Radiotherapy For Breast Cancer Research Articles

Kiosk 5R-TA-03 - Cardiac Magnetic Resonance-assessed Subclinical Cardiac Dysfunction During 2 Years After Breast Cancer Irradiation: The Medirad-early Heart Study

Kiosk 5R-TA-03 - Cardiac Magnetic Resonance-assessed Subclinical Cardiac Dysfunction During 2 Years After Breast Cancer Irradiation: The Medirad-early Heart Study

Application of Intraoperative Radiotherapy in Early-Stage Breast Cancer Patients in a Clinical Setting.

Background: Intraoperative radiation therapy (IORT) has gained popularity in recent years as an alternative to external beam whole breast radiation therapy (WBRT) for early-stage breast cancer. Here, we report 43-month recurrence and survival outcomes in a multiethnic cohort treated with IORT in a clinical context. Method: Two hundred and eleven patients with low-risk features were treated with IORT for early-stage breast cancer from 2014 to 2021. Selection criteria were based on Group Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines: preferably unifocal intraductal carcinoma (IDC), aged > 50, tumor size ≤ 2.0 cm, and without lymph node involvement. All patients received 20 Gy of radiation dose during the lumpectomy. Information on patient and tumor characteristics was collected. Results: The mean age of this cohort was 67.5 years; 95.2% of patients are Jewish, and the rest are Bedouins (4.7%). Most tumors were intraductal carcinoma (97.2%) and stage 1 (94.8%). The mean follow-up time was 43.4 months. Bedouins had larger tumor sizes (mean 1.21 vs. 1.13 cm) and were younger at diagnosis than Jewish patients (mean 65.4 vs. 67.6 years), although the differences are not significant. The overall recurrence rate was 1.4%. One case of local recurrence (0.5%) and two cases of metastasis (0.9%) were observed during the study period. One patient died from metastasis. Conclusion: Our findings suggest that IORT in selected low-risk patients can achieve an excellent prognosis with low rates of recurrence and metastasis.

Single-cell and spatial profiling identify three response trajectories to pembrolizumab and radiation therapy in triple negative breast cancer

Strategies are needed to better identify patients that will benefit from immunotherapy alone or who may require additional therapies like chemotherapy or radiotherapy to overcome resistance. Here we employ single-cell transcriptomics and spatial proteomics to profile triple negative breast cancer biopsies taken at baseline, after one cycle of pembrolizumab, and after a second cycle of pembrolizumab given with radiotherapy. Non-responders lack immune infiltrate before and after therapy and exhibit minimal therapy-induced immune changes. Responding tumors form two groups that are distinguishable by a classifier prior to therapy, with one showing high major histocompatibility complex expression, evidence of tertiary lymphoid structures, and displaying anti-tumor immunity before treatment. The other responder group resembles non-responders at baseline and mounts a maximal immune response, characterized by cytotoxic T cell and antigen presenting myeloid cell interactions, only after combination therapy, which is mirrored in a murine model of triple negative breast cancer.

A Beam Angle Selection Method to Improve Plan Robustness Against Position Error in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer.

We report a dosimetric study in whole breast irradiation (WBI) of plan robustness evaluation against position error with two radiation techniques: tangential intensity-modulated radiotherapy (T-IMRT) and multi-angle IMRT (M-IMRT). Ten left-sided patients underwent WBI were selected. The dosimetric characteristics, biological evaluation and plan robustness were evaluated. The plan robustness quantification was performed by calculating the dose differences (Δ) of the original plan and perturbed plans, which were recalculated by introducing a 3-, 5-, and 10-mm shift in 18 directions. M-IMRT showed better sparing of high-dose volume of organs at risk (OARs), but performed a larger low-dose irradiation volume of normal tissue. The greater shift worsened plan robustness. For a 10-mm perturbation, greater dose differences were observed in T-IMRT plans in nearly all directions, with higher ΔD98%, ΔD95%, and ΔDmean of CTV Boost and CTV. A 10-mm shift in inferior (I) direction induced CTV Boost in T-IMRT plans a 1.1 (ΔD98%), 1.1 (ΔD95%), and 1.7 (ΔDmean) times dose differences greater than dose differences in M-IMRT plans. For CTV Boost, shifts in the right (R) and I directions generated greater dose differences in T-IMRT plans, while shifts in left (L) and superior (S) directions generated larger dose differences in M-IMRT plans. For CTV, T-IMRT plans showed higher sensitivity to a shift in the R direction. M-IMRT plans showed higher sensitivity to shifts in L, S, and I directions. For OARs, negligible dose differences were found in V20 of the lungs and heart. Greater ΔDmax of the left anterior descending artery (LAD) was seen in M-IMRT plans. We proposed a plan robustness evaluation method to determine the beam angle against position uncertainty accompanied by optimal dose distribution and OAR sparing.

