597 results on '"Post mastectomy"'
Search Results
2. A Comparative Study of Cardiac Toxicity Analysis in Hypo-Fractionated Vs Conventionalfractionated Adjuvant Radiotherapy in Post-Mastectomy Leftbreast Carcinoma.
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BEGUM, S., RUMMAN, M. K., HAQ, M. N., AFRIN, T., MAMUN, A., HOSSAIN, T., TANIA, K. N., HUQUE, M. S., ISLAM, J., AKHTER, B., and HOSSEN, M. M.
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CARDIOTOXICITY , *MASTECTOMY , *CANCER relapse , *RADIOTHERAPY , *CANCER hospitals , *SYMPTOMS - Abstract
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]
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- 2024
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3. Feasibility and Toxicity of Hypofractionated Radiation Therapy in Patients Undergoing Post Mastectomy Radiation Therapy.
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Velarasan, Kanmani, Ramasundaram, Deivanayagam, and Prasad, Gopi
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BREAST tumor treatment ,COUGH -- Risk factors ,SHOULDER pain ,LYMPH nodes ,THREE-dimensional imaging ,RADIOTHERAPY ,SKIN inflammation ,COMPUTER software ,BREAST tumors ,PHARYNGITIS ,RADIATION dosimetry ,HEART ,TREATMENT duration ,CANCER patients ,DESCRIPTIVE statistics ,ADJUVANT chemotherapy ,METASTASIS ,PAIN ,COMBINED modality therapy ,CHEST (Anatomy) ,RADIATION doses ,MASTECTOMY ,TUMOR classification ,CANCER fatigue ,NONOPIOID analgesics ,PATIENT monitoring ,DATA analysis software ,PATIENT aftercare ,ACTIVITIES of daily living ,BREAST ,DISEASE risk factors ,SYMPTOMS - Abstract
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]
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- 2024
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4. Effect of cold application versus transcutaneous nerve stimulation on chemotherapy induced diabetic peripheral neuropathy post mastectomy.
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Elshinnawy, Ahmed M., Eraky, Zeezy S., Abdelaziz, Sarah Sami, and Abd‐Elrahman, Noha A. F.
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GLYCOSYLATED hemoglobin , *MATHEMATICAL statistics , *NONPARAMETRIC statistics , *PAIN measurement , *SAMPLE size (Statistics) , *PARAMETERS (Statistics) , *CANCER chemotherapy , *DIABETIC neuropathies , *COLD therapy , *TREATMENT duration , *VISUAL analog scale , *MANN Whitney U Test , *RANDOMIZED controlled trials , *LEG , *NEURAL conduction , *TREATMENT effectiveness , *COMPARATIVE studies , *T-test (Statistics) , *DESCRIPTIVE statistics , *MASTECTOMY , *STATISTICAL sampling , *DATA analysis software , *BREAST tumors , *TRANSCUTANEOUS electrical nerve stimulation , *PAIN management - Abstract
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]
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- 2024
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5. Effects of Local Wound Infiltration Post-Mastectomy Using Bupivacaine Alone, Bupivacaine With Ketamine, and Bupivacaine With Dexmedetomidine: A Randomized Double-Blind Study.
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Raj P, Sinha N, Kharwar RK, Singh D, Kumar S, Priye S, and Prakash J
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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.)
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- 2024
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6. Analisis Dukungan Sosial Pada Pasien Kanker Payudara Pasca Mastektomi di Kecamatan Semaka Kabupaten Tanggamus Lampung
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Ika Nurmia and Lina Handayani
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Breast Cancer ,Post Mastectomy ,Social Support ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
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.
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- 2022
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7. Increasing use of post‐mastectomy hypofractionated radiation therapy for breast cancer in Victoria.
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Kim, Sohyun, Pitson, Graham, Koh, Tze Lui, Chao, Michael, Byrne, Keelan, Hornby, Colin, Foroudi, Farshad, Millar, Jeremy, and Ong, Wee Loon
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CANCER radiotherapy , *MASTECTOMY , *OLDER women , *PROGRESSIVE collapse - Abstract
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]
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- 2022
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8. A Pilot Study Assessing the Effect of Lymphaticovenous Micro-Anastomosis in the Treatment of Postmastectomy Lymphedema
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- 2018
9. Post mastectomy exercises: Outcome on shoulder pain among women undergone mastectomy surgery
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Anishya, A and Appavu, Santhi
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- 2021
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10. Exploring Lived Experiences of Married Pakistani Women Post-Mastectomy
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Laila Hussain, Zeenatkhanu Kanji, Sharifa Lalani, Shabnam Moledina, and Abida K Sattar
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Breast cancer ,coping strategies ,post mastectomy ,quality of life ,support groups ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 ,Nursing ,RT1-120 - Abstract
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.
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- 2019
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11. Women’s perceptions of body image post-mastectomy: a literature review
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Alice Walsh and Neil James
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Post mastectomy ,Perception ,media_common.quotation_subject ,General Medicine ,Psychology ,Clinical psychology ,media_common - Published
- 2021
12. A Study Protocol on the Effectiveness of Post Mastectomy Exercises in Breast Cancer Patients on Reduction of Lymphedema and Improving Range of Motion among Patients Undergone Mastectomy
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Ruchira Ankar and Amruta Kothe
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medicine.medical_specialty ,Lymphedema ,Breast cancer ,Post mastectomy ,business.industry ,medicine.medical_treatment ,medicine ,Range of motion ,business ,medicine.disease ,Reduction (orthopedic surgery) ,Mastectomy ,Surgery - Abstract
Background: Breast cancer is the most commonly diagnosed type of cancer in the world and it is a major stressor in women's lives. Breast cancer cases are increasing in both rural and urban settings. Mastectomy is a procedure that removes the breast to prevent cancer cells from returning. Many complications can develop after a mastectomy but lymphedema and limited range of motion are the most prevalent. The present study aimed to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. Objectives: To assess pre interventional level of lymphedema among patients undergone mastectomy. To assess pre interventional range of motion among patients undergone mastectomy. To evaluate the effectiveness of post mastectomy exercises in reducing lymphedema among patients undergone mastectomy To evaluate the effectiveness of post mastectomy exercises in improving range of motion among patients undergone mastectomy. To associate demographic variable with post mastectomy exercises. To associate correlation of post mastectomy exercise with lymphedema and range of motion. Methodology: A pre interventional one group pretest posttest design would be adopted to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. In this study interventional analytical study will be used. Purposive sampling technique will be used to collect the data. The study will include 30 patients undergone mastectomy will be assessed by using American lymphology lymphedema scale and Elvaru STJ (Subtalar joint) range of motion and range of motion reliability tool with the help of inch tape and goniometer and then post mastectomy exercises will be teach by researcher as intervention. Expected Results: The goal of this study is to see how effective post-mastectomy exercises are at reducing lymphedema and improving range of motion in breast cancer patients who had undergone mastectomy. Teaching post-mastectomy exercises can help the respondents reduce lymphedema and improve their range of motion.
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- 2021
13. Increasing use of post‐mastectomy hypofractionated radiation therapy for breast cancer in Victoria
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Tze Lui Koh, Colin Hornby, Sohyun Kim, Keelan Byrne, Michael Chao, Graham Pitson, Wee Loon Ong, Farshad Foroudi, and Jeremy Millar
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Oncology ,medicine.medical_specialty ,Hypofractionated Radiation Therapy ,Multivariate analysis ,Victoria ,medicine.medical_treatment ,Population ,Breast Neoplasms ,Logistic regression ,Breast cancer ,Post mastectomy ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,education ,Mastectomy ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,medicine.disease ,Radiation therapy ,Cohort ,Female ,Radiation Dose Hypofractionation ,Radiotherapy, Adjuvant ,business - Abstract
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
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- 2021
14. Efficacy of a Single Dose of Peri-Operative Antibiotics in Breast Implant Surgery and Risk Factors for Infection in Post-Mastectomy Patients Undergoing Placement of Permanent Breast Implants
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David M. Otterburn, Alyssa B. Valenti, and Marcos Lu Wang
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Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,Breast Implants ,Mammaplasty ,Antibiotics ,Breast Neoplasms ,law.invention ,Risk Factors ,Post mastectomy ,law ,medicine ,Humans ,skin and connective tissue diseases ,Mastectomy ,Retrospective Studies ,business.industry ,Perioperative ,Anti-Bacterial Agents ,Surgery ,Infectious Diseases ,Breast implant ,Female ,Implant ,business ,Breast reconstruction - Abstract
Background: Breast implant placement is a common operation performed by plastic surgeons, with more than 78,664 implant-based breast reconstructions carried out in the United States in 2016. Infect...
