Changes in acute and late toxicity and patient-reported health-related quality of life following radiotherapy in women with breast cancer:A 1-year longitudinal study

Objective:The objective of this study was to investigate the frequency of acute and late toxicities,as well as changes in the quality of life(QOL)for breast cancer patients following radiotherapy(RT).Materials and Methods:A total of 108 breast cancer women were recruited for this prospective study.Data were collected at various intervals;prior to,and 1,3,6 months,and 1 year after radiation therapy.The primary outcomes were toxicity radiation therapy oncology group/European Organization for Research and Treatment of Cancer(EORTC)criteria.Our secondary outcome was QOL,measured using EORTC QLQ-C30 and Edmonton Symptom Assessment Scale.We employed Friedman’s two-way analysis to evaluate the changes in QOL over the course of 1 year.Results:The early toxicities that are most commonly experienced include pharyngeal,skin,and mucous membrane toxicity.Late toxicities frequently involve skin and submucosal toxicity.To measure patient functionality,all functional subscale scores except for the patient’s emotional state increased over time compared to pre-RT.Symptoms of the patients,which were included in the QOL symptom scale,decreased during the follow-up period,except for fatigue;however,changes in pain,insomnia,and loss of appetite did not significantly change.We identified the analogous symptom profiles in Edmonton.Although patients’overall health scores declined in the 1st and 3rd months after radiotherapy(RT),they rebounded at 6 and 12 months.Conclusion:For breast cancer patients,RT did not adversely affect functional capacity or exacerbate symptoms,but persistent fatigue did increase during the observation period.Health-care professionals ought to devise strategies to assist patients with skin toxicity and fatigue.

Study on the Impact of Post-Mastectomy Radiotherapy on Immediate Breast Reconstruction and Complications: A Meta-Analysis

Background and objective:Immediate breast reconstruction not only reduces the number of surgeries for patients after mastectomy but also decreases psychological and physical trauma,making it increasingly popular.However,there is currently no consensus on the integration of post-mastectomy radiotherapy(PMRT)with reconstruction techniques.This review evaluates the impact of PMRT on complications following immediate breast reconstruction,providing guidance for clinical treatment decisions.Methods:PubMed,Web of Science,Embase,and other databases were searched for studies published in the past 15 years on outcomes of implant-based breast reconstruction in the context of radiotherapy to identify articles for analysis.RevMan 5.4 software was used to analyze the risks of seroma,infection,wound dehiscence,flap necrosis,implant exposure,capsule contracture,and reconstruction failure.Results:A total of 1l relevant studies were included,comprising 6323 cases of immediate breast reconstruction.It was found that breasts receiving postoperative irradiation had a significantly increased risk of complications,with statistically significant differences in seroma(P=0.004),infection(P<0.00001),wound dehiscence(P=0.04),implant exposure(P<0.00001),capsule contracture(P<0.00001),and reconstruction failure(P<0.00001).There was no statistically significant difference in flap necrosis(P=0.88).Conclusion:The results indicate that postoperative radiotherapy significantly increases the risk of complications for patients undergoing immediate implant-based reconstruction.Preventive measures may be taken in advance with the assistance of healthcare providers if necessary.

Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Postoperative chemoradiotherapy with capecitabine and oxaliplatin vs.capecitabine for pathological stage N2 rectal cancer

