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Pandey M, Wen PX, Ning GM, Xing GJ, Wei LM, Kumar D, Mayuren J, Candasamy M, Gorain B, Jain N, Gupta G, Dua K. Intraductal delivery of nanocarriers for ductal carcinoma in situ treatment: a strategy to enhance localized delivery. Nanomedicine (Lond) 2022; 17:1871-1889. [PMID: 36695306 DOI: 10.2217/nnm-2022-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Ductal carcinoma in situ describes the most commonly occurring, noninvasive malignant breast disease, which could be the leading factor in invasive breast cancer. Despite remarkable advancements in treatment options, poor specificity, low bioavailability and dose-induced toxicity of chemotherapy are the main constraint. A unique characteristic of nanocarriers may overcome these problems. Moreover, the intraductal route of administration serves as an alternative approach. The direct nanodrug delivery into mammary ducts results in the accumulation of anticancer agents at targeted tissue for a prolonged period with high permeability, significantly decreasing the tumor size and improving the survival rate. This review focuses mainly on the intraductal delivery of nanocarriers in treating ductal carcinoma in situ, together with potential clinical translational research.
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Affiliation(s)
- Manisha Pandey
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia.,Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh, 123031, India
| | - Pung Xiau Wen
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Giam Mun Ning
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Gan Jia Xing
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Liu Man Wei
- School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Dinesh Kumar
- Department of Pharmaceutical Sciences, Central University of Haryana, Mahendergarh, 123031, India
| | - Jayashree Mayuren
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Mayuren Candasamy
- Department of Life Sciences, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Bapi Gorain
- Department of Pharmaceutical Sciences & Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, India
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura, Jaipur, 302017, India.,Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai, 602105, India.,Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, 248007, India
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia.,Faculty of Health, Australian Research Centre in Complementary & Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Breast boost vector: a new metric proposed to optimise isocentre location in an fIMRT–VMAT hybrid technique for a simultaneous integrated boost in breast radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurpose:Evaluating the improvements of placing the treatment isocentre at the boost centre of mass (CoM) in a hybrid treatment for breast cancer radiotherapy.Material and methods:Twenty-two patients were planned in two isocentre locations with two forward intensity-modulated radiation therapy (fIMRT) tangentials to the breast and a volumetric-modulated arc therapy (VMAT) to the boost. A simultaneous integrated boost technique was used. Breast Boost (BB) Vector was investigated as a criterion for selecting an appropriate isocentre placement. Various metrics for boost, breast and hybrid plans were analysed using analysis of variance statistics.Results:Comparing hybrid plans at the boost CoM vs. hybrid plans at the breast CoM, no significant differences were found. Analysis of relative variations of planning target volume (PTV) boost coverage vs. BB Vector indicated an upgrade in boost CoM isocentre strategy. Dose to organs at risk was comparable: V5Gy (26·24 vs. 25·69%, p = 0·8), V20Gy (14·66 vs. 14·58%, p = 0·959) and the mean dose (7·37 Gy vs. 7·26 Gy, p = 0·879) to ipsilateral lung; V5Gy (15·60 vs. 15·22%, p = 0·903), and the mean dose (4·91 Gy vs. 4·86 Gy, p = 0·950) to heart and dose to free breast of boost (46·71 Gy vs. 46·62 Gy, p = 0·408).Findings:The hybrid fIMRT–VMAT technique centred at the boost CoM resulted equivalent to plans centred at the breast CoM, while benefiting from an enhancement in PTV boost coverage for patients with BB Vector superior to 5.