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- 2021
15. Arm Function and Quality of Life Among Patients after Mastectomy
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Anu Thomas and Kanmani Job
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breast cancer ,malignancy ,post mastectomy ,Medicine - Abstract
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.
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- 2018
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16. Dissatisfaction After Post-Mastectomy Breast Reconstruction: A Mixed-Methods Study
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Rachel A. Greenup, Sachi Oshima, Ronnie L. Shammas, Clara N. Lee, Laura J. Fish, Amanda R. Sergesketter, Scott T. Hollenbeck, Anaeze C. Offodile, and Brett T. Phillips
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Weakness ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,media_common.quotation_subject ,Adult women ,Oncology ,Feeling ,Post mastectomy ,medicine ,Physical therapy ,Surgery ,Implant ,medicine.symptom ,business ,Breast reconstruction ,Psychosocial ,Mastectomy ,media_common - Abstract
Breast reconstruction is associated with improved patient well-being after mastectomy; however, factors that contribute to post-surgical dissatisfaction remain poorly characterized. Adult women who underwent post-mastectomy implant-based or autologous breast reconstruction between 2015 and 2019 were recruited to participate in semi-structured interviews regarding their lived experiences with reconstructive care. Participants completed the BREAST-Q, and tabulated scores were used to dichotomize patient-reported outcomes as satisfied or dissatisfied (high or low) for each BREAST-Q domain. A convergent mixed-methods analysis was used to evaluate interviews for content related to satisfaction or dissatisfaction with breast reconstruction. Overall, we interviewed 21 women and identified 17 subcodes that corresponded with the five BREAST-Q domains. Sources of dissatisfaction were found to be related to the following domains: (a) low breast satisfaction due to asymmetry, cup size, and lack of sensation and physical feeling (n = 8, 38%); (b) poor sexual well-being due to shape, look and feel (n = 7, 78% [of 9 who discussed sexual well-being]); (c) reduced physical well-being of the chest due to persistent pain and weakness (n = 11, 52%); (d) reduced abdominal well-being due to changes in abdominal strength, numbness, and posture (n = 6, 38% [of 16 who underwent abdominally based reconstruction]); and (e) low psychosocial well-being impacted by an unexpected appearance that negatively influenced self-confidence and self-identity (n = 13, 62%). Patients may be unprepared for the physical, sexual, and psychosocial outcomes of breast reconstruction. Targeted strategies to improve preoperative education and shared decision making are needed to mitigate unexpectedness associated with breast reconstruction and related outcomes.
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- 2021
17. Long Term Arm and Shoulder Toxicities in Breast Cancer Patients Receiving Hypofractionated Radiation Therapy
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Prateek Daga, Kamlesh Kumar Harsh, Shankar Lal Jakhar, Neeti Sharma, and Harvinder Singh Kumar
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medicine.medical_specialty ,Hypofractionated Radiation Therapy ,business.industry ,medicine.medical_treatment ,General Medicine ,medicine.disease ,Asymptomatic ,Radiation therapy ,Axilla ,medicine.anatomical_structure ,Breast cancer ,Lymphedema ,Brachial plexus injury ,Post mastectomy ,Medicine ,Radiology ,medicine.symptom ,business - Abstract
Aim: The purpose of this study is to evaluate the late toxicities in hypo fractionated radiation schedule in breast cancer patients with regional nodal irradiation (RNI), limited to axilla and supraclavicular regions. Late effects on arm and shoulder were noted as follows: skin edema (lymphedema), restricted shoulder movements (brachial plexus injury) and localised pain.Material and Methods: In this study we randomly enrolled 100 breast cancer post mastectomy cases in the year 2018. All cases were previously asymptomatic after surgery. They were prospectively treated with hypo fractionated local and regional nodal irradiation by 2.67 gray / fraction dose, total 15 fractions (total dose-40 gray). Evaluation was done at 12 months after completion of radiation therapy. Assessment was done by RTOG, LENT- SOMA scales. Results: Significant lymphedema was observed in 17 (17%) cases. Restricted arm mobility was seen in 14 (14%) of patients. Pain (moderate/severe) in arm and shoulder was most commonly seen, in 25 (25%) cases. Conclusions: As hypo fractionated regimes in breast cancer treatment have become new standard; its late term effects are significant and comparable to other conventional radiation therapy regimes. These studies need further and longer duration of evaluation.
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- 2021
18. Impact of GBBS algorithm on post-mastectomy scar boost irradiation of breast using catheter flap
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Muniyappan Kannan, Vijayaprabhu Neelakandan, Saravanan Kandasamy, Seenisamy Ramapandian, Gunaseelan Karunanidhi, Mourougan Sinnatamby, and Elakiya Sampath
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Original Paper ,surface mould ,business.industry ,Acuros® BV ,medicine.medical_treatment ,Brachytherapy ,GBBS ,chest wall ,Radiation therapy ,Catheter ,scar boost ,Oncology ,Post mastectomy ,Total dose ,Boost irradiation ,medicine ,catheter flap ,Thick skin ,Medicine ,Radiology, Nuclear Medicine and imaging ,External beam radiotherapy ,business ,Algorithm - Abstract
Purpose Post-mastectomy radiation therapy significantly reduces locoregional recurrence rates, which can be achieved with external beam radiotherapy delivered to chest wall, followed by scar irradiation either by electron or high-dose-rate (HDR) mould brachytherapy. The present study evaluates dosimetric advantage of Acuros® BV, a TG-186 MBDCA, over TG-43 formalism using 192Ir source for HDR brachytherapy in chest wall scar boost using catheter flap. Material and methods A total of 25 patients, free of cardiac and pulmonary co-morbidities, who met the inclusion criteria were involved in the study. Catheter flap made of silicon with 20 channels was used to deliver a total dose of 7.5 Gy/3 fx by HDR surface mould brachytherapy to delineated scar volume. Plan was optimized with iterative method to obtain desired results with TG-43 formalism, followed by Acuros® BV (GBBS algorithm) without altering dwell positions or time. The two algorithm plans were analyzed qualitatively and quantitatively with dose-volume histograms. Results The mean D98% CTV-HDR_evl coverage decreased by 1.16% compared to TG-43, and near-maximum dose decreased by 8.18% (p = 0.000), mean Dmax dose to CTV-HDR_evl, and mean Dmean dose was lesser by 6.25% (p = 0.000) and 10.82% (p = 0.000), respectively, compared to TG-43. Heart D2% showed significant results, whereas Dmedian (cGy) revealed very significant difference. A 5 mm thick skin contour showed statistically significant results (p = 0.000) for V150% and V200%. Conclusions The presented data showed how Acuros® BV, algorithm-based calculation in scar boost irradiation of breast, accounting for a mass density of the medium and scatter condition, considered actual dose prediction in a medium.
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- 2021
19. Effect of Low-Level Laser on Axillary Web Syndrome Post Mastectomy
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Hussein Gamal Hussein, Eman M. Shoukry, Wafaa H. Borhan, and Marwa Mahmoud Selim
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medicine.medical_specialty ,Medical treatment ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Cancer ,Physical examination ,Axillary web syndrome ,medicine.disease ,Surgery ,Post mastectomy ,medicine ,business ,Body mass index ,Mastectomy ,Low level laser therapy - Abstract
Background: Axillary Web Syndrome (AWS) is characterized by axillary pain radiating down the ipsilateral arm, shoulder range-of-motion limitation, and an axillary web of tissue most obvious on physical examination when the patient tries to abduct her arm. The use of laser as a non-surgical medical treatment modality for assisting the normal processes of healing has increased over the last few years. However, the efficacy of laser in reducing pain or promoting tissue repair remains controversial. Objective: This study was undertaken to determine the effect of low-level laser therapy on axillary web syndrome post mastectomy. Patients and Methods: This study included forty female patients who underwent mastectomy and received their treatment in Tagamoo branch of National Cancer Institute. Their ages ranged 40 to 55 years and body mass index ranged 25 to 30 (kg/m2). The patients were selected from Medical Oncology Department, National Cancer Institute, between January 2019 to June 2019. Results: The results of this study revealed that Group A and Group B showed significant improvement in shoulder mobility (Flexion, Abduction and External rotation) and decrease of pain but by comparison between the two groups, group A showed greater improvement than Group B. Conclusion: It could be concluded that low level laser in addition to traditional therapy and medical therapy can improve shoulder mobility and decrease pain more than using only traditional and medical therapy.The result of this study supported the expectation that Low Level Laser had a position effect on axillary web syndrome.
