Radiation Treatment For Breast Cancer Research Articles

Glutathione-Depleted Photodynamic Nanoadjuvant for Triggering Nonferrous Ferroptosis to Amplify Radiotherapy of Breast Cancer.

Radiotherapy plays a crucial role in the treatment of advanced breast cancer, but the increased antioxidant system, especially the rise in glutathione (GSH), presents a significant obstacle to its effectiveness. To address this challenge, a versatile GSH-depleted photodynamic nanoadjuvant is developed to augment the efficacy of radiotherapy for breast cancer treatment. This nanoadjuvant operates within the tumor microenvironment to effectively deplete intracellular GSH through a sequence of cascaded processes, including GSH exhaustion, biosynthetic inhibition, and photodynamic oxidation. This leads to a notable accumulation of lipid peroxides (LPO) and subsequent suppression of glutathione peroxidase 4 (GPX4) activity. Consequently, the combined GSH depletion induced by the nanoadjuvant markedly promotes nonferrous ferroptosis, thereby contributing to the augmentation of antitumor efficiency during radiotherapy in breast cancer. This work presents an innovative approach to designing and synthesizing biocompatible nanoadjuvants with the goal of improving the efficacy of radiotherapy for breast cancer in prospective clinical scenarios.

Effect of using bolus on the efficiency of the 3DCRT of the breast cancer after mastectomy.

To assess the effect of using bolus on the efficiency of three-dimensional conformation radiation treatment of breast cancer post-mastectomy. The prospective, clinical study was conducted at Al-Amal Center for Radiation Therapy and Nuclear Medicine, Iraq, from November 2020 to April 2021, and comprised patients with synchronous bilateral breast cancer with regional lymph nodes who underwent mastectomy. The three-diensional conformation radiation treatment technique was used to evaluate the dose received by the planning target volume and the organs at risk. The plans were generated using a treatment planning system, the plans were then fed into a linear accelerator. The plans had one isocenter for both breasts to avoid the errors that may cause the overlapping of the radiation fields with and without the use of bolus. Data was analysed using SPSS 24. There were 23 female patients with mean age 49.28±8.79 years (range: 35-62 years). There were 7(30.4%) females residing in rural areas, while 16(69.6%) lived in urban areas. The use of bolus increased the radiation dose coverage percentage of the planning target volume of the right (p=0.0002) and left (p=0.0164) breasts, while the right (p=0.3977) and left (p=0.7940) supraclavicular nodes were not significantly covered by the radiotherapy dose. The use of bolus showed a strong significant decrease of the mean dose that was received by the left lung (p=0.00001). Also, the use of bolus caused significant reduction in the amount of the mean scattered dose that reached the heart (p=0.00001) and larynx (p=0.00004). The use of bolus provided a complete radiotherapy dose coverage for the right and left breasts, as well as an excellent protection for the left lung, heart and larynx.

Resource implications of evolving breast cancer radiotherapy treatment protocols

Resource implications of evolving breast cancer radiotherapy treatment protocols

Collateralization of the upper extremity lymphatic system after axillary lymph node dissection.

Lymphatic drainage from the arm may be altered after axillary lymph node dissection (ALND). Understanding these alterations is important as they may change standard surgical and radiation treatment in recurrent breast cancer or upper extremity skin cancers, including melanoma. Utilizing a single-institution planar and single photon emission computed tomography/computed tomography lymphoscintigraphy database, we identified patients with a diagnosis of upper extremity cutaneous melanoma from 2008 to 2023 who previously underwent ALND for cancer treatment and did not develop upper extremity cancer-related lymphedema. ALND patients were matched to control patients presenting with cutaneous melanomas at the same anatomic sites. Sentinel lymph nodes (SLNs) were compared between both groups. Of 3628 upper extremity melanoma cutaneous patients, 934 met inclusion criteria, including 22 ALND and 912 control patients. Level I axillary SLN drainage was observed in 98% of controls and 27% of ALND patients (p < 0.001). Level II axillary SLN drainage was observed in 3% of controls and 27% of ALND patients (p < 0.001). Level III axillary SLN drainage was observed in 1% of controls and 32% of ALND patients (p < 0.001). Epitrochlear SLN drainage was observed in 9% of controls and 32% of ALND patients, respectively (p < 0.046). Brachial SLN drainage was observed in 4% of controls and 23% of ALND patients (p < 0.001). Distinct changes in functional lymphatic drainage were seen between the arms of patients who previously underwent ALND versus control patients. Levels II and III axillary, epitrochlear, and brachial nodes are possible sites of metastatic disease that should be considered in patients with a prior ALND.

