Background: In the large breast tumors or locally-advanced breast cancers, breast conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) had an acceptable local control, but greater risk of recurrence. Adding boost dose radiation to whole breast radiotherapy is involved with a reduced risk of recurrence. Boost radiotherapy can be delivered in 3 methods, including (1) external beam radiotherapy (EBRT), (2) intraoperative radiotherapy with electron (IOERT), and (3) intraoperative radiotherapy with low-kV X-ray (IOXRT). Objectives: This study compared the outcomes of these 3 methods with each other. Methods: Within 60 months, 217 unselected breast cancer patients in Cancer Research Center of Shahid Beheshti were under treatment with BCS after NACT. They received boost dose radiation in 3 groups; 115 patients in the EBRT group, 39 patients IOXRT group, and 63 patients in the IOERT group. All of them received WBRT after surgery. Results: The patients had large tumors or stage 3 breast cancer. Local recurrences were 1 (2.5%) in IOXRT, 2 (3.2%) in IOERT, and 1 (0.9%) in EBRT groups. Systemic recurrences were 4 (10.3%) in IOXRT, 10 (15.9%) in IOERT, and 16 (13.9%) in EBRT groups. Deaths were 3 (7.7%) in IOXRT, 2 (3.2%) in IOERT, and 10 (6.9%) in EBRT groups. Patients with any events were 4 (10.3%) in IOXRT, 11 (17.5%) in IOERT, and 33 (15.2%) in the EBRT group. Death due to distant metastases was lower in IOERT group, but it was not significant. No significant difference was observed in disease-free survival (DFS) among 3 groups. IOXRT group had non-significant, lower events, and better DFS. Especially, in non-PCR (non-pathologic complete response) patients, multivariate COX analysis showed better outcome (DFS) in IOXRT group (HR = 0.50), although it was not significant (P = 0.53). Conclusions: Intraoperative radiotherapy (IORT or IOXRT) as tumor bed boost during BCS after NACT had at least non-inferiority compared with EBRT. In non-PCR patient, IOXRT group had non-significant better outcomes (DFS).
Background: MicroRNA (miRNA) is a regulatory molecule capable of positively or negatively regulating signaling pathways and furthermore assumes a part tumorigenesis and various aspects of cancer. The purpose of this study is to investigate the expression level of miR-133a, miR-637 and miR-944 genes in serum and tumor tissue and their relationship with the expression level of phosphatidylinositol-3-kinase (PI3K (and protein kinase-B (AKT) genes and proteins and its clinical significance in breast cancer. Methods: The expression of miR-133a, miR-637, miR-944, PI3K and AKT genes in tumor tissues and tumor margins tissues of 40 patients with breast cancer, as well as the serum levels of miR-133a, miR-637 and miR-944 in these patients and 40 healthy groups were examined by quantitative real-time PCR (qRT-PCR). PI3K and AKT proteins expression in tumor tissue and tumor margins tissues were detected by immunohistochemistry (IHC). Results: The expression levels of miR-133a and miR-637 in the tumor tissue and serum of patients were lower than the tumor margin tissue and serum of the healthy group, respectively. Also, the expression level of miR-944 in the tumor tissue was lower than in the tumor margin tissue, but its expression increased in the serum of cancer patients compared to the healthy group. The expression of miR-637 was correlated with tumor location, tumor size, and Her2 receptors, as well as the expression of miR-944 with tumor location and family history. PI3K and AKT mRNA and protein levels were higher in tumor tissues compared to tumor margin tissue (p<0.05). Conclusion: The results of our study show that miR-637 has a better diagnostic value in breast cancer than miR-133a and miR-944.
Background: MicroRNA (miRNA) is a regulatory molecule capable of positively or negatively regulating signaling pathways and furthermore assumes a part tumorigenesis and various aspects of cancer. The purpose of this study is to investigate the expression level of miR-133a, miR-637 and miR-944 genes in serum and tumor tissue and their relationship with the expression level of phosphatidylinositol-3-kinase (PI3K (and protein kinase-B (AKT) genes and proteins and its clinical signi cance in breast cancer.Methods: The expression of miR-133a, miR-637, miR-944, PI3K and AKT genes in tumor tissues and tumor margins tissues of 40 patients with breast cancer, as well as the serum levels of miR-133a, miR-637 and miR-944 in these patients and 40 healthy groups were examined by quantitative real-time PCR (qRT-PCR). PI3K and AKT proteins expression in tumor tissue and tumor margins tissues were detected by immunohistochemistry (IHC).Results: The expression levels of miR-133a and miR-637 in the tumor tissue and serum of patients were lower than the tumor margin tissue and serum of the healthy group, respectively. Also, the expression level of miR-944 in the tumor tissue was lower than in the tumor margin tissue, but its expression increased in the serum of cancer patients compared to the healthy group. The expression of miR-637 was correlated with tumor location, tumor size, and Her2 receptors, as well as the expression of miR-944 with tumor location and family history. PI3K and AKT mRNA and protein levels were higher in tumor tissues compared to tumor margin tissue (p<0.05). Conclusion:The results of our study show that miR-637 has a better diagnostic value in breast cancer than miR-133a and miR-944.
Background: Intraoperative radiotherapy (IORT) within breast conserving surgery (BCS) is progressively utilized to deliver the optimal dose of radiotherapy immediately after the excision of cancer during the same operation to the well-vascularized tissue and to the margin of resected cancer to damage the cancer cells, which might remain nearby the tumor just on time without no delay as radical irradiation for particular cases or as boost dose for others. Methods: This study reports 54-month single-center experiences after introduction to deliver IORT (50 kV x-ray) as a tumor bed boost in BCS for breast cancer and comparison with external beam radiation therapy (EBRT). In this retrospective study, 255 patients (stages 1-3) with breast cancer were treated with BCS and IORT in the Cancer Research Center, Shahid Beheshti University of Medical Sciences (April 2014-September 2018). They received 20 Gy IORT as a boost compared with 321 patients in the same stages with EBRT. Results: Within 54 months, there were 3 (1.2%) occurrences of local recurrence in IORT patients compared with 8 (2.5%) local recurrences in EBRT patients (P = 0.361) and 12 (4.7%) metastasis in the IORT group vs. 20 (6.2%) in the EBRT group (P = 0.724). The 5-year disease-free survival (DFS) was 85.1% in the IORT group compared with 86% in the EBRT group. Conclusions: IORT tumor bed boost with 50 kV x-ray during breast conserving therapy had a better outcome, but it was not significant compared with EBRT.
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