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Background: Post-mastectomy adjuvant radiotherapy improves long-term survival by reducing the risk of locoregional recurrence in breast cancer patients with high-risk features. Considering radiation therapy to the left sided chest wall heart is an important organ at risk. Hypo-fractionated radiotherapy is increasingly being used due to involvement of fewer treatment sessions and is almost radio-biologically equivalent to conventionally fractionated radiotherapy. Objective: This study was conducted to evaluate cardiac toxicities between hypo and conventionally fractionated radiotherapy. Methods: This quasi-experimental study was done at the National Institute of Cancer Research and Hospital, Mohakhali, Dhaka from January 2019 to December 2019, 60 patients were purposively assigned into two groups and each group included 30 patients. Arm A: received Conventional fractionated radiotherapy (50Gy/25 fractions over 5 weeks, at 2Gy/fraction). Arm B: received Hypo-fractionated radiotherapy (40.05 Gy in 15 fractions over 3 weeks at 2.67 Gy/fraction). Echocardiography (ECHO), Electrocardiography (ECG) was performed to find the cardiac toxicities. Results: The mean age of the patients in arm A was 50.03 ± 6.82 years and that of arm B was 48.08 ± 5.08 years. No significant statistical difference was found between the two groups regarding socio-demographic variables and clinical presentations. Most of the patients in both arms showed grade 0 cardiac toxicity (arm A: 70% and arm B: 80%) & few showed grade 1 cardiac toxicity (arm A: 20% and arm B: 13.3%) and three patients (10.0%) in arm A and two patients (6.66%) in arm B had shown grade 2 cardiac toxicities six months after treatment. However, this difference was statistically not significant (p >0.05). Before treatment, the ejection fraction (EF) of arm A and arm B were 63.3 ± 5.621 and 64.7± 4.991. Six months after treatment the EF of both arms decreased (arm A 60.2 ± 4.051 & arm B 60.9 ± 5.121) but the difference was statistically not significant (p >0.05). Conclusion: Hypo-fractionated radiotherapy in the adjuvant setting for the treatment of left breast cancer has no additional cardiac toxicity in comparison to conventionally fractionated radiotherapy while maintaining same efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Post mastectomy radiation (PMRT) plays major role in breast cancer treatment. Hypofractionated radiation is a relatively newer modality. Hypofractionation is more commonly used after breast conservation surgery. Landmark trials that studied hypofractionation had fewer PMRT subjects. Here we report our study on feasibility and toxicity profile of hypofractionated PMRT. Aim: To describe the clinical and toxicity profile of patients undergoing hypofractionated 3D conformal radiation therapy in breast cancer patients. Materials & Methods: This study included patients who are eligible for post mastectomy radiation therapy above 18 years planned for adjuvant PMRT (40.05Gy in 15 fractions delivered over 3 weeks in 3D conformal radiation) to the chest wall and supraclavicular nodes between April 2021 to October 2022., active lung infection, patient preference for conventional fractionation. Dosimetric parameters to target & organs at risk were analyzed. Toxicities including hematologic, dermatitis, pharyngitis & other were monitored. Results: Of 71 patients, 70 patients were female and 1 is male. Majority (46%) of patients belonged to 46-55 years age group. Age ranged from 34 to 85 years. Mean age is 52 years. Clinical Stage IIIA was the most common stage with 29.5% patients followed by Stage IIB with 25.3% patients. Majority received adjuvant chemotherapy (52%). Mean treatment time is 21 days. All patients completed treatment without any major complications. Follow up ranged from 17 months to 27 months. Out of 71 patients, 1 patient expired on follow up after 4 months of radiation therapy due to non cancer related cause (Chronic pancreatitis). On follow up, 3 patients had distant metastasis alone (lung, bone metastasis, brain metastases) and 1 patient had both local disease and distant metastasis. 3 patients who progressed had stage IIIC disease & 1 had stage IIIB disease. The V90 to the Planned Target volume (PTV) ranged from 90.4% to 99% to right sided disease, 90.3% to 96.5% to left sided disease. Heart V17Gy ranged from 1.27% to 12.5% & heart V35Gy was 0.16% to 7.2%. Dermatitis was the most common adverse effect in this study. 31 patients (43.6%) developed fatigue during treatment. They continued their daily activities without any limitations. 35 patients (49.2%) had throat pain, of which 2 patients had it in 1st week, 21 patients had it in 2nd week and 12 patients had it in 3rd week. They were treated with non opioid analgesics. Shoulder pain was observed in 10 patients (14%) during treatment. Blood parameters were monitored weekly during treatment. No changes were observed. Conclusion: Hypofractionated post mastectomy radiation therapy is well tolerated in our study group. None of them developed any major acute reactions during and post treatment in the follow up period. Patients completed their treatment without any breaks during treatment. Respiratory motion management especially left sided disease patients should be used for achieving dose constraints. [ABSTRACT FROM AUTHOR]

