AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

Déformation d'un continent au-dessus d'une dorsale océanique active en subduction

The spreading ridge subduction is an unavoidable process during the subduction-related belt elovution. The aim of this thesis concerns the evolution of the Central Patagonian Cordillera, at the latitude of the Chile triple junction, in relation with the Chile spreading ridge subduction inducing the opening of a slab-window beneath the South American plate. By a morphologic, and a structural analysis, coupled with the analysis of satelittes and topographic images, we show the influence of the slab-window development at 3 Ma on the morphostructural evolution of the Central Patagonia. During the Pliocene, the Central Patagonian Cordillera experiences a major extensional phase inducing the formation of transverse and internal depressions. Negative tectonic inversion, responsible to the rift-type topography, induces the inversion of the morphotectonic front and the disruption of the volcano-sedimentary piedmont with the rest of the Cordillera at 3 Ma. Radial extensional regime is characterized by a magnitude comprises between 800 m and 3500 meters and vertical movements are localized along polyphazed faults. We suggest that the Plio-Quaternary morphostructural evolution is related to the opening of the slab-window at 3 Ma beneath the Central Patagonia. The upwelling of asthenospheric hot mantle through the slab window induces the regional collapse of the Central Patagonian Cordillera.La subduction d'une dorsale active sous un continent est un processus inévitable dans l'évolution des chaînes de subduction. Le travail de cette thèse concerne l'évolution de la Cordillère de Patagonie Centrale, à la latitude du point triple du Chili, en relation avec la subduction de la dorsale active du Chili induisant le développement d'une fenêtre asthénosphérique sous la plaque sudaméricaine. A l'aide d'une approche morphologique, structurale, couplée à l'analyse d'images satellites et topographiques, nous montrons l'influence de la fenêtre asthénosphérique depuis 3 Ma sur l'évolution morphostructurale de la Patagonie Centrale. Au cours du Pliocène, la Cordillère de Patagonie Centrale est marquée par une phase d'extension majeure induisant la formation de dépressions transverses et internes à la chaîne. L'inversion négative du relief responsable de la topographie générale de type rift induit l'inversion du front morphotectonique et la déconnexion du piedmont volcano-sédimentaire du reste de la Cordillère à partir de 3 Ma. L'extension radiale dont l'amplitude est comprise entre 800 mètres et 3500 mètres, se localise dans la plupart des cas au niveau de failles polyphasées. L'évolution morphostructurale plioquaternaire proposée est directement reliée à l'ouverture de la fenêtre asthénosphérique à 3 Ma sous la Patagonie et à la remontée de matériel asthénosphérique chaud induisant la collapse régionale de la Cordillère de Patagonie Centrale

Subduction de dorsales actives et atténuation des cordillères de type Andine

International audienceWe address the possible link between the age of subducting oceanic lithosphere and growth of elevated cordilleras versus extension-dominated arc regions. Singularity exists in South America: the lowest elevated Andean segments are found in Patagonia where the active Chile Ridge enters the trench. Subduction of active ridge triggers thermal doming, crustal extension and attenuation of former cordilleras. At the Antarctica–South America connection, three active ridge subductions induced the disruption of a former continuous cordillera during the opening of Drake Passage. Active ridge subduction induces lithosphere thermal erosion and related crustal extension in the upper plate. Evolution of regions worldwide experiencing ridge subduction confirms this hypothesis

Relief inversion triggered by subduction of an active spreading ridge: evidence from glacial morphology in Central Patagonia

International audienceThis study examines the response of the Central Patagonian Cordillera to the subduction of the active South Chile Ridge and the development of the asthenospheric slab window beneath Patagonia since the Pliocene. We investigated the eastern part of the Cordillera where the glacio-volcanic piedmont is topographically inverted. Glacial morphology and associated deposits capping the top of these piedmonts reveal that during the Pliocene (after 3 Ma), glaciers were flowing to the east over a regional surface connecting the western Cordillera and the palaeo-piedmont. N160-trending normal faulting along the western edge of the inverted plateau disrupted the geomorphic surface after 3 Ma. At a regional scale, extensional tectonics is responsible for a relief inversion with a minimum value of 800 m. The timing of extensional tectonics is contemporaneous with the subduction of the spreading axis and the development of the slab window beneath Central Patagonia

Mio-Pliocene glaciations of Central Patagonia: New evidence and tectonic implications

Patagonia is well known for spectacular occurrences of a variety of glacial-derived landforms and deposits and for a long history of ancient glaciations. In this paper, we first review the diverse evidence that demonstrates the development of glacial-related sedimentary units within the Central Patagonian Cordillera since 7 Ma. Well preserved glacial landforrns at the top surface of mesetas on both sides of the Lago General Carrera-Buenos Aires are described: the Meseta Guenguel to the north, and the volcanic Meseta del Lago Buenos Aires to the south. The latter meseta corresponds to a 3 Ma old, morphologically inverted paleo-piedmont, based on Ar/Ar dates of the uppermost lava flows. It shows evidence of glacier advances to the NE direction. Over a distance of 20 km, glacial landforms observed by remote sensing data and digital elevation model define glacial tongues that were fed by the Cordillera reliefs to the west. These lobes are now beheaded from their westward sources along a morpho-structural corridor that bounds the Meseta del Lago Buenos Aires to the west. These remnants can be correlated with the oldest glacial landforms recognized north of Lago General Carrera-Buenos Aires, on the Meseta Guenguel that form the Chipanque moraine system. From these features it is concluded that the glacial drainage network of Central Patagonia has been strongly modified following relief inversion in response to erosion processes and to tectonic causes. Changes occurred after 3 Ma, from a smooth piedmont surface covered by an extensive ice mantle ending with ample glacial lobes, to the current series of deeply incised glacial valleys such as the Lago General Carrera-Buenos Aires depression. These new data bear important constraints on the history and development of the first glaciations in southern South America

