• Journal of Medicine and Life Science
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• v.20 no.2
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• pp.89-93
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• 2023

We present three cases of patients with breast cancer and psoriasis who received radiotherapy following breast-conserving surgery. One patient developed an extensive flare-up of psoriasis during chemotherapy. After discontinuing chemotherapy, she received conventional radiotherapy to the ipsilateral whole breast, axillary, and supraclavicular lymph nodes with 50.4 Gy in 28 fractions and boosted with 10 Gy in five fractions to the tumor bed. Two patients received hypofractionated whole-breast radiotherapy at a total dose of 40.05-42.4 Gy in 15-16 fractions. In all three cases, there was no flare-up of psoriatic events at least 6 months after the completion of radiotherapy. We hypothesized that there is a close relationship between psoriatic events and the extent of trauma rather than the daily dose of the fraction. Therefore, we confirmed that the effect of radiotherapy on psoriatic events is minimal if the radiation field size does not exceed that of the whole breast.

• Radiation Oncology Journal
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• v.33 no.1
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• pp.50-56
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• 2015

Purpose: To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. Materials and Methods: Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. Results: The median level I and II axillary volume coverage percentages at the $V_{D95%}$ line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. Conclusion: The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.1207-1211
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• 2015

Background: Breast cancer is by far the most frequent cancer of women (23 % of all cancers), ranking second overall when both sexes are considered together. Contralateral breast cancer (CBC) is becoming an important public health issue because of the increased incidence of primary breast cancer and improved survival. The present communication concerns a study to evaluate the role of various clinico-pathological factors on the occurrence of contralateral breast cancer. Materials and Methods: A detailed analysis was carried out with respect to age, menopausal status, family history, disease stage, surgery performed, histopathology, hormone receptor status, and use of chemotherapy or hormonal therapy. The diagnosis of CBC was confirmed on histopathology report. Relative risk with 95%CI was calculated for different risk factors of contralateral breast cancer development. Results: CBC was found in 24 (4.5%) out of 532 patients. Mean age of presentation was 43.2 years. Family history of breast cancer was found in 37.5% of the patients. There was statistically significant higher rate (83.3%) of CBC in patients in age group of 20-40 years with RR=11.3 (95% CI: 1.4, 89.4, p=0.006) seen in 20-30 years and RR=10.8 (95% CI:1.5-79.6, p=0.002) in 30-40 years as compared to older age of 60-70 years. Risk of development was higher in premenopausal women (RR=8.6, 95% CI: 3.5-21.3, $p{\leq}0.001$). Women with family history of breast cancer had highest rate (20.9%) of CBC (RR=5.4, 95% CI: 2.5-11.6, $p{\leq}0.001$). Use of hormonal therapy in hormone receptor positive patients was protective factor in occurrence of CBC but not significant (RR=0.7, 95% CI: 0.3-1.5, p=0.333). Conclusions: Younger age, premenopausal status, and presence of family history were found to be significant risk factors for the development of CBC. Use of hormonal therapy in hormone receptor positive patients might be protective against occurrence of CBC but did not reach significance.

• Journal of the Korean Society of Radiology
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• v.12 no.3
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• pp.313-319
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• 2018

In radiation treatment, it is unavoidable to block the influence of scattered ray on a skin and prevent internal normal organs from being exposed to radiation. It is fair to say that radiation therapy aims to reduce an absorbed dose of normal tissues. In particular, in radiation therapy of left-sided breast cancer, the internal neighboring organs are normal breast tissues, the heart, and the lung. The side effects on the heart include cardioplegy and myocardial infarction. This study tried to observe changes in the volume and dose of the heart in general radiation therapy plan and respiratory control based radiation therapy plan for patients with left-sided breast cancer, and to find the heart's volume and dose generated by respiration. According to the 4D computer tomography (CT), a volume of the heart had $12.8{\pm}8.7cc$ on average, and its dose had $17.3{\pm}12.1cGy$ on average. The differences in the volume and dose may cause side effects in radiation treatment. Therefore, it is necessary to apply respiratory control technique to establish the radiation treatment plan based on an accurate position of the heart.

• Korean Journal of Digital Imaging in Medicine
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• v.13 no.3
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• pp.99-103
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• 2011

Radiation Therapy has been used in the treatment of breast cancer for over 80 years. Technically, it should include a part or all of such areas as chest wall or breast, axilla, internam mammary nodes and supraclavicular nodes. The purpose of this study is treated breast cancer patient to use 6 MV, 10 MV with bolus so that we observe changing of skin dose and evaluate those usefulness. Using woman's phantom, after CT simulate scanning, Through RTP system to make treatment plan, select three any place. And then, we measure that dose rate. After moving the phantom to linac, we put for TLD to three point same as RTP system which we put on the phantom. We exposed 6 MV, 10 MV with bolus and without so that it is measured dose by TLD device(4000 Harshaw). As a reult expose 6 MV,10 MV, it differences 10%, 15% according to bolus and withoout bolus where lateral point from RAO, LPO beam, other one is 20% where the furthest from both beams. To use bolus in the hospital is material to include closely part at skin among tissue of breast cancer. Acquired skin dose from RTP system is uncertainity. So it has to test another system likely TLD or other dosimetry system. Also exposed field of breast cancer is included inhomogeneity such as lung, bone and so on. Therefore it has to be accomplished a dose calculating of inhomogeneity part from treatment plan.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4577-4581
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• 2016