Objective:Several studies have been conducted on the effects and toxicity of adding oxaliplatin to fluorouracilbased or capecitabine-based chemoradiotherapy(CRT)regimens as significantly increasing the toxic response without benefit to survival.In this study,we further explored the role of these two postoperative CRT regimens in patients with pathological stage N2 rectal cancer.Methods:This study was a subgroup analysis of a randomized clinical trial.A total of 180 patients with pathological stage N2 rectal cancer were eligible,85 received capecitabine with radiotherapy(RT),and 95 received capecitabine and oxaliplatin with RT.Patients in both groups received adjuvant chemotherapy[capecitabine and oxaliplatin(XELOX);or fluorouracil,leucovorin,and oxaliplatin(FOLFOX)]after CRT.Results:At a median follow-up of 59.2[interquartile range(IQR),34.0−96.8]months,the three-year diseasefree survival(DFS)was 53.3%and 64.9%in the control group and the experimental group,respectively[hazard ratio(HR),0.63;95%confidence interval(95%CI),0.41−0.98;P=0.04].There was no significant difference between the groups in overall survival(OS)(HR,0.62;95%CI,0.37−1.05;P=0.07),the incidence of locoregional recurrence(HR,0.62;95%CI,0.24−1.64;P=0.33),the incidence of distant metastasis(HR,0.67;95%CI,0.42−1.06;P=0.09)and grade 3−4 acute toxicities(P=0.78).For patients with survival longer than 3 years,the conditional overall survival(COS)was significantly better in the experimental group(HR,0.39;95%CI,0.16−0.96;P=0.03).Conclusions:Our results indicated that adding oxaliplatin to capecitabine-based postoperative CRT is safe and effective in patients with pathological stage N2 rectal cancer.

Signal intensity changes of dentate nucleus on plain MR T1WI innasopharyngeal carcinoma patients after radiotherapy andmultiple injections of gadolinium-base contrast agent

Objective To observe changes of plain MR T1WI signal intensity of dentate nucleus in nasopharyngeal carcinoma patients after radiotherapy and multiple times of intravenous injection of gadolinium-based contrast agent(GBCA).Methods Fifty patients with pathologically confirmed nasopharyngeal carcinoma and received intensity-modulated radiotherapy were retrospectively enrolled as the nasopharyngeal carcinoma group,and 50 patients with other malignant tumors and without history of brain radiotherapy were retrospectively enrolled as the control group.All patients received yearly GBCA enhanced MR examinations for the nasopharynx or the head.T1WI signal intensities of the dentate nucleus and the pons on same plane were measured based on images in the year of confirmed diagnosis(recorded as the first year)and in the second to the fifth years.T1WI signal intensity ratio of year i(ranging from 1 to 5)was calculated with values of dentate nucleus divided by values of the pons(ΔSI i),while the percentage of relative changes of year j(ranging from 2 to 5)was calculated withΔSI j compared toΔSI 1(Rchange j).The values of these two parameters were compared,and the correlation ofΔSI and GBCA injection year-time was evaluated within each group.Results No significant difference of gender,age norΔSI 1 was found between groups(all P>0.05).The second to the fifth yearΔSI and Rchange in nasopharyngeal carcinoma group were all higher than those in control group(all P<0.05).Within both groups,ΔSI was positively correlated with GBCA injection year-time(both P<0.05).Conclusion Patients with nasopharyngeal carcinoma who underwent radiotherapy and multiple times of intravenous injection of GBCA tended to be found with gradually worsening GBCA deposition in dentate nucleus,for which radiotherapy might be a risk factor.

Advances in regional nodal management of early-stage breast cancer

With the continuous improvement of systemic treatment, reasonable local regional control of early-stage breast cancer can be translated into survival benefits. The optimization of regional nodal management in patients with limited sentinel lymph node(SLN) metastasis needs to be weighed by surgical complications, regional recurrence risk, and lymph node status, as well as other escalating treatment(systemic/radiotherapy) that may result from deescalating surgery. With the effective support and supplementation of systemic therapy and radiotherapy, the management of axillary surgery is developing in a de-escalating trend. The widespread application of neoadjuvant therapy has contributed to optimizing the management of patients with clinically node-negative/imaging nodepositive disease. In clinical practice, it is necessary to consider the residual tumor burden of regional lymph nodes when formulating the optimal irradiation fields in patients with limited positive SLN without axillary lymph node dissection. The combined application of genomic tests and American College of Surgeons Oncology Group Z0011/AMAROS criteria could provide patients with a better strategy of dual de-escalation treatment, which includes the de-escalation of both axillary surgery and systemic treatment. In the era of sentinel lymph node biopsy(SLNB), the regional nodal management of breast cancer should adhere to the concept of “updating ideas, making bold assumptions, and carefully seeking proof”, make full use of the benefits of systemic therapy and radiotherapy to reduce the scope of surgery and complications, and expand the “net benefit” of efficacy and quality of life. This review discusses the optimization of regional nodal management in the era of SLNB, in order to provide reference information for clinicians.