Outcomes with and without postmastectomy radiotherapy for pT3N0-1M0 breast cancer: An institutional experience.

The objective of this study is to comprehensively evaluate the therapeutic efficacy of postmastectomy radiotherapy (PMRT) in treating patients with pT3N0-1M0 breast cancer within the context of modern therapeutic strategies. Clinical data from patients with pT3N0-1M0 breast cancer who underwent mastectomy from January 2005 to December 2018 at our institution were retrospectively analyzed. The study involved a total of 222 participants, with 112 individuals undergoing PMRT and 110 individuals not receiving it. The median follow-up duration was 77 months (range: 6-171 months). The entire cohort demonstrated 5-year disease-free survival (DFS) and overall survival (OS) rates of 85.1% and 91.0%, respectively, along with a locoregional recurrence (LRR) rate as low as 7.2%. The PMRT group showed significantly better 5-year DFS (90.2% vs. 80.0%, p = 0.02) and OS (95.5% vs. 86.4%, p = 0.012) rates, as well as a lower LRR rate (4.5% vs. 10.0%, p = 0.122), compared to the group without PMRT. Cox regression analysis confirmed the independent prognostic significance of PMRT for both DFS (p = 0.040) and OS (p = 0.047). Following propensity score matching (PSM), the analysis included 100 matched patients, revealing an improved prognosis for those who received PMRT (DFS: p = 0.067; OS: p = 0.043). Our study reveals favorable prognoses for pT3N0-1M0 breast cancer patients treated within contemporary therapeutic approaches. The pivotal role of PMRT in this context is evident. However, due to the retrospective design of our study and the relatively limited sample size, further investigation is imperative to validate and enhance these initial findings.

Radiation for inflammatory breast cancer: Updates.

Inflammatory breast cancer (IBC) is a diagnosis based on a constellation of clinical features of edema (peau d'orange) of a third or more of the skin of the breast with a palpable border and a rapid onset of breast erythema. Incidence of IBC has increased over time, although it still makes up only 1-4% of all breast cancer diagnoses. Despite recent encouraging data on clinical outcomes, the published local-regional control rates remain consistently lower than the rates for non-IBC. In this review, we focus on radiotherapy, provide a framework for multi-disciplinary care for IBC, describe local-regional treatment techniques for IBC; highlight new directions in the management of patients with metastatic IBC and offer an introduction to future directions regarding the optimal treatment and management of IBC.

Therapeutic Vaccines in Breast Cancer

Breast cancer (BC) is a major worldwide health issue, characterised by an increasing occurrence in both males and females. The classification of breast cancer subgroups is determined by variations in hormone receptor expression. Although traditional breast cancer therapies, including chemotherapy, surgery, and radiotherapy, have demonstrated effectiveness in the treatment of patients, they are frequently associated with significant adverse effects and recurrence. The emergence of therapeutic vaccines has become a promising option for the field of immunotherapy. These vaccines enhance the body’s immune system to identify and eliminate cancerous tumour cells. The current approach to vaccine therapy for breast cancer focuses on the targeting of two main categories of antigens: tumour associated antigens and tumour specific antigens. Excitingly, multiple vaccine strategies for breast cancer treatment have been employed, all of which have demonstrated promise and effectiveness in clinical studies. Currently, proposed vaccine types include peptide-based vaccines, whole tumour cell vaccines, DNA/RNA-based vaccines, dendritic cell vaccines, and viral-vector vaccines, etc. This review examined the present state of different types of vaccines in breast cancer therapy, including the therapeutic mechanism and the treatment outcomes.

