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Manouchehri K, Lokhandwala A, Jayatilaka A, Hadedeya D, Yaremko BP, Brackstone M, Perera FE, DeLyzer T, Grant A, Lock MI. Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT): A Retrospective Case-Cohort Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e192-e193. [PMID: 37784831 DOI: 10.1016/j.ijrobp.2023.06.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients are increasingly offered implant-based reconstruction prior to radiotherapy. However, it is unclear if the radiation treatment technique itself impacts upon toxicity. We performed this study to compare outcomes following implant-based reconstruction amongst breast cancer patients treated with a standard radiotherapy technique that irradiates the entire chest wall versus a novel technique which uses a smaller clinical target volume (CTV) to spare the implant. Need for corrective surgery, capsular contracture, and cosmetic outcomes were evaluated, with the hypothesis that the novel technique would result in fewer adverse outcomes and less need for corrective surgery. MATERIALS/METHODS A retrospective case-cohort analysis of 57 patients who had post-mastectomy, implant-based reconstruction was conducted. Patients with invasive mammary carcinoma (IMC) or ductal carcinoma in-situ (DCIS) who were treated either with the novel radiotherapy technique (n = 26) or standard PMRT (n = 31) were included. Patient demographics such as age, BMI, TNM stage, implant size, hormone receptor status, and radiation course was collected. Primary endpoint was the need for corrective surgery within two years and cosmetic outcomes, measured using the Baker Classification Scale for capsular contracture and the Modified Harvard Harris Cosmetic Scale. Secondary endpoint was radiation-induced toxicity measured using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE). Cosmesis and toxicity were evaluated at 3 months post-radiation, 1 year, and after 13 months. Unpaired t-tests were used to compare need for corrective surgery, cosmesis (Baker Grade 2 or higher and Harvard Harris "Good" or worse), and toxicity (NCI CTCAE Grade 2 or higher). RESULTS For the primary endpoint, need for corrective surgery, there was no significant difference between the novel and standard groups (two-sided p = 0.378, CI -0.38-0.14). The other primary endpoint of cosmesis, measured with the Baker scale and Harvard Harris, was also not significantly different (two-sided p = 0.147, CI -0.06-0.45), with the Harvard Harris cosmesis differences remaining insignificant across the 3 month, 1 year, and greater than 13 month periods (two-sided p = 0.854, 0.351, 0.468, respectively). The secondary endpoint, toxicity, was not significantly different between the novel and standard PMRT groups across 3 months and 1 year time periods (two-sided p = 0.328, 0.323, respectively). We will also be reporting the analysis for predictive factors related to toxicity, need for corrective surgery and cosmesis. CONCLUSION Compared with standard PMRT, the novel technique was not significantly different in rates of reoperation, toxicity and cosmetic outcomes. Better understanding the factors involved in PMRT outcomes for breast cancer patients with implant-based reconstructions will aid in the development of standardized approaches to treating the breast cancer patient population.
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Affiliation(s)
- K Manouchehri
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - A Lokhandwala
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - A Jayatilaka
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - D Hadedeya
- London Health Sciences Centre, London, ON, Canada; Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - B P Yaremko
- London Health Sciences Centre, London, ON, Canada
| | - M Brackstone
- London Health Sciences Centre, London, ON, Canada
| | - F E Perera
- London Health Sciences Centre, London, ON, Canada; London Regional Cancer Centre, University of Western Ontario, London, ON, Canada
| | - T DeLyzer
- London Health Sciences Centre, London, ON, Canada; Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - A Grant
- London Health Sciences Centre, London, ON, Canada; Div Plastic & Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada
| | - M I Lock
- London Health Sciences Centre, London, ON, Canada; London Regional Cancer Program, London, ON, Canada
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Da Silva T, Lokhandwala A, Al Kaabi N, Semenchuk J, Goobie GC, Camacho E, Reid WD, Fisher JH, Ryerson CJ, Rozenberg D. Characterization and reliability of internet resources on pulmonary rehabilitation for individuals with chronic lung disease. Chron Respir Dis 2023; 20:14799731231158119. [PMID: 36790021 PMCID: PMC9936390 DOI: 10.1177/14799731231158119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Individuals with lung disease commonly use the internet as a source of health information on pulmonary rehabilitation (PR). The objective of this study was to characterize internet resources on PR, and to assess the content, readability, and quality of patient-directed PR resources. METHODS The first 200 websites for the search term 'pulmonary rehabilitation resources and exercise' were analyzed on Google, Yahoo, and Bing. Website content was assessed based on 30 key components of PR from the 2013 and 2021 international consensus statements. Website quality was determined using DISCERN, JAMA benchmarks, and Global Quality Scale (GQS). RESULTS 66 unique PR websites were identified with the two most common categories being scientific resources (39%) and foundation/advocacy organizations (33%). The average reading level of websites was 11 ± 3. PR content varied significantly across websites (mean range 13.4-21.5). Median DISCERN total score and GQS score were 4 (IQR 3-4) and 3.5 (IQR 2-4), respectively, representing moderate-good quality. Foundation/advocacy websites had higher DISCERN and GQS scores compared to other websites. CONCLUSION Foundation/advocacy websites had the highest quality and reliability metrics; however, the higher-than-recommended reading levels may compromise patient comprehension and utilization. This study provides critical insight on the current state of online PR health-related information.
