Stereotactic body radiation therapy currently occupies its place in the complex treatment of cancer patients with liver metastases. It is assumed that certain groups of patients with breast cancer can benefit from the use of this method, which can be converted into improved overall survival and survival rates without signs of progression of the process. Purpose of the study was to evaluate the efficacy and tolerability of stereotactic radiotherapy in patients with breast cancer metastases in the liver. We have analyzed the results of using stereotactic radiotherapy in 25 breast cancer patients with 43 liver metastases. The treatment was carried out in 3 fractions with a fraction dose of 10-15 Gy and a total dose of 30-45 Gy. Growth of the irradiated lesions was recorded only in 1 case out of 43 metastases (2,3%) and 25 (4%) patients. 1-, 3- and 5-year overall survival rates from the moment of stereotactic radiotherapy were 82,9%, 62% and 38,7%, respectively. Long-term post-radiation adverse events were observed in 8% of cases and did not have a significant effect on the quality of life and the possibility of antitumor treatment. So stereotactic radiotherapy can be recommended as a relatively safe and highly effective method of elimination of breast cancer liver metastases. Taking into account the high achieved local control, further studies on dose escalation in this group of patients are not required.
Purpose: To evaluate the oncological results and late complication rate in breast cancer patients who underwent immediate implant-based breast reconstruction and adjuvant radiotherapy. Material and methods: 32 patients with I–IIIC breast cancer after combined treatment which included immediate implant-based breast reconstruction, chemotherapy and radiotherapy, were reviewed. Results: All 32 patients got skin erythema as an acute adverse effect. 6 (18 %) of them got acute mucositis. Median follow-up was 35 months (range 12–112 months). 2 (6 %) patients had local recurrence after 46 and 31 months since the operation day. Locoregional control rate was 94 %. 9 (28 %) patients presented distant metastases at term 8–71 months since the operation day, and metastases in bones, brain, lungs, liver and non-regional lymph nodes were diagnosed. 2 (6 %) patients died because of disease progression. Late adverse effects of skin and soft tissue in irradiated area were found in 4 (13 %) patients – capsular contracture was diagnosed 1 (n = 1), 2 (n = 2) and 3 (n = 1) stages. In two cases of four, capsular contracture was asymptomatic and found during the second stage of breast reconstruction while changing tissue expander to implant. Capsulotomy was performed, and aesthetic effect was good. In one case capsular contracture was the reason of implant removal, and then second reconstruction using tissue expander was performed. Conclusion: Nowadays immediate implant-based breast reconstruction is an essential part of combined treatment. Breast cancer patients after immediate implant-based breast reconstruction can be treated in adequate manner, and breast reconstruction is not a contraindication for radiotherapy. Low complication rates can still be acquired with the use of state-of-art 3D and 4D radiotherapy techniques and supportive care.
Vasospasm that occurs after subarachnoid hemorrhage (SAH), despite successful surgical or radiological intervention remains with an ominous prognostic recovery period. 1 We investigated the correlation of S100B protein in CSF and serum with incident of vasospasm and neurological outcome in patients undergoing intracerebral aneurysm clipping. Twenty five patients were enrolled. All patients received combined anesthetic techniques. Brain protection was provided by isoflurane. A CSF sample (2 cc) and blood sample (5 cc) were drawn 3 times (before skin incision, 30 minutes and 24 hours after clipping). Patients were followed for the incidence of vasospasm in Neurosurgical Intensive Care Unit and the neurological status at discharged was assessed using Glasgow Outcome Scale. Compared with baseline level (at 0 minute) we found that early changes in CSF S100 B level at 30 minutes significantly correlate with vasospasm (P = 0.005, sensitivity 90% and specificity 90%) but the correlation dissipated at 24 hours. In addition, early changes in S100B in CSF at 30 minutes significantly correlate with neurological outcome (P = 0.003). The relationship persisted at 24 hours (P , 0.011). In Serum we found no significant correlation between S100B at 30 minutes or 24 hours with either vasospasm or neurological outcome. We conclude that changes of S100B level in CSF in patients undergoing intracerebral aneurysm clipping surgery are strongly correlated with vasospasm and can be a reliable diagnostic tool to identified patients who are endangered with evolving vasospasm after a successful securing aneurysm surgery. Reference: 1. Pluta RM. Delayed cerebral vasospasm and nitric oxide: review, new hypothesid, and proposed treatment.
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