provides long-term patient reported metrics in women treated with APBI at one institution. Materials/Methods: Records of 164 women treated with APBI using balloon catheter high dose rate brachytherapy (BCHDRB) in 34 Gy in 10 fractions from 2005 to 2013 were reviewed after institutional review board approval. Women with ipsilateral or distant recurrence, poor prognosis, second primary, or known dates of death were excluded; women with contralateral recurrence were included if mastectomy was not performed. The Decisional Regret and Satisfaction Scales, quality of life, and cosmesis were captured using questions adapted from NSABP B39. Instruments were administered via mail, telephone, or email to eligible women. Results: Of 141 women who met inclusion criteria, 74 participated, 9 declined, and 58 have yet to be reached. Median age at diagnosis was 62 years(SDZ9), and median time from RT completion to surveys was 95 months(SDZ8). Histology was pure DCIS(25%), invasive ductal carcinoma(51%), and mixed(24%). The majority had estrogen/progesterone receptor positive disease. Decisional satisfaction was high, and regret was low; 94% felt satisfied with their decision, and 92% would make the same choice again. Factors that were important in decision making included convenience, physician recommendation, financial considerations, novelty of treatment, desire to avoid mastectomy, and recovery time; 46% reported convenience to be the most important factor. Prior to radiation 74% of women were totally satisfied with their breast size, and 96% continued to be totally/somewhat satisfied after APBI. Women were neutral, somewhat/ completely dissatisfied in the appearance of their breast before and after APBI in 18% and 19% respectively. After ABPI, 32% reported moderate/ large changes in breast size, while 68% reported slight/no changes. Seroma or needle aspiration of seroma were reported in 14% of women, and 89% of those reported this as little/somewhat/very much bothersome. Other side effects reported, were moderate or large hardening of breast(29%), thickening of breast skin(22%), swelling of breast(11%), skin reddening(7%) or darkening(8%). Despite these cosmetic changes, a majority of women(85%) reported total satisfaction with therapy. Overall breast appearance was reported as good/excellent in 70% of women, while 21% and 8% reported fair and poor overall appearance, respectively. Conclusion: Decisional satisfaction remains high 9 years after APBI, even in women with treatment sequela. This study highlights the importance of patient reported cosmesis and quality of life metrics as an adjunct to provider assessment of treatment outcomes.
Brain metastases are the most common intracranial tumors in the adult population and historically treated with whole brain radiation therapy (WBRT). However, as medical oncology advances improve life expectancy, stereotactic radiosurgery (SRS) has replaced WBRT as the standard for limited brain metastases,1-3 nevertheless has been less published in the case of multiple brain metastases. In these cases reports, we detail two patients at our institution that received SRS for multiple brain metastases and demonstrated acceptable tolerance and response. SRS is emerging as an acceptable alternative in multiple brain metastases and the decision to indicate it should be made with consideration of overall prognosis for each patient.
Purpose/Objective(s): Radiation therapy (RT) is one of main treatments for cancer. Patients with cancer receiving radiation therapy may experience psychological problems not only from the treatment, but also from the fearing of losing themselves. Music intervention was one of the effective methods to alleviate patient's anxiety, depression, fatigue, however, its efficacy in patients receiving radiation therapy remained unclear. Therefore, this study aimed to assess the effect of music intervention on possible emotional problems including anxiety, depression, and fatigue during radiation therapy. Materials/Methods: We performed a systematic review by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant studies from database inception until November 1, 2019. The study comparing the outcome between music intervention and non-music intervention in patients under radiation therapy would be included. Two independent authors assess the eligibility and quality of included studies according to the protocol. We used Cochrane Risk of bias assessment tool for randomized controlled trials, and Newcastle-Ottawa Scale for non-RCT. The random-effect meta-analysis was used to combine the data. Mean difference (MD) with 95% confidence interval (CI) was used for to reported the continuous outcome. The outcome was the improvement of anxiety, depression, and fatigue after intervention. Results: Eight randomized controlled trials and one cohort study, comprising 840 patients (music group: 356; non-music group: 484), were included. When comparing with non-music group, the music group had a greater improvement of State-Trait Anxiety Inventory, STAI-S score (mean difference (MD),-4.36, 95% CI,-7.25 to-1.47), and a greater improvement of State Anxiety Scale, SAS score (mean difference (MD),-2.06, 95% CI,-4.17 to 0.06). Four randomized controlled trials and one cohort study was investigated the association of music intervention with music medicine (MM) and music therapy (MT). The subgroup analysis showed that music therapy is the more effective option (mean difference (MD),-9.4, 95% CI,-13.58 to-5.22). The improvement of depression and fatigue were not significantly different between two groups. Conclusion: The use of music intervention could probably improve anxiety status of patients receiving radiation therapy. The music intervention should be considered to be incorporated into routine care for patients under radiation therapy.
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