Patient perceptions and expectations regarding imaging for metastatic disease in early stage breast cancer

Abstract Purpose The probability of detecting radiologically evident metastatic disease in asymptomatic women with newly diagnosed operable breast cancer is low. Despite the recommendations of most practice guidelines imaging is still frequently performed. Relatively little is known about what patients believe is important when it comes to radiologic staging. Methods Patients with early stage breast cancer who had completed their definitive breast surgery were surveyed about their personal experiences, perceptions, and expectations on the issue of perioperative imaging for distant metastatic disease. Results Over a 3 month period, 245 women with primary operable breast cancer completed the questionnaire (87.0% response rate) and 80.8% indicated having had at least one imaging test for distant metastatic disease. These were either of the thorax (72.2%), abdomen (55.9%) or skeleton (65.3%) with a total of 701 imaging tests (average of 3.5 tests per patient imaged) performed. Overall, 57.1% indicated that they would want imaging done if the chance of detecting metastases was ≤10%. Although 80.0% of patients indicated that, “doing whatever their doctor recommended” was important to them, 70.4% also noted that they would be uncomfortable if their physician did not order imaging, even if this was in keeping with practice guidelines. Conclusions Most patients with early stage breast cancer recall having imaging tests for distant metastases. Given the choice, most would prefer having imaging performed, even if this is not in line with current guidelines. If patient expectations are, in part, driving excessive imaging, new strategies addressing this are required

Définition de volumes anatomiques par une méthode de logique floue, à partir d'images tomographiques (évaluation et performance de la méthode sur des images par résonance magnétique nucléaire (IRM) et tomodensitométriques (TDM))

Les progrès de l'informatique ont permis l'installation et l'utilisation croissante pour le diagnostic de l'imagerie tomographique numérique: la tomodensitométrie (TMD ou scanographie), l'imagerie par résonance magnétique (IRM), la tomoscintigraphie à photon unique (SPECT) et la tomographie par émission de positon (TEP). Sur les différentes coupes tomographiques, il est donc possible de délimiter manuellement, ou automatiquement à l'aide de logiciels spécifiques, une structure anatomique. Ce volume sera reconstruit le plus souvent en reliant les contours 2 dimensions (2D) associés à chaque coupe par des facettes, selon diverses techniques. Cette reconstruction permet la visualisation dans les 3 dimensions (3D) de la structure anatomique et permet aussi de quantifier son volume. Pour des raisons anatomiques mais aussi des raisons liées aux appareils d'imagerie et liées aux caractéristiques de la formation de l'image en coupe, il existe des incertitudes et des imprécisions dans la définition des contours 2D qui induisent donc des erreurs lors de la création du volume. Nous avons développé une nouvelle méthode de reconstruction de volume basée sur une méthode de logique floue (LF) permettant un raisonnement 3D avec une définition de volume à construire délimité par une iso surface. Dans le même temps, ces progrès de l'informatique ont permis la mise en place de calculs de dose tri-dimensionnels avec des logiciels exploitant les informations de l'imagerie tomographique numérique, et notamment la représentation 3D des structures anatomiques. Les progrès des équipements technologiques des accélérateurs linéaires et de nouveaux appareils d'irradiation permettent de délivrer et de moduler le flux de photons, donc la dose d'irradiation. Cet ensemble a permis de développer et utiliser en routine la radiothérapie conformationnelle 3D. Dans ce contexte, nous avons évalué la précision et la robustesse de la méthode logique floue pour la reconstruction de structures et volumes tumoraux à partir d'images IRM et TDM. Les résultats ont montré la précision et la robustesse de cette nouvelle méthode de reconstruction. Sur la base d'une revue de la littérature, une réflexion a été menée sur la place de cette méthode ou autre outil mathématique pour aider à la décision de traitement et notamment la définition des volumes tumoraux microscopiques. Enfin, nous avons essayé de montrer les liens très étroits entre la radiologie et la radio-oncologie qui évolue vers une irradiation thérapeutique guidée par l'image.Modalities of digital tomographic images, such as computer tomography scanner (CT-scanner), magnetic resonance imaging (MRI), single photon emission tomography (SPECT), position emission tomography (PET) have been implemented over the last decades, folowing the dramatic improvements in informatics. From tomography slices, a contour of any structure can be delineated manually or using automatic procedures. A volume can be created, usually by joining the stack of the several 2 dimensions (2D) contours and by surfacing with a specific algorithm. Then, an anatomical structure can be visualized in 3 dimensions (3D) and its volume can also be quantified. Due to shapes of anatomical structures but also due to analysis of signal in digital tomography images, 2D contours are created with uncertainties and inaccuracies leading to deviations from the original structure. To resolve these issues, we have developed a method of 3D reconstruction based on a fuzzy logic method. A structure in reconstructed not by a stack of 2D contours but by a real 3D enveloppe based on a voxel unit. Also over the last decades, we have seen dramatic changes in radiation oncology thank to informatics and imaging improvements. The treatment planning software are now able to calculate the 3D dose distribution on reconstucted 3D tumoral volume. Also, technology of linear accelerator and new type of radiation delivery are able to modulate and conform the delivery of the dose to the shape of the 3D tumoral volume while avoiding the normal tissue structures: the concept of 3D conformal radiotherapy is born. In this era of 3D images, accuracy and robustness of our fuzzy logic method in reconstruction and quantifying structures and tumoral volumes on MRI and CT-scanner images were evaluated. Accuracy and robustness of our method were demonstrated and confirmed by the results. Based on an extensive review of litterature about breast cancer, we try to develop a medical decision tool to help the radiation oncologist to define microscopic extension of the disease. Trough this report, we have tried to emphasize that there is now strong links and connections between radiology and radiation oncology, which is quickly evolving to images guided radiation therapy (IGT).LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Radiothérapie exclusive après chimiothérapie néoadjuvante pour des cancers du sein opérables (à propos de 53 patientes)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Report on the Clinical Outcomes of Permanent Breast Seed Implant for Early-Stage Breast Cancers