Radiation-induced angiosarcoma of the breast: retrospective analysis at a regional treatment centre.

Radiation-induced angiosarcoma (RIA) is an uncommon but morbid complication after radiotherapy for breast cancer. Retrospective analysis of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England. 22 patients were identified between 2010 and 2022. Median age of diagnosis was 65years (range 41-78). Median time from breast radiotherapy to RIA diagnosis was 6.5years (range 2.4-16.0)-this interval has decreased over the last 24years (r2 = 0.6601). 9% had metastasis at presentation. All patients underwent surgery (55% at CUH, 45% at local hospitals). 27% received peri-operative pegylated liposomal doxorubicin in the first-line setting. 62% relapsed following their primary curative-intent treatments after a median of 28months. Metastases occurred in 36%, the commonest sites being lung (100%) and lymph node (50%). 2-year and 5-year overall survival (OS) rates for all patients were 73% and 60%, respectively. No correlation between progression-free survival (PFS) and OS was found with tumour size, margin, peri-operative chemotherapy, and whether surgery was performed at CUH. Patients with multifocal disease on their breasts had shorter PFS following surgery compared to single-lesion disease (median 10 vs 65months; HR = 4.359 [95% CI 1.342-14.16]; P = 0.0143). Patients aged > 72years had a median OS of 45months vs 102months for those ≤ 72years (HR = 7.129 [95% CI 1.646-30.88]; P = 0.0086). RIA has high rates of recurrence and mortality and appears to be occurring sooner after breast radiotherapy. Further studies on its pathogenesis and effective treatment are warranted.

Locoregional Ablative Radiation Therapy for Patients With Breast Cancer Unsuitable for Surgical Resection

Breast cancer patients unsuitable for surgical resection are typically managed with palliative systemic therapy alone. We report outcomes of 5-fraction ablative radiotherapy for non-resected breast cancers. Retrospective analysis of an institutional registry of breast cancer patients unsuitable for resection who underwent 35-40 Gy/5 fractions to the primary breast tumour and/or regional lymph nodes from 2014-2021. Primary outcomes were cumulative incidence of local failure (LF) and grade ≥3 toxicity (CTCAE v5.0). We reviewed 57 patients who received 61 treatment courses (median age of 81 years, range 38-99). Unresectable tumour (10%), patient refusal (18%), medical inoperability (35%), and metastatic disease (37%) were the causes of not having surgery. Five patients (8%) had previously undergone adjuvant locoregional radiotherapy. Fifty-four percent (n=33/61) of treatment courses targeted the breast only, 31% (n=19/61) both the breast and lymph nodes, and 15% (n=9/61) the lymph nodes only. Sixty-seven percent (n=35/52) of the courses that targeted the breast were delivered with partial breast irradiation and 33% (n=17/52) with whole breast radiotherapy (median dose of 25Gy in 5 fractions) ± simultaneous integrated boost to the primary tumour. Most primary tumours (65%, n=34/52) and target lymph nodes (61%, n=17/28) were treated with a dose of 35 Gy in 5 fractions. Most treatments (52%) were delivered with intensity-modulated radiotherapy (IMRT). Radiotherapy was delivered daily (20%), every other day (18%), twice weekly (36%) or weekly (26%). The 2-year cumulative incidence of LF was 11.4% and grade≥3 toxicity was 15.1%. The grade ≥3 toxicity was 6.5% for IMRT treatments, versus 7.7% for non-IMRT treatments targeting partial breast and/or lymph nodes (HR 1.13, P=0.92), versus 38.9% for non-IMRT treatments targeting the entire breast (HR 6.91, P=0.023). All grade ≥3 toxicity cases were radiation dermatitis. No cases of brachial plexopathy were observed. 35-40 Gy in 5 fractions is a safe and effective breast stereotactic body radiotherapy regimen and may be an attractive option for patients who are not surgical candidates. Highly conformal techniques (i.e. IMRT or partial breast irradiation) were associated with a reduced risk of toxicity and should be the preferred treatment approaches.