Background: The adverse effects of chemotherapy‐induced diabetic peripheral neuropathy (CIDPN) are rather prevalent. There is no known pharmaceutical treatment that can stop CIDPN. Objective: This study compared the effects of cold application and transcutaneous nerve stimulation (Transcutaneous electrical nerve stimulation (TENS)) on individuals who had undergone mastectomy following CIDPN. Subjects and methods: Between Mars 2021 and September 2021, a randomised controlled experiment was carried out at physical therapy clinics at the Modern University for Technology and Information. 30 patients were randomly split into two equal groups (A and B). Both lower limbs received cold application (Group A) three times per week for 12 weeks and TENS application (Group B) three times each week for 12 weeks. The Visual Analogue Scale and nerve conduction velocity for the sural nerve were used to assess patients before and after 12 weeks of therapy. Results: The results showed that Group A significantly (p < 0.05) decreased pain intensity after treatment by 70.83% compared with Group B by 55.17%. Moreover, Group A improved significantly (p < 0.05) the sural nerve amplitude by 44.12% compared with group B which recorded 26.87%. After treatment, both pain intensity and sural nerve amplitude significantly (p < 0.05) changed between Group A versus Group B. Conclusion: Cold application has a better effect on pain in CIDPN post mastectomy. [ABSTRACT FROM AUTHOR]

Background: Social support in post-mastectomy breast cancer patients is still lacking, patients who do not get social support will feel inferior and isolate themselves. Objective: How is the social support provided by the immediate environment of cancer patients with mastectomy treatment? Methods: This research is a type of qualitative research that uses a case study design. Informants were taken using snowball sampling technique and found 4 key informants and 4 triangulated informants. Results: The appreciation support received by post-mastectomy breast cancer patients in Semaka District, Tanggamus Regency, Lampung is mostly words of encouragement, motivation and respect for patients. Material support received in the form of financial assistance from spouses and families, as well as assistance in providing fruits, food, drinks and purchasing medicines. Post-mastectomy breast cancer patients do not get informational support from their partners, friends and family. Conclusions: The emotional support received by the patient is affection, attention and sympathy, but not all patients get this support.

