Tomasz Nowikiewicz

The Assessment of the Magnitude of Frontal Plane Postural Changes in Breast Cancer Patients After Breast-Conserving Therapy or Mastectomy – Follow-up Results 1 Year After the Surgical Procedure

Breast cancer is the most common malignancy in Polish women. Management of breast cancer includes surgical treatment as well as adjuvant chemotherapy, radiotherapy, hormonal therapy, and combination regimens. One of the adverse consequences of oncological management of breast cancer may involve changes in frontal plane body posture. The objective of the study was to assess the frontal plane body posture changes in women treated for breast cancer. A prospective study including 101 of female breast cancer patients subjected to surgical treatment in the period from October 2011 to October 2012 (mastectomy was performed in 51 cases while breast conserving therapy was administered in the remaining 50 cases). The body posture in the frontal plane was assessed using the computer-assisted postural assessment system with Moiré fringe analysis. No statistically significant differences were observed in pre-operational postural parameters of interest. Exam II revealed highly significant differences in SLA values; results suggesting more pronounced dysfunction were observed in the MAS group. Exam III revealed highly significant differences in PIA, SH, SD and SLA values; results suggesting more pronounced dysfunction were observed in the MAS group. Undesirable postural changes occur both in women who were treated with radical mastectomy and in those who underwent breast-conserving surgery; breast-conserving surgery is associated with decreased severity in postural abnormalities;

Application of artificial neural networks for predicting presence of non-sentinel lymph node metastases in breast cancer patients with positive sentinel lymph node biopsies

Introduction The aim of this study was to present a new predictive tool for non-sentinel lymph node (nSLN) metastases. Material and methods One thousand five hundred eighty-three patients with early-stage breast cancer were subjected to sentinel lymph node biopsy (SLNB) between 2004 and 2012. Metastatic SLNs were found in 348 patients – the retrospective group. Selective axillary lymph node dissection (ALND) was performed in 94% of cases. Involvement of the nSLNs was identified in 32.1% of patients following ALND. The correlation between nSLN involvement and selected epidemiological data, primary tumor features and details of the diagnostic and therapeutic management was examined in metastatic SLN group. Multivariate analysis was performed using an artificial neural network to create a new nomogram. The new test was validated using the overall study population consisting of the prospective group (365 patients – SLNB between 01–07.2013). Results Accuracy of the new test was calculated using area under the receiver operating characteristics curve (AUC). We obtained AUC coefficient equal to 0.87 (95% confidence interval: 0.81–0.92). Sensitivity amounted to 69%, specificity to 86%, accuracy – 80% (retrospective group) and 77%, 46%, 66% (validation group), respectively. The Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram the calculated AUC value was 0.71, for Stanford – 0.68, for Tenon – 0.67. Conclusions In the analyzed group only the MSKCC nomogram and the new model showed AUC values exceeding the expected level of 0.70. Our nomogram performs well in prospective validation on patient series. The overall assessment of clinical usefulness of this test will be possible after testing it on different patient populations.

Sagittal Plane Postural Changes in Female Patients with Breast Cancer after Different Surgical Techniques

To the Editor: One of the important objectives of the treatment of cancer patients is to minimize the adverse effects of the treatment while striving to maintain its radicality. Delayed outcomes of anticancer treatment may lead to postural changes of patients. Direct consequences of the disturbance in proper posture include a number of adverse outcomes such as motor organ deformities, back pains, circulatory and respiratory insufficiency, or headaches (1). Due to this facts, we think that it would be interesting to determine and compare postural changes as assessed within the sagittal plane in female patients after surgical treatment of breast cancer involving different surgical techniques and to compare sagittal plane postural changes women treated of breast cancer with body posture women before surgical procedure. We carried out a cross-sectional study which involved a group of 105 women who had undergone treatment for breast cancer. With 40 women was preformed Patey method (MAS) and with 35 women was preformed Breast Conserving Therapy (BCT). Table 1 presents somatic and clinical characteristics of study groups. Photogrammetric examinations were performed for researched groups (MAS and BCT) 2 year after the surgical procedure. All patients after mastectomy had used external breast prostheses. Patient in both exanimate groups have taken part in rehabilitation session. The scheme of examination was the following: 1 Determination of body weight, height and body mass index (BMI) 2 Examination with Moir e system Posturometric examination allows to determine about 30 postural parameters assessed in the sagittal plane. A total of six measurements (selected on the basis of the difference between the mean and median values) were used in the statistical analysis: • ALPHA – lumbosacral inclination angle, • BETA – thoracolumbar inclination angle, • GAMMA – thoracic inclination angle, • LLA – lumbar lordosis angle, • TKA – thoracic kyphosis angle, • TIA – trunk inclination angle. Address correspondence and reprint requests to: Iwona Głowacka, Department of Rehabilitation, Collegium Medicum of the Nicolaus Copernicus University in Torun, Maria Curie-Skłodowskiej Street 9, 85-094 Bydgoszcz, Poland, or e-mail: iwona.glowacka@cm.umk.pl