Objective: The aim of this study was to assess thyroid function in breast cancer patients exposed to therapeutic external beam radiation. The focus was on possible progressive changes and any relationships between the incidence of primary hypothyroidism, the time required to become hypothyroid, and factors such as chemotherapy, hormonotherapy and immunotherapy. Materials and Methods: Seventy females undergoing 3D conformal and IMRT radiation therapy for breast cancers were enrolled in a non-randomized prospective study. The patients was divided into two groups: those after mastectomy or breast conserving surgery (BCS) were irradiated to a scar of the chest wall/breast and the ipsilateral supraclavicular and the axillary areas (supraclavicular radiotherapy group - SC-RT group - 32 patients) and the control group receiving adjuvant chest wall/breast RT only (BCT group - 38 patients).The total doses were 50.0 to 70 Gy in 5 to 7 weeks. The median follow-up term was 24 months (range, 1-40 months). Thyroid function was evaluated by measuring thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. The minimum, maximum and mean thyroid gland doses for 20 Gy (V20) were calculated for all patients. Results: Statistically significant results were obtained for the SC-RT group. Two yearsa fter the end of RT the chance of an event was increased in 6% of the population (p=0.009) in the SC-RT group. In the BCT group no significance was noted. No statistically significant differences were found for V20, chemio-, immunotherapy and hormonotherapy or Ki67 values (p=0.12). No significant results were obtained for development of hypothyroidism and clinical factors (age, thyroid volume, treatment modalities). Conclusion: Radiotherapy is associated with a higher incidence of thyroid toxicity in breast cancer patients. Routine thyroid function monitoring should be recommended in such cases.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.10
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• pp.4225-4231
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• 2014

Aim: To determine prognostic value of blood parameters on overall and progression-free survival in cases received adjuvant radiotherapy and chemotherapy with diagnosis of stage I-III breast cancer. Materials and Methods: We retrospectively reviewed files of 350 patients with non-metastatic breast cancer who were treated in the Radiation Oncology Department of Kayseri Teaching Hospital between 2005 and 2010. Pretreatment white blood cell (WBC), neutrophil, monocyte, basophil and eosinophil counts, and the neutrophil/lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were recorded. The relationship between clinicopathological findings and blood parameters was assessed. Results: Overall, 344 women and 6 men were recruited. Median age was $55.3{\pm}0.3$ years (range: 22-86). Of the cases, 243 (61.4%) received radiotherapy while 329 (94.3%), received chemotherapy and 215 (61.4%) received hormone therapy. Mean overall survival (OS) and progression-free survival (PFS) was 84.4 and 78.8 months, respectively. During follow-up, 48 patients died due to either disease-related or non-related causes. Local recurrence was detected in 14 cases, while distant metastasis was noted in 45 cases. In univariate analysis, age, pathology, perinodal invasion were significantly associated with overall survival, whereas gender, stage and hormone therapy were significantly associated with progression-free survival. In multivariate analysis, histopathological diagnosis (OR: 0.3; 95%: 0.1-0.7; p=0.006) and perinodal invasion (OR: 0.1; 95% CI: 0.1-1.3; p=0.026) were significantly associated with overall survival, whereas tumor stage (OR: 2.1; 95% CI: 0.0-0.7; p=0.014) and hormone therapy (OR: 2.1; 95%: 1.2-3.8; p=0.010) were significantly associated with progression-free survival. Conclusions: It was found that serum inflammatory markers including WBC, neutrophil, lymphocyte and monocyte counts, and NLR and PLR had no effect on prognosis in patients with breast cancer who underwent surgery and received adjuvant radiotherapy and chemotherapy.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.153-162
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• 2009

Purpose: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. Materials and Methods: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. Results: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ($\leq$6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conclusion: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

• Radiation Oncology Journal
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• v.32 no.1
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• pp.1-6
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• 2014

Purpose: To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). Materials and Methods: We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. Results: The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or ${\geq}1$ mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). Conclusion: Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.629-635
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• 2019

In term of the factors affecting psychosocial adjustment of breast cancer patients, their quality of life after surgical operation, radiation, and chemotherapy were systematically meta-analyzed. As a result, their qualities of life of the patients that had radiation therapy was the lowest right after the therapy, and gradually increased after the end of the therapy. However, after six months, their quality of life failed to reach the same level before the therapy. They had depression and side effects the most right after the therapy, and somewhat reduced them after the end of the therapy. In case of surgical operation, the more they were educated, the more they had psychosocial adjustment, and the more they had a medical examination and took out an insurance policy, the more they had psychosocial adjustment. In case of chemotherapy, their cognitive function is influenced so that they have impairments in memory, learning, and thinking stages. Since subjective cognitive impairment has a relationship with depression, it is necessary to monitor depression of chemotherapy patients. Given the results of this systematic meta-analysis, when three types of therapies (surgical operation, radiation therapy, and chemotherapy) are applied to patients with breast cancer, it is necessary to recognize their psychosocial adjustment, depression, anxiety, and quality of life in the nursing and radiation therapy fields and thereby to introduce an intervention program for a holistic approach.