Cosmetic outcome 1–5 years after breast conservative surgery, irradiation and systemic therapy

More than 35 years ago, calls were made for research on the constitutive role of accounting. Since then, many statements have been made to specify what accounting is or is not. This study describes what accounting does, in order to amalgamate a fragmented picture of accounting in practice, instead of seeking the answer to the existential question of what accounting really is. The purpose of this study was to investigate and describe what accounting does, and how this is done on the basis of business meetings in order to contribute to a better understanding of the role of accounting in practice.This study is based on the actor-network theory approach. Particular attention hasbeen paid to accounting as named numbers, when becoming a performative participantin framed situations. The framed situations of business meetings contained three elements; 1) pure calculation, 2) qualculation which include both calculation and judgments, and 3) calqulation as a collective social process. An ethnographically inspired field studywas carried out at Eton Fashion AB, a Swedish shirt making company. Data was collected by participant observations of business meetings supported by interviews. Photography, sound recording, and field notes were used as techniques for documentation.Diagnoses of five business meetings revealed that; 1) accounting restricted time,place and content, 2) accounting brought past and future into the present, 3) accounting summarized and obscured discontinuities, 4) accounting defined people and things, and 5) accounting called for the filling of content. Accounting became an actor in these five ways as they were allied with people and things that appeared in the meetings. Accounting was in a context where people made sense of situations by making both estimates and judgments. During the meetings, an ongoing reduction of complexity was taking place. Step by step, diversity and complexity were reduced until an order filled with numbers was the only thing remaining. At the same time, something was gained, as we step by step achieved greater legibility, transportability and universality. In this way the situation could subsist. It might move to new situations and it might allow for new summaries and new situations to take place. The situation of a meeting contained elements of pure calculation representing the cold, anonymous and empty part. Oftenthough, calculation, because of its emptiness, initiated for qualculation and calqulation to begin. Accounting as an idea is a taken for granted phenomenon, with influence, often far beyond what we can see when we find ourselves in a given situation. I conclude that it could have been some other way. It is not accounting in itself, its own excellence or ability to represent the truth, which makes it successful. The success story of accounting is simply about “the others” with whom accounting is an ally.För avläggande av ekonomie doktorsexamen i företagsekonomi som med tillstånd av Handelshögskolans fakultetsnämnd vid Göteborgs universitet framlägges för offentlig granskning fredagen den 30 mars kl. 13.15 i CGsalen vid Företagsekonomiska institutionen, Vasagatan 1, Göteborg

Individual positioning: a comparative study of adjuvant breast radiotherapy in the prone versus supine position

PURPOSE: To study breast radiotherapy in the prone vs. supine positions through dosimetry and clinical implementation. METHODS AND MATERIALS: Conformal radiotherapy plans in 61 patients requiring only breast irradiation were developed for both the prone and supine positions. After evaluation of the of the first 20 plan pairs, the patients were irradiated in the prone or supine position in a randomized fashion. These cases were analyzed for repositioning accuracy and skin reactions related to treatment position and patient characteristics. RESULTS: The planning target volume covered with 47.5-53.5 Gy in the prone vs. the supine position was 85.1% +/- 4.2% vs. 89.2 +/- 2.2%, respectively (p < 0.0001). Radiation exposure of the ipsilateral lung, expressed in terms of the mean lung dose and the V(20Gy), was dramatically lower in the prone vs. supine position (p < 0.0001), but the doses to the heart did not differ. There was no difference in the need to correct positioning during radiotherapy, but the extent of displacement was significantly higher in the prone vs. supine position (p = 0.021). The repositioning accuracy in the prone position exhibited an improvement over time and did not depend on any patient-related parameters. Significantly more radiodermatitis of Grade 1-2 developed following prone vs. supine irradiation (p = 0.025). CONCLUSIONS: Conformal breast radiotherapy is feasible in the prone position. Its primary advantage is the substantially lower radiation dose to the ipsilateral lung. The higher dose inhomogeneity and increased rate of Grade 1-2 skin toxicity, however, may be of concern

Hogyan befolyásolja a brca-státusz az emlőrák ellátását 2019-ben?