Fertility impairment in radiotherapy

Infertility as a result of antineoplastic therapy is becoming a very important issue due to the growing incidence of neoplastic diseases. Routinely applied antineoplastic treatments and the illness itself lead to fertility disorders. Therapeutic methods used in antineoplastic treatment may cause fertility impairment or sterilization due to permanent damage to reproductive cells. The risk of sterilization depends on the patients sex, age during therapy, type of neoplasm, radiation dose and treatment area. It is known that chemotherapy and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. The progress in antineoplastic therapy improves treatment results, but at the same time requires a deeper look at existential needs of the patient. Reproductive function is an integral element of self-esteem and should be taken into account during therapy planning.

Evaluation of the effects of mammography screening program on cancer progression and implemented treatment in patients with breast cancer.

UNLABELLED The primary goal of mammography screening is to decrease mortality in patients with breast cancer. THE AIM OF THE STUDY Evaluation of the screening program results on course of implemented therapy and its results in breast carcinoma patients. MATERIAL AND METHODS Evidence includes data on the group of 1818 patients with breast cancer that were subject to surgical treatment at the Clinic of Breast Cancer and Reconstructive Surgery of the Oncology Center in Bydgoszcz (558 patients hospitalized from January 2006 to December 2006 and 1260 patients treated from January 2011 to June 2012). Analysis included type of diagnostic procedure implemented before surgical treatment, as well as grade of cancer progression, results of pathology tests done on specimens and type of surgical procedure. Additionally, the screening group (tumor diagnosed based on screening mammography) and symptomatic group (cancer diagnosed otherwise that within the screening program) were identified. RESULTS In 2006, in 28.4% of patients included in the study, primary tumor was discover in screening process (vs 61.5% in 2011-2012). In the first period, 35.7% of changes did not exceed 2 cm--cT1 (vs 48.3% in 2011-2012), while the percentage of cT4 was 9.9% (vs 4.7% in 2011-2012). In 2006, 30.8% of patients were treated in the grade I of clinical progression (vs 44.2% in 2011-2012), 53.4% in the grade II, 14% in grade III and 0.2% in grade IV (vs 45.7%, 9.7%, and 0.4%, respectively). In 45.5% (2006) and 39.9% (in 2011-2012) of patients, metastases were found in axillary lymph nodes. Differences were similar both in screening and symptomatic group. In 2006, in 12.4% of surgical patients breast conserving therapy (BCT) was implemented (vs 49.8% in 2011-2012). In the screening group, it was applied in 15.2% of patients (in 2006) and in 63% (in 2011- 2012), while in symptomatic group the percentages were 11.8% and 41%, respectively. CONCLUSIONS In both periods of analysis, significant differences were observed as to implementation of breast cancer screening program, as well as to grade of clinical and pathological progression of the cancer. Observable increase of screening tests allowed for significantly more frequent implementation of breast conserving surgical procedures.

Clinical Significance of Van Nuys Prognostic Index As A Qualification Criterion to Sentinel Lymph Node Biopsy in Patients Diagnosed with Ductal Carcinoma in Situ

UNLABELLED Diagnose of ductal carcinoma in situ (DCIS) requires, at least in a part of cases, assessment of auxiliary lymph nodes. The aim of the study was to analyze clinical value of Van Nuys Prognostic Index (VNPI) as the important criterion for qualification of DCIS patients to sentinel lymph node biopsy (SLNB). MATERIAL AND METHODS Analysis included patients diagnosed with DCIS and qualified to SLNB, operated in years 2004-2013. We performed a statistical analysis to assess correlation between VNPI value and positive pathological verification of excised sentinel lymph node (SLN). The influence of other clinical factors on presence of metastases in SLN was also determined. RESULTS 3,6% of DCIS patients were diagnosed with metastases in SLN. Metastases were diagnosed in 6.7% patients with VNPI > 10 points vs 3.4% in patients with VNPI < 10 points. In 75% of patients with metastatic SLN the value of VNPI was at least 10 points. In premenopausal patients metastases in SLN were diagnosed in 8.1% of cases vs 1.4% in postmenopausal patients. In patients diagnosed with cancer of the other breast metastases in SLN were found in 6.3% of cases vs 3.2% in one-sided cancer. Patients with multifocal cancer were over twice as often diagnosed with metastases in SLN (5% vs 2%). There was no correlation found between VNPI value and positive pathological verification of SLN. No differences between prevalence of SLN metastases depending on selected clinical features were found. CONCLUSIONS Recommendation of VNPI as the criterion of qualification to SLNB starting with 10 points could be more favourable in patients with DCIS. Deciding on SLNB in DCIS patients, we should also take into consideration other clinical features.