Crustal structure and gravity anomalies beneath the Rif, northern Morocco: implications for the current tectonics of the Alboran region

International audienceWe analyse Bouguer anomaly data and previously published Moho depths estimated from receiver functions in order to determine the amount of isostatic compensation or uncompensa-tion of the Rif topography in northern Morocco. We use Moho depth variations extracted from receiver function analyses to predict synthetic Bouguer anomalies that are then compared to observed Bouguer anomaly. We find that Moho depth variations due to isostatic compensation of topographic and/or intracrustal loads do not match Moho depth estimates obtained from receiver function analyses. The isostatic misfit map evidences excess crustal root as large as 10 km in the western part of the study area, whereas a 'missing' crustal root of ∼5 km appears east of 4.3 • E. This excess root/missing topography correlates with the presence of a dense mantle lid, the noticeable southwestward drift of the Western Rif area, and with a current surface uplift. We propose that a delaminated mantle lid progressively detaching westward or southwestward from the overlying crust is responsible for viscous flow of the ductile lower crust beneath the Rif area. This gives rise to isostatic uplift and westward drift due to viscous coupling at the upper/lower crust boundary. At the same time, the presence of this dense sinking mantle lid causes a negative dynamic topography, which explains why the observed topography is too low compared to the crustal thickness

Subduction of the South Chile active spreading ridge: A 17 Ma to 3 Ma magmatic record in central Patagonia (western edge of Meseta del Lago Buenos Aires, Argentina)

International audienceThe Chile Triple junction is a natural laboratory to study the interactions between magmatism and tectonics during the subduction of an active spreading ridge beneath a continent. The MLBA plateau (Meseta del Lago Buenos Aires) is one of the Neogene alkali basaltic plateaus located in the back-arc region of the Andean Cordillera at the latitude of the current Chile Triple junction. The genesis of MLBA can be related with successive opening of slabs windows beneath Patagonia: within the subducting Nazca Plate itself and between the Nazca and Antarctic plates. Detailed Ar-40/Ar-39 dating and geochemical analysis of bimodal magmatism from the western flank of the MLBA show major changes in the back-arc magmatism. which occurred between 14.5 Ma and 12.5 Ma with the transition from calc-alkaline lavas (Cerro Plomo) to alkaline lavas (MLBA) in relation with slab window opening. In a second step, at 4-3 Ma, alkaline felsic intrusions were emplaced in the western flank of the MLBA coevally with the MLBA basalts with which they are genetically related. These late OIB-like alkaline to transitional basalts were generated by partial melting of the subslab asthenosphere of the subducting Nazca plate during the opening of the South Chile spreading ridge-related slab window. These basalts differentiated with small amounts of assimilation in shallow magma chambers emplaced along transtensional to extensional zones. The close association of bimodal magmatism with extensional tectonic features in the western MLBA is a strong support to the model of Patagonian collapse event proposed to have taken place between 5 and 3 Ma as a consequence of the presence of the asthenospheric window (SCR-1 segment of South Chile Ridge) below the MLBA area

Geometry of the coastline and morphology of the convergent continental margin of Ecuador

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A morphotectonic analysis of central Patagonian Cordillera: Negative inversion of the Andean belt over a buried spreading center?

International audienceWe use digital elevation models and satellite imagery data completed with field observations to develop an integrated morphotectonic analysis of the anomalous topography of the Central Cordillera of Patagonia between 46 degrees S and 48 degrees S, in a region overlying subducted segments of the Chile Spreading Ridge. This region shows a number of peculiar features, not expected in a normal subduction-related belt located away from a buried spreading center. First, it is characterized by overall short-wavelength topography and highly contrasted reliefs, typical of deeply incised young mountain belts, but surprisingly, also by an average very low elevation of similar to 900 m. Second, the Cordillera lacks central high reliefs; instead, there is a central, depressed domain with average low slope gradients including the deepest point of the study area (300 m below sea level in the bottom of Lake General Carrera/Buenos Aires). This depressed area is flanked by western and eastern regions of higher elevation having opposite general slope dips. To the east, the central Patagonian Cordillera is now separated from the flat plains of the Pampean domain (representing its former piedmont) and several elevated basaltic plateaus (mesetas) by 160 degrees N-180 degrees N trending morphotectonic corridors and the western border scarps of the mesetas. These scarps correspond to neotectonic features controlled by recent vertical faults, mostly active after 3 Ma. Remnants of a former peneplain, the Avellanos surface, are widespread within the entire Cordilleran region. From geological evidence, this peneplain formed between 15 and 4 Ma and was connected originally with the mesetas domain and now is dissected by these corridors. It is shown that a negative inversion related to extensional and strike-slip faulting occurred in the frontal region of the Cordillera at 3 Ma synchronously with the emplacement of magmatic products. Timing of the extensional deformation in central Patagonia is concomitant with the migration at depth of different segments of the South Chile Ridge, which entered the trench at 6 and 3 Ma, respectively, and the consequent opening of a slab window allows asthenospheric hot mantle to reach lithospheric regions. Finally, migration of segments of the Chile Spreading Ridge since 6 Ma triggered regional uplift of the Cordillera followed by limited extension in relation with increased thermal weakening of the crust