Intraoperative Radiation Therapy Delivered by Brachytherapy in Breast Cancer: An Interim Analysis of a Phase 2 Trial

PurposeIntraoperative breast cancer radiotherapy (IORT) offers an alternative to external beam radiotherapy (EBRT) after breast-conserving surgery (BCS). The Intraoperative brachytherapy (IOBT) trial applies high dose rate (HDR) brachytherapy with a new applicator prototype as IORT after BCS. In this interim analysis of the IOBT trial, we present the oncological safety and toxicity of the method MethodsEligible patients were women, ≥ 50 years old with an unifocal nonlobular, estrogen-receptor-positive, HER2-negative breast cancer, cN0, ≤ 3 cm, treated with BCS and sentinel node biopsy (SNB). Toxicity was registered according to the LENT-SOMA scale. Cumulative incidence of local (LR) and regional recurrence (RR) were calculated through cumulative incidence function whereas overall survival (OS) was illustrated through Kaplan–Meier curve. ResultsUntil February 2023, 155 women (median age 68 years) were included in the trial. Twenty-nine women (18.7%) received supplemental EBRT, mostly due to positive SNB. Three-year cumulative incidence of LR and RR were 1.0% (CI 95 % 0.1%-2.3%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five- year cumulative incidence of LR and RR were 3.9% (CI 95% 1.8%-6.4%) and 2.1% (CI 95% 0.8%-4.2%) respectively. Five-year OS was 96.3% (CI 95% 93.6%-98.4%). Side effects were limited, low grade, and transient. ConclusionAcknowledging the short median follow-up time at interim analysis, our initial results indicate that delivering IORT through HDR brachytherapy in carefully selected breast cancer patients is feasible and oncological safe so far. A long-term follow-up is essential to confirm the initial results.

Evaluation of the theranostic characteristics of chitosan-decorated bismuth oxide nanoparticles conjugated curcumin and 5-aminolevulinic acid as a biocompatible targeted nanoplatform in CT and breast cancer radiation therapy

Developing safe and effective multifunctional nanomaterials for cancer therapy is crucial. A highly effective contrast agent is necessary for optimal results in CT scans during radiotherapy.we synthesized bismuth oxide using the sol-gel method, coated it with chitosan, and added layers of 5-aminolevulinic acid and curcumin. The curcumin in the nano complex makes it ideal for targeted applications.Bi2O3/CS@5-ALA-CUR NPs with a size of about 80 nm and exceptional stability were synthesized and fully characterized through FTIR, XRD, DLS, and TEM analysis. An MTT assay showed that Bi2O3/CS@5-ALA-CUR NPs had the highest cytotoxicity at 160 μg/mL with radiation after 48 h incubation time on SKBr-3 cells, with no significant cytotoxicity on normal cells. Bi2O3/CS@5-ALA-CUR NPs increased the generation of reactive oxygen species (ROS) and enhanced radiosensitization effects by up to 450 %. SKBr-3 cells were CT scanned after 48 h incubation with 400 μM concentration, revealing the highest X-ray attenuation at 80 kVp. Bi2O3/CS@5-ALA-CUR NP injection and 2 Gy radiation exposure at 6 MV significantly reduced tumor size in female BALB/c mice compared to controls.These exciting findings suggest that Bi2O3/CS@5-ALA-CUR nanoparticles have immense potential as theranostic agents for diagnosing and treating tumors, with the added benefit of being guided by CT imaging during radiotherapy.