Introduction: The aim of this study was to evaluate the use of post‐mastectomy hypofractionationed radiation therapy (HFRT) for breast cancer in Victoria, Australia. Methods: This is a population‐based cohort of women with breast cancer who received post‐mastectomy RT to the chest wall with or without nodal irradiation between 2012 and 2017. HFRT was defined as <25 fractions of RT. Data were captured in the Victorian Radiotherapy Minimum Dataset (VRMDS). The changing pattern of HFRT use was evaluated using the Cochran–Armitage test. Patient‐, treatment‐ and institutional‐related factors associated with HFRT use were evaluated using multivariable logistic regression. Results: Two thousand and twenty‐one women were included in this study, of which 238 (12%) received HFRT. This increased from 8% in 2012 to 18% in 2017 (P‐trend < 0.001). Older women were more likely to have HFRT (26% in women above 70 years vs 6% in women under 50 years; P < 0.001). Women who did not have nodal irradiation were more likely to have HFRT than those who did (18% vs 9% respectively; P < 0.001). In multivariate analyses, the progressive increase in HFRT use over time remained statistically significant – women treated in 2017 were four times more likely to receive HFRT than those treated in 2012 (95% CI = 2.1–7.7; P < 0.001). Other factors independently associated with increased likelihood of HFRT use included increasing age at RT, and lack of nodal irradiation. Conclusion: In this first Australian study evaluating the use of post‐mastectomy HFRT, we observed increasing HFRT use in Victoria over time. We anticipate this rising trend will continue in the coming years. [ABSTRACT FROM AUTHOR]

Background and aim While the infiltration of surgical incisions with local anesthetics is not a new practice, it remains a crucial component of contemporary multimodal analgesia protocols. This study aimed to evaluate the efficacy and safety of using adjuvants in combination with local anesthetic wound infiltration for pain management in patients undergoing mastectomy surgery. Methods Eighty-one patients aged 18-60 years, classified as American Society of Anesthesiologists (ASA) grade I or II, were scheduled for unilateral mastectomy and randomly assigned to three groups of 27 each. The groups were designated as Group C (bupivacaine alone), Group D (bupivacaine with dexmedetomidine), and Group K (bupivacaine with ketamine). Group C received 0.25% bupivacaine alone, Group D received 0.25% bupivacaine with 1 mcg/kg dexmedetomidine, and Group K received 0.25% bupivacaine with 1 mg/kg ketamine. The time to achieve a Visual Analogue Scale (VAS) score of 3 following local wound infiltration was recorded for each group. Additionally, total postoperative fentanyl intake during the first 24 hours, as measured by the patient-controlled analgesia (PCA) pump, was compared among the groups. Sedation levels were assessed using the Ramsay Sedation Scale (RSS). Data were analyzed using the Chi-Square test and one-way ANOVA in IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA). Results Demographic factors were similar across the three groups. Analysis of the VAS scores revealed that the ketamine group provided better postoperative pain control than the dexmedetomidine group (p < 0.001). Groups D (71.72 ± 71.73) and K (3.53 ± 13.42) had significantly lower 24-hour fentanyl intake (in mcg) compared to Group C (the control group), as measured by PCA. Additionally, Group C had a significantly lower RSS at the sixth hour (p = 0.003) compared to both Groups D and K. Conclusion Ketamine, when used as an adjuvant to bupivacaine for local infiltration, enhances the effectiveness and prolongs postoperative analgesia more effectively than dexmedetomidine in patients undergoing mastectomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Rajendra Institute of Medical Sciences, Ranchi issued approval 231. The study was ethically cleared by the Institutional Ethical Committee (IEC) via letter no. 231, dated 19/5/21, and it was prospectively registered under the CTRI with registration number CTRI/2021/08/035933. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Raj et al.)

Objective: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy. Methods: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified. Results: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations. Conclusions: The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange.