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Affiliation(s)
- Tania Da Silva
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ashira Lokhandwala
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Noor Al Kaabi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Julie Semenchuk
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Gillian C Goobie
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Encarna Camacho
- Division of Respirology, Temerty Faculty of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada,Interdepartmental Division of Critical Care Medicine, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jolene H Fisher
- Division of Respirology, Temerty Faculty of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada,Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Dmitry Rozenberg
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada,Division of Respirology, Temerty Faculty of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada,Toronto Lung Transplant Program, Ajmera Transplant Centre, University Health Network, Toronto, ON, Canada,Dmitry Rozenberg, Toronto General Hospital Research Institute, 200 Elizabeth Street, 13 EN-229, Toronto, ON M5G 2C4, Canada.
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Jayatilaka A, Lokhandwala A, Manouchehri K, Brackstone M, Lock M. Are Radiation Target Volumes for Postmastectomy Radiation Therapy Too Large? Initial Report of the Complication Avoidance of Reconstruction Implant Radiation Therapy (CARIT) Study. Curr Oncol 2023; 30:2271-2276. [PMID: 36826136 PMCID: PMC9954939 DOI: 10.3390/curroncol30020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
Following mastectomy for breast cancer, women may choose implant-based reconstruction for many reasons, such as cosmesis, self-identity, and the ability to wear particular items of clothing. However, postmastectomy radiation therapy (PMRT) can compromise these cosmetic goals, including as much as a 40% loss of implant rate. To minimize the risk of radiation toxicity, it is important to consider how clinical target volumes (CTVs) can be optimized in PMRT to preserve the implant and reduce complications. Typically, guidelines from organizations such as the Radiation Oncology Group are used, which include regions previously encompassed by tangential fields. This includes all structures below the pectoralis muscle, such as the chest wall, where the risk of recurrence is negligible; this technique often requires incidental inclusion of portions of the lung and heart plus circumferential radiation of the implant. We present the preliminary single institution case series of a technique of complication avoidance of reconstruction implant radiation therapy, called CARIT, where the chest wall, and a large proportion of the implant, is not irradiated. In a retrospective review of 30 cases in which CARIT has been attempted, it was found that 24% of patients treated required a second surgery due to Baker grade III/IV capsular contracture. Using the Modified Harvard Harris Cosmetic Scale, 66.5% of patients had cosmetic outcomes rated as "good" or "excellent". CARIT could offer a technique to reduce complications in postmastectomy implant-based reconstruction patients, with our next steps focusing on improving dosimetry, and formally comparing the cosmesis and tumor control aspects with commonly used techniques.
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Affiliation(s)
- Aruni Jayatilaka
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Ashira Lokhandwala
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Kimya Manouchehri
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Muriel Brackstone
- Department of Oncology, London Regional Cancer Program, London, ON N6A 5W9, Canada
- Division of General Surgery, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Michael Lock
- Department of Oncology, London Regional Cancer Program, London, ON N6A 5W9, Canada
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