Large institutional experience of early outcomes and dosimetric findings with postoperative stereotactic partial breast irradiation in breast cancer

PurposeTo analyze the dosimetric and toxicity outcomes of patients treated with postoperative stereotactic partial breast irradiation (S-PBI). MethodsWe identified 799 women who underwent S-PBI at our institution between January 2016 and December 2022. The most commonly used dose-fraction and technique were 30 Gy in 5 fractions (91.7 %) and a robotic stereotactic radiation system with real-time tracking (83.7 %). The primary endpoints were dosimetric parameters and radiation-related toxicities. For comparison, a control group undergoing ultra-hypofractionated whole breast irradiation (UF-WBI, n = 468) at the same institution was selected. ResultsA total of 815 breasts from 799 patients, with a median planning target volume (PTV) volume of 89.6 cm3, were treated with S-PBI. Treatment plans showed that the mean and maximum doses received by the PTV were 96.2 % and 104.8 % of the prescription dose, respectively. The volume of the ipsilateral breast that received 50 % of the prescription dose was 32.3 ± 8.9 %. The mean doses for the ipsilateral lung and heart were 2.5 ± 0.9 Gy and 0.65 ± 0.39 Gy, respectively. Acute toxicity occurred in 175 patients (21.5 %), predominantly of grade 1. Overall rate of late toxicity was 4 % with a median follow-up of 31.6 months. Compared to the UF-WBI group, the S-PBI group had comparably low acute toxicity (21.5 % vs. 25.2 %, p = 0.12) but significantly lower dosimetric parameters for all organs-at-risks (all p < 0.05). ConclusionIn this large cohort, S-PBI demonstrated favorable dosimetric and toxicity profiles. Considering the reduced radiation exposure to surrounding tissues, external beam PBI with advanced techniques should at least be considered over traditional WBI-based approaches for PBI candidates.

Cardiac structure, function, and coronary anatomy 10 years after isolated contemporary adjuvant radiotherapy in breast cancer patients with low cardiovascular baseline risk.

The effects of isolated contemporary low-dose breast cancer (BC) radiotherapy (RT) on the heart remain poorly understood. This study aims to assess the long-term impacts of BC-RT on cardiac structure and function. Seventy-six women (62 ± 7 years) without history of prior heart disease, who had undergone RT for either first left (n = 36) or right (n = 40) BC, without additional medical oncology therapy apart from hormonal treatment 11 ± 1 years earlier, underwent transthoracic echocardiography, cardiac magnetic resonance imaging (CMR), computed tomography coronary angiography (CTCA), NT-proBNP, and a 6-min walk test (6MWT). They were compared with 54 age-matched healthy female controls. By CTCA, 68% of BC patients exhibited no or very mild coronary disease, while only 11% had moderate stenosis (50-69%) and 3% had significant stenosis (>70%). Despite slightly reduced regional echocardiographic midventricular strains, BC patients exhibited similar global left and right ventricular volumes, ejection fractions, and global strains by echocardiography and CMR as controls. Mitral E/e' ratios were slightly higher, and mitral deceleration times were slightly lower, but NT-proBNP was similar to controls. Also, 6MWT was normal. None had late gadolinium enhancement, and extracellular volume fraction was similar in BC (28 ± 3 vs. 29 ± 3, P = 0.15) and controls. No differences were observed relative to dose or side of RT. Aside from minor alterations of regional strains and diastolic parameters, women who received isolated RT for BC had low prevalence of coronary disease, normal global systolic function, NT-proBNP, and exercise capacity and showed no structural changes by CMR, refuting significant long-term cardiotoxicity in such low-risk patients.

Development of automated region of interest selection algorithms for surface-guided radiation therapy of breast cancer.