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Kustić D, Klarica Gembić T, Grebić D, Petretić Majnarić S, Nekić J. The role of different lymph node staging systems in predicting prognosis and determining indications for postmastectomy radiotherapy in patients with T1-T2pN1 breast carcinoma. Strahlenther Onkol 2020; 196:1044-1054. [PMID: 32710122 DOI: 10.1007/s00066-020-01669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Based on the risk of locoregional recurrence (LRR), postmastectomy radiotherapy (PMRT) is recommended in T1-T2pN1 breast carcinoma (BC). We aimed to elucidate our institutional strategies underlying selection of these patients for PMRT. In the no-PMRT subset, we compared various lymph node (LN) staging systems' abilities to predict 5‑year overall and locoregional-free survival (OS/LRFS). METHODS We retrospectively enrolled 548 women with T1-T2pN1 BC undergoing mastectomy and axillary LN dissection. Depending on PMRT delivery, the participants were divided into the PMRT and no-PMRT groups. Predictors of OS/LRFS were calculated for the no-PMRT group only. Based on Cox regression modelling, the number of positive LNs (PLN), negative LNs (NLN), LN ratio (LNR), log odds of PLN (LODDS), and modified LNR (mLNR) were modelled, each respectively, with OS model covariates (age, grade III, lymphovascular invasion [LVI], tumor size, hormone receptor [HR] status) and LRFS model covariates (age, grade III, LVI). The C‑statistic, Akaike information criterion, and likelihood ratio χ2 of the models were compared. RESULTS Median follow-up was 60.5 (18-82), 61 (28-82), and 60 (18-80) months for the entire cohort, PMRT, and no-PMRT group, respectively. The PMRT and no-PMRT groups had comparable OS (p = 0.235). LRFS was better (p = 0.030) in the PMRT group comprising 105 subjects (19.16%) who were younger, more likely to have a higher-grade, HR-, HER2+ tumors, more PLNs, fewer NLNs, Ki-67 ≥ 20%, LVI, and extranodal extension (p ≤ 0.001). In the no-PMRT group, LNR-based OS/LRFS models exhibited superior prognostic performance. CONCLUSION In early-stage BC patients undergoing mastectomies, LN dissections and no PMRT, we propose LNR-based multivariable models to predict OS/LRFS with superior accuracy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/secondary
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymphatic Irradiation
- Lymphatic Metastasis/radiotherapy
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Staging/methods
- Neoplasms, Hormone-Dependent/therapy
- Prognosis
- Proportional Hazards Models
- Radiotherapy, Adjuvant/methods
- Retrospective Studies
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Affiliation(s)
- Domagoj Kustić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Damir Grebić
- Clinic for Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Jasna Nekić
- Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
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Kim AY, Kim JH. Factors Influencing Quality of Life Among Breast Cancer Patients Following Immediate Breast Reconstruction. ASIAN ONCOLOGY NURSING 2020. [DOI: 10.5388/aon.2020.20.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Young Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Hye Kim
- Department of Clinical Nursing, University of Ulsan, Ulsan, Korea
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Klein J, Tran W, Watkins E, Vesprini D, Wright FC, Look Hong NJ, Ghandi S, Kiss A, Czarnota GJ. Locally advanced breast cancer treated with neoadjuvant chemotherapy and adjuvant radiotherapy: a retrospective cohort analysis. BMC Cancer 2019; 19:306. [PMID: 30943923 PMCID: PMC6448234 DOI: 10.1186/s12885-019-5499-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/20/2019] [Indexed: 12/31/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) is increasingly used to treat locally advanced breast cancer (LABC). Improved response to NAC correlates with better survival outcomes. The dual purpose of this study is to report recurrence and survival outcomes for LABC patients treated with NAC, surgery and adjuvant radiotherapy and to correlate these outcomes with tumour response after NAC using multiple response assessment methods. Methods All LABC patients treated for curative intent with NAC, surgery, and adjuvant radiotherapy at our institute between January 2009 and December 2014 were included for analysis. NAC was mostly anthracycline and taxane-based; radiotherapy consisted of 50 Gy to the breast/chest wall and regional lymph nodes. Response to NAC was categorized using synoptic pathology reports, modified-RECIST and Chevallier scores. Survival curves were generated by the Kaplan-Meier method and compared using the log-rank test. Results The cohort included 103 patients nearly equally divided between Stage II (n = 53) and Stage III (n = 50). Rates of locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were 99, 98, and 100% at 1 year and 89, 69 and 77% at 5 years, respectively. Responses to NAC did not correlate with LRC (p > 0.05) but did correlate with RFS and OS (p < 0.05), except that the Chevallier score did not predict RFS (p = 0.06). Using bivariate Cox modeling tumour size before (p = 0.003) and after (p < 0.001) NAC, stage group (p = 0.05), and response assessed by synoptic pathology (p = 0.05), modified-RECIST (p = 0.001), and Chevallier score (p = 0.015) all predicted for RFS. No factors predicted for LRC. Conclusion Pathologic response by all tested methods correlated with improved survival but were not associated with decreased LRC.
