To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.
Breast Neoplasms/surgery* ; Female ; Humans ; Mastectomy, Segmental ; Organs at Risk ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

BACKGROUND: Serial volumetric changes of reconstructed breasts have not been studied in detail. In this study, we analyzed serial volumetric changes of reconstructed and contralateral normal breasts during long-term follow-up, with a focus on the effect of various adjuvant therapies. METHODS: Among all patients who underwent immediate breast reconstruction with a unilateral pedicled transverse rectus abdominis musculocutaneous (p-TRAM) flap, 42 patients with valid data from ≥3 postoperative positron emission tomography-computed tomography (PET-CT) scans were included. The volumes of the reconstructed and normal breasts were measured, and the ratio of flap volume to that of the contralateral breast was calculated. Serial changes in volume and the volume ratio were described, and the effects of chemotherapy, radiation therapy, and hormone therapy on volumetric changes were analyzed. RESULTS: The mean interval between the initial reconstruction and each PET-CT scan was 16.5, 30, and 51 months respectively. Thirty-five, 36, and 10 patients received chemotherapy, hormone therapy, and radiation therapy, respectively. The flap volume at each measurement was 531.0, 539.6, and 538.0 cm3, and the contralateral breast volume was 472.8, 486.4, and 500.8 cm3, respectively. The volume ratio decreased from 115.1% to 113.4%, and finally to 109.6% (P=0.02). Adjuvant therapies showed no significant effects. CONCLUSIONS: We demonstrated that the p-TRAM flap maintained its volume over a long-term follow up, while the volume of the contralateral native breast slowly increased. Moreover, adjuvant breast cancer therapies had no statistically significant effects on the volume of the reconstructed p-TRAM flaps or the contralateral native breasts.
Breast Neoplasms ; Breast ; Drug Therapy ; Electrons ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Myocutaneous Flap ; Radiotherapy ; Rectus Abdominis ; Surgery, Plastic

BACKGROUND: Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy. METHODS: All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy. RESULTS: During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocialwell-being (77.7±3.2). CONCLUSIONS: Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.
Breast Neoplasms ; Breast* ; Cohort Studies ; Demography ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Necrosis ; Nipples* ; Patient Satisfaction* ; Postoperative Complications ; Radiotherapy, Adjuvant ; Reconstructive Surgical Procedures ; Superficial Back Muscles* ; Surgery, Plastic