To investigate automation of the preparation of the region of interest (ROI) for surface-guided radiotherapy (SGRT) of the whole breast with two algorithms based on contour anatomies: using the body contour, and using the breast contour. The patient dataset used for modeling consisted of 39 breast cancer patients previously treated with SGRT. The patient's anatomical structures (body and ipsilateral breast) were retrieved from the planning system, and the clinical ROI (cROI) drawn by the planners was retrieved from the SGRT system for comparison. For the body-contour-based algorithm, a convolutional neural network (MobileNet-v2) was utilized to train a synthetic human model dataset to predict body joint locations. With the body joint location knowledge, an automated ROI (aROIbody ) can be created based on: (1) the superior-inferior (S-I) borders defined by the joint locations, (2) the left-right (L-R) borders defined with 3/4 of chest width, and (3) a curation of the ROI to avoid the ipsilateral armpit. For the breast-contour-based algorithm, an aROIbreast was created by first defining the ROI in the S-I direction with the ipsilateral breast boundaries. Other steps are the same as with the body-contour-based algorithm. Among the 39 patients, 24 patients were used to fine-tune the algorithm parameters, and the remaining 15 patients were used to evaluate the quality of the aROIs against the cROIs. A blinded evaluation was performed by three SGRT expert physicists to rate the acceptability and the quality (1-10 scale) of the aROIs and cROIs, and the dice similarity coefficient (DSC) was also calculated to compare the similarity between the aROIs and cROIs. The results showed that the average acceptability was 14/15 (range: 13/15-15/15) for cROIs, 13.3/15 (range: 13/15-14/15) for aROIbody , and 14.6/15 (range: 14/15-15/15) for aROIbreast . The average quality was 7.4 ± 0.8 for cROIs, 8.1 ± 1.2 for aROIbody , and 8.2 ± 0.9 for aROIbreast . The DSC with cROIs was 0.81 ± 0.06 for aROIbody , and 0.83 ± 0.04 for aROIbreast . The ROI creation time was ∼120s for clinical, 1.3s for aROIbody , and 1.2s for aROIbreast . The proposed automated algorithms can improve the ROI compliance with the SGRT protocol, with a shortened preparation time. It is ready to be integrated into the clinical workflow for automated ROI preparation.

Protocol of the HISTOTHERM study: assessing the response to hyperthermia and hypofractionated radiotherapy in recurrent breast cancer.

Breast cancer is globally the leading cancer in women, and despite the high 5-year survival rate the most frequent cause of cancer related deaths. Surgery, systemic therapy and radiotherapy are the three pillars of curative breast cancer treatment. However, locoregional recurrences frequently occur after initial treatment and are often challenging to treat, amongst others due to high doses of previous radiotherapy treatments. Radiotherapy can be combined with local hyperthermia to sensitize tumor cells to radiation and thereby significantly reduce the required radiation dose. Therefore, the combination treatment of mild local hyperthermia, i.e. locally heating of the tissue to 39-43°C, and re-irradiation with a reduced total dose is a relevant treatment option for previously irradiated patients. The mechanisms of this effect in the course of the therapy are to date not well understood and will be investigated in the HISTOTHERM study. Patients with local or (loco)regional recurrent breast cancer with macroscopic tumors are included in the study. Local tumor control is evaluated clinically and histologically during the course of a combination treatment of 60 minutes mild superficial hyperthermia (39 - 43°C) using water-filtered infrared A (wIRA) irradiation, immediately followed by hypofractionated re-irradiation with a total dose of 20-24 Gy, administered in weekly doses of 4 Gy. Tumor and tumor stroma biopsies as well as blood samples will be collected prior to treatment, during therapy (at a dose of 12 Gy) and in the follow-up to monitor therapy response. The treatment represents the standard operating procedure for hyperthermia plus re-irradiation. Various tissue and blood-based markers are analyzed. We aim at pinpointing key mechanisms and markers for therapy response which may help guiding treatment decisions in future. In addition, quality of life in the course of treatment will be assessed and survival data will be evaluated. The study is registered at the German Clinical Trials Register, Deutsches Register Klinischer Studien (DRKS00029221).

