Impact of the New ESTRO-ACROP Target Volume Delineation Guideline on Breast-Related Complications after Implant-Based Reconstruction and Postmastectomy Radiotherapy

PURPOSE/OBJECTIVE(S)

The European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) recently updated a new target volume delineation guideline for postmastectomy radiotherapy (PMRT) after implant-based reconstruction. This study aimed whether this change has impact on breast-related complications.

MATERIALS/METHODS

We retrospectively reviewed patients who underwent PMRT after mastectomy with tissue expander or permanent implant insertion from 2016 to 2021. In total, 412 patients were included; 277 received RT by the new ESTRO-ACROP target delineation (ESTRO-T), and 135 received RT by conventional target delineation (CONV-T). The primary endpoint was comparison between the target groups of major breast-related complication, including infection, capsular contracture, deformity and necrosis requiring re-operation or re-hospitalization during follow-up after RT or delayed implant replacement. Complications were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0., and capsular contracture was graded by the Baker Classification.

RESULTS

The median follow-up was 29.5 months (range, 0.3-76.8). The 1-, 2-, and 3-year incidence rates of major breast-related complication were 5.7%, 10.0%, and 11.6% in the ESTRO-T group, and 8.2%, 13.8%, and 14.7% in the CONV-T groups; it did not show a difference between the groups (P = 0.55). In multivariate analyses, target delineation is not significantly associated with the major complications (hazard ratio [HR] = 0.93; P = 0.83, Table 1). There was no significant difference between the ESTRO-T and CONV-T groups in the incidence of any breast-related complications (3-year cumulative incidence, 37.3% vs. 29.4%, respectively; P = 0.28). Symptomatic RT-induced pneumonitis rates were 2.7% in the ESTRO-T group (7 patients) and 2.2% in the CONV-T group (3 patients). Only one local recurrence event occurred in the ESTRO-T group, which was within the ESTRO-target volume.

CONCLUSION

Target volume delineation according to the new ESTRO-ACROP guideline did not reduce the risk of major or any breast-related complications. As the dosimetric benefits of heart and lung have been reported, further analyses with long-term follow-up are necessary to evaluate whether it could be connected to better clinical outcomes.

Temporal changes in functional magnetic resonance imaging activation of heterosexual couples for visual stimuli of loved partners

OBJECTIVE

Previous neuroimaging studies on romantic love have focused on determining how the visual stimuli that serve as a representation of loved ones induce the neural activation patterns of romantic love. The purpose of this study was to investigate the temporal changes in romantic love over a period of 6 months and their correlated neurophysiological changes.

METHODS

Five heterosexual couples (n=10, mean age 21.1+/-1.97) who started dating not less than 100 days previously were recruited to measure their blood oxygen level dependent (BOLD) signals using functional magnetic resonance imaging (fMRI) while showing them pictures of their loved ones and their previously identified, opposite-sex friends. Subsequently, the subjects were scanned under the same experimental conditions to assess possible changes in their brain activities after 180 days.

RESULTS

WE FOUND THAT THEIR PASSIONATE LOVE SCORE (PLS) VALUES (M: 118.6+/-9.1, F: 120.2+/-7.0) were significantly reduced after 6 months (M: 110.8+/-4.0, F: 106.2+/-3.0). Furthermore, significantly increased activations were found in the cingulate gyri, inferior frontal gyri, supramarginal gyri, etc., after 6 months, whereas the head and tail of the right caudate nucleus were deactivated, which is indicative of the inhibition of expression and sensory neglect.

CONCLUSION

These findings suggest that dynamic neural processes in the cortical-subcortical regions are involved in temporal changes in romantic love.

Kinetics of rac-1-oleyl-2-[4-(3-pyrenyl)butanoyl]glycerol transfer between high density lipoproteins

The mechanism of transfer of diglyceride between high density lipoproteins (HDL) was investigated with a pyrene-containing analogue whose fluorescent properties depend on the microscopic concentration in the lipoprotein. Transfer rates were first order, rapid (3.5s-1), and invariant over a 100-fold range of HDL concentration and over a 10-fold range of rac-1-oleyl-2-[4-(3-pyrenyl)butanoyl]glycerol concentrations. Similar behavior of the probe was observed with HDL3, although the rate was 40% slower. These results support a mechanism in which rate-limiting dissociation of the diglyceride analogue from one HDL particle into the aqueous phase precedes rapid diffusion and subsequent uptake by another such particle.

Stopped flow kinetics of pyrene transfer between human high density lipoproteins

The transfer of pyrene between high density lipoproteins was studied as a model of lipid exchange. When high density lipoprotein containing pyrene was mixed with unlabeled lipoprotein, pyrene excimer fluorescence decreased with a half-time of approximately 3 ms. The rate of pyrene transfer was invariant over a 100-fold range of unlabeled lipoprotein concentrations. Since a decrease in excimer fluorescence indicates a decrease in the microscopic concentrations of pyrene, the observed fluorescence change relfects pyrene transfer to unlabeled lipoproteins, and, therefore, dilution of the pyrene molecules. When high density lipoprotein labeled with pyrene was rapidly diluted 1:14 into buffer, a small decrease in excimer fluorescence was observed. The half-time of this fluorescence change was also about 3 ms and represents the half-time for the dissociation of pyrene from high density lipoprotein into water. The latter observation, coupled with the invariant exchange rate with lipoprotein concentration suggests strongly that the limiting step in the transfer of pyrene between high density lipoproteins is the dissociation of pyrene into solvent. Finally, regardless of mechanism, the exchange of pyrene, and presumably other hydrophobic aromatic compounds, among serum high density lipoproteins is extremely fast. This result indicates that these types of compounds can be rapidly assimilated and transported through the body by plasma lipoproteins.

Hot Hydrogen Atoms: Initiators of Reactions of Interest in Interstellar Chemistry and Evolution

Photochemically generated hot hydrogen atoms initiate reactions with simple molecular substrates including methane to produce organic alcohols, amines, acids, amino acids, and other compounds. The typical quantum yields for the formation of amino acids are 2 x 10(-5) to 4 x 10(-5). Hot hydrogen atoms may be important initiators of reactions in interstellar space and in planetary atmospheres.