Magnetic resonance imaging findings of radiation-induced breast angiosarcoma:A case report

BACKGROUND Breast conservation surgery(BCS)with adjuvant radiotherapy has become a gold standard in the treatment of early-stage breast cancer,significantly reducing the risk of tumor recurrence.However,this treatment is associated with adverse effects,including the rare but aggressive radiation-induced angiosarcoma(RIAS).Despite its rarity and nonspecific initial presentation,RIAS presents a challenging diagnosis,emphasizing the importance of imaging techniques for early detection and accurate diagnosis.CASE SUMMARY We present a case of a 48-year-old post-menopausal woman who developed skin ecchymosis on the right breast seven years after receiving BCS and adjuvant radiotherapy for breast cancer.Initial mammography and ultrasound were inconclusive,showing post-treatment changes but failing to identify the underlying angiosarcoma.Contrast-enhanced breast magnetic resonance imaging(MRI)revealed diffuse skin thickening and nodularity with distinctive enhan-cement kinetics,leading to the diagnosis of RIAS.This case highlights the crucial role of MRI in diagnosing and determining the extent of RIAS,facilitating timely and appropriate surgical intervention.CONCLUSION Breast MRI is crucial for detecting RIAS,especially when mammography and ultrasound are inconclusive.

Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation

BACKGROUND Radiation esophagitis(RE)is one of the most common clinical symptoms of regional lymph node radiotherapy for breast cancer.However,there are fewer studies focusing on RE caused by hypofractionated radiotherapy(HFRT).AIM To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes.METHODS Between January and December 2022,we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F.RESULTS Of the 64 patients in this study,24(37.5%)did not develop RE,29(45.3%)developed grade 1 RE(G1RE),11(17.2%)developed grade 2 RE(G2RE),and none developed grade 3 RE or higher.Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose,mean dose,relative volume 20-40,and absolute volume(AV)20-40.Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE(P<0.001).The optimal threshold for AV30 was 2.39 mL[area under the curve(AUC):0.996;sensitivity:90.9%;specificity:91.1%].The optimal threshold for AV35 was 0.71 mL(AUC:0.932;sensitivity:90.9%;specificity:83.9%).CONCLUSION AV30 and AV35 were significantly associated with G2RE.The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL,respectively.

Survey on physicians' opinions of post-mastectomy radiotherapy for breast cancer in Guangdong province

Objective:The aim of our study was to comprehensively access current status of radiotherapy physicians' opinions in post-mastectomy radiotherapy(PMRT) for breast cancer in Guangdong province.Methods:From June 2007 to June 2008,questionnaires on the clinical value,sequencing with chemotherapy and endocrine therapy,indications and irradiated targets for PMRT were sent to physicians of all radiotherapy departments registering at Radiotherapy Professional Committee of Guangdong Anti-cancer Association.Results:There were 126 physicians joining this investigation.Proportions of physicians who accepted the views that PMRT could merely improve local control or can improve both local control and overall survival were 100% and 25.2%.The most common sequences of PMRT and chemotherapy or endocrine therapy were "sandwich" and sequential modes,performed 46.9% and 59.5% respectively.The median interval of surgery and PMRT was 8 weeks.Proportions of physicians who accepted T3-4 diseases,or four or more axillary lymph nodes metastasis,or T1-2 with 1-3 positive lymph nodes,or T1-2N0 with primary tumor located in the center or inner quadrant as the indications of PMRT were 97.6%,100%,46.8%,13.5%,respectively.Proportions of physicians who accepted chest wall,supraclavicular region,internal mammary chain or axilla as irradiated targets were 86.5%,100%,49.2% and 38.9% respectively.Conclusion:For Radiotherapy physicians of Guangdong Province,there is still lacking of consensus in the opinions of whether PMRT can improve survival,and optimal sequencing with chemotherapy or endocrine therapy,and how to make decision for patients with T1-2 with 1-3 positive lymph nodes,and rational irradiated targets,which requires advanced professional training for physicians and further prospective clinical trial evidences to guide clinical practice.