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- 2021
20. Established and Validated Novel Nomogram for Predicting Prognosis of Post-Mastectomy pN0-1 Breast Cancer without Adjuvant Radiotherapy
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Shengguang Zhao, Cheng Xu, Jiayi Chen, Wei-Xiang Qi, and Lu Cao
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0301 basic medicine ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,nomogram ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,breast cancer ,Post mastectomy ,Internal medicine ,Adjuvant therapy ,Medicine ,Original Research ,Adjuvant radiotherapy ,business.industry ,mastectomy ,Nomogram ,medicine.disease ,pN0-1 ,030104 developmental biology ,Cancer Management and Research ,030220 oncology & carcinogenesis ,Cohort ,T-stage ,prognosis ,business ,Mastectomy ,LASSO analysis - Abstract
Wei-Xiang Qi, Lu Cao, Cheng Xu, Shengguang Zhao, Jiayi Chen Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Jiayi Chen; Wei-xiang QiDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of ChinaEmail jiayichen2019@126.com; qiweixiang1113@163.comAim: To establish and validate a nomogram for predicting prognosis of breast cancer patients with pN0-1 who were treated with mastectomy and without adjuvant radiotherapy.Material and Methods: The LASSO regression was performed to identify predictors of breast cancer-specific survival (BCSS), local regional recurrence (LRR) and distant metastasis (DM). Model performance was evaluated by the concordance index (C-index) and calibration plot.Results: The 5-year BCSS, LRR and DM rates for the entire cohort were 98%, 2% and 4%, respectively. LASSO regression analysis found that pathological T stage, number of positive LN, grade and Ki-67 were significant predictors for both BCSS and DM-free survival, while number of resected LN and PR status were predictors for DM-free survival. In addition, number of positive LN was the only significant predictor for developing LRR. The C-indexes for the 5-year BCSS and DM nomograms were 0.81 and 0.78 in the training data set, 0.65 and 0.70 in the testing set and 0.72 and 0.69 in the external validation set, respectively.Conclusion: Our prognostic nomograms accurately predict 5-year BCSS and DM-free survival in post-mastectomy breast cancer without adjuvant radiotherapy, which provides a useful tool to identify high-risk patients who could benefit from additional adjuvant therapy.Keywords: breast cancer, pN0-1, mastectomy, LASSO analysis, nomogram, prognosis
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- 2021
21. Factors Associated with Quality of Life among Women Undergoing Hormonal Therapy Post Mastectomy at Outpatients Clinics in El-Beheira Oncology Center
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Nadia Mohammed Darder, Wesam kamal Ali Farag, and Abeer Abdel Aziz Madian
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Associated ,Quality of life ,Oncology Center ,El-Beheira ,Outpatient Clinics ,Post mastectomy ,Factors ,Hormonal therapy - Abstract
Background: Health is the major reference regarding quality of life ;when it comes to breast cancer in particular, the loss of abreast traumatically affects a women’s life, reflecting on her quality of life. Aim of this study is to identify factors associated with quality of life among women undergoing hormonal therapy post mastectomy at outpatient’s clinics in El-Beheira oncology center. Research design: a descriptive cross sectional research design. Settings: This study was carried out in hormonal therapy outpatient clinics in oncology center in EL-Beheira governorate. Subjects: this study was carried on a convenient sample of 200 women. Data collection tools: data were collected using two tools: women structured interview schedule and Quality of Life Assessment scale Sheet (WHOQOL-100).Results: the age of the studied women ranged from less than 30years to equal or less than 45 years with a Mean ± SD(36.64 ± 5.33) years. More than half of the studied women (57.5%) had fair quality of life while more than two fifths (42%) of them had poor quality of life. According to linear regression model for predictors of quality of life among women undergoing hormonal therapy post mastectomy : women's education, monthly income, using of family planning methods, stage (III) of breast cancer and the presence of sores in the breast skin are the most independent risk factors associated with poor quality of life . On the other hand, the most independent protective factors associated with good QoL are women's age(OR=0.837, P=0.015) in which old age are (80%) protective for good QoL than young age , occupation (OR=0.201, P=0.017) in which worker women are (20%) protective factors associated with good QoL than non-worker, number of children (OR=0.709, P=0.011) in which women who have higher number of children are (70.0%) protective for good QoL than women have lower number of children . Conclusion: the study concluded that, women's education, monthly income, using of family planning methods, stage (III) of breast cancer and the presence of sores in the breast skin are the most independent risk factors associated with poor quality of life. Therefore, results are useful to establish strategy to improve quality of life of post mastectomies women. Recommendations: this study recommends Providing financial support for underprivileged, post mastectomies survivors and patients with low socioeconomic status in order to help them in continuing treatment according to protocol and an experimental study should be carried out to find out the effectiveness of a liaison psychiatric nursing program in reducing the stress levels, improving quality of life and enhancing coping strategies among the patients with cancer especially those undergoing mastectomy. Keywords: Factors, Associated, Women, Outpatient Clinics, El-Beheira, Oncology Center, Quality of life, Hormonal therapy, Post mastectomy. Title: Factors Associated with Quality of Life among Women Undergoing Hormonal Therapy Post Mastectomy at Outpatients Clinics in El-Beheira Oncology Center Author: Nadia Mohammed Darder, Wesam kamal Ali Farag, Abeer Abdel Aziz Madian International Journal of Novel Research in Healthcare and Nursing ISSN 2394-7330 Vol. 9, Issue 2, May 2022 - August 2022 Page No: 1-16 Novelty Journals Website: www.noveltyjournals.com Published Date: 10-May-2022 DOI: https://doi.org/10.5281/zenodo.6535624 Paper Download Link: https://www.noveltyjournals.com/upload/paper/Factors%20Associated%20with-10052022-1.pdf, International Journal of Novel Research in Healthcare and Nursing, Novelty Journals, Website: www.noveltyjournals.com, {"references":["[1]\tTyagi N , Sharma G, Sahu N , Chaudhary N and Sharivistiva B. Cancer: An Overview. International Journal of Research and Development in Pharmacy & Life Sciences . 2017; 6(5): 2740-2747. DOI org/10.21276/IJRDPL.227 8-0238.","[2]\tWorld Health Organization. Cancer . World Cancer Day in 2018 .Available from: https://www.who.int/health-topics/cancer#tab.","[3]\tWorld Health Organization. Breast cancer: international agency for research in cancer 2020. [Cited 26 march 2021]. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer.","[4]\tWorld Health Organization/International Agency for Research on Cancer: Egypt. December2020.Availableat https://gco.iarc.fr/today/data/factsheets/populations/818-egypt-fact-sheets.pdf. Accessed March 5, 2021.","[5]\tFeng Y et al. Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes & diseases . 2018 ; 5(2): 77-106. DOI: 10.1016/j.gendis.2018.05.001.","[6]\tWang F et al. The impact of radiation therapy, lymph node dissection, and hormonal therapy on outcomes of tissue expander–implant exchange in prosthetic breast reconstruction. Plastic and reconstructive surgery. 2016 ; 137(1): 1-9 . DOI : 10.1097/PRS.0000000000001866.","[7]\tSimon R et al. Adherence to adjuvant endocrine therapy in estrogen receptor-positive breast cancer patients with regular follow-up. Can J Surg. 2014; 57(1):26–32. DOI: 10.1503/cjs.006211.","[8]\tKunkel EJ and Chen. Psychiatric aspects of women with breast cancer. Psychiatric Clinics. 2003; 26 ( 3): 713-724. DOI: 10.1016/s0193-953x(03)00038-8.","[9]\tShao J et . al . Multidisciplinary care of breast cancer patients: a scoping review of multidisciplinary styles, processes, and outcomes. Current Oncology . 2019 ; 26(3): 385-397. DOI: 10.3747/co.26.4713.","[10]\tSajadian A, Motaharinasab A, Kazemnejad A , Eklily D. Breast Cancer Coping Strategies after Diagnosis: A Six-month Follow-up. Psychological Studies.2017; 12(3):85-101. DOI: 10.9790/1959-0802034660","[11]\tarroys and lópez . psychological problems derived from mastectomy: a qualitative study.2011; 2(11):132 - 461. DOI: 10.1155/2011/132461.","[12]\tYılmaz M And Turk K. The effect on quality of life and body image of mastectomy among breast cancer survivors. European journal of breast health .2018; 14(4): 205. DOI: 10.5152/ejbh.2018.3875.","[13]\tWhoqol Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Social scienc &medicine .1995;41(10):140309.[cited2019oct19].Availablefrom:https:// www.who.int/healthinfo/survey/whoqol-qualityoflife/en.","[14]\tLidón V and Castilla IM. Longitudinal analysis of subjective well-being in preadolescents: The role of emotional intelligence, self-esteem and perceived stress. Journal of health psychology .2020 ;27(2) 278–29. DOI:13591053 20951605.","[15]\tNancy P, Barker C. The partner relationship in psychological response to breast cancer.Social Science & Medicine. 2000 ; (40.6): 789-797. DOI:org/10.1023/A:1022163205450."]}
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- 2022