OBJECTIVE: To compare the dosimetric differences between volumetric modulated arc therapy and intensity modulated radiotherapy for breast cancer patients after breast-conserving surgery. METHODS: Ten patients who received radiotherapy after breast-conserving surgery were selected. Eclipse planning system was used to design volumetric rotating intensity-modulated (2F-RapidArc) and two field intensity-modulated radiation therapy (2F-IMRT) planning for each patient. 2F-RapidArc plans were made using two partial arcs with gantry rotation from 287°-293° to 152°-162°, and 0° to 90 ° was avoidance sector. The gantry angle of 2F-IMRT were 301°-311° and 125°-135°. The prescription dose was 46 Gy/23 fractions. All plans required 95% of the target volume receiving the prescription dose. The dose distribution of the target, organs at risk, machine unit (MU) and treatment time were compared. RESULTS: 2F-RapidArc and 2F-IMRT plans' uniformity index was 1.12±0.02 and 1.11±0.03 (P=0.282), respectively; conformal index was 0.80±0.03 and 0.65±0.04 (P<0.001), respectively. V110 of plan target volume was 20.98%±14.47% and 10.43%±10.49% (P=0.030), respectively. Compared with the 2F-IMRT, 2F-RapidArc plans had a higher dosimetric parameters for left lung: V5 (48.06%±17.32% vs. 24.23%±6.56%,P=0.001), V10 (28.89±9.28 vs.17.07±4.78%,P=0.004), Dmean [(9.70±2.14) Gy vs. (6.86±1.77) Gy, P=0.002], increased the double lung: V5 (22.85%±7.55% vs. 11.01%± 2.95%,P=0.001), V10 (13.16%±4.33% vs. 7.76%± 2.16%, P=0.006), Dmean [(4.66±0.95) Gy vs. (3.17±0.82) Gy, P=0.001], reduced the left lung: V40 (3.58%±1.46% vs. 6.19%±3.04%, P=0.006), reduced the double lung: V40 (1.61%±0.64% vs. 2.81%± 1.39%,P=0.005), increased cardiac: V5 (39.3%±17.19% vs. 8.79%±4.24%, P<0.001), V10 (21.31%±13.8% vs. 5.73%±3.42%, P=0.002), V20 (7.80%±6.08% vs. 4.05%±2.85%,P=0.018), Dmean [(0.64±0.25) Gy vs. (0.29±1.39) Gy,P<0.001],reduced the heart: V40(0.50%±0.40% vs. 1.86%±1.94%,P=0.037),increased the contralateral breast Dmean [(1.63±1.26) Gy vs. (0.09±0.05) Gy, P=0.004]. Compared with 2F-IMRTplan, 2F-RapidArc increased the treatment time [(132.9±7.2) s vs. (140.3±11.6) s, P=0.030]. Both the machine units were almost the same [(467.0±30.4) MU vs. (494.7±44.9) MU, P=0.094]. CONCLUSION Both 2F-RapidArc and 2F-IMRT plans could reach the clinical requirements. 2F-RapidArc had a better conformal index, reduced the high dose area, but increased the low dose regions of the lung, heart, body area, and increased the average dose of the contralateral breast. The treatment time of 2F-RapidArc was longer than that of 2F-IMRT, and the MU of 2F-RapidArc and 2F-IMRT plans were almost the same.
Breast Neoplasms/surgery* ; Female ; Humans ; Mastectomy, Segmental ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated

OBJECTIVETo introduce the application of "tennis racket" flap with fascial pedicle on the healthy chest for radiation ulcer after surgical treatment of breast cancer.

METHODSThe " tennis racket" flap was designed on the healthy chest along the cartilage with fascia pedicle near the sternum. 9 cases were treated. The flaps size ranged from 5.0 cm x 3.5 cm to 13 cm x 11 cm with pedicle size of 2-8 cm in length and 2.0-3.0 cm in width.

RESULTSAll the 9 flaps survived completely with satisfactory appearance. The patients were followed up for 2 months to 3 years without ulcer reoccurrence.

CONCLUSIONSThe "tennis racket" flap has a slender fascial pedicle without major blood vessel. It has the advantages of good flexibility for rotation and large flap size for the reconstruction of the radiation ulcer after surgical treatment of breast cancer.

Breast Neoplasms ; radiotherapy ; Fascia ; Female ; Humans ; Radiodermatitis ; surgery ; Skin Ulcer ; etiology ; surgery ; Sternum ; Surgical Flaps ; Tennis

OBJECTIVETo explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy.

METHODSSix patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back.

RESULTSPain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well.

CONCLUSIONSOn the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.

Breast Neoplasms ; radiotherapy ; surgery ; Debridement ; Humans ; Mastectomy, Radical ; methods ; Myocutaneous Flap ; Neck Injuries ; surgery ; Necrosis ; Pressure Ulcer ; surgery ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Superficial Back Muscles ; Surgical Flaps ; blood supply ; Wound Healing

OBJECTIVETo explore different therapies and affecting factors in breast cancer patients ≥ 65 years old.

METHODSTo retrospectively analyze the clinical characteristics, treatments, comorbidity and survival rate of 126 female breast cancer patients over 65 years old who underwent surgical operation in our hospital from January 2009 to December 2010. To compare and analyze the differences in the treatment patterns, and find out the affecting factors.