Failure mode and effects analysis in consensus-based GDM for surface-guided deep inspiration breath-hold breast radiotherapy for breast cancer under the framework of linguistic Z-number

Most of the cancer patients cannot get the usual treatment in the advanced stage of the disease. In particular, for breast cancer, it is to use a special kind of radiation that targets the tumor while the patient holds their breath. This is called surface-guided (SG) breast radiotherapy (RT) with deep inspiration breath-hold (DIBH). This treatment is very complicated and different from the normal way of treating breast cancer. It can also have many errors and problems that are not well-studied or understood. To prevent these problems, we need to use a method called failure mode and effects analysis (FMEA). This method helps us find and rank the possible risks and how to avoid them. In keeping with this aim, this paper studies consensus-reaching process-based group decision-making (GDM) with completely unknown risk factors' weights and the gained-lost dominance score (GLDS)-based ranking process. We cannot avoid the uncertainty related to relativity information in medical science. Therefore, in this study, we offer the experts to provide their opinions using the linguistic Z number (LZN) because LZN is designed to capture such types of information in medical science. For the consensus-reaching process (CRP), the relativity among experts is considered for consensus measurement, and the minimum adjustment sum with group consensus opinion-based feedback is offered. For unknown weight of risk factors, we don't know how much each risk factor weighs. So, we use a method that combines two ways of calculating weights. One way is a subjective weight computation process, and the other way is based on the data using entropy and division. Finally, we applied our proposed CRP-based GDM approach for ranking the identified FMs related to the SG DIBH RT process. We conduct sensitive, comparative, and statistical assessments to ensure our method is reasonable and practical.

Duplex Imaging Assessment of the Internal Mammary Arteries in Women after Unilateral Mastectomy and Radiotherapy for Breast Cancer

The effects of incidental radiation exposure on internal mammary arteries remain unclear. The present study was designed to test the hypothesis by comparing diameter and blood flow of the irradiated and nonirradiated internal mammary arteries, using Duplex ultrasound imaging. The study was designed as a single-center, transversal, comparative study. The main outcomes were diameter and volumetric blood flow of the internal mammary arteries. The Wilcoxon rank-sum test was used to assess the differences between the irradiated and nonirradiated internal mammary arteries with regard to the diameter and volumetric blood flow. The diameter (median [interquartile range]) of the irradiated internal mammary arteries (0.170mm [0.160, 0.180]) was smaller than that of the contralateral nonirradiated ones (0.180mm [0.170, 0.200], P<0.0001) and that of the internal mammary arteries in the control group (0.180mm [0.170, 0.190], P<0.0001). Similarly, blood flow (median [interquartile range]) of the irradiated internal mammary arteries (52.4ml/min [37.78, 65.57]) was smaller than that of the contralateral nonirradiated ones (62.7ml/min [46.87, 84.17], P<0.0001), as well as of the left (56.7ml/min [46.88, 72.58], P=0.02) and the right internal mammary arteries in the control group (61.0ml/min [47.47, 74.52], P=0 0.0009). The data indicate that the irradiated internal mammary arteries in patients with a history of total mastectomy followed by radiotherapy for breast cancer had significantly smaller diameter and blood flow compared to the nonirradiated internal mammary arteries.

Women's Preferences for Hypofractionated Radiation Therapy for Treatment of Early-Stage Breast Cancer: A Discrete Choice Experiment