Purpose: Permanent breast seed implant is an accelerated partial breast irradiation technique realizing the insertion of 103 Pd seeds in the seroma after lumpectomy. We report the 5-year efficacy and tolerance for a cohort, pooling patients from 3 clinical trials. Methods and Materials: The trials accrued postmenopausal patients with infiltrating ductal carcinoma or ductal carcinoma in situ Results: The cohort included 134 patients, and the observed local recurrence rate at a median follow-up period of 63 months was 1.2% +/- 1.2%, similar to the estimate for whole breast irradiation (P=.23), significantly better than for surgery alone (relative risk 0.27; P Conclusions: The 5-year data suggest that permanent breast seed implantation is a safe accelerated partial breast irradiation option after lumpectomy for early-stage breast cancer with a tolerance profile similar to that of whole breast irradiation. (C) 2015 Elsevier Inc. All rights reserved

IMRT sparing of normal tissues in locoregional treatment of breast cancer

Abstract Purpose This clinical study was designed to prospectively evaluate the acute and moderately-late cardiac and lung toxicities of intensity modulated radiation therapy delivered by helical tomotherapy (IMRT-HT) for locoregional breast radiation treatment including the internal mammary nodes (IMN). Material/methods 30 patients with stage III breast cancers have been accrued in this study. All patients received adjuvant chemotherapy. Target volumes were defined as follows: the PTV included breast/chest wall, axillary level II, III, infra/supraclavicular, IM nodes CTVs plus 3 mm margins. The heart with subunits and the lungs were defined as critical organs. Dose to PTV was 50 Gy in 25 fractions. Acute toxicities were assessed every week and 2 weeks post treatment using the CTCAE v3.0.scale. The moderately-late toxicities were assessed clinically plus by cardiac myoview perfusion tests scheduled at baseline, 3 and 12-month follow-up, as well a CT chest at the 6 month follow-up. The data analysis is descriptive. Results All participants completed the 5-week course of radiation without interruption. Skin erythema was modest and mainly grade 1–2 between the 3rd and the 5th week of radiation treatment. Only 4/30 patients experienced grade 3 skin reactions, mostly seen 2 weeks post radiation. Only 5 patients demonstrated grade 1 or 2 dyspnea, but 3 of them already had symptoms pre-radiation treatment. With a median follow-up of 58 (24–76) months, there have been infrequent moderately-late side effects. Most were grade 1 and were sometimes present at the baseline assessment. Cardiac myoview tests done at baseline and 1-year follow-up for 15 out of 18 left sided breast cancers did not show any abnormalities related to radiation. The 6-month follow-up chest CT-scans done for 25 out of 30 patients showed minimal anterior lung fibrosis for 7 patients and were completely normal for the other 18. No locoregional recurrence has been recorded and the 5-year survival is 78% (95% CI: 70-97%). Conclusion IMRT-HT for locoregional breast radiation is very well tolerated with minimal acute or moderately-late side effects. Cardiac and respiratory tests did not show any strong evidence of significant treatment related abnormalities. Trial registration clinicaltrials.gov: http://NCT00508352