Nutritional support in the complex of medical rehabilitation at the stage of adjuvant radiation therapy of breast cancer

BACKGROUND: Currently it is known that there exists the need for complex medical rehabilitation at the stage of adjuvant radiation treatment of breast cancer. However, data on the combined use of nutritional support and physical factors at this stage of oncological treatment are not available. AIM: Evaluation of the effectiveness of specialized therapeutic and preventive nutrition in patients with malignant breast diseases and a history of polychemotherapy at the stage of adjuvant radiation therapy in complex medical rehabilitation using low-temperature plasma and general magnetic therapy. MATERIALS AND METHODS: A prospective simple randomized study was conducted, which involved 60 patients at the stage of adjuvant radiation therapy for breast cancer. The main group (n=30) received a course of medical rehabilitation with the inclusion of nutritional support using specialized therapeutic and preventive nutrition LEOVIT ONCO®, as well as exposure to low-temperature plasma and general magnetotherapy. In the comparison group (n=30), the rehabilitation course included general magnetic therapy without therapeutic and preventive nutrition. All patients underwent individual physiotherapy exercises, and sessions with a medical psychologist. The results obtained were recorded using clinical and functional, laboratory, instrumental studies. RESULTS: It has been established that the use of specialized dietary products LEOVIT ONCO and physical factors is an effective method of rehabilitation. The use of nutritional support demonstrates the maintenance of the patient’s protein status, reduces intoxication, and reduces the negative impact of oxidative stress factors in the body at the stage of adjuvant radiation treatment. The inclusion of low-temperature plasma and general magnetic therapy in the rehabilitation program has a beneficial effect on hemomicrocirculation in the area of ionizing radiation exposure. CONCLUSION: The use of nutritional support and physical factors, as a component of complex medical rehabilitation, helps to maintain the optimal nutritional status of the patient, reduces the manifestations of skin radiation reactions, improves the psycho-emotional state of patients and the quality of life of patient.

Breast-Conserving Therapy and Irradiation in Women with Prior Breast Augmentation

Introduction: The incidence of breast-augmented women developing breast cancer is increasing and there is some disagreement regarding the optimal cancer treatment, in the setting of prior breast augmentation. The purpose of this study was to describe the outcome of Breast-conserving surgery and Radiation Treatment (BCT) for breast cancer, with preservation of the breast implants in breast-augmented women. Methods: Medical records of 30 women with prior breast augmentation, undergoing BCT at our institution between 2018 and 2021, were retrospectively reviewed. Data regarding complications, capsular contracture rates, oncological and overall cosmetic outcomes following treatment were registered. Results: Median follow-up time was 29 months with an overall complication rate of 30%. Surgeryrequiring complications (capsular contracture) were observed in 10% of the patients, one case resulting in implant removal and two cases resulting in implant exchange, whereas 20% had complications not requiring reoperation. Two patients (7%) had positive margins and underwent re-excision. No patients experienced cancer recurrence. Fifty percent of those with relevant information (n=3/6) developed or had worsening of capsular contracture, and 63% (n=7/11) were evaluated as having an excellent to good overall cosmetic appearance upon follow-up.

The Japanese breast cancer society clinical practice guidelines for radiation treatment of breast cancer, 2022 edition.