IntroductionThe primary treatment recommended for early-stage breast cancer is breast conserving surgery followed by external beam radiation therapy of the whole breast. Previously radiation therapy for early-stage breast cancer was given using more fractions over longer durations. Guidelines support treatments with fewer fractions over a shorter time (hypofractionated radiation therapy-HFRT). This study aimed to understand women's preferences for different features of treatments for early-stage breast cancer. MethodsA discrete choice experiment (DCE) with 12 choice tasks was conducted, describing the treatments by: extent of surgery, duration of radiation treatment, need to relocate for treatment, local side effects, changes in breast appearance, costs, and difficulty with daily activities during and after treatment. Participants were women with breast cancer and from the general population. Mixed logit analyses were conducted and trade-offs between attributes estimated. Results420 respondents completed the DCE. The relative importance of attributes varied by respondent characteristics; the most influential attribute for younger women was type of surgery (breast conserving surgery); type of surgery did not influence older women's preferences. Shorter treatment duration, avoiding relocation, fewer local side effects, and less difficulty with daily activities all positively influenced treatment preference. Younger women were willing to accept 32-40 days of radiation treatment before a treatment that included mastectomy was potentially acceptable. Conclusionattributes of treatment such as duration, need for relocation, side effects and impacts on normal daily activities during and after treatment significantly influenced women's preference for treatment, including surgery. Our findings have the potential for real impact for patients and services including supporting one on one clinical discussions, supporting program and patient resource development, and by informing service funding, organisation and delivery.

Breast lymphedema following breast-conserving treatment for breast cancer: current status and future directions.

To examine the current evidence on breast lymphedema (BL) diagnosis and treatment after breast-conserving surgery, identify gaps in the literature, and propose future research directions. A comprehensive literature review was conducted using Ovid, PubMed, and Cochrane, including studies published between 2000 and 2023. References were reviewed manually for eligible studies. Inclusion criteria were as follows: patients who underwent breast conserving treatment (surgery ± radiation) for breast cancer, goals of the paper included analyzing or reviewing BL measurement with ultrasound or tissue dielectric constant, or BL treatment. Twenty-seven manuscripts were included in the review. There is variation in incidence, time course, and risk factors for BL. Risk factors for BL included breast size, primary and axillary surgery extent, radiation, and chemotherapy but require further investigation. Diagnostic methods for BL currently rely on patient report and lack standardized criteria. Tissue dielectric constant (TDC) and ultrasound (US) emerged as promising ambulatory BL assessment tools; however, diagnostic thresholds and validation studies with ICG lymphography are needed to establish clinical utility. The evidence base for treatment of BL is weak, lacking high-quality studies. The natural history of BL is not well defined. TDC and US show promise as ambulatory assessment tools for BL; however, further validation with lymphatic imaging is required. BL treatment is not established in the literature. Longitudinal, prospective studies including pre-radiation measurements and validating with lymphatic imaging are required. These data will inform screening, diagnostic criteria, and evidence-based treatment parameters for patients with BL after breast-conserving surgery and radiation.

The effect of demographic and clinical data on anxiety and depression levels in breast cancer patients receiving radiotherapy.

The aim of this study is to investigate the effects of sociodemographic and clinical data on depression and anxiety levels in patients who undergoing radiotherapy for breast cancer. A total of 111 patients with breast cancer treated in the Radiation Oncology Department of Kayseri City Education and Research Hospital were included in this study. The study was planned prospectively as a survey research based study. Ethics committee approval was obtained. After obtaining the necessary consent for voluntary participation, patients were interviewed face-to-face. The research survey included the Hospital Anxiety and Depression Scale (HADS), as well as demographic and clinical information. Statistical analysis was performed with the collected data. According to the results of repeated measures analysis of variance, the mean difference between the 3-month and 6-month measurements of the depression scale values on the first day of radiotherapy was statistically significant (P &lt; 0.001). Mean differences were statistically notable for age and marital status variables in anxiety and for age, education level, marital status, employment status, family history of cancer, menopause, surgery, chemotherapy and hormone therapy variables in depression. When the change in the presence (&gt; 10 depression scale) or absence (&lt; 10 depression scale) of depression at three different times of radiotherapy (first day, 3 and 6 months) was examined, a statistically notable difference was found between the depression scale values of patients receiving radiotherapy on the first day, 3 months after radiotherapy and 6 months after radiotherapy (P &lt; 0.05). According to the results of our study, the psychological health of women with breast cancer was affected during and after radiotherapy. As a response, psychiatric counseling should be considered as a part of the treatment for depression and anxiety that occur during and after treatment in breast cancer patients.