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22. A look at racial and socioeconomic disparities in post‐mastectomy breast reconstruction at a midwestern academic hospital
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Ryan M. Gobble, Juliana Madzia, Suma Yalamanchili, Michael Ortman, and Doug Dembinski
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Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,Insurance Coverage ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Post mastectomy ,Internal Medicine ,medicine ,Humans ,Healthcare Disparities ,Private insurance ,Socioeconomic status ,Mastectomy ,Public health insurance ,business.industry ,Hospitals ,Social Class ,Oncology ,030220 oncology & carcinogenesis ,Female ,Surgery ,Breast reconstruction ,business ,Demography - Abstract
Purpose of this study was to assess likelihood of undergoing breast reconstruction based on race, socioeconomic status, insurance, and distance from the hospital. Patients with public insurance were less likely to undergo reconstruction than patients with private insurance (OR = 2.99, p
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- 2021
23. Comparing outcomes of post-mastectomy breast reconstruction between United States and Western Europe✰
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Jeffrey J. Aalberg, Abhishek Chatterjee, Zachary Erlichman, Sina Foroutanjazi, and Joshua A Bloom
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medicine.medical_specialty ,business.industry ,Post mastectomy ,Western europe ,medicine ,Surgery ,Breast reconstruction ,business - Published
- 2021
24. Post‐mastectomy surveillance of BRCA1 / BRCA 2 mutation carriers: Outcomes from a specialized clinic for high‐risk breast cancer patients
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Osnat Halshtok, Nayroz Kanana, Renata Faermann, Eitan Friedman, Noam Nissan, Meirav A Ben David, Eyal Klang, Dov Zippel, Orit Kaidar-Person, Mohammad Yassin, David Samoocha, Yael Yagil, Miri Sklair Levy, Anat Shalmon, Michael Gotlieb, Tima Davidson, Dana Madorsky Feldman, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, and Radiotherapie
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Heterozygote ,medicine.medical_specialty ,endocrine system diseases ,Breast imaging ,medicine.medical_treatment ,Genes, BRCA2 ,surveillance scheme ,Breast Neoplasms ,Disease ,Asymptomatic ,030218 nuclear medicine & medical imaging ,breast cancer risk ,03 medical and health sciences ,brca1 ,0302 clinical medicine ,Breast cancer ,Post mastectomy ,risk‐ ,Internal Medicine ,Humans ,Medicine ,skin and connective tissue diseases ,mri ,Retrospective Studies ,BRCA2 Protein ,BRCA2 mutation carriers ,BRCA1 Protein ,business.industry ,mastectomy ,reducing surgery ,Retrospective cohort study ,medicine.disease ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,Mutation ,Mutation (genetic algorithm) ,Female ,medicine.symptom ,business ,Mastectomy - Abstract
Female BRCA1/BRCA2 mutation carriers may elect bilateral risk-reducing mastectomy. There is a paucity of data on yield of imaging surveillance after risk-reducing mastectomy. This retrospective study focused on female BRCA1/BRCA2 mutation carriers who underwent bilateral mastectomy either as primary preventative, or as secondary preventative, after breast cancer diagnosis. All participants underwent breast imaging at 6- to 12-month intervals after mastectomy. Data on subsequent breast cancer diagnosis and timing were collected and compared between the groups. Overall, 184 female mutation carriers (134 BRCA1, 45 BRCA2, 5 both BRCA genes) underwent bilateral mastectomy after initial breast cancer diagnosis, between April 1, 2009 and August 31, 2018. During a mean follow-up of 6.2 +/- 4.2 years, 13 (7.06%) were diagnosed with breast cancer; 12 ipsilateral (range: 0.4-28.8 years) and 1 contralateral breast cancer, 15.9 years after surgery. On the contrary, among asymptomatic BRCA1 (n = 40) and BRCA2 (n = 13) mutation carriers who underwent primary risk-reducing mastectomy (mean age at surgery 39.5 +/- 8.4 years); none has developed breast cancer after a mean follow-up of 5.4 +/- 3.4 years. BRCA1/BRCA2 mutation carriers with prior disease who underwent risk-reducing mastectomy after breast cancer diagnosis are still prone for developing ipsi or contralateral breast cancer, and therefore may benefit from continues clinical and imaging surveillance, unlike BRCA1/BRCA2 mutation carriers who undergo primary preventative bilateral mastectomy.
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- 2021
25. Study protocol: a pilot quasi-experimental trial of tele-rehabilitation and tele-drain care post-mastectomy
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Gladys Yu Hui Teng, Miho Asano, Yee Sien Ng, May Leng Mabel Tan, Benita Kiat Tee Tan, Petrina Li Ling Liew, Preetha Madhukumar, Gerald Choon-Huat Koh, and Saraswathi Nagalingam
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medicine.medical_specialty ,medicine.medical_treatment ,Medicine (miscellaneous) ,Study Protocol ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Tele-rehabilitation ,Breast cancer ,Post mastectomy ,Health care ,medicine ,030212 general & internal medicine ,Protocol (science) ,lcsh:R5-920 ,Rehabilitation ,business.industry ,Pilot trial ,medicine.disease ,030220 oncology & carcinogenesis ,Physical therapy ,business ,lcsh:Medicine (General) - Abstract
BackgroundBreast cancer is the leading cancer affecting women in Singapore. Its survivors commonly experience decline in physical function and quality of life post-mastectomy, due to their upper limb morbidity and wound issues. Rehabilitation can address the aforementioned issues. When rehabilitation is accessible and easy to adhere, it can optimize recovery.Home-based tele-rehabilitation guided by healthcare professionals and self-managed by patients can potentially optimize the patients’ adherence to rehabilitation and recovery. With that in mind, a team of breast cancer specialists (oncologists, nurses, and therapists) in Singapore has developed one of the first tele-rehabilitation systems for local women undergoing a unilateral mastectomy. To our knowledge, no such systems have been evaluated or proven effective as a treatment option among local breast cancer patients with acute disabilities.MethodsThis is a pilot quasi-experimental trial that aims to evaluate the feasibility of tele-rehabilitation and tele-drain care compared to usual care. Up to 40 patients (20 per group) will be recruited for this trial. They will be assigned to an intervention group that receives rehabilitation via a tele-rehabilitation system or a control group that receives rehabilitation in person at their clinic. The primary outcome of this trial is rehabilitation participation (i.e., the time spent on rehabilitation). The secondary outcomes are upper extremity functioning, perceived health, and quality of life.DiscussionAs part of this pilot trial, patients who opt in for the tele-rehabilitation will be asked to share their experience with and thoughts on the tele-rehabilitation system. With the evidence obtained from the tele-rehabilitation patients of this trial, we will be able to improve the current system for our future trial. Further, our additional data on rehabilitation participation, physical function, and quality of life will help us design a sufficiently powered future main trial.Trial registrationThe trial was approved by the National Healthcare Group’s Domain Specific Review Board (#2019/00283) and registered withwww.ClinicalTrials.gov(#NCT04269967) in February 2020.
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- 2021
26. Analysis of physical therapy treatment in post-mastectomy sensitivity disorder
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Tatiane Caetano de Souza, Cristianne Confessor Castilho Lopes, Liamara Basso Dala Costa, Eduardo Barbosa Lopes, Laisa Zanatta, Youssef Elias Ammar, Marilda Morais da Costa, Daniela dos Santos, Tulio Gamio Dias, Vanessa da Silva Barros, Caroline Lehnen, Talitta Padilha Machado, Paulo Sérgio Silva, Joyce Kelly Busolin Jardim, Lucas Castilho Lopes, and Heliude de Quadros e Silva
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medicine.medical_specialty ,business.industry ,Post mastectomy ,Medicine ,Radiology ,Sensitivity (control systems) ,business - Published
- 2021
27. Breast cancer recurrences in myocutaneous flap reconstruction
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Jessica W.T. Leung and Hannah L. Chung
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Skin sparing mastectomy ,Breast cancer recurrence ,business.industry ,lcsh:R895-920 ,medicine.medical_treatment ,Autologous breast reconstruction ,Case Report ,Ductal carcinoma ,Invasive ductal carcinoma ,medicine.disease ,Breast cancer ,Recurrence ,Post mastectomy ,medicine ,Deep inferior epigastric perforator (DIEP) flap ,Radiology, Nuclear Medicine and imaging ,Radiology ,Papillary carcinoma ,business ,Mastectomy - Abstract
Autologous flap reconstruction is widely used after skin sparing mastectomy to reconstruct the appearance of the breast. We present 2 cases of breast cancer recurrence in a deep inferior epigastric perforator reconstruction, including a 65-year-old female with history of papillary carcinoma and a 35-year-old female with history of a high grade invasive ductal carcinoma with extensive ductal carcinoma in situ. Differential imaging considerations of the post mastectomy patient are reviewed. Typical appearance of a deep inferior epigastric perforator flap reconstruction as well as location and timing of presentation may help differentiate a recurrence from the more commonly encountered postsurgical etiologies.