A germinalis BRCA-státusz korai vagy előrehaladott/áttétes emlőrákban egyaránt befolyásolja az ellátás menetét. Így ideális esetben a beteg informáltan dönthet a műtét típusáról, a sugárkezelés elkerüléséről; a BRCA-státusz a legújabb eredmények alapján befolyásolja a neoadjuváns, adjuváns, palliatív kemoterápia megválasztását, továbbá új, hatékony célzott (target) terápia alkalmazását vetheti fel. Specifikus terápiának számítanak a DNS-támadáspontú citosztatikumok, mindenekelőtt a platinakészítmények és a szintetikus letalitás elve alapján ható PARP-inhibitorok. E speciális gyógyszercsoportok optimális helye és sorrendje egyelőre nem ismert. A nemzetközi ajánlások valamennyi HER2-negatív (NCCN) vagy legalább a mutatók alapján valószínű BRCA-mutációt hordozó (ESMO) előrehaladott/áttétes emlőrákos esetben sürgetik a BRCA-státusz-vizsgálatot a megfelelő terápiás stratégia meghatározása érdekében. Az elmúlt időszakban a BRCA-státusz meghatározására szolgáló módszerek óriási fejlődésen mentek át, és egyre szélesebb körben elérhetőek különféle szolgáltatók kínálatában. A mutáció azonosításához a teljes gének szekvenálása szükséges, amelyre a korábbi módszereknél gyorsabb és költséghatékonyabb megoldást nyújt az új generációs szekvenálóplatformok (next generation sequencing – NGS) alkalmazása. A kezelőorvos felelőssége, hogy amennyiben a részletes családi anamnézis, a beteg életkora, esetleges megelőző daganatos betegsége és nem utolsósorban a daganatjellemzők alapján felmerül, gondoljon patogén BRCA-mutáció jelenlétére, mérlegelje a teszt indokoltságát, illetve vesse fel a beteg számára a lehetőséget. Kulcsszavak: bioetika, BRCA-mutáció, diagnosztika, platinaalapú kemoterápia, PARP-inhibitorok SUMMARY – Germinal BRCA status infl uences patient care both in early and advanced/metastatic breast cancer. Ideally, the patient should make the decision on the type of surgery or the avoidance of radiotherapy being aware of the BRCA status; based on the most recent clinical studies, this knowledge may infl uence the type of chemotherapy in the neoadjuvant, adjuvant, or metastatic setting or may raise the use of emerging targeted therapies. DNA-targeting cytostatic agents, mostly platinum agents and PARP inhibitors that act by inducing synthetic lethality, provide specifi c therapies in BRCA-mutant cases. The optimum place and sequence of these specifi c agents in treatment, however, are not known yet. International guidelines promote BRCA testing for the specifi cation of treatment strategy in all HER2-negative advanced/metastatic breast cancer cases (NCCN) or at least in all cases when, based on certain predictors, the presence of mutations is likely (ESMO). Recently, the methods employed for BRCA testing have improved immensely and are widely available through the services of various providers. For the identifi cation of the mutation, sequencing of the whole genes is needed, which can be achieved faster and more cost-effi ciently using next-generation sequencing (NGS) platforms compared to previous methods. It i s the responsibility of the physician to consider the possibility of BRCA mutations and to raise the issue of BRCA testing to the patient if the family history, the age, previous malignant disease(s) of the patient, or the cancer features are suggestive of genetic risk. Key words: bioethics, BRCA mutation, diagnostics, platinum-based chemotherapy, PARP inhibitor