The Breast Cancer Clinical Practice Guidelines, organized by the Japanese Breast Cancer Society (JBCS), were published in 2022. We present the English version of the Radiation Therapy (RT) section of the guidelines. The JBCS formed a task force to update the 2018 version of the JBCS Clinical Practice Guidelines. The Background Questions (BQs) contain the standard treatments for breast cancer in clinical practice, whereas the Clinical Questions (CQs) address daily clinical questions that remain controversial. Future Research Questions (FRQs) explore the subjects that are considered important issues, despite there being insufficient data for inclusion as CQs. The task force selected the 12 BQs, 8 CQs, and 6 FRQs for the RT section. For each CQ, systematic literature reviews and meta-analyses were conducted according to the Minds Manual for Guideline Development 2020, version 3.0. The recommendations, strength of recommendation, and strength of evidence for each CQ were determined based on systematic reviews and meta-analyses, and finalized by voting at the recommendation decision meeting.

Through Clinicians Eyes: Use of an In-consultation Patient Decision Aid in Radiation Treatment for Early Breast Cancer. A Qualitative Study

IntroductionShared decision making (SDM) has become a crucial element on the political agenda and represents a vital aspect of modern healthcare. However, successful implementation of SDM highly depends on the attitude of clinicians towards SDM. The overall aim of our study was to explore the experience of oncologists and nurses with SDM using the Decision Helper, an in-consultation decision aid, at four Danish radiotherapy departments. MethodsSemi-structured interviews were conducted with 20 clinicians. The participants were selected using purposive sampling to include nurses and oncologists, male and female, with different levels of experience with SDM and clinical work. The analysis was a data-driven, iterative process with inductive coding of all interviews and meaning condensation. ResultsTwo main themes emerged: “Using the Decision Helper changes the consultation” and “Change of attitude among Danish oncologists.” Each of the two themes included four elaborative subthemes, which are reported with supporting citations in this paper. In brief, the use of SDM and the Decision Helper should ideally be adjusted to the individual patient and depends highly on the oncologist. The participants described ambitions towards “making the right decision for this patient at this time.” The healthcare system, however, has pitfalls that may hinder SDM, e.g., rigid interpretation of guideline-based recommendations. ConclusionUsing an in-consultation Decision Helper has the potential for individualized, structured patient engagement in decision making. There is a need for patient decision aids in clinical guidelines to ensure patient engagement in decision making.

Using narrative 360° video as a tool to promote breast self-examination

This experiment examined the feasibility of 360° video as a tool for public health messaging by investigating the effect that viewing the 360° documentary The Waiting Room VR had on female viewers’ sense of identification, attitudes to breast cancer screening and mortality salience. A key part of the documentary places participants in a viewpoint ambiguously aligned to that of the film’s director and subject, Victoria Mapplebeck (VM), in a scene that recreates her radiotherapy treatment for breast cancer. Eighty female participants watched the documentary either sitting upright with the chair back set at a 90° angle or reclining with the chair back set at a 140° angle (consistent with VMs posture) under conditions of either high or low cognitive load. The effect of posture type was measured explicitly using questionnaires on presence, identification and breast self-examination (BSE) intention as well as implicitly using a lexical decision task to measure death-thought awareness (DTA). Reclined posture led to a higher sense of spatial presence but no increase in identification with VM. Significantly increased identification with VM led to greater intention to conduct BSE. There were no effects of posture, cognitive load or identification on DTA. The implications of these results for using 360° video as a behaviour change tool, the effects of the COVID-19 pandemic on the terror management manipulation and the relevance of spatial viewpoint in 360° video are discussed.

Financial Implications of Evolving Breast Cancer Radiotherapy Treatment Protocols

Adjuvant radiotherapy for breast cancer represents a significant portion of radiotherapy (RT) treatments. The resource implications of evidence-based changes in treatment protocols must be defined to facilitate RT service planning. We designed a study to calculate the impact of past changes and create a model to allow prediction of costs implications for future changes. Changes in RT treatment (shown in table 1) in the past 3 years were identified in consultation with clinical staff and by reviewing institutional treatment guidelines. Resource and infrastructure costs were calculated for each protocol. Staff time was calculated using standard time slots where known (e.g., CT simulation appointment) and estimates based on discussion with staff (e.g., time to plan whole breast RT). Cost / Gy was calculated based on Linac cost of €2.5M, 10% annual service charge over 12-year lifetime, 2.7 patients treated / hour (verified institutional metric) and standard 2Gy fraction, giving €37.72 / Gy. We did not include facilities costs nor account for differing treatment outcomes. We collected relevant data on a consecutive 6-month sample (Jan - Jun 2019) of women receiving adjuvant RT for breast cancer (n = 224). Total costs were calculated by applying costs for each protocol change to the women in this cohort eligible for the changes. Protocol changes and costs are summarized in table 1. The use of DIBH for women <60 years receiving IMN RT (left and right sided) added a cost. The largest cost saving resulted from more selective tumor bed boost, a saving of €462,138. The potential impact of a 5-fraction boost for women with non-low risk DCIS was estimated. In the cohort analyzed, identified changes in adjuvant breast radiotherapy resulted in overall savings due to updated indications for boost and the implementation of ultra-hypofractionated radiotherapy. We are now analyzing the impact of introducing simultaneous integrated boost and partial breast radiotherapy.

