of the women was 47.29±8.38 years. The frequency of seroma formation in patients undergoing modified radical mastectomy with neo-adjuvant therapy was found in 41.94% (91/217). The average seroma Volume and number of resected lymph nodes were 56.64±5.64 ml and 7.59±1.08. Conclusion: Prediction of seroma formation following Modified Radical Mastectomy with neo-adjuvant therapy remains challenging. We identified no potential risk factors other than the pathological status of the tumor which was associated with an increased frequency of seroma formation.

78P Breast cancer hypofractionated radiotherapy and its implications

Breast cancer is the most common cancer in female, worldwide. Radiation is an integral part of treatment for local control and even adds to overall survival. Most patients need it, except selective early-stage patients undergoing modified radical mastectomy or elderly patients who were operated & fitting to PRIME II trial criteria. 50 Gy in 25 # is the age-old radiation regimen as given by NSABP trial. In 2008, UK START B trial had shown non-inferiority of 40 Gy in 15 # regimen. Fast Forward trial published in 2020 had proved ultra-hypo-fractionated radiation of 26 Gy in 5 #.

Segmental Thoracic Spinal for Modified Radical Mastectomy in Carcinoma of Breast

Segmental Thoracic spinal anesthesia for modified Radical Mastectomy in patients with compromised Pulmonary Function Test provides good hemodynamic stability, and adequate intraoperative and postoperative analgesia, with patient satisfaction. Here, we present a 60 years old patient with carcinoma of the breast posted for Modified Radical Mastectomy under Segmental Thoracic Spinal Anaesthesia.

Postoperative Analgesia in Modified Radical Mastectomy Patients After Instillation of Bupivacaine Through Surgical Drains.

Background: In contrast to other breast surgeries, modified radical mastectomy (MRM) with axillary lymph node clearance involves intense tissue dissection, with postoperative seroma formation and pain being the major complaints affecting patients. Among these, 40% of females experience acute postoperative pain, and between 25 to 60% develop persistent chronic postsurgical pain. The rationale of this study was that minimally invasive procedures can result in immediate pain relief in patients undergoing mastectomy, which has been proven to satisfy their needs and lead to early discharge in the local population.Objective: This study determined to find out the efficacy of instilling bupivacaine on wounds by means of surgical drains in controlling pain after MRM.Methodology: This was a randomized control study trial that was carried out in Surgical Unit 1, Ward 3, Jinnah Postgraduate Medical Centre, Karachi, from November 2020 to April 2021. All patients tested negative for coronavirus disease 2019 (COVID-19) by PCR test before randomly allocating them into two groups. Thirty women in Group B received 40 ml of 0.25% injection bupivacaine, and 30 in Group C received no drug. Duration of analgesia was recorded as time in hours when the patient was received after surgery in the post-anesthesia care unit until the patient felt ache and discomfort of > three scores according to the visual analog pain score chart (VAS).Results: The average age was 52.48±4.76 years. The mean period of time during which analgesia was observed was significantly higher in Group B as compared to Group C (10.93±1.84 vs 5.03±1.35 hours, p=0.0005).Conclusion: There is improvement in postoperative analgesia after instilling bupivacaine through surgical drains on wound beds in MRM patients.

Comparison of Dosimetric Parameters of Three- Dimensional Conformal Radiotherapy and Intensity- Modulated Radiotherapy in Breast Cancer Patients Undergoing Adjuvant Radiotherapy after Modified Radical Mastectomy