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Affiliation(s)
- Jonathan Klein
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2-067, Toronto, Ontario, M4N 3M5, Canada. .,Department of Medical Biophysics, University of Toronto, Toronto, Canada.
| | - William Tran
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2-067, Toronto, Ontario, M4N 3M5, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Elyse Watkins
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Danny Vesprini
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2-067, Toronto, Ontario, M4N 3M5, Canada
| | - Frances C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, and Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nicole J Look Hong
- Department of Surgery, Sunnybrook Health Sciences Centre, and Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sonal Ghandi
- Division of Internal Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Alex Kiss
- Institute of Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Gregory J Czarnota
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2-067, Toronto, Ontario, M4N 3M5, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
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Agrawal A. Oncoplastic breast surgery and radiotherapy-Adverse aesthetic outcomes, proposed classification of aesthetic components, and causality attribution. Breast J 2019; 25:207-218. [DOI: 10.1111/tbj.13193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Amit Agrawal
- Cambridge Breast Unit, Cambridge University Hospitals; Cambridge UK
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Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Abstract
Advances in imaging of the female breast have substantially influenced the diagnosis and probably also the therapy and prognosis of breast cancer in the past few years. This article gives an overview of the most important imaging modalities in the diagnosis of breast cancer. Digital mammography is considered to be the gold standard for the early detection of breast cancer. Digital breast tomosynthesis can increase the diagnostic accuracy of mammography and is used for the assessment of equivocal or suspicious mammography findings. Other modalities, such as ultrasound and contrast-enhanced magnetic resonance imaging (MRI) play an important role in the diagnostics, staging and follow-up of breast cancer. Percutaneous needle biopsy is a rapid and minimally invasive method for the histological verification of breast cancer. New breast imaging modalities, such as contrast-enhanced spectral mammography, diffusion-weighted MRI and MR spectroscopy can possibly further improve breast cancer diagnostics; however, further studies are necessary to prove the advantages of these methods so that they cannot yet be recommended for routine clinical use.
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Affiliation(s)
- M Funke
- Radiologische Klinik, Klinikum Baden-Baden, Balger Str. 50, 76532, Baden-Baden, Deutschland.
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Li Y, Zhong R, Wang X, Ai P, Henderson F, Chen N, Luo F. Effects of online cone-beam computed tomography with active breath control in determining planning target volume during accelerated partial breast irradiation. Cancer Radiother 2017; 21:99-103. [PMID: 28325619 DOI: 10.1016/j.canrad.2016.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE To test if active breath control during cone-beam computed tomography (CBCT) could improve planning target volume during accelerated partial breast radiotherapy for breast cancer. METHODS Patients who were more than 40 years old, underwent breast-conserving dissection and planned for accelerated partial breast irradiation, and with postoperative staging limited to T1-2 N0 M0, or postoperative staging T2 lesion no larger than 3cm with a negative surgical margin greater than 2mm were enrolled. Patients with lobular carcinoma or extensive ductal carcinoma in situ were excluded. CBCT images were obtained pre-correction, post-correction and post-treatment. Set-up errors were recorded at left-right, anterior-posterior and superior-inferior directions. The differences between these CBCT images, as well as calculated radiation doses, were compared between patients with active breath control or free breathing. RESULTS Forty patients were enrolled, among them 25 had active breath control. A total of 836 CBCT images were obtained for analysis. CBCT significantly reduced planning target volume. However, active breath control did not show significant benefit in decreasing planning target volume margin and the doses of organ-at-risk when compared to free breathing. CONCLUSION CBCT, but not active breath control, could reduce planning target volume during accelerated partial breast irradiation.
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Affiliation(s)
- Y Li
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
| | - R Zhong
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
| | - X Wang
- Division of Breast Surgery, Department of Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - P Ai
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
| | - F Henderson
- University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - N Chen
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China.
| | - F Luo
- Department of Radiation Oncology, Cancer center, West China Hospital of Sichuan University, N(o). 37 Guoxuexiang, Wuhou District, Chengdu, 610041, China
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Montero A, Sanz X, Hernanz R, Cabrera D, Arenas M, Bayo E, Moreno F, Algara M. Accelerated hypofractionated breast radiotherapy: FAQs (Frequently Asked Questions) and facts. Breast 2014; 23:299-309. [DOI: 10.1016/j.breast.2014.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 01/14/2014] [Accepted: 01/19/2014] [Indexed: 10/25/2022] Open
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11
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The use of radiotherapy for early breast cancer in woman at different ages. Clin Transl Oncol 2014; 16:680-5. [DOI: 10.1007/s12094-014-1164-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
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