Biological Aging Accelerated by Radiation Treatment in Breast Cancer

Biological Aging Accelerated by Radiation Treatment in Breast Cancer

In-vivo dosimetry with EBT-3 gafchromic films and thermoluminescent dosimeters in breast cancer radiotherapy treatments

In-vivo dosimetry with EBT-3 gafchromic films and thermoluminescent dosimeters in breast cancer radiotherapy treatments

Comparative radiosensitization efficiency assessment of graphene oxide and Ti3C2 MXene as 2D carbon-based nanoparticles against breast cancer cells: characterization, toxicity and mechanisms

The efficacy of two carbon-based nanomaterials, graphene oxide (GO) and Ti3C2 MXene (MX), on the radiosensitivity of the breast cancer cells (BCCs) was investigated using clinical x-ray irradiation. The prepared GO and MX nanoparticles (NPs) were firstly characterized utilizing Fourier transform infrared, ultraviolet–visible, atomic force microscopy and transmission electron microscopy techniques and subsequently assessed in terms of their radiobiological properties. The results of the cell toxicity assay indicated that neither NPs exhibited significant cytotoxicity after 48 h incubation with BCC up to 50 µg ml−1 concentration without irradiation. The cell internalization results showed an approximately equivalent cellular uptake for both NPs after 6 h incubation with BCC. Our comparative studies with radiotherapy demonstrated that both NPs substantially increased cell proliferation inhibition and cell apoptosis of BCC under x-ray irradiation when compared to BCC treated with irradiation alone. Additionally, the 2ʹ,7ʹ-dichlorofluorescin diacetate flow cytometry results and fluorescent microscopy images revealed that both NPs remarkably increased the level of intracellular reactive oxygen species (ROS) generation in BCC under x-ray irradiation. The MX nanosheets exhibited superior radiosensitization efficiency than GO under x-ray irradiation due to its higher level of intracellular ROS generation (MX = 75.2% and GO = 65.2%). Clonogenic cell survival assay and extracted radiobiological parameters revealed that both NPs in combination with x-ray irradiation induced more lethal damage and less sublethal damage to BCC. Generally, the obtained results demonstrate that the MX NPs, as a stronger radiosensitizer than GO, could be a promising candidate for enhancing the effectiveness of radiotherapy in breast cancer treatment.

Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions

The use of medical 3D printing has expanded dramatically for breast diseases. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides updated appropriateness criteria for breast 3D printing in various clinical scenarios. Evidence-based appropriateness criteria are provided for the following clinical scenarios: benign breast lesions and high-risk breast lesions, breast cancer, breast reconstruction, and breast radiation (treatment planning and radiation delivery).

Adjuvant Radiation Treatment of Breast Cancer After Mastectomy: Advanced Algorithms and Partial Bolus Improve the Dose Calculation Accuracy in the Case of Thin-Chest-Wall Irradiation

