Introduction: During postmastectomy radiotherapy (PMRT), it is recommended to boost the postmastectomy surgical scar with additional 10 Gy in 5 fractions in the patients with close or positive surgical margins. The electron beam therapy, though cumbersome, is usually preferred since it has the desired rapid fall of a dose beyond R 85 . An alternative but easier and reproducible treatment method for PMRT surgical scar boost using 3D CT image-based HDR surface mould brachytherapy is introduced and analyses of the target coverage and dose nearby organs-at-risk (OARs) using this method are evaluated in this study. Methods and Materials: This study includes twelve patients (five left-sided and seven right-sided chest wall), who were planned and treated with CT-image based surface mould HDR brachytherapy for chest wall scar boost (CWB) using Catheter Flap Set TM (Varian Medical Systems, USA) that were given concurrently during external beam radiotherapy (EBRT) treatments. Since no guidelines are available for delineating clinical target volume (CTV) structure to be used for postmastectomy scar boost, the CTV in this study was a uniform 5-mm thick volume drawn at 5 mm beneath the skin (CTVhdr_evl) and its extent was made conforming to the boost area marked on the skin and made visible in CT images by radiopaque wires. Results: Prescribed dose (PD) to CTVhdr_evl is 7.5 Gy in 3 fractions, and 2.5 Gy per fraction. The CTVhdr_evl volume receives the PD with mean V 100% , V 98% and V 95% values which are 98.57%, 99.63% and 100% respectively. The mean dose for heart (MHD) is 2.71 Gy in left-sided CWB and 1.80 Gy in right-sided CWB plans. Mean lung dose (MLD) is 2.48 Gy for ipsilateral lung and 0.76 Gy for contralateral lung. Maximum dose to contralateral breast is 4.93 Gy and the mean dose is 0.79 Gy. The mean percent dose to the skin volume overlying the CTVhdr_evl is 138.6% and 3.7% of skin volume received 200% of the PD. Conclusion: The 3D image-based HDR surface mould achieved good CTV coverage with acceptable doses to OARs. Patient preparation, treatment planning, and execution in this method are less cumbersome and reproducible. Thus surface mould using flap applicator can be used whenever postmastectomy surgical scar boost is required.
To dosimetrically compare high-dose-rate interstitial brachytherapy (HDR-BT) with volumetric-modulated arc therapy (VMAT) for tumor bed boost, following breast conservative treatment.Material and methods: 50 patients with early-stage breast cancer who underwent breast conservation surgery, followed by either HDR-BT (n = 25) of 15 Gy in 6 fractions over a period of 3 days, or VMAT dose of 16 Gy in 8 fractions (n = 25) for tumor bed boost, were retrospectively reviewed. All patients received whole breast irradiation of 46 Gy in 23 fractions. Dosimetric parameters for organs at risk (OARs), including ipsilateral and contralateral lungs, heart, contralateral breast, skin, and ribs, were evaluated with the help of dose-volume histograms (DVH).Results: Heart sparing was similar in both modalities (left-sided breast irradiation, HDR-BT D 2cc 20.5% vs. VMAT 30.2%, p-value = 0.243; right-sided breast irradiation, D 2cc 6.5% vs. 4.4%, p-value = 0.165). Left-sided cases received higher dose to heart compared to right-sided patients. Interstitial brachytherapy resulted in significantly less dose to contralateral breast (D 2cc 4.3% vs. 9.6%, p-value < 0.0001), ipsilateral lung (D 2cc 27.6% vs. 73.2%, p-value < 0.0001), contralateral lung (D 2cc 4.2% vs. 14.5%, p-value < 0.0001), ribs (D 2cc 24.1% vs. 41.2%, p-value < 0.0001), and skin (D 2cc 77.3% vs. 95%, p-value < 0.0001).Conclusions: HDR-BT-based tumor bed boost irradiation results in significantly lower doses to most organs at risk with similar heart sparing compared to VMAT.
Paroxysmal sympathetic hyperactivity (PSH) is not a well-recognized syndrome in pediatric brain tumors, but has been described in adults with traumatic brain injury. We describe the case of a child with medulloblastoma presenting with PSH. An index of suspicion is important in early diagnosis of PSH and this ultimately has an impact on the long-term outcome of patients with the syndrome.
Methods: A retrospective cohort of 300 patients, was used to develop 'CanAssist-Breast'(CAB)-an immunohistochemistry based test comprising 5 biomarkers plus three clinical parameters (Tumor size, node status and grade) using machine learning based algorithm. Retrospective clinical validation on 850þ cases was performed and Kaplan Meier survival analysis, multivariate analysis was performed to assess robustness of the test. Results: CanAssist-Breast classifies patients into 'low or high' risk of recurrence based on recurrence score on a scale of 1-100 with a cut off at 15.5. Clinical validation of CAB showed distant metastasis-free survival (DMFS) was significantly different between low-(DMFS: 95%) and high-risk (DMFS 80%) groups in the validation cohort treated with hormone therapy alone (n ¼ 195) and in the entire validation cohort of 857 patients as well. In multivariate analysis, CAB risk score was the most significant independent predictor of distant recurrence with a hazard ratio of 4.25 (P ¼ 0.009). Patients stratified as high-risk by CAB have 19% chemotherapy benefit. We also show that CAB can further identify discrete low-and high-risk sub-groups within IHC4 intermediate risk group and also in a node and age independent manner. Conclusions: To our knowledge, CAB is the first machine learning based prognostic risk of recurrence prediction classifier using a combination of unique biomarkers and clinicopathological parameters. We believe that CAB enables accurate treatment planning in early stage HRþ/HER2-breast cancer patients in low-resource settings.Legal entity responsible for the study: OncoStem Diagnostics. Funding: Privately funded by venture capitalist. Disclosure: M. Bakre: Founder and CEO: OncoStem Diagnostics; co-inventor of the patent; Stock: OncoStem Diagnostics. 5P Topical silymarin administration for prevention of radiodermatitis in breast cancer patients: A randomized, double-blind, placebo-controlled clinical trial
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