Abstract Background Protecting the heart and left lung is important for left-sided breast cancer radiotherapy. So，this study was to investigate the effect of geometric parameters on the dose of left lung and heart in whole breast radiotherapy. Methods A plan was designed for each patient using VMAT technology for thirty patients. A triangular ABC of the target was defined layer by layer. The geometric parameters were defined: Rat-H (the ratio of heart), Rat-L (the ratio of lung), the curvature and thickness of the target ρ and d . Explored the relationships between these parameters and the dose-volume of heart (V 5,h , V 10,h , V 20,h , MHD) and left lung (V 5,LL , V 10,LL , V 20,LL , V 30,LL , V 40,LL , MLD). Results The V 5,h , V 10,h and MHD were all significantly associated with Rat-H (p&lt;0.05). The V 5,LL , V 10,LL , V 20,LL , V 30,LL , V 40,LL and MLD were all significantly associated with Rat-L (p&lt;0.05). And the V 20,LL , V 30,LL and V 40,LL were all significantly associated with d (p&lt;0.05). Meanwhile，V 30,LL and V 40,LL were all significantly associated with ρ (p&lt;0.05) . The correlations of the dose-volume of left lung and the four geometric parameters could be expressed by linear functions. Conclusions The geometric parameters Rat-H, Rat-L, d and ρ were closely related to the dose-volume of heart and left lung in whole breast radiotherapy. 

Geometric factor analysis for dose distribution in the whole breast irradiation

A study on the effect of clinical intervention of evidence-based nursing measures on complications in patients after breast-conserving surgery.

Background/Aim: Following the National Comprehensive Cancer Network guidelines, radiotherapy is administered after breast-conserving surgery (BCS) in patients with more than four positive lymph nodes. Four positive lymph nodes are typically considered an indicator to assess disease spread and patient prognosis. However, the subjective counting of positive axillary lymph nodes underscores the need for biomarkers to improve diagnostic precision and reduce the risk of unnecessary treatments. Loss of E-cadherin expression is associated with cancer metastasis, but its potential as a predictive marker for cancer treatment remains uncertain. This study aimed to investigate the validity of E-cadherin as a reference for adjuvant radiotherapy in breast cancer patients with positive lymph nodes post-mastectomy. Materials and Methods: Immunohistochemistry was performed on 60 clinical tissue specimens to assess these implications. Results: Although no significant result was found in a single E-cadherin subgroup (low, medium, and high subgroups according to the X-tile algorithm), the proposed multivariate model, including the E-cadherin category, breast cancer subtype, and tumor size, yielded satisfactory recurrence risk estimation results for patients undergoing BCS. Patients with a low E-cadherin category, triple-negative breast cancers, and tumor size over 5 cm could have an increased risk of recurrence. Conclusion: Our study proposed a multivariate model that serves as a candidate prognostic factor for recurrence-free survival in patients undergoing BCS and radiotherapy. Utilizing this model for patient stratification in high-risk diseases and as a standard for assessing postoperative intensified therapy can potentially improve patient outcomes.

Evaluating Recurrence Risk in Patients Undergoing Breast-conserving Surgery Using E-cadherin Staining as a Biomarker.

Intraoperative Radiation for Breast Tumors

Background/Aim: Mastectomy is the standard treatment of in-breast-recurrence of breast cancer after breast conserving surgery (BCS) and external beam radiation therapy (EBRT). In selected cases, it is possible to preserve the breast if targeted intraoperative radiotherapy (TARGIT-IORT) can be given during the second lumpectomy. This is a comparative analysis of overall survival and quality of life (QoL). Patients and Methods: Patients in our database with in-breast-recurrence and either mastectomy or BCS and TARGIT-IORT were included. Identified patients were offered participation in a prospective QoL-analysis using the BREAST-Q questionnaire. The cohorts were compared for confounding parameters, overall survival, and QoL. Results: Thirty-six patients treated for in-breast-recurrence were included, 21 had received a mastectomy and 16 patients had received BCS with TARGIT-IORT. Mean follow-up was 12.8 years since primary diagnosis and 4.2 years since recurrence. Both groups were balanced regarding prognostic parameters. Overall survival was numerically longer for BCS and TARGIT-IORT, but the numbers were too small for formal statistical analysis. No patient had further in-breast-recurrence. Psychosocial and sexual wellbeing did not differ between both groups. Physical wellbeing was significantly superior for those whose breast could be preserved (p-value=0.021). Patient-reported incidence and severity of lymphedema of the arm was significantly worse in the mastectomy group (p=0.007). Conclusion: Preserving the breast by use of TARGIT-IORT was safe with no re-recurrence and no detriment to overall survival in our analysis and led to a statistically significant improvement in physical wellbeing and incidence of lymphedema. These data should increase the confidence in offering breast preservation after in-breast-recurrence of breast cancer.