Current role of modern radiotherapy techniques in the management of breast cancer

Breast cancer is the most common type of malignancy in females. Advances in systemic therapies and radiotherapy(RT) provided long survival rates in breast cancer patients. RT has a major role in the management of breast cancer. During the past 15 years several developments took place in the field of imaging and irradiation techniques, intensity modulated RT, hypofractionation and partial-breast irradiation. Currently, improvements in the RT technology allow us a subsequent decrease in the treatment-related complications such as fibrosis and long-term cardiac toxicity while improving the loco-regional control rates and cosmetic results. Thus, it is crucial that modern radiotherapy techniques should be carried out with maximum care and efficiency. Several randomized trials provided evidence for the feasibility of modern radiotherapy techniques in the management of breast cancer. However, the role of modern radiotherapy techniques in the management of breast cancer will continue to be defined by the mature results of randomized trials. Current review will provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer.

Recent advances in breast cancer radiotherapy:Evolution or revolution,or how to decrease cardiac toxicity?

Radiation therapy has a major role in the management of breast cancers.However,there is no consensus on how to irradiate and on volume definitions,and there are strong differences in strategies according to different centers and physicians.New treatment protocols and techniques have been used with the principal purpose of decreasing lung and heart toxicity and adapting radiation treatment to patients' anatomy.There is evidence that indicates internal mammary chain radiotherapy should be used carefully and that high quality techniques should be used for decreasing the dose delivered to the heart.This review of the literature presents the state of the art on breast cancer radiotherapy,with special focus on the indications,techniques,and potential toxicity.

Hypofractionated radiotherapy in the treatment of early breast cancer

Radiotherapy(RT) after tumorectomy in early breast cancer patients is an established treatment modality which conventionally takes 6-7 wk to complete.Shorter RT schedules have been tested in large multicentre randomized trials and have shown equivalent results to that of standard RT(50 Gy in 25 fractions) in terms of local tumor control,patient survival and late post-radiation effects.Some of those trials have now completed 10 years of follow-up with encouraging results for treatments of 3-4 wk and a total RT dose to the breast of 40-42.5 Gy with or without boost.A reduction of 50% in treatment time makes those RT schedules attractive for both patients and health care providers and would have a significant impact on daily RT practice around the world,as it would accelerate patient turnover and save health care resources.However,in hypofractionated RT,a higher(than the conventional 1.8-2 Gy) dose per fraction is given and should be managed with caution as it could result in a higher rate of late postradiation effects in breast,heart,lungs and the brachial plexus.It is therefore advisable that both possible dose inhomogeneity and normal tissue protection should be taken into account and the appropriate technology such as three-dimensional/intensity modulated radiation therapy employed in clinical practice,when hypofractionation is used.

Helical tomotherapy and volumetric modulated arc therapy:New therapeutic arms in the breast cancer radiotherapy

AIM To analyse clinical and dosimetric results of helical tomotherapy(HT) and volumetric modulated arc therapy(VMAT) in complex adjuvant breast and nodes irradiation.METHODS Seventy-three patients were included(31 HT and 42 VMAT). Dose were 63.8 Gy(HT) and 63.2 Gy(VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes(SCN) and internal mammary chain(IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort(7 mm vs 5 mm).RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC:96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5%(HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2%(VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1%(HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9%(VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy(HT) and 4.6 ± 0.9 Gy(VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.CONCLUSION HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.