Assessment of quality of life in women five years after breast cancer surgery, members of Breast Cancer Self-Help Groups – non-randomized, cross-sectional study

Aim of the study To assess the quality of life in patients treated for breast cancer who were 5 years after diagnosis and were active members of Breast Cancer Self-Help Groups. Material and methods The study had a non-randomized, cross-sectional design. We enrolled 167 women who were more than 5 years after mastectomy and were active members of Breast Cancer Self-Help Groups (group A1). As a control group we enrolled 117 women after mastectomy – not members of such support groups (group A2). For the evaluation of the quality of life in both groups we used the following standardized questionnaires – EORTC QLQ-C30 and EORTC QLQ-BR23 as well the Mini-MAC scale for the assessment of strategies of coping with disease. Results Based on QLQ C30 scores, group A1 had better emotional functioning (p = 0.0005) and a higher general quality of life (p = 0.0259), whereas group A2 had better role functioning (p = 0.0042). Based on QLQ BR23 scores, there were statistically significant differences in body image (p = 0.0366) and life perspectives (p = 0.0313) in favor of group A1. In the control group, there was a greater use of destructive coping strategies and anxious preoccupation (p = 0.1957). Conclusions Membership in Amazon groups improves functioning in breast cancer patients that can also extend into a five-year period after treatment completion.

Analysis of sparing surgical procedures use in breast cancer patients at the Oncology Centre in Bydgoszcz in 2002–2017

Introduction. Diagnosis of breast cancer at its early stage influences significantly long-term treatment outcomes in patients. As result, more often application of breast-conserving surgical procedures becomes possible. This paper presents our centre’s up-to-date experiences in this field. Materials and methods. 12,337 patients diagnosed with primary malignant neoplasm of the breast surgically treated at the Oncology Centre in Bydgoszcz between 2002 and 2017. Analysis of applied breast-conserving procedures in the analysed group. Results. Observation of consecutive years indicates over double increase in the number of patients (498 in 2002, 1136 in 2017). Breast-conservative treatment (BCT) was recorded in 10.6% of patients (2002) and 65.1% in 2017. Treatment sparing lymph nodes of the axillary fossa concerned 2.2–79.0% in the analyzed period. Conclusions. In the analyzed time period, we recorded a significant increase in the number of surgical BCT procedures applied. It was possible due to regular introduction of changes regarding diagnostic and therapeutic algorithms to our everyday clinical practice in patients suffering from malignant breast neoplasms.

Variation in treatment and survival of older patients with non-metastatic breast cancer in five European countries: a population-based cohort study from the EURECCA Breast Cancer Group

BackgroundOlder patients are poorly represented in breast cancer research and guidelines do not provide evidence based recommendations for this specific group. We compared treatment strategies and survival outcomes between European countries and assessed whether variance in treatment patterns may be associated with variation in survival.MethodsPopulation-based study including patients aged ≥ 70 with non-metastatic BC from cancer registries from the Netherlands, Belgium, Ireland, England and Greater Poland. Proportions of local and systemic treatments, five-year relative survival and relative excess risks (RER) between countries were calculated.ResultsIn total, 236,015 patients were included. The proportion of stage I BC receiving endocrine therapy ranged from 19.6% (Netherlands) to 84.6% (Belgium). The proportion of stage III BC receiving no breast surgery varied between 22.0% (Belgium) and 50.8% (Ireland). For stage I BC, relative survival was lower in England compared with Belgium (RER 2.96, 95%CI 1.30–6.72, P < .001). For stage III BC, England, Ireland and Greater Poland showed significantly worse relative survival compared with Belgium.ConclusionsThere is substantial variation in treatment strategies and survival outcomes in elderly with BC in Europe. For early-stage BC, we observed large variation in endocrine therapy but no variation in relative survival, suggesting potential overtreatment. For advanced BC, we observed higher survival in countries with lower proportions of omission of surgery, suggesting potential undertreatment.

A first case report of rare synchronous double cancers: malignant cutaneous melanoma and gastrointestinal stromal tumor

Address for correspondence: MSc Maciej Nowacki MD, PhD, Chair and Department of Surgical Oncology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Oncology Centre – Prof. Franciszek Łukaszczyk Memorial Hospital, 2 Romanowskiej St, 85-796 Bydgoszcz, Poland, e-mail: maciej.s.nowacki@gmail.com Received: 4.12.2016, accepted: 5.12.2016. A first case report of rare synchronous double cancers: malignant cutaneous melanoma and gastrointestinal stromal tumor