III. Emlőrák Konszenzus Konferencia – Sugárterápiás irányelvek

The radiotherapy expert panel revised and updated the radiotherapy (RT) guidelines accepted in 2009 at the 2nd Hungarian Breast Cancer Consensus Conference based on new scientific evidence. Radiotherapy of the conserved breast is indicated in ductal carcinoma in situ (St. 0), as RT decreases the risk of local recurrence by 60%. In early stage (St. I-II) invasive breast cancer RT remains a standard treatment following breast conserving surgery. However, in elderly (>/=70 years) patients with stage I, hormone receptor positive tumour hormonal therapy without RT can be considered. Hypofractionated (15x2.67 Gy) whole breast irradiation and for selected cases accelerated partial breast irradiation are validated treatment alternatives of conventional (25x2 Gy) whole breast irradiation. Following mastectomy RT significantly decreases the risk of locoregional recurrence and improves overall survival of patients having 1 to 3 (pN1a) or >/=4 (pN2a, pN3a) positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be omitted and substituted with axillary RT. After neoadjuvant chemotherapy (NAC) followed by breast conserving surgery whole breast irradiation is mandatory, while after NAC followed by mastectomy locoregional RT should be given in cases of initial stage III-IV and ypN1 axillary status

Áttétes vesedaganatos betegek everolimusterápiájával szerzett hazai tapasztalatok

Everolimus is indicated for the therapy of adults with advanced renal cell carcinoma after failure of treatment with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI). The aim of the study was a multicenter evaluation of efficiency and toxicity of everolimus in patients with metastatic renal carcinoma who received one line of VEGFR-TKI therapy. Data of one hundred and one patients were analyzed retrospectively. Patients received everolimus therapy between January 2010 and July 2013. Data were collected in 7 different oncology institutes in Hungary. Starting daily dose of everolimus was 10 mg in 28-day cycles. Physical and laboratory examinations were done monthly. Imaging tests were performed every 3 months. Tumor response and toxicity were evaluated according to RECIST 1.0 and NCI CTCAE 3.0, respectively. Statistical analysis was performed with SPPS version 20.0 for Windows. Currently 26 (27%) patients are being treated, 52 (54.1%) patients are alive. Median progression-free survival (PFS) was 5.7 months (95% CI 4.07-7.33). Partial remission, stable disease and progression occurred in 6 (6%), 71 (74%) and 19 (20%) patients, respectively. Median overall survival (OS) was 14.3 months (95% CI 6.99-19.81). PFS and OS results were more favorable in patients with ECOG 0-1. Survival was poorer in case of anemia, while better if PFS was longer than 12 months. In anemic patients with ECOG 0-1 and ECOG 2-3 OS was 30.9 and 7.7 months, respectively (p=0.031). Dose reduction and treatment delay happened in 8 (7.9%) and 12 (11.9%) cases, respectively. The most common side effects were the following: exanthema, edema, stomatitis, pneumonitis, anemia and abnormal kidney-, liver functions, blood sugar and cholesterol levels. According to the Hungarian experience, everolimus can safely be administered. PFS and OS results representing the centers' everyday practice, are similar to the results of the respective subgroups in the registration study

Individually selected teletherapy technique for accelerated partial breast irradiation

Background: The aim of the study was to individualize accelerated partial breast irradiation based on optimal dose distribution, protect risk organ and predict most advantageous technique. Materials and methods: 138 breast cancer patients receiving postoperative APBI were enrolled. APBI plans were generated using 3D-conformal (3D-CRT), sliding window intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). In the case of superficial tumours, additional plans were developed by adding electron beam. To planning target volume (PTV) 37.5 Gy/10 fractions, 1 fraction/day was prescribed. A novel plan quality index (PQI) served as the basis for comparisons. Results: IMRT was the most advantageous technique regarding homogeneity. VMAT provided best conformity, 3D-CRT — the lowest lung and heart exposure. PQI was the best in 45 (32.61%) VMAT, 13 (9.42%) IMRT, 9 (6.52%) 3D-CRT plans. In 71 cases (51.45%) no difference was detected. In patients with large PTV, 3D-CRT was the most favourable. Additional electron beam improved PQI of 3D-CRT plans but had no meaningful effect on IMRT or VMAT. IMRT was superior to VMAT if the tumour was superficial (p &lt; 0.001), situated in the medial (p = 0.032) or upper quadrant (p = 0.046). Conclusions: In half of all cases, individually selected teletherapy techniques provide superior results over others; relevance of a certain technique may be predicted by volume and PTV localization