Background and purpose: In superficial tumors of the breast, it is necessary to plan the thickness of surgical skin flaps, and whether skin can be preserved for esthetics results. This study aimed to find an ultrasound measured cut-off distance between tumor and skin (TSD) that allows patients to have the skin over the tumor spared. Methods: This is a diagnostic accuracy study comparing preoperative ultrasound TSD with pathological TSD and the thickness of the skin flaps. We recruited all consecutive women diagnosed with breast cancer between January 2017 and December 2019 whose surgical planning allowed to have the tumor and overlying skin to be removed in bloc (reconstruction procedures, situations where skin removal would not lead to esthetic problems and superficially located tumors). Measurements were made: preoperatively (by ultrasound), during surgery (using a metal caliper to obtain the thickness of surgical skin flap) and after surgery (pathological). A pathological tumor-skin distance greater than surgical skin flap thickness would indicate preservation of skin above the tumor. Results: We evaluated 95 consecutive patients with 102 lesions. The average surgical flap thickness was 5.5mm (3-10 mm). The ultrasound-measured cut-off TSD of 2.1mm obtained 96.0% accuracy in predicting free anterior margin, considering a 5-mm thick surgical flap. Conclusion: In breast superficial tumors, a cut-off distance of 2.1 mm or more measured preoperatively by ultrasound allows safe preservation of the skin above the tumor. Future studies need to follow up for longer the women submitted to skin preservation surgeries, especially those not undergoing radiotherapy.
Introduction: The continuous advance in the early detection and treatment of breast cancer has significantly reduced mortality and, consequently, increased the number of survivors with treatment side effects that act on the quality of life, such as lymphedema, loss of upper limb strength, shoulder dysfunction, decreased functional capacity, flexibility, and joint mobility. Exercise therapy is a recognized practice for the rehabilitation of these disorders; however, acupuncture needs to be better evaluated to compare its equivalence with classical therapy. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing strength, lymphedema and quality of life. Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement in upper limb muscle strength over time in all groups, except for abduction and internal rotation movements. During treatment, there was no increase in the number of patients with lymphedema and there was no statistical difference between the groups. Regarding the EORTC QLQ-C30 quality of life questionnaire, nine of the fifteen factors analyzed showed significant differences between sessions. The factors that did not have significant differences between the three groups were Social Function, Nausea and Vomiting, Dyspnea, Loss of Appetite, Constipation and Diarrhea. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in upper limb muscle strength, lymphedema and quality of life, proved to be effective, without difference between groups, which leads to the conclusion that acupuncture didn’t show superiority of results when compared with exercise therapy, thus being an effective approach for the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Samantha K. Lopes de Almeida Rizzi, Afonso Nazário, Simone Elias. Effect of acupuncture and exercise therapy on muscular strength, lymphedema and quality of life in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-10.
Introduction: Axillary web syndrome (AWS) is a complication in women with breast cancer and occurs immediately after axillary surgery. It is characterized by pain, limited shoulder range of motion (ROM), and presence of cords. Objectives: This study aimed to evaluate the impact of physical therapy interventions, such as physical exercise with tissue mobilization and exercise alone. Methods: A randomized clinical trial was conducted at the Divison of Breast Cancer disease of the Universidade Federal de São Paulo. Seventy-three women with AWS were randomized into the mobilization (ME) group (N=37) and exercise (E) group (N=36) and followed up for 3 months after breast cancer surgery. Both groups were provided with specific guidelines for performing regular shoulder exercise at home, while tissue mobilization was performed in a specific group with a maximum of six sessions, according to the patient’s need. ROM, pain, and presence of cords were evaluated in each postoperative period (PO). Results: In both treatment groups, at the end of 90 days, improvement in flexion was observed as well as less pain and number of cords. In terms of abduction, the E group was better than the ME group. Conclusions: Physical exercise after breast cancer surgery is extremely important for functional recovery, resumption of activities of daily living, improvement of pain, and reduction in the number of cords. Tissue mobilization appears as an adjunct for causing a more immediate improvement in ROM, pain, and presence of cords, but at times not sustaining the gains for the following PO. Keywords: breast neoplasms, axillary web syndrome, physical exercise, articular range of motion, pain Citation Format: Patricia V. Figueira, Cinira Haddad, Samantha K. Lopes de Almeida Rizzi, Amanda Estevao, Simone Elias, Gil Facina, Afonso Nazário. Association between tissue mobilization with physical exercise and physical exercise alone in patients with axillary web syndrome who underwent breast cancer surgery [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-44.
OBJECTIVE: Evaluate the presence of changes in post-chemotherapy sensibility with Taxane and the efficiency of a physiotherapy intervention that aims at the improvement of this condition. METHODS: We conducted an uncontrolled, longitudinal quantitative and prospective study on 23 patients. Four were not included in the study for not showing changes in sensibility or having a skin condition that rendered the evaluation impossible. The patients responded to the McGill and FACT G-Taxane questionnaires after the sensibility evaluation with a Semmes-Weinstein esthesiometer, an intervention session using a Peridell® therapeutic massager and a subsequent sensibility revaluation. RESULTS: Two regions with the best responses to the intervention were the dermatomes L5 and S1, with initial means of 5.33 and 5.53 and final means of 5.64 and 5.78, respectively (p = 0.012 e 0.020). The general analysis for both superior and inferior limbs showed an increase in the means, with an initial mean of 5.69 and a final mean of 5.81 (p = <0.001). There was a negative correlation between FACT G-Taxane and the McGill Questionnaire (-0.738 e p = <0.001). CONCLUSION: Vibratory stimulus of Peridell® therapeutic massager showed a significant improvement of changes in sensibility on the region of the dermatomes L5 and S1, especially on milder changes. The correlation between FACT G-Taxane and the McGill questionnaire suggests that the more pain the patient feels, there is less life quality and there are more symptoms of toxicity.
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