The aim of this study was to examine measured and calculated dose distributions in a thin-chest-wall phantom and estimate the variations in the dose-volume histogram (DVH) parameters used in plan evaluation for patient geometries with chest-wall thicknesses <15 mm with and without bolus implementation. Measurements were made using thermoluminescent dosimeters in a chest-wall phantom. The Monte Carlo method, anisotropic analytical algorithm, and Acuros XB Eclipse algorithms were used to calculate dose distributions for clinical plans. DVH parameters for clinical target volume tumor (CTVT) and planning target volume (PTV) and mean doses were evaluated for 15 patients with a chest-wall thickness of 8 to 15 mm with and without partial bolus and for 10 patients with a chest-wall thickness of 20 to 25 mm without bolus. Measurements showed that the dose at a depth of 2 to 12 mm at the beam entrance and laterally was within 90% of the dose at 8 mm depth. Monte Carlo and Acuros XB calculations were well aligned with the experimental data, whereas the anisotropic analytical algorithm underestimated the beam entrance and lateral doses. The DVH parameters for the patients with a thin chest wall were sensitive to calculation algorithm, resolution, body structure definition, and patient geometry. The parameters CTVTV95%, CTVTD98%, and PTVD98% were much lower than the tolerance criteria. Partial bolus improved the values for all algorithms and decreased the variations due to patient geometry. Dose calculations for patients with a chest-wall thickness of 20 to 25 mm resulted in sufficient target coverage and low dependence on patient geometry and calculation algorithm without the use of bolus. Dose calculations using advanced algorithms and resolution <2 mm are recommended for patients with a thin chest wall. Specific DVH criteria or the implementation of partial bolus was needed to facilitate plan development and evaluation for this patient group.

Global research trends in radiotherapy for breast cancer: a systematic bibliometric analysis.

Breast cancer is the most common malignant tumor in women. Radiotherapy (RT) is an important adjunctive therapy for breast cancer, but the current international research trend of RT in breast cancer treatment and management is unclear. This bibliometric analysis was conducted to investigate the current trends and hot topics in this area. The Web of Science Core Collection (WoSCC; Clarivate) database was searched, VOSviewer 1.6.18 and CiteSpace 6.1.R2 software were employed for the quantitative and qualitative analysis. 12,268 publications were included in this bibliometric analysis. There was an increasing trend of publications and international collaborations in the topic. The United States and The University of Texas MD Anderson Cancer Center were the most productive countries and institutions, respectively. The analysis of journals showed researches focused on both basic and clinical medicine on breast cancer RT. Park Won published the most papers and Fisher B had the most co-citations. The most co-cited paper was published in the Lancet. Survival, risk, chemotherapy, mastectomy, and surgery were regarded as current research hotspots through the analysis of keywords. Through quantitative and qualitative bibliometric analyses, this study provides insights into the research trends and potential research hotspots on breast cancer RT.

DNA Methylation Alterations in Fractionally Irradiated Rats and Breast Cancer Patients Receiving Radiotherapy.

Radiation-Induced CardioVascular Disease (RICVD) is an important concern in thoracic radiotherapy with complex underlying pathophysiology. Recently, we proposed DNA methylation as a possible mechanism contributing to RICVD. The current study investigates DNA methylation in heart-irradiated rats and radiotherapy-treated breast cancer (BC) patients. Rats received fractionated whole heart X-irradiation (0, 0.92, 6.9 and 27.6 Gy total doses) and blood was collected after 1.5, 3, 7 and 12 months. Global and gene-specific methylation of the samples were evaluated; and gene expression of selected differentially methylated regions (DMRs) was validated in rat and BC patient blood. In rats receiving an absorbed dose of 27.6 Gy, DNA methylation alterations were detected up to 7 months with differential expression of cardiac-relevant DMRs. Of those, SLMAP showed increased expression at 1.5 months, which correlated with hypomethylation. Furthermore, E2F6 inversely correlated with a decreased global longitudinal strain. In BC patients, E2F6 and SLMAP exhibited differential expression directly and 6 months after radiotherapy, respectively. This study describes a systemic radiation fingerprint at the DNA methylation level, elucidating a possible association of DNA methylation to RICVD pathophysiology, to be validated in future mechanistic studies.