RESULTSOne hundred and twenty-six cases were included in this retrospective study, and they were divided into two groups according to age: 65-74 years old group (71 cases) and >74 years group (55 cases). Most patients in the two groups received modified radical mastectomy (84.5% and 89.1%); 73.2% and 54.5% of patients received adjuvant chemotherapy in the two groups, respectively. 67.6% and 61.8% of the patients had adjuvant endocrine therapy respectively. 19.7% and 7.3% of the patients received radiotherapy, respectively. Chemotherapy in elderly breast cancer patients was correlated with age, pathological types, progesterone receptor (PR) status and comorbidity. Radiotherapy in elderly breast cancer patients was related to age, surgical patterns, TNM stage and lymph node status. Multivariate analysis showed that age, pathological types, PR expression and comorbidity were independent factors affecting choice of chemotherapy in elderly breast cancer patients (P < 0.05 for all). Age and surgical patterns were independent factors affecting choice of radiotherapy (P < 0.05 for all). The 3-year disease-free survival (DFS) rate and overall survival (OS) rate in these patients were 91.3% and 92.0%, respectively. Furthermore, endocrine therapy was related to 3-year DFS rate (P = 0.038) and age was correlated with 3-year OS rate (P = 0.037) in these elderly patients.

CONCLUSIONSBreast cancer in the elderly patients receive similar surgery and endocrine therapy, but the elderly patients are less likely to have chemotherapy and radiotherapy, due to age, PR expression, pathological types, surgical patterns and comorbidity. Only age contributes to the lower 3-year overall survival rate in >74-year old patients.

Adenocarcinoma, Mucinous ; pathology ; surgery ; therapy ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; pathology ; surgery ; therapy ; Carcinoma, Ductal, Breast ; pathology ; surgery ; therapy ; Carcinoma, Intraductal, Noninfiltrating ; pathology ; surgery ; therapy ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Neoadjuvant Therapy ; Neoplasm Staging ; Radiotherapy, Adjuvant ; Receptors, Progesterone ; metabolism ; Retrospective Studies ; Survival Rate

We report the case of a 33-year-old lactating woman who presented with a 10-cm breast abscess. Biopsy of the abscess wall revealed a poorly differentiated invasive ductal carcinoma. The patient had no family history of breast cancer or other risk factors for breast cancer. The disease was considered to be a large noninflammatory invasive breast cancer, for which the patient received neoadjuvant chemotherapy, breast-conserving surgery using axillary dissection (the patient did not consent to a mastectomy), and postoperative radiotherapy. Final histologic examination revealed a 4-cm, triple negative, high-grade adenosquamous carcinoma. At follow-up four years after surgery, the patient was doing well with no signs of recurrence. Adenosquamous carcinoma is an extremely rare disease that mainly presents in low-grade forms. High-grade forms are aggressive and frequently present with axillary involvement. To the best of our knowledge, there has been no report of adenosquamous carcinoma presenting as a breast abscess in the literature. The case we report highlights that, although rare, cancer should be considered in lactating breast abscesses.
Adult ; Breast Neoplasms ; diagnosis ; drug therapy ; radiotherapy ; surgery ; Carcinoma, Adenosquamous ; diagnosis ; drug therapy ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; diagnosis ; drug therapy ; radiotherapy ; surgery ; Female ; Humans ; Inflammation ; Lactation ; Risk Factors ; Treatment Outcome

OBJECTIVEPure epithelial breast metaplastic carcinoma is a rare and highly malignant tumor. In this study, our purpose was to analyze the clinical features, treatment method and prognostic factors, so to explore the approach for early diagnosis and appropriate treatment of this cancer.

METHODSClinical data of 22 patients with histopathologically confirmed pure epithelial breast metaplastic carcinoma and treated at Tianjin Cancer Hospital from 1974 to 2008, were reviewed retrospectively. Survival rate was calculated by life tables. Kaplan-Meier unvariate analysis and Log-rank test were used to compare the survival rates. Multivariate factors for survival were analyzed by Cox proportional hazards regression model.