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- 2021
28. Case report of stacked intercostal artery perforator flaps: a novel technique using anterior and lateral intercostal artery perforator flaps for full autologous breast reconstruction post-mastectomy
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Chi Wei Mok, Hui Jun Lim, and Su-Ming Tan
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Novel technique ,medicine.medical_specialty ,business.industry ,Post mastectomy ,medicine.artery ,medicine ,General Medicine ,business ,Breast reconstruction ,Intercostal arteries ,Perforator flaps ,Surgery - Published
- 2023
29. Clinical practice guidelines for post-mastectomy breast reconstruction: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021
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Yan-Shuang Li, Jun-Xian Du, Hong-Chuan Jiang, Wei Zhu, Chinese Society of Breast Surgery, and Yuan-Yuan Ji
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medicine.medical_specialty ,China ,business.industry ,General surgery ,Breast surgery ,medicine.medical_treatment ,Mammaplasty ,Consensus Statement ,Breast Neoplasms ,General Medicine ,Chinese society ,Clinical Practice ,Asian People ,Post mastectomy ,medicine ,Medicine ,Humans ,Female ,Breast reconstruction ,business ,Mastectomy - Published
- 2021
30. Commentary on: Post-Mastectomy Surgical Pocket Irrigation With Triple Antibiotic Solution vs Chlorhexidine Gluconate: A Randomized Controlled Trial Assessing Surgical Site Infections in Immediate Tissue Expander Breast Reconstruction
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Peter W. Thompson
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medicine.medical_specialty ,medicine.drug_class ,Mammaplasty ,medicine.medical_treatment ,Antibiotics ,Breast Neoplasms ,Tissue expander breast ,law.invention ,Randomized controlled trial ,law ,Post mastectomy ,Chlorhexidine gluconate ,Surgical site ,medicine ,Humans ,Surgical Wound Infection ,Mastectomy ,business.industry ,Chlorhexidine ,Tissue Expansion Devices ,General Medicine ,Anti-Bacterial Agents ,Surgery ,Female ,business - Published
- 2021
31. Exploring the Effect of Post-mastectomy complications on 5-year survival
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Erwin A. Kruger, Heide E. Kosiorek, Chad M. Teven, Jacob B. Hammond, Barbara A. Pockaj, Ga ram Han, Patricia A. Cronin, Alanna M. Rebecca, and William J. Casey
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Adult ,medicine.medical_specialty ,Disease free survival ,Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Post mastectomy ,medicine ,Overall survival ,Humans ,030212 general & internal medicine ,Stage (cooking) ,Mastectomy ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General Medicine ,Middle Aged ,Surgery ,Survival Rate ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,Complication ,business - Abstract
Ramifications of postoperative complications on long-term survival after mastectomy are uncertain.Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS).A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction.Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival.
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- 2020
32. POST-MASTECTOMY FEMALE SEX DYNAMES DUE TO BREAST CANCER: AN INTEGRATIVE REVIEW
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Rebeca Santos, Francisco Stélio de Sousa, Julyanne Pereira, and Laura Xavier de Moraes
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Oncology ,medicine.medical_specialty ,Breast cancer ,business.industry ,Post mastectomy ,Internal medicine ,medicine ,Female sex ,Ocean Engineering ,business ,medicine.disease - Published
- 2020
33. Multistage Latissimus Dorsi Flap with Implant for Complex Post-Mastectomy Reconstruction: An Old but Still Current Technique
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Francesca De Lorenzi, Pietro Loschi, Elisabetta Maria Cristina Rossi, Paolo Veronesi, Pietro Sala, Francesco Borelli, Paola Naninato, and Anna Rita Vento
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Surgery ,Oncology ,Post mastectomy ,Seroma ,Ambulatory ,medicine ,Implant ,Latissimus dorsi flap ,Stage (cooking) ,business ,Breast reconstruction ,Mastectomy ,Research Article - Abstract
Introduction: The latissimus dorsi (LD) flap has been used for reconstructing mastectomy defects since the early 1900s. Although its popularity has declined over the last decades, it still retains an important role in breast reconstruction. We present our recent experience with the multistage LD flap and implant for extremely complex post-mastectomy defects. Patients and Methods: Between 2011 and 2020, 42 consecutive patients underwent post-mastectomy LD reconstruction with an expander (STAGE 1). Some of them received prior fat-grafting of the mammary region (STAGE 0). All patients were scheduled for an expander-definitive implant change (STAGE 2). Some of them completed the program with fat-grafting, nipple and areola reconstruction, and other refinements (STAGE 3 or 4). Results: Two patients underwent fat-grafting at STAGE 0. Mean age at STAGE 1 was 46.7 years, mean BMI was 23.6, 14.4% of the patients were smokers, and 21.4% had comorbidities. Immediate reconstructions were performed in 35.7% and delayed in 64.3%. Mean surgical time at STAGE 1 was 194.7 min for delayed reconstructions and 242.3 min for immediate ones. Mean hospital stay for STAGE 1 procedures was 3.8 days; all other STAGES were performed as ambulatory surgery. No flap necrosis was observed and only 1 patient required a surgical revision for bleeding. Dorsal seroma occurred in 45.2% of cases. Conclusions: The multistage LD flap with implant is a useful and safe tool within the reconstructive armamentarium for post-mastectomy defects. It combines multiple simple procedures and does not require specific skills and surgical training (level of evidence 4).
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- 2020
34. Using the Bolus in Post-mastectomy Radiation Therapy (PMRT): A National Survey on Behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group
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Lucia Anna Ursini, F. Patani, Luciana Caravatta, Fabiana Gregucci, Icro Meattini, Marianna Trignani, Consuelo Rosa, Domenico Genovesi, Monica Di Tommaso, Marianna Nuzzo, and A. Ciabattoni
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Cancer Research ,medicine.medical_specialty ,Mammaplasty ,medicine.medical_treatment ,Planning target volume ,Breast Neoplasms ,Medical Oncology ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Post mastectomy ,medicine ,Humans ,Practice Patterns, Physicians' ,Thoracic Wall ,Mastectomy ,Aged ,Skin ,Clinical Oncology ,business.industry ,General surgery ,Radiation Oncologists ,Dose-Response Relationship, Radiation ,General Medicine ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,Italy ,Oncology ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,Radiotherapy, Conformal ,Breast reconstruction ,business ,Bolus (radiation therapy) - Abstract
Background/aim This study aimed to investigate the bolus practice among Italian radiation oncologists. Patients and methods In 2018, a survey on bolus application was sent to all members of the Italian Association of Radiotherapy and Clinical Oncology. Results The survey was joined by 102 radiation oncologists. Not all respondents answered to every question. A 69.5% of 82 respondents used bolus in case of skin infiltration and 52 of 68 respondents (76.5%) applied it every day. Skin was included as part of chest wall Clinical Target Volume both in the absence or the presence of breast reconstruction. Five mm bolus was the most used. 3D Conformal radiotherapy was the most used technique, in 73.5% of cases. Acute RTOG G2-G3 skin toxicity was recorded by 93.9% physicians. Conclusion There was heterogeneity in the use of bolus, though an agreement was found in some topics. The achievement of a National Consensus may represent an interesting future goal.