A Machine Learning Framework for Early Prediction of Radiation Dermatitis in Patients with Breast Cancer Receiving Radiation Treatment: A Multicenter Retrospective Analysis Study

<h3>Purpose/Objective(s)</h3> Radiation-induced dermatitis (RD) is one of the major toxicities in patients with breast cancer (BC) receiving adjuvant radiation treatment (RT), which significantly affects the patient's treatment tolerance and quality of life and potentially compromises tumor control probability. However, to differentiate the degree of RD could be challenging due to the wide variations related to current methods used to evaluate the skin toxicity symptoms. In this study, we developed, for the first time to our knowledge, a machine learning framework synergistically integrating multi-region dose gradient correlated-radiomics features extracted from pre-treatment planning CT images and dosimetric factors with clinical variables for early prediction of RD. <h3>Materials/Methods</h3> A total of 214 patients with BC receiving RT between 2019 and 2021 from four cancer centers were included in this study. Three machine learning classifiers (a 5-fold cross-validation random forest, Radial Kernel svm, and gradient boosting decision tree (GBDT)) were employed for model training and validation. Radiomics features extracted from 3 PTV ROIs and 3 skin dose-related ROIs on planning CT image and 14 dosimetric factors as well as 17 clinical variables were used to train machine learning models. The utility of the constructed models in predicting RD was evaluated by the ROC analysis in the validation cohort. <h3>Results</h3> The random forest model combining 10 radiomic features, 3 dosimetric factors and 6 clinical variables achieved a better performance with an AUC value of 0.946 (95%[CI]: 0.887-0.987) compared with GBDT (AUC=0.912, 95%[CI]: 0.839-0.985) and SVM model (AUC=0.844, 95%[CI]: 0.786-0.913). The most valuable influence factors for model performance include 10 radiomics features (PTV105.F8.ShapeMeanBreadth, PTV108.F1.GOH0.975Quantile, PTV108.F2._GLCM25180.1Dissimilarity, SKIN20.F2._GLCM25225.4Contrast, SKIN20.F4.ID_GlobalMin, SKIN30.F2._GLCM25225.4Contrast, SKIN30.F6.IHGaussFit1GaussStd, SKIN30.F8.ShapeMax3Ddiameter), 3 dosimetric factors (PR, EQD2_all, fractionation.regimen.Gy.fx.), and 6 clinical variables (laterality quadrant positions, histologic type, T stage, hormone therapy and lotion application). <h3>Conclusion</h3> The machine learning models depicting the correlation of dose gradient related radiomics features, dosimetric factors and clinical variables can be used to accurately predict the severe RD in patients with BC receiving RT, which can potentially improve the effectiveness of RT for BC from a precision treatment perspective.

Dosimetric assessment and secondary cancer risk in breast radiotherapy: a Monte Carlo approach

To calculate the risk of secondary cancer induction resulting from this dose through a Monte Carlo simulation code and voxel-based anthropomorphic phantom to determine the radiation dose in organs and/or tissues with dosimetric importance and the effect of using static MLC in the 3D-CRT technique. In this work, a radiotherapy treatment of breast cancer was simulated using the radiation transport code MCNPX 2.7.0 and the adult anthropomorphic simulator FSTA_H50_M50. The absorbed doses for a set of organs with dosimetric importance were determined. A LINAC Varian 2100C device operated with two techniques was simulated: 2D with open field (OF) and 3D-conformational (3D-CRT), the latter with the use of a multilayer collimator (MLC) of the breast, both acting with 6 MV energy. The highest values of absorbed dose were obtained for the ipsilateral lung (7.22 Gy (3D-CRT) and 8.49 Gy (OF)) and the contralateral breast (6.29 Gy (3D-CRT) and 6.56 Gy (OF)), generating for these organs the greatest risks of secondary cancer induction. With the OF technique, due to the non-collimation of the beam, there was an increase in the absorbed dose in all organs compared to 3D-CRT, thus evidencing a more effective treatment with the 3D-CRT technique, improving both homogeneity and conformity with the dose absorbed in the target organ.

The effect of using virtual bolus on VMAT plan quality for left-sided breast cancer patients

In breast cancer radiotherapy treatment with Volumetric Modulated Arc Therapy (VMAT), the respiratory motion may lead to underdosing of the target and overdosing of critical organs such as the heart and lungs. This study aims to investigate the effect of using Virtual Bolus with different thicknesses on VMAT plan quality for patients with 20 advanced left-sided breast cancers. The result of the study showed that using Virtual Bolus for VMAT treatment planning is a viable method to avoid any missing target coverage.