RESULTSThe median age of the 22 cases of pure epithelial breast metaplastic carcinoma was 52.5 years. Among them 20 cases went to see a doctor for painless mass, and two cases shown as skin inflammation. Clarifying a diagnosis was difficult before operation so that its diagnosis mainly depended on postoperative histopathologic examination. Twelve cases had axillary lymph node metastasis, 7 cases distant metastasis, and the lung was the most common metastatic organ. The 5-year survival rate was 55.6%, with a median follow-up of 46 months. It was found by Kaplan-Meier unvariate analysis that the age (P = 0.044), number of positive axillary lymph nodes (P = 0.011) and therapeutic schedule (P = 0,003) significantly influenced the outcome of the patients, but tumor size (P = 0.194) was not. Cox multivariate analysis results showed that number of positive axillary lymph nodes was independent prognostic factor for pure epithelial breast metaplastic carcinoma (P = 0.038).

CONCLUSIONSPure epithelial breast metaplastic carcinoma is seldom seen. It is easy to cause distant metastasis and has a poor prognosis. ER, PR and HER-2 expressions in most samples are negative. The more axillary lymph nodes have metastasis, the poorer is the prognosis. A reasonable and comprehensive treatment can improve the prognosis obviously.

Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Carcinoma ; drug therapy ; pathology ; radiotherapy ; surgery ; Carcinoma, Adenosquamous ; drug therapy ; pathology ; radiotherapy ; surgery ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; radiotherapy ; secondary ; surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; secondary ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Mastectomy, Radical ; methods ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate

OBJECTIVETo evaluate the efficacy and prognostic factors of personalized treatment for breast cancer patients who failed chemotherapy.

METHODSSeventy-two patients with breast cancer who failed chemotherapy were treated at the Tumor Hospital of Harbin Medical University from January 2001 to January 2012. Among them, 42 cases received 5.6 cycles (range, 4-8 cycles) of postoperative adjuvant chemotherapy, and 30 cases received 12.2 cycles (range, 6-22 cycles), both postoperative adjuvant and salvage chemotherapy. All of the 72 patients of stage IV were given personalized treatment. Under guidance of the principle that multidisciplinary treatment improves control rate but does not or less damage the normal tissues and host immune function, precise radiotherapy combined with Chinese herbal medicine (CHM), biological agent and others were chosen for the patients.

RESULTSThe median survival time was 20 months. Univariate analysis showed that non-invasive ductal carcinoma, less metastasized organs, without brain, liver and lung metastasis, Karnofsky performance scores ≥ 80, not combined with chemotherapy, and multiple courses of Chinese herbal medicine and biolojical agent treatment had significant impact on survival (P < 0.05). Multivariate analysis showed that no brain metastasis, non-invasive ductal carcinoma, and Chinese herbal medicine and biological agent treatment ≥ 7 courses and not combined with chemotherapy had obvious significance (P < 0.05). The rate of grade 3 and 4 treatment-related hematological toxicity was 8.3% (6/72) and 5.6% (4/72), respectively. All the patients with grade 4 hematological toxicity were the cases of grade 3 at hospital admission. No grade 3 and 4 acute radiation damages of the lung and liver were noticed.

CONCLUSIONChinese herbal medicine combined with biological agents and others prolongs survival time in breast cancer patients who failed chemotherapy, and provides an alternative treatment modality for them.

Adult ; Aged ; Aromatase Inhibitors ; therapeutic use ; Bone Density Conservation Agents ; therapeutic use ; Bone Neoplasms ; drug therapy ; secondary ; Brain Neoplasms ; drug therapy ; secondary ; Breast Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; drug therapy ; pathology ; radiotherapy ; secondary ; surgery ; Chemotherapy, Adjuvant ; Diphosphonates ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Imidazoles ; therapeutic use ; Lung Neoplasms ; drug therapy ; secondary ; Medicine, Chinese Traditional ; Middle Aged ; Neoplasm Staging ; Nitriles ; therapeutic use ; Radiotherapy, Adjuvant ; Radiotherapy, Conformal ; methods ; Remission Induction ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Triazoles ; therapeutic use