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- 2020
35. Irradiation en situation postopératoire après reconstruction mammaire
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M. Rogé, Sofia Rivera, J. Carrilho, Sébastien Thureau, and Juliette Thariat
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Prothesis ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,Post mastectomy ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Implant ,Radiology ,business ,Total Mastectomy ,Breast reconstruction ,Mastectomy - Abstract
Immediate breast reconstruction versus delayed breast reconstruction improves quality of life of breast cancer patients undergoing total mastectomy without impacting oncologic outcomes. Two types of immediate reconstruction are possible, implant-based reconstruction or autologous reconstruction. These reconstructions interpose a tissue in the operating bed, which modifies target volume definition compared to a wall without reconstruction Post mastectomy radiotherapy increases the rate of postoperative complications for both surgical procedures. Recent guidelines were published about target volume definition in the post mastectomy setting after implant-based reconstruction. Guidelines about target volume definition after autologous reconstruction are still awaited. The aim of our work is to present the different surgical procedures for immediate breast reconstruction, their complications, and the definition of the postmastectomy target volume.
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- 2020
36. Chylous Leakage Post-mastectomy and Axillary Dissection
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Ronald Wasike and Matheka Mwongeli
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Chylous leakage ,medicine.medical_specialty ,Chyle ,RD1-811 ,Conservative management ,business.industry ,medicine.medical_treatment ,axillary dissection ,mastectomy ,Modified Radical Mastectomy ,chylous leakage ,Surgery ,Post mastectomy ,chyle ,medicine ,Axillary Dissection ,business ,Complication ,Mastectomy - Abstract
Chylous leakage is a rare complication following mastectomy and axillary dissection. We report a case of a 46-year-old female who underwent modified radical mastectomy and developed chylous leakage. She was treated successfully with conservative management. Keywords: Chylous leakage, chyle, mastectomy, axillary dissection
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- 2021
37. Factors associated with the desire to undergo post-mastectomy breast reconstruction in a Mexican breast cancer center
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Paulina Bajonero-Canonico, Cynthia Villarreal-Garza, Melina Miaja-Avila, Ana S. Ferrigno, David Eugenio Hinojosa-Gonzalez, Brizio Moreno-Jaime, Carlos de la Cruz-de la Cruz, Cristel G de la O-Maldonado, Jorge Alberto Saldaña-Rodriguez, José Moral de la Rubia, and Mariela Hernandez-Pavon
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Adult ,medicine.medical_specialty ,Mammaplasty ,medicine.medical_treatment ,Decision Making ,Breast Neoplasms ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Post mastectomy ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Stage (cooking) ,Total Mastectomy ,Mexico ,Mastectomy ,Aged ,business.industry ,Public health insurance ,Nursing research ,General surgery ,Middle Aged ,medicine.disease ,Oncology ,030220 oncology & carcinogenesis ,Female ,business ,Breast reconstruction - Abstract
To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. Women with stage I–III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.
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- 2020
38. Effectiveness of 5% Lidocaine Patch in Post Mastectomy Cancer Pain – A Randomized Controlled Trial
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Sushree Das
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Randomized controlled trial ,business.industry ,Post mastectomy ,law ,Anesthesia ,Medicine ,Lidocaine Patch ,business ,Cancer pain ,law.invention - Published
- 2020
39. Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy
- Author
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Bin Li, Weifeng Wang, Konglong Shen, Zhonghua Deng, Jidan Zhou, Wan Li, Zhiguo Wang, Jie Xiong, and Renming Zhong
- Subjects
Systematic error ,Vacuum ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,Planning target volume ,Breast Neoplasms ,Radiotherapy Setup Errors ,030218 nuclear medicine & medical imaging ,Motion ,03 medical and health sciences ,0302 clinical medicine ,Post mastectomy ,Regular Paper ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Mastectomy ,Cone beam ct ,Mathematics ,Radiation ,Radiotherapy ,breast vacuum bag ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Respiration ,Respiratory motion ,technology, industry, and agriculture ,global and local setup errors ,Margins of Excision ,Reproducibility of Results ,Radiotherapy Dosage ,Equipment Design ,Ptv margin ,Cone-Beam Computed Tomography ,Radiation therapy ,030220 oncology & carcinogenesis ,Random error ,AcademicSubjects/SCI00960 ,post-mastectomy radiation therapy ,Female ,AcademicSubjects/MED00870 ,Radiotherapy, Intensity-Modulated ,Nuclear medicine ,business ,Radiotherapy, Image-Guided - Abstract
To design a new breast vacuum bag to reduce global and local setup errors in post-mastectomy radiation therapy (PMRT). A total of 24 PMRT patients were immobilized with an old vacuum bag and 26 PMRT patients were immobilized with a new vacuum bag. The registration results were analysed using four regions of interest (ROI): the global ROI [including the whole region of the planning target volume (PTV), GROI], the supraclavicular area (SROI), the ipsilateral chest wall region (CROI) and the ipsilateral arm region (AROI). The global and local setup errors of the two groups were compared. The global setup errors of the new vacuum group were significantly smaller than those in the old vacuum group with the exception of yaw axes (P
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- 2020
40. In search of a one plan solution for VMAT post‐mastectomy chest wall irradiation
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A. Day, Thalat Theresa Monajemi, P. A. K. Oliver, and Mammo Yewondwossen
- Subjects
brass mesh ,Materials science ,Optically stimulated luminescence ,Breast Neoplasms ,VMAT ,Imaging phantom ,030218 nuclear medicine & medical imaging ,tangents ,03 medical and health sciences ,0302 clinical medicine ,Bolus (medicine) ,skin dose ,Post mastectomy ,Humans ,Radiation Oncology Physics ,Radiology, Nuclear Medicine and imaging ,Irradiation ,Radiometry ,Thoracic Wall ,Radiation treatment planning ,Instrumentation ,Mastectomy ,Radiation ,Dosimeter ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Radiotherapy Dosage ,Skin dose ,bolus ,030220 oncology & carcinogenesis ,chest wall radiation therapy ,Female ,Radiotherapy, Intensity-Modulated ,Nuclear medicine ,business - Abstract
Purpose This study was designed to evaluate skin dose in both VMAT and tangent treatment deliveries for the purpose of identifying suitable bolus use protocols that should produce similar superficial doses. Methods Phantom measurements were used to investigate skin dose in chest wall radiotherapy with and without bolus for 3D and rotational treatment techniques. Optically stimulated luminescence dosimeters (OSLDs) with and without housing and EBT3 film were used. Superflab (3, 5, and 10 mm) and brass mesh were considered. Measured doses were compared with predictions by the Eclipse treatment planning system. Patient measurements were also performed and the bolusing effect of hospital gowns and blankets were highlighted. The effect of flash for VMAT plans was considered experimentally by using 2 mm couch shifts. Results For tangents, average skin doses without bolus were 0.64 (EBT3), 0.62 (bare OSLD), 0.77 (jacketed OSLD), and 0.68 (Eclipse) as a fraction of prescription. For VMAT, doses without bolus were 0.53 (EBT3), 0.53 (bare OSLD), 0.64 (jacketed OSLD), and 0.60 (Eclipse). For tangents, the average doses with different boluses as measured by EBT3 were 0.99 (brass mesh), 1.02 (3 mm), 1.03 (5 mm), and 1.07 (10 mm). For VMAT with bolus, average doses as measured by EBT3 were 0.83 (brass), 0.96 (3 mm), 1.03 (5 mm), and 1.04 (10 mm). Eclipse doses agreed with measurements to within 5% of measurements for all Superflab thicknesses and within 15% of measurements for no bolus. The presence of a hospital gown and blanket had a bolusing effect that increased the surface dose by approximately 10%. Conclusions Results of this work allow for consideration of different bolus thicknesses, materials, and usage schedules based on desired skin dose and choice of either tangents or an arc beam techniques.
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- 2020
41. Patient-Reported Outcome Measures for Post-mastectomy Breast Reconstruction: A Systematic Review of Development and Measurement Properties
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Kerry N L Avery, Shelley Potter, Jane M Blazeby, Charlotte F Davies, and Rhiannon C Macefield
- Subjects
medicine.medical_specialty ,Future studies ,medicine.medical_treatment ,Mammaplasty ,Breast Neoplasms ,Prom ,030230 surgery ,Patient reported outcome measure ,Reconstructive Oncology ,03 medical and health sciences ,0302 clinical medicine ,Post mastectomy ,Surveys and Questionnaires ,medicine ,Content validity ,COSMIN ,Humans ,Medical physics ,Reconstructive breast surgery ,Patient Reported Outcome Measures ,Prospective Studies ,Mastectomy ,Retrospective Studies ,Core measurement set ,business.industry ,Core outcome set ,Reproducibility of Results ,Checklist ,Cross-Sectional Studies ,Oncology ,030220 oncology & carcinogenesis ,Systematic review ,Quality of Life ,Surgery ,Patient-reported outcome ,business ,Breast reconstruction ,Measurement properties - Abstract
BackgroundBreast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set be robustly developed and validated so data are reliable and accurate. The aim of this systematic review is to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies.MethodsA PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using three steps: (1) the methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist; (2) criteria were applied for assessing good measurement properties; and (3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach.ResultsFourteen articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality.ConclusionsBREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.