Introduction Adjuvant radiotherapy has an important role in preventing locoregional recurrences. But radiation-induced late sequelae have become an important area of concern. The ideal postmastectomy radiotherapy technique is an area of controversy. The present study was designed to compare two widely practiced conformal techniques, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), in terms of dosimetry. Material and Methods A total of 50 postmodified radical mastectomy patients were selected and were randomized to treatment either by 3DCRT or IMRT technique. Two opposing tangential beams were used in 3DCRT plans whereas five to seven tangential beams were used for IMRT plans. The prescribed dose was 50 Gy in 25 fractions over 5 weeks. The dosimetric parameters were compared for planning target volume (PTV), lungs, heart, and left ventricle, opposite breast and esophagus. Results The dosimetric parameters of PTV in terms of D95%, D90%, D50%, and Dmean showed no significant difference among both techniques. The IMRT technique had significantly better mean values of Dnear-min/D98% (45.56 vs. 37.92 Gy; p = 0.01) and Dnear-max/D2% (51.47 vs. 53.65 Gy; p &lt; 0.001). Also, conformity index (1.07 vs. 1.29; p = 0.004) and homogeneity index (0.22 vs. 0.46; p = 0.003) were significantly better in IMRT arm. The dosimetric parameters of ipsilateral lung were significantly higher in IMRT arm in terms of mean dose (19.92 vs. 14.69 Gy; p &lt; 0.001) and low/medium dose regions (V5, V10, V13, V15, V20; p &lt; 0.05). However, high-dose regions (V40) were significantly higher in 3DCRT arm (15.57 vs. 19.89 Gy; p = 0.02). In contralateral lung also, mean dose was significantly higher in IMRT technique (3.63 vs. 0.53 Gy; p &lt; 0.0001) along with low-dose regions (V5, V10, V13, V15; p &lt; 0.05) while V20 was comparable between both the arms. In left-sided patients, the heart dose favored 3DCRT technique in terms of mean dose (17.33 vs. 8.51 Gy; p = 0.003), low/medium dose regions (V5, V10, V20; p &lt; 0.05), and doses to partial/whole volumes (D33, D67, D100). But the high-dose regions (V25, V30, V40) were comparable between both the arms. The dosimetry of left ventricle also showed significantly lesser values of mean dose and V5 in 3DCRT technique (p &lt; 0.0001). The opposite breast also showed higher mean dose with IMRT technique (2.60 vs. 1.47 Gy; p = 0.009) along with higher V5 (11.60 vs. 3.83 Gy; p = 0.001). The dosimetric parameters of esophagus showed higher mean dose in IMRT technique (10.04 vs. 3.24 Gy; p &lt; 0.0001) but the high-dose regions V35 and V50 were comparable between both the arms. Conclusion A clear advantage could not be demonstrated with any of the techniques. The IMRT technique led to more conformal and homogenous dose distribution with reduction in high-dose regions in ipsilateral lung while the 3DCRT technique showed lesser mean dose to organs at risk (OARs). The exposure of large volumes of OARs to low doses in IMRT technique may translate to increased long-term radiation-induced complications. The shortcomings of 3DCRT technique can be overcome by using multiple subfields within tangential fields.

A comparative study of pulmonary toxicity between hypofractionated and conventionally fractionated radiation therapy in postmastectomy carcinoma breast

Background: Hypofractionated schedule has multiple advantages over conventional fractionation radiation therapy in terms of logistics and patient compliance. However, pulmonary toxicity is a major concern in breast cancer radiotherapy about which there are limited data comparing these two radiation regimens. Objective: This study aimed at comparing these two radiation schedules in terms of acute pulmonary toxicity and parameters of pulmonary function. Materials and Methods: Postmodified radical mastectomy patients with nonmetastatic carcinoma breast were randomized into two groups: study-arm patients received hypofractionated radiotherapy with 42.5 Gy in 16 fractions, over 3.5 weeks, whereas control-arm patients received conventionally fractionated radiotherapy with 50 Gy in 25 fractions, over 5 weeks. Patients underwent pulmonary function test (PFT) before radiotherapy (baseline), then at one and 3 months after completion of radiotherapy for changes in parameters of PFT and acute toxicities. Results: PFT changes were comparable in both the arms at day 30 and day 90 postradiation. Incidences of cough 1 month after radiotherapy and 3 months after radiotherapy were comparable (P = 0.3 and 0.07). Higher grade dyspnea at 3 months posttreatment, though numerically was higher in the study arm, was not significant (P = 0.44). In study arm at 90 days postradiation, Grade 2 and Grade 3 radiation pneumonitis were numerically more (15% vs. 3% and 3.5% vs. 0%), but not statistically significant (P = 0.08). Conclusion: Both conventional and hypofractionated arms showed almost similar results in terms of acute pulmonary toxicity and change in PFT parameters. Hence, considering the logistic advantages, the hypofractionated schedule can be considered an effective alternative to conventional radiotherapy for postmastectomy breast cancer patients.

Comparison of Efficacy of I/V Tramadol and Bupivacaine Irrigation through Drains after Modified Radical Mastectomy

Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain. Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast. Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains. Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in severity of pain in both treatment groups. In Group-A at 0, 2, 4 and 6 hour postoperatively, 68.8%, 71.4%, 57.1% and 60% respectively had reported no pain while in Group-B at 0, 2, 4 and 6 hour postoperatively, 48.6%, 65.7%, 45.7% and 54.3% patients had reported no pain. Complaints of Nausea, vomiting, sedation, urinary retention was higher in patients in Tramadol Group as compared to Bupivacaine Group. Conclusion: Results of this study demonstrated that bupivacaine administrated through surgical drain was equally effective as intravenous tramadol for controlling postoperative mastectomy pain with less side effects. Keyword: Breast Cancer, Acute Pain, Analgesia, Tramadol, Bupivacaine, Radical Mastectomy, Nausea, Vomiting, Sedation, Urinary retention, Hypotension