Dosimetric Comparison of Integral Radiation Dose: Anisotropic Analytical Algorithm and Acuros XB in Breast Radiotherapy

The impact of the difference between Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB) in breast radiotherapy is not clearly due to different uses and further research is required to explain this effect. The aim of this study is to investigate the contribution of calculation differences between AAA and AXB to the integral radiation dose (ID) on critical organs. Seven field intensity modulated radiotherapy (IMRT) plans were generated using with AAA and AXB algorithms for twenty patients with early stage left breast cancer after breast conserving surgery. Volumetric and dosimetric differences, as well as, the Dmean, V5, V20 doses of the left and right-sided lung, the Dmean, V10, V20, V30 doses of heart and the Dmean, V5, V10 doses of the contralateral breast were investigated. The mean dose (Dmean), V5, V20 doses of the left-sided lung, the Dmean, V5, V10 doses of right-sided lung, the Dmean, V10, V20, V30 doses of heart and the Dmean, V5, V10 doses of the contralateral breast were found to be significantly higher with AAA. In this research integral dose was also higher in the AAA recalculated plan and the AXB plan with the average dose as follows left lung 2%, heart 2%, contralateral breast 8%, contralateral lung 4% respectively. Our study revealed that the calculation differences between Acuros XB (AXB) and Anisotropic Analytical Algorithm (AAA) in breast radiotherapy caused serious differences on the stored integral doses on critical organs. In addition, AXB plans showed significantly dosimetric improvements in multiple dosimetric parameters.

Adjuvant chemotherapy and acute toxicity in hypofractionated radiotherapy for early breast cancer

AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy(HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0 Mx. The patients received3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity.RESULTS: The acute radiation induced skin toxicity was as following: grade Ⅰ 27.6%, grade Ⅱ 7.8% and grade Ⅲ 2.6%. No significant correlation was noted between toxicity grading and chemotherapy(P = 0.154, χ2 test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively(P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions(P = 0.47, χ2test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse.CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions.

Factors influencing comfort level in head and neck neoplasm patients receiving radiotherapy

Objective:To determine factors that influence comfort in head and neck neoplasm patients receiving radiotherapy.Methods:In total,200 head and neck neoplasm patients receiving radiotherapy were recruited from three tertiary first class hospitals.They were assessed by Radiotherapy Comfort Questionnaire for patients with head and neck neoplasm,Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score of comfort was 60.54±8.32.Multiple linear regression analysis indicated that number of radiation treatments,family accompaniment,educational level,resignation coping mode,complications due to diabetes,accompanying chemotherapy,and the utilization of social support significantly influenced comfort level(p<0.05).Among these,number of radiation treatments,complications due to diabetes,accompanying chemotherapy,and resignation coping were negative factors.Conclusion:Encouraging utilization of social support systems and a positive coping mode is important for increasing comfort level in head and neck neoplasm patients during radiotherapy.Nurses should pay particular attention to those patients during later stages of radiotherapy or chemotherapy,with diabetes,without family accompaniment,and with lower education level.

Intensity-modulated radiotherapy for breast cancer:a systematic review

Objective:The aim of this study was to assess the long-term effect of breast conservation with breast intensitymodulated radiotherapy (IMRT) for early-stage breast cancers.Methods:Pub Med,EMBASE,Cochrane Library,Chinese Biomedical Literature Database were searched to identify relevant original published trails,and the references of eligible studies were manually screened.Randomized controlled trails reported in any language,comparing breast IMRT with conventional radiotherapy (RT) in patients with early-stage breast cancer were eligible for inclusion.Two investigators independently assessed the quality of included trials and extracted data.The RevMan 5.0 software was used for statistical analysis.Results:Four trials involving 1440 patients were included.The results showed that in the IMRT group,the occurrence of acute moist dermatitis,the edema of the mammary gland and the occurrence of hyperpigmentation were lower than those of RT group,the pooled risk ratio value and 95% confidence interval were 0.28 (0.17-0.48),0.03 (0.00-0.21) and 0.06 (0.02-0.15) respectively.The use of IMRT did not correlate with pain and quality of life,but the presence of moist desquamation did significantly correlate with pain and reduced quality of life.Conclusion:The currently available evidence showed that IMRT significantly reduces the occurrence of moist acute dermatitis anywhere in the breast and alleviates the suffering of patients and improves the quality of life of patients.Future large-scale,high-quality,double-blind trials are needed.