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- 2020
42. Arms positioning in post-mastectomy proton radiation: Feasibility and development of a new arms down contouring atlas
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Shannon M. MacDonald, Andrew D. Johnson, Rachel B. Jimenez, Nicolas Depauw, and E. Batin
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_treatment ,IMPT ,lcsh:R895-920 ,THERAPY ,lcsh:RC254-282 ,030218 nuclear medicine & medical imaging ,Pencil beam scanning ,03 medical and health sciences ,0302 clinical medicine ,Atlas (anatomy) ,Post mastectomy ,Post-mastectomy ,Dosimetry ,mental disorders ,medicine ,otorhinolaryngologic diseases ,BREAST-CANCER ,Radiology, Nuclear Medicine and imaging ,Original Research Article ,Breast ,Setup ,Radiation treatment planning ,Pencil-beam scanning ,Proton therapy ,RISK ,Contouring ,Radiation ,business.industry ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Radiation therapy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Atlas ,Nuclear medicine ,business ,Treatment planning ,psychological phenomena and processes ,Positioning ,PMRT ,RADIOTHERAPY - Abstract
Highlights • Arms down positioning is achievable for proton post-mastectomy radiation therapy. • Arms down position is dosimetrically comparable to conventional arms up position. • Arms down position setup is as accurate as the conventional arms up position setup. • An arms-down contouring atlas has been provided for reproducibility., Background and purpose Breast cancer patients receiving radiation are traditionally positioned with both arms up, but this may not be feasible or comfortable for all patients. We evaluated the treatment planning and positioning reproducibility differences between the arms up and arms down positions for patients receiving post-mastectomy radiation therapy (PMRT) using proton pencil beam scanning (PBS). Materials and methods Ten PMRT patients who were scheduled to receive PBS underwent CT-based treatment planning in both an arms down and a standard arms up position. An arms down contouring atlas was developed for consistency in treatment planning. Treatment plans were performed on both scans. A Wilcoxon test was applied to compare arms up and arms down metrics across patients. Five patients received treatment in the arms-down position at our institution while others were treated with the arms up. Residual set-up errors were recorded for each patient’s treatment fractions and compared between positions. Results Target structure coverage remained consistent between the arms up and arms down positions. In regard to the OAR, the heart mean and maximum doses were statistically significantly lower in the arms up position versus the arms down position, however, the absolute differences were modest. Patients demonstrated similar setup errors, less than 0.5 mm differences, in all directions. Conclusions PBS for PMRT in the arms down position appeared stable and reproducible compared to the traditional arms up positioning. The degree of OAR sparing in the arms down group was minimally less robust but still far superior to conventional photon therapy.
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- 2020
43. Current status of and trends in post-mastectomy breast reconstruction in Korea
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Song, Woo Jin, Kang, Sang Gue, Kim, Eun Key, Song, Seung Yong, Lee, Joon Seok, Lee, Jung Ho, and Jin, Ung Sik
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medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Post mastectomy ,big data ,medicine ,Health insurance ,breast neoplasms ,Stage (cooking) ,mammaplasty ,Topic ,business.industry ,lcsh:RD1-811 ,statistics ,030220 oncology & carcinogenesis ,Mammaplasty ,Implant reconstruction ,Surgery ,Radiology ,Implant ,Breast reconstruction ,business ,Mastectomy ,insurance - Abstract
Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.
- Published
- 2020
44. Analysis of local setup errors of sub-regions in cone-beam CT-guided post-mastectomy radiation therapy
- Author
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Xiaoyu Li, Shuai Li, An Li, Konglong Shen, Weifeng Wang, Jidan Zhou, Sen Bai, Chengwei Ye, Renming Zhong, and Gang Chen
- Subjects
Adult ,Systematic error ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,Planning target volume ,Image registration ,Breast Neoplasms ,Radiotherapy Setup Errors ,Thoracic Vertebrae ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Post mastectomy ,Vertebral region ,Regular Paper ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,Mastectomy ,Cone beam ct ,Retrospective Studies ,Physics ,Radiation ,Radiotherapy ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Reproducibility of Results ,Cone-Beam Computed Tomography ,Middle Aged ,local setup errors ,Sub region ,Radiation therapy ,030220 oncology & carcinogenesis ,post-mastectomy radiation therapy ,Female ,CBCT guidance ,Nuclear medicine ,business ,Radiotherapy, Image-Guided - Abstract
The purpose of the study was to quantify local setup errors and evaluate the planning target volume (PTV) margins for sub-regions in cone-beam computed tomography (CBCT)-guided post-mastectomy radiation therapy (PMRT). The local setup errors of 20 patients undergoing CBCT-guided PMRT were analysed retrospectively. Image registration between CBCT and planning CT was performed using four sub-regions of interest (ROIs): the supraclavicular area (SROI), ipsilateral chest wall region (CROI), ipsilateral chest wall plus supraclavicular region (SROI + CROI) and vertebral region (TROI). Bland–Altman analysis, correlation, local setup errors and PTV margins among these ROIs were evaluated. There was no significant consistency or correlation for registration results between the TROI and the CROI or SROI regions on any translational axis. When using the SROI + CROI as the ROI, the systematic error (Σ) and random error (σ) of the local setup errors for the CROI region were 1.81, 1.19 and 1.76 mm and 1.84, 2.64 and 3.00 mm along the medial–lateral (ML), superior–inferior (SI) and anterior–posterior (AP) directions, respectively. The PTV margins for the CROI region were 5.80, 4.82 and 6.50 mm. The Σ and σ of the local setup errors for the SROI region were 1.29, 1.15 and 0.77 mm and 1.96, 2.65 and 2.2 mm, respectively, and the PTV margins were 4.59, 4.73 and 3.47 mm. Large setup errors and local setup errors occur in PMRT. The vertebral body should not be a position surrogate for the supraclavicular region or chest wall. To compensate for the local setup errors, different PTV margins are required, even with CBCT guidance.
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- 2020
45. Trillium Flap for Postmastectomy Neo-Nipple Reconstruction (A Novel Technique)
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Ahmed Abdelmoez Alsayed
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Novel technique ,medicine.medical_specialty ,education.field_of_study ,biology ,Computer science ,medicine.medical_treatment ,Population ,biology.organism_classification ,Trillium ,Surgery ,Post mastectomy ,medicine ,Breast reconstruction ,education ,Nipple reconstruction ,Mastectomy - Abstract
Introduction: Breast cancer cases, mastectomy and following reconstruction procedures are growing in numbers. Despite being lifesaving, mastectomies have a destructive psychological impact on the patients. On the other hand, breast reconstruction improves psychological damages within the same population. Various techniques for nipple reconstruction were described in literature. Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. Objectives: To come up with an innovative design for reconstructing a neo-nipple post mastectomy, that is superior to other popular flaps. Results: The Trillium flap design has less visible and easily camouflaged scars, is geometry-based, specific, well-detailed and flexible to produce a tailored nipple with any desired height and diameter and ensures the flaps good vascularity and the neo-nipple projection sustainability. Conclusion: Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. The results shown in the study are for experimental procedures done on human tissue samples of excised flaps from abdominoplasties and brachioplasties. Further application on actual cases is needed with monitoring of neo-nipple projection sustainability on the long term.
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- 2020
46. Breast telecobalt beam therapy using multi-isocentric technique
- Author
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R Dhanabalan, Ganesarajah Selvaluxmy, Iyer Priya, N Vivekanandan, and Balasubramanian Ananthi
- Subjects
medicine.medical_specialty ,Screening techniques ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Original research article ,Isocenter ,Cancer ,Computed tomography ,medicine.disease ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,Post mastectomy ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Stage (cooking) ,business - Abstract
Aim To treat breast cancer patients in telecobalt unit with image based conformal radiotherapy planning using the multi-isocentric technique. Background Breast cancer is the leading cancer among all the female cancers. With improved screening techniques, many patients are being diagnosed at an early stage and the need for radiotherapy in such patients has increased. The telecobalt machine is still a preferred machine in many of the low income countries as it is cost-effective and can offer uninterrupted treatment to large number of patients. Materials and Methods Three hundred patients requiring radiotherapy had a computed tomography based planning. Patients were immobilized using a breast board with a thermoplastic mould. Three dimensional planning was done with the multi-isocentric technique. These patients were then simulated using a Nucletron Simulix digital simulator for field verification and were treated in a Theratron Phoenix telecobalt treatment unit. Results The doses to the heart, ipsilateral lung and the conformity index were within the recommended values. The homogeneity index was not comparable; however, a section by section qualitative analysis was done and a final plan approved. As per the RTOG toxicity grading system, acute skin reaction grade 3 was observed in 3.6% of treatments to intact breast including nodal regions and in 3.5% of post mastectomy radiation patients. Conclusion Single isocenter technique was not feasible as the telecobalt unit did not have multileaf collimators and asymmetric jaws. With improved image based planning, a multi-isocentric technique was planned. By evaluating the dose distribution, beam modifications can be made and treatments can be given with acceptable toxicity.