Introduction: For many women with breast cancer, mastectomy is a common form of treatment which has an indirect effect on female beauty, sexuality and feminity. Also, the patients suffer severe arm and shoulder morbidity post surgery which affects their quality of life. Aim: To determine the arm function and quality of life among patients after mastectomy and find correlation between these two aspects. Materials and Methods: A quantitative descriptive correlational design with non probability convenience sampling technique was used to collect data from 60 post mastectomy women. The setting used for the study was Gynaecological Oncology OPD at Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala, India. Data collection was done from November 2016 to December 2016. A standardised Quality of Life-Breast Cancer Patient Version (QOL-BCV) questionnaire and DASH (Disability of Arm Shoulder Hand) tool was used for the assessment along with a structured questionnaire to assess sociodemographic and clinical data. Karl Pearson correlation test was used for data analysis. Results: The study result showed that majority of the patients 48 (80%) had good arm function with less disability. Quality of life of 21 (35%) patients was high and 39 (65%) patients had moderate quality of life. There was a significant correlation found between disability score and quality of life (r=-0.802) and with all the domains of quality of life {physical (r=-0.771), psychological (r=-0.695), social (r=-0.746) and spiritual (r=-0.500)}. Also a significant association was found between arm function and the clinical variables like oedema (p=0.006) and radiation therapy (p=0.017). Conclusion: Arm disability influences quality of life of patients after mastectomy. The results of this study will help to improve actions to reduce arm disabilities such as lymphoedema as early as possible, through proper assessment and post mastectomy exercises, including special care for patients undergoing radiation therapy. This will improve the quality of life of post mastectomy patients.

Purpose To examine the feasibility of volumetric modulated arc therapy (VMAT) for post mastectomy radiotherapy (PMRT). Methods and materials Fifteen PMRT patients previously treated at our clinic with helical tomotherapy (HT) were identified for the study. Planning target volumes (PTV) included the chest wall and regional lymph nodes. A systematic approach to constructing VMAT that met the clinical goals was devised. VMAT plans were then constructed for each patient and compared with HT plans with which they had been treated. The resulting plans were compared on the basis of PTV coverage; dose homogeneity index (DHI) and conformity index (CI); dose to organs at risk (OAR); tumor control probability (TCP), normal tissue complication probability (NTCP) and secondary cancer complication probability (SCCP); and treatment delivery time. Differences were tested for significance using the paired Student's t-test. Results Both modalities produced clinically acceptable PMRT plans. VMAT plans showed better CI (p < 0.01) and better OAR sparing at low doses than HT plans, particularly at doses less than 5Gy. On the other hand, HT plans showed better DHI (p < 0.01) and showed better OAR sparing at higher doses. Both modalities achieved nearly 100% tumor control probability and approximately 1% NTCP in the lungs and heart. VMAT showed lower SCCP than HT (p < 0.01), though both plans showed higher SCCP values than conventional mixed beam (electron-photon) plans reported by our group previously. VMAT plans required 66.2% less time to deliver than HT. Conclusions Both VMAT and HT provide acceptable treatment plans for PMRT. Both techniques are currently utilized at our institution. [ABSTRACT FROM AUTHOR]

Objective: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy., Methods: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified., Results: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations., Conclusions: The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange., Competing Interests: There are no conflicts of interest.

Purpose: To evaluate the feasibility of using Helical Tomotherapy (HT) for post mastectomy left-sided breast cancer., Methods and Materials: Treatment plans were generated for 5 post mastectomy left sided breast cancer patients treated at king Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, comparing three-dimensional technique with the HT planning. The prescribed dose was 50 Gy in 25 fractions; the planning target volume (chest wall and nodal volumes) was contoured according to RTOG atlas and the heart, lungs, spinal cord and contralateral breast were contoured as Organs at Risks (OARs)., Results: Both plans achieved the planning criteria, however the HT plan increased the minimal dose to the PTV (78% vs. 45.4%, p=0.043), improving the dose conformity (0.76 vs. 0.38, p=0.034) and dose homogeneity (1.05 vs. 1.2, p=0.08), while a three-dimensional technique has better V20 of lung (15.8% vs. 22.6%, p=0.04), Mean Lung Dose (7.6Gy vs. 13.8Gy, p=0.043), contralateral breast dose (0.1 vs. 12.7, p=0.043) and comparable Mean Heart Dose (4.4Gy vs. 5.3Gy, p=0.136)., Conclusion: Both plans achieved comparable target coverage and OARs sparing, however HT plans provided better dose conformity and homogeneity than did the three-dimensional plans at the cost of less sparing of the heart, left lung and contralateral breast for treatment of left-sided post mastectomy breast cancer., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)