The breast journal
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Locally advanced breast cancer (LABC) is a disease that is heterogeneous in its presentation, potentially curable, and generally necessitating multidisciplinary management. Radiation therapy (RT) plays an important role in the management of LABC. The integration of radiation with surgery, chemotherapy, and sometimes breast reconstruction can be complex. ⋯ The American College of Radiology Appropriateness Criteria is evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is either lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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The current standard therapeutic option for early stage breast cancer (EBC) employs a multimodality treatment approach including conservative surgery, radiotherapy, chemotherapy, and hormone therapy. The most common adjuvant radiotherapeutic strategy consists of external beam radiation therapy (EBRT) delivered to the whole breast using 1.8-2 Gy fractions given five times a week, up to a total dose of 45-50 Gy over a period of 5 weeks. In recent years, altered schedules employing larger dose per fraction delivered in fewer treatment sessions over a shorter overall treatment time began to be explored. ⋯ Only 2% of the patients experienced grade 3 skin toxicity at the very end of the radiotherapy course. Cosmetic result was assessed and scored at 6 months, 1 year, 2 years: 100% of patients showed excellent or good cosmetic result. The explored accelerated hypofractionated adjuvant radiotherapeutic approach for early breast cancer with concomitant photon boost seems to be feasible providing consistent clinical results with excellent short-to-medium-term toxicity profile.
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The purpose of this study was to compare short-term versus long-term axillary drainage in women treated for lymph node positive breast cancer. A comparative cohort study on differences between short-term or long-term axillary drainage was performed. Primary outcome measures were seroma formation demanding aspiration and wound related complications. ⋯ Short-term axillary drainage does not lead to an increase in wound-related problems, but is associated with a higher incidence of seroma. This seems especially the case in patients who underwent MRM. Therefore, we propose a differentiated policy: patients treated with MRM should be offered long-term axillary drainage, whereas patients treated with breast conserving therapy and ALND or completing ALND after a positive sentinel node should be offered short-term axillary drainage.