Background: Breast conserving surgery (BCS) and its following radiotherapy is an accepted therapeutic method for patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). Objectives: The aim of this study was to investigate the effect of intraoperative electron radiotherapy on women with breast cancer (invasive lobular and ductal carcinoma). Methods: Between August 2013 and September 2017, 968 patients, who were referred to Cancer Research Center, Shahid Beheshti University of Medical Sciences with invasive breast cancer, were treated with breast-conserving surgery and radiotherapy. Of those, 426 patients received a tumor bed boost with intraoperative electron radiotherapy (IOERT) during lumpectomy (58 patients with pure invasive lobular carcinoma, 239 patients with pure invasive ductal carcinoma, and 129 patients with other diagnoses). 542 patients received a tumor bed boost with conventional external beam radiotherapy post lumpectomy (24 patients with pure invasive lobular carcinoma, 418 patients with pure invasive ductal carcinoma, and 100 patients with other diagnoses). The patients were followed up to 49 months. A comprehensive list of clinical and pathologic features was evaluated for all patients. We retrospectively analyzed outcomes of breast cancer treated with boost intraoperative electron radiotherapy (pure ILC and IDC groups) and in other group treated with boost conventional external beam radiotherapy (pure ILC group). Results: None of the ILC patients had recurrence in the two groups. The four-year survival rate for ILC patients was 100%, but in the IDC group the survival rate was 97%. Survival analyses showed patients with IDC had a higher risk of ipsilateral breast tumor recurrence (IBTR) and metastasis. Conclusions: Overall, the rates of IBTR and metastasis in the ILC boost IOERT group were significantly low. This finding suggests that IOERT technique deployment in ILC had no inferiority compared with the control group.
Background:In order to evaluate the diagnostic capabilities of various methods of breast cancer, it was expected that the use of non-invasive imaging techniques would be the earliest and the best technique of patient management. Objectives: We attempted to evaluate mammography and ultrasonography reports along with clinical diagnosis and their agreement with the definite diagnosis of breast lesions by pathology report. Methods: This cross sectional study was conducted on 287 women, who were referred to the cancer research center and breast clinic in Tehran between August 2016 and September 2017. The patients' basic information and their history were asked and recorded on the checklist. Also, the information obtained from the imaging report as well as the results of the pathological assessment were extracted. Results: Compared with the pathological evaluation, the clinical assessment showed a sensitivity of 89.7%, a positive predictive value (PPV) of 97.6%, and a diagnostic accuracy of 90.24% in differentiation between malignant and non-malignant lesions. And specificity of 51.6%, and negative predictive value (NPV) of 89.2%, and a diagnostic accuracy 87.8% in differentiation between non-benign and benign lesions. Mammography had a sensitivity of 24.7%, PPV of 100%, and an accuracy of 40.2% in differentiation between malignant and non-malignant lesions. And specificity of 82.0%, NPV of 31.1%, and an accuracy of 59.0% in differentiation between non-benign and benign lesions. Ultrasonography had a sensitivity of 26%, PPV of 100%, and an accuracy of 41.44% in differentiation between malignant and non-malignant lesions. And specificity of 58.2%, NPV of 53.3%, and an accuracy of 80.6% in differentiation between non-benign and benign lesions. The cost for correct diagnosis ratio was estimated 12.31 Dollars in clinical assessment, 109.66 Dollars in mammography assessment, and 122.32 Dollars for the assessment with ultrasonography. Conclusions: We deduced that clinical assessment was in line with pathology finding in comparison to mammography and ultrasonography in differentiation between malignant and benign lesions. In conclusion, we suggest that every radiologist pass more specialized training for reporting the mammography and ultrasonography images for declining false negative and positive results.
Background: Intraoperative radiation therapy (IORT) is a novel approach to breast cancer (BC) treatment. Objectives: In this study, we compared the cellular and molecular effects of IORT-treated post-lumpectomy wound fluid (seroma) at the point of IOeRT versus IOxRT on the BC cell line. Methods: Immortalized human BC cell lines: MCF-7, MDA-MB-231, and MCF10 were incubated with seroma from 3 groups of patients (as a pilot study). The first group received Intraoperative electron radiation therapy (IOeRT, Boost dose=12Gy), the second one received IOeRT (Radical dose=21Gy), and the third group was prescribed Intraoperative x-ray radiation therapy (IOxRT, X-ray=20Gy). Cellular and molecular tests were used to investigate how cells are influenced by the IORT-treated seroma. Results: We evaluated the effects of dose-time and source-dependent IORT-treated seroma on BC cell lines. In this study, we observed that IOxRT-treated seroma has the most significant effects on the reduction of proliferation, induced cell cycle arrest, and apoptosis. Furthermore, inhibited migration and invasion of BC cell lines were compared to IOeRT -treated seroma. Conclusions: Although this is a pilot study, we suggest that at 24 h, the IORT (specifically IOxRT)-treated seroma may play an important protective role in the breast tumor bed, which is followed by local recurrence decreases.
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