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- 2020
47. Breast journal 2020 special issue: Post‐mastectomy radiation: Tracking changes in the standard of care over 25 years
- Author
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Beryl McCormick
- Subjects
medicine.medical_specialty ,Standard of care ,medicine.medical_treatment ,Breast Neoplasms ,History, 21st Century ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Post mastectomy ,Internal Medicine ,medicine ,Humans ,Medical physics ,skin and connective tissue diseases ,Mastectomy ,Randomized Controlled Trials as Topic ,business.industry ,Standard of Care ,History, 20th Century ,Review article ,Oncology ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,Surgery ,sense organs ,Tracking (education) ,Neoplasm Recurrence, Local ,business - Abstract
This is an invited review article, tracking the changes in the indications and use of post-mastectomy radiation over the last 25 years. While radiation after mastectomy has been in use for decades, several key prospective randomized trials published in recent years have changed and strengthened role of this modality. This manuscript will track the milestones over the last three decades.
- Published
- 2019
48. Post Mastectomy Quality of Life in Breast Cancer Patients
- Author
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Mizanur Rahman
- Subjects
medicine.medical_specialty ,Quality of life (healthcare) ,Breast cancer ,Post mastectomy ,business.industry ,General surgery ,medicine ,medicine.disease ,business - Abstract
Background: Quality of life in patients with breast cancer is an important outcome. This paper presents an overview and outcome after surgery in breast cancer patients on the topic ranging from descriptive findings to clinical trials. Methods: This is a bibliographic review of the literature covering publications that appeared in English language in biomedical journals between 1992 and 2013. The search strategy included a combination of key words 'quality of life' and 'breast cancer', 'breast carcinoma' or post mastectomy in Titles. Of these, research articles like randomized controlled trials, reviews, abstracts, editorials, brief commentaries, letters were included. The major findings are summarized and presented under several headings: instruments used, validation studies, measurement issues, surgical treatment, quality of life as predictor of survival, psychological distress, supportive care, symptoms and sexual functioning. Results: Instruments-Several valid instruments were used to measure quality of life in breast cancer patients. The European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer specific complementary measure (EORTC QLQ-BR23) were listed in this study, as it is a common, highly standard and well developed instruments to measure quality of life in breast cancer patients. Different surgical procedures led to relatively similar results in terms of quality of life assessments, although mastectomy patients compared to conserving surgery patients usually reported a lower body image and sexual functioning. Systemic therapies-almost all studies indicated that breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that negatively affect their quality of life. Adjuvant hormonal therapies also were found to have similar negative impact on quality of life, although in general they were associated with improved survival. Quality of life as predictor of survival-similar to known medical factors, quality of life data in metastatic breast cancer patients were found to be prognostic and predictive of survival time. Psychological distress-anxiety and depression were found to be common among breast cancer patients even years after the disease diagnosis and treatment. Psychological factors also were found to predict subsequent quality of life or even overall survival in breast cancer patients. As recommended, recognition and management of these symptoms is an important issue since such symptoms impair health-related quality of life. Sexual functioning-breast cancer patients especially younger patients suffer from poor sexual functioning that negatively affect quality of life. Conclusion: There was quite an extensive body of the literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care, although their exact benefit was hard to define. However, quality of life data provided scientific evidence for clinical decision-making and conveyed helpful information concerning breast cancer patients' experiences during the course of the disease diagnosis, treatment, disease-free survival time, and recurrences. Journal of Surgical Sciences (2013) Vol. 17 (1) : 35-44
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- 2019
49. Variations in the utilization of immediate post-mastectomy breast reconstruction
- Author
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Cara G. Moses, Michelle C. Roughton, Karishma G. Reddy, Kandace P. McGuire, Apoorve Nayyar, Danielle I. Jameison, Kristalyn K. Gallagher, and Paula D. Strassle
- Subjects
Adult ,medicine.medical_specialty ,Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,030230 surgery ,Logistic regression ,White People ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Post mastectomy ,medicine ,Humans ,Mastectomy ,Aged ,Marital Status ,business.industry ,Obstetrics ,Age Factors ,Cancer ,General Medicine ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,United States ,Black or African American ,030220 oncology & carcinogenesis ,Marital status ,Female ,Surgery ,business ,Breast reconstruction ,Psychosocial ,Procedures and Techniques Utilization - Abstract
For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical location of the patient.Women ≥18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2014 were eligible. Women with inflammatory BC, Stage IV BC diagnoses, and bilateral BC were excluded. Multivariable logistic regression, adjusting for patient and cancer characteristics, were used to assess the association between of race, marital status, and region on immediate PMBR utilization.321,206 women were included and 24% underwent immediate PMBR (4 months after mastectomy). Compared to white women, black and other non-white women (OR 0.67, 95% CI 0.65, 0.70 and OR 0.52, 95% CI 0.50, 0.53, respectively) were significantly less likely to receive PMBR. Additionally, women who were single (OR 0.72, 95% CI 0.70, 0.75) or no longer married (OR 0.84, 95% CI 0.82, 0.86) were significantly less likely to undergo breast reconstruction, compared to married women. Regional differences were also seen, with women in the Northeast (OR 2.11, 95% CI 2.05,2.17), Midwest (OR 1.53, 95% CI 1.48, 1.58) and South (OR 1.20, 95%CI 1.17, 1.23) all being more likely to undergo breast reconstruction compared to the West.Significant variations exist in the utilization of post-mastectomy breast reconstruction across race, marital status or geographical location of the patient. Further research is needed to elucidate these differences and identify areas for intervention to increase awareness, and access to reconstruction for all breast cancer patients.
- Published
- 2019
50. Impact of Post-Mastectomy Radiation Therapy for Sentinel Lymph Node Micrometastases in Early-Stage Breast Cancer Patients
- Author
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Jun Ling He, Hua Luo, Ou Ou Yang, and Tian Lan
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Sentinel lymph node ,Breast Neoplasms ,Cohort Studies ,Breast cancer ,Post mastectomy ,medicine ,Humans ,Stage (cooking) ,Mastectomy ,Aged ,business.industry ,Age Factors ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Radiation therapy ,Neoplasm Micrometastasis ,Lymphatic Metastasis ,Female ,Radiotherapy, Adjuvant ,Radiology ,Sentinel Lymph Node ,business ,Follow-Up Studies - Abstract
BACKGROUND The association of radiotherapy with breast cancer survival in patients who underwent a mastectomy and had micrometastases in the sentinel lymph node is unclear. MATERIAL AND METHODS The survival benefit of radiotherapy was examined in patients with T0/1-T2N1mi breast cancer undergoing mastectomy plus sentinel lymph node biopsy (SLNB). Kaplan-Meier curves were employed for survival analysis and competing risk analysis, and a propensity score matching (PSM) cohort was enrolled to investigate whether such patients benefit from radiotherapy. RESULTS We identified 2864 patients in the SEER database from 2004 to 2015. All eligible patients were divided into the radiotherapy and the no-radiotherapy cohorts. With the median follow-up of 53 months, 5-year breast cancer-specific survival (BCSS) was 94.4% vs 95.2% (P=0.135), and 5-year overall survival (OS) was 91.2% vs 90.1% (P=0.466) in the radiotherapy cohorts and no-radiotherapy cohorts, respectively. The results of the competing risk analysis showed a comparable 5-year cumulative incidence of breast cancer-specific death (BCSD) in the radiotherapy and no-radiotherapy groups (5.5% vs 4.7%, P=0.107) but a higher 5-year cumulative incidence of other causes of death (OCD) in the no-radiotherapy cohort (3.3% vs 5.3%, P=0.011). No significant difference was observed for BCSS or OS in the PSM cohort. CONCLUSIONS Radiotherapy has no benefit for patients with T0/1-T2 breast cancer undergoing mastectomy with N1mi disease on SLNB. This analysis provides evidence that radiotherapy may safely be omitted in this group of patients.
- Published
- 2021
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