Norbert Mészáros

Multicatheter interstitial brachytherapy versus intensity modulated external beam therapy for accelerated partial breast irradiation: A comparative treatment planning study with respect to dosimetry of organs at risk.

OBJECTIVE To dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and intensity modulated radiotherapy (IMRT) for accelerated partial breast irradiation (APBI) with special focus on dose to normal tissues and organs at risk (OAR-s). MATERIAL AND METHODS Thirty-four patients with early stage breast cancer treated with MIBT were selected for the study. For each patient an additional IMRT treatment plan was created using the same CT data and contours as used in MIBT plans. OAR-s included ipsilateral non-target and contralateral breast, lung of both sides, skin, ribs and heart for left sided lesions. The CTV was created from the outlined lumpectomy cavity with a total margin (surgical+radiation) of 20mm in six main directions. The PTV in IMRT plans was generated from CTV with an addition of isotropic 5mm margin. The prescribed dose was 30.1Gy with 7×4.3Gy fractionation for both techniques. From dose-volume histograms quality parameters including volumes receiving a given dose (e.g. V100, V90, V50) and doses to specified volumes (e.g. D0.01cm3, D0.1cm3, D1cm3) were calculated and compared. RESULTS Except for high dose, non-target breast received less dose with MIBT. V90 was 3.6% vs. 4.8% and V50 was 13.7% vs. 25.5% for MIBT and IMRT, respectively. Ipsilateral lung was spared better with MIBT. Mean lung dose was 5.1% vs. 7.1%, [Formula: see text] was 39.0% vs. 54.3% and V5 was 32.9% vs. 41.7% in favour of MIBT. For left sided lesions the heart was generally irradiated by larger doses with MIBT. Mean heart dose was 4.5% vs. 2.0% and [Formula: see text] was 18.3% vs. 19.7%, correspondingly. Volumetric maximal skin doses were similar, but regarding dose to 0.1cm3 and 1cm3 of most exposed volume MIBT provided significantly less doses (76.6% vs. 94.4% and 60.2% vs. 87.8%, respectively). Ribs received less dose with MIBT with values of 45.6% vs. 69.3% for [Formula: see text] and 1.4% vs. 4.2cm3 for V50. Dose to contralateral breast and lung was low with both techniques. No significant differences were observed in maximal doses, but dose to volumes of 0.1cm3 and 1cm3 were less with MIBT for both organs. [Formula: see text] was 3.2% vs. 6.7% for breast and 3.7% vs. 5.6% for lung with MIBT and IMRT, respectively. CONCLUSIONS The target volume can be appropriately irradiated by both techniques, but MIBT generally spares normal tissues and organs at risk better than IMRT. Except for the heart, other critical structures receive less doses with brachytherapy. To observe whether these dosimetric findings translate into clinical outcome more studies are needed with assessment of toxicity profiles.

Clinical experiences with the use of ULTRAPRO® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study

BACKGROUND Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO® mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO® mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION Partially absorbable ULTRAPRO® mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.

Második emlőmegtartó műtét és szövetközi sugárkezelés az emlődaganat lokális kiújulásának kezelésére. Ötéves eredmények