Breast Conserving Surgery in Combination With Targeted Intraoperative Radiotherapy Compared to Mastectomy for In-breast-tumor-recurrence


 Background: Mastectomy is the treatment recommended by most national and international guidelines for in-breast-recurrence of breast cancer after breast conserving surgery (BCS) and external beam radiation therapy (EBRT). In selected cases it is possible to preserve the breast if TARGIT-IORT can be given during the second lumpectomy. We present a comparative analysis of overall survival, QoL and side effects. Methods: We identified patients who had local recurrence of breast cancer after BCS and EBRT in our prospectively maintained database. Patients were included if they had undergone either a mastectomy or BCS along with TARGIT-IORT. Patients with distant disease were excluded. Identified patients were contacted and offered participation in a prospective QoL-analysis using the BREAST-Q questionnaire. The cohorts were compared for confounding parameters, overall survival, side effects, physical, sexual and psychosocial wellbeing and satisfaction with the surgical result. Results: 36 patients treated for local recurrence were included in this analysis, 21 had received a mastectomy and 16 patients had chosen to preserve their breast and after interdisciplinary tumor board decision received BCS and TARGIT-IORT. Mean follow-up was 12.8 years since primary diagnosis and 4.2 years since recurrence. There were no significant differences between both groups regarding age, ER, PR, HER2neu, tumor size or nodal status at primary diagnosis or at recurrence and the distribution of invasive versus non-invasive recurrences. 1 patient in the BCT and TARGIT-IORT group (6.7%) and 3 patients in the mastectomy group (14.3%) died during follow up. Overall survival was numerically longer for BCS and TARGIT-IORT either calculated from primary diagnosis (median 18 years versus 8 years) or from recurrence (median 5.1 years versus 3.2 years). The numbers were too small for formal statistical analysis. No patient had another local recurrence of breast cancer during follow-up. 12 patients in the mastectomy group and 10 patients in the BCS and IORT group returned the BREAST-Q questionnaire. Psychosocial wellbeing, sexual wellbeing and satisfaction with the surgeon did not differ between both groups. Physical wellbeing was significantly superior for those whose breast could be preserved (median score for BCS and TARGIT-IORT group was 91 (71-100) vs. 66 (14-100) for the mastectomy group, p-value = 0.021). Whereas most side effects were comparable and showed no significant differences, patient-reported incidence and severity of lymphedema of the arm on the side of surgery was significantly worse in the mastectomy group (p=0.007). Conclusion: Many patients who have local recurrence of breast cancer are reluctant to lose their breast. We found that preserving the breast by use of TARGIT-IORT was safe with no re-recurrence and no detriment to overall survival. This is necessarily a small series, because local recurrence is rare, yet, this novel approach led to a statistically significant improvement in physical wellbeing and incidence and severity of lymphedema. These data increase the confidence in offering breast preservation and TARGIT-IORT for surgery of in-breast-recurrence of breast cancer.
 Citation Format: Hans-Christian Kolberg, Helena Niesing, Jayant S Vaidya, Leyla Akpolat-Basci, Abdrhman Maguz, Oliver Hoffmann, György Lövey, Miltiades Stephanou, Cornelia Kolberg-Liedtke. Comparison of length and quality of life (QoL) and the side effects of therapy between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy for in-breast-recurrence of breast cancer [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 P1-09-04.

Abstract P1-09-04: Comparison of length and quality of life (QoL) and the side effects of therapy between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy for in-breast-recurrence of breast cancer

Background Mastectomy is the standard treatment of in-breast-recurrence of breast cancer after breast conserving surgery (BCS) and external beam radiation therapy (EBRT). In selected cases of in-breast-recurrence it is possible to offer BCS and TARGIT-IORT. We present a comparative analysis of overall survival and QoL between BCS with TARGIT-IORT and mastectomy. 

Breast preservation after in-breast-recurrence of breast cancer:
 comparison of overall survival and quality of life (QoL) between breast
 conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus
 mastectomy

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Breast Conserving Surgery in Combination With Targeted Intraoperative Radiotherapy Compared to Mastectomy for In-breast-tumor-recurrence

Abstract P1-09-04: Comparison of length and quality of life (QoL) and the side effects of therapy between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy for in-breast-recurrence of breast cancer

Breast preservation after in-breast-recurrence of breast cancer: comparison of overall survival and quality of life (QoL) between breast conserving surgery with intraoperative radiotherapy (TARGIT-IORT) versus mastectomy