Psychosomatic symptoms affect radiotherapy setup errors in early breast cancer patients

Objective: To examine the trajectory of psychosomatic symptoms and to explore the impact of psychosomatic symptoms on setup error in patients undergoing breast cancer radiotherapy.Methods: A total of 102 patients with early breast cancer who received initial radiotherapy were consecutively recruited. The M.D. Anderson Symptom Inventory(MDASI) and three different anxiety scales, i.e., the Self-Rating Anxiety Scale(SAS), State-Trait Anxiety Inventory(STAI), and Anxiety Sensitivity Index(ASI), were used in this study. The radiotherapy setup errors were measured in millimetres by comparing the real-time isocratic verification film during radiotherapy with the digitally reconstructed radiograph(DRR). Patients completed the assessment at three time points: before the initial radiotherapy(T1), before the middle radiotherapy(T2), and before the last radiotherapy(T3).Results: The SAS and STAI-State scores of breast cancer patients at T1 were significantly higher than those at T2 and T3(F=24.44, P<0.001;F=30.25, P<0.001). The core symptoms of MDASI were positively correlated with anxiety severity. The setup errors of patients with high SAS scores were greater than those of patients with low anxiety levels at T1(Z=-2.01, P=0.044). We also found that higher SAS scores were associated with a higher risk of radiotherapy setup errors at T1(B=0.458, P<0.05).Conclusions: This study seeks to identify treatment-related psychosomatic symptoms and mitigate their impact on patients and treatment. Patients with early breast cancer experienced the highest level of anxiety before the initial radiotherapy, and then, anxiety levels declined. Patients with high somatic symptoms of anxiety may have a higher risk of radiotherapy setup errors.

The Effect of Hypofractionated Radiotherapy on Tumor Control and Survival in Patients with High-Risk Breast Cancer

BACKGROUND Adjuvant radiotherapy is given following surgery in breast cancer patients. Hypofractonated radiotherapy can significantly reduce the waiting time for radiotherapy, working load on machines, patient visits to radiotherapy departments and medical costs. Material and Methods 244 patients with high-risk breast cancer (stage IIB, stage III and stage IA with any of the following criteria: lymphovascular invasion, hormonal receptor negative, young age) who underwent Breast conservative surgery (BCS) or Modified radical mastectomy (MRM) were enrolled in this study. All patients received adjuvant radiotherapy with different hypofractionation schedules either 3900 cGY/13 fractions or 4240 cGY/16 fractions or 4005 cGY/15 fractions using linear accelerator with 6 MV photon beam. Lateral/Medial tangential and Ipsilateral supraclavicular fields were employed and the ipsilateral axilla was also irradiated if required to the same dose with posteroanterior field. Patients were followed every 3 mons for the first 2 years and every 6 mons thereafter. Outcomes were analyzed in terms of tumor control and survival. Results 244 patients with high-risk breast cancer requiring postoperative radiotherapy to the intact breast or chest wall were treated. The mean age was 48 years (range 28 - 69 years). The 5-year locoregional free survival of all patients was 93.8% the local relapse reported in 15 patients (6.2%) 7 patients at site of operated scar & 8 patients at the regional lymph nodes. The median follow up period was 75 months ranged from 49 to 102 months. Distant metastasis free survival was 92.2%, the distant metastasis reported in 19 patients which represent (7.8%) of all patients, median survival is 75 months ranged from 49 to 102 months and overall survival was 88.6%. Conclusion It is concluded that hypofractionated radiotherapy is a simple and effective protocol in patients with high-risk breast cancer regarding tumor control and survival.

Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy

Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.