INTRODUCTION AND AIM To report the clinical outcomes of second breast-conserving therapy with perioperative interstitial radiotherapy for the treatment of ipsilateral breast tumor recurrences. METHOD Between 1999 and 2015, 33 patients, presenting with an ipsilateral breast tumor recurrence after previous breast conserving therapy, were salvaged by re-excision and perioperative high-dose-rate interstitial brachytherapy. A median of 8 (range: 4-24) catheters were implanted into the tumor bed intraoperatively. A total dose of 22 Gy in 5 fractions of 4.4 Gy was delivered to the tumor bed with a margin of 1-2 cm, on 3 consecutive days. The adjuvant systemic treatments consisted of hormonal therapy for 24 patients (73%) and chemotherapy for 6 patients (18%). The survival results were estimated by the Kaplan-Meier method. Late side effects and cosmetic results were also registered. RESULTS The median follow-up time following the second breast conserving therapy was 61 months (range: 26-189 months). During the follow-up, 4 patients (12.1%) developed second local recurrence. The five-year actuarial rates of the second local, regional and distant recurrence were 6.3%, 6.1%, and 14.9%, respectively. The five-year probabilities of disease-free, cancer-specific and overall survival were 76.2%, 92.4%, and 89.2%, respectively. Four (12%), 19 (58%), 4 (12%) and 6 (18%) patients had excellent, good, fair and poor cosmetic results, respectively. Grade 2 and 3 fibrosis developed in 9 (27%) and 1 (3%) patients. Asymptomatic fat necrosis was detected in 7 (21%) women. CONCLUSION Second breast conserving therapy with perioperative high-dose-rate interstitial brachytherapy is a safe and feasible option for the management of ipsilateral breast tumor recurrences. Interstitial brachytherapy may decrease the risk of second local relapse with acceptable cosmetic results and low rate of late side effects. Hence, in selected cases it can provide a feasible alternative to salvage mastectomy. Orv Hetil. 2018; 159(11): 430-438.Absztrakt: Bevezetes es celkitűzes: Masodik emlőmegtarto műtet es nagy dozisteljesitmenyű szovetkozi sugarkezeles eredmenyeinek bemutatasa azonos oldali emlődaganat kiujulasa miatt kezelt betegeknel. Modszer: Korai invaziv emlőrak előzetes emlőmegtarto kezelese utan jelentkező helyi daganatkiujulas miatt 1999 es 2015 kozott 33 betegnel vegeztunk masodik emlőmegtarto műtetet perioperativ szovetkozi sugarkezelessel. A masodik emlőmegtarto műtet soran a tumoragyba atlagosan 8 (tartomany: 4–24) darab flexibilis katetert ultettunk be. A perioperativ időszakban a tumoragy es annak 1–2 cm-es biztonsagi zonajanak teruletere adott osszdozis 22 Gy volt (5 × 4,4 Gy, 3 nap alatt). Adjuvans szisztemas kezeleskent 24 beteg (73%) egyeduli endokrin kezelesben, 6 beteg (18%) pedig kemoterapiaban reszesult. A tulelesi eredmenyeket a Kaplan–Meier-modszerrel elemeztuk. A kesői mellekhatasokat es a kozmetikai eredmenyeket feljegyeztuk. Eredmenyek: A masodik emlőmegtarto kezelestől szamitott kovetesi idő kozeperteke 61 honap (...

Progressive breast fibrosis caused by extreme radiosensitivity: Oncocytogenetic diagnosis and treatment by reconstructive flap surgery

Fibrosis, a proliferative response of fibrocytes after tissue injury, is a common sequela of external radiotherapy and can vary greatly among patients even in the absence of DNA repair syndromes, due to their different intrinsic radiosensitivity. Fibrosis is also a serious cosmetic problem for patients, and in some cases it can also imply pain.

EP-1957: Partial breast irradiation with brachy- and teletherapy: comparative dosimetry of treatment plans

ESTRO 35 2016 _____________________________________________________________________________________________________ energy deposition and particle fluence. The software package, written in Matlab, incorporates interaction sampling methods employed in general-purpose Monte Carlo codes. Users select the incident particle type, energy, target material and (optionally) particle cut-off energies. Modes of operation include; 3D views of particle tracks from a broad beam incident on selected media, views of interaction probabilities and outgoing particle energy and direction, or energy deposition and charged particle fluence scored as a function of depth for a user-defined number of incident particles. In addition, the ‘physics’ underlying radiation transport can be modified, by ‘switching off’ multiple Coulomb scattering, delta–ray production and radiative energy losses, in order to observe the effect this has on energy deposition and so gain a greater understanding of the physics involved.