• Radiation Oncology Journal
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• v.37 no.4
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• pp.254-258
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• 2019

Purpose: Deep inspiration breath hold (DIBH) is a well-established technique that enables efficient cardiac sparing in patients with left-sided breast cancer. The aim of the current study was to determine if DIBH is effective for reducing radiation exposure of of liver and other organs at risk in right breast radiotherapy (RT). Materials and Methods: Twenty patients with right-sided breast cancer were enrolled in this study. Three-dimensional conformal RT plans were generated for each patient, with two different computed tomography scans of free breathing (FB) and DIBH. Nodes were contoured according to the Radiation Therapy Oncology Group contouring guidelines. Dose-volume histograms for the target volume coverage and organs at risk were evaluated and analyzed. Results: DIBH plans showed significant reduction in mean liver dose (5.59 ± 2.07 Gy vs. 2.54 ± 1.40 Gy; p = 0.0003), V_20Gy (148.38 ± 73.05 vs. 64.19 ± 51.07 mL; p = 0.0003) and V_10Gy (195.34 ± 93.57 vs. 89.81 ± 57.28 mL; p = 0.0003) volumes compared with FB plans. Right lung doses were also significantly reduced in DIBH plans. Heart and left lung doses showed small but statistically significant improvement with application of the DIBH technique. Conclusion: We report that the use of DIBH for right-sided breast cancer significantly reduces the radiation doses to the liver, lungs, and heart.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.473-477
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• 2020

Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.729-736
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• 2021

Multiple primary malignant neoplasms refer to two or more malignancies in an individual that are not related. We report a case of a 78-year-old male with concurrent breast mucinous carcinoma and extramammary lymphoma. The patient initially presented with palpable masses in the left breast and the right groin, which were pathologically confirmed after a surgical biopsy as breast mucinous carcinoma and diffuse large B-cell lymphoma, respectively. He underwent whole-body 18-fluorine deoxyglucose PET/CT before surgery, and an enhancing nodular lesion in the left lingual tonsil was found incidentally. It was later confirmed as a diffuse large B-cell lymphoma, a pathology of the same type as the right inguinal mass. Unspecified lymphadenopathies in breast cancer patients may easily be considered as metastatic lesions. However, this case suggests that lymphomas should be included in the differential diagnoses to avoid misdiagnosis and treatment delay, especially in older adult patients.

• Journal of Genetic Medicine
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• v.9 no.1
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• pp.25-30
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• 2012

Among the treatment options for BRCA mutation carriers, risk reducing surgery is the most effective. However, this procedure has been rarely performed in Korea. Interestingly, our case showed double heterozygosity for BRCA1 and BRCA2 mutations. The patient was diagnosed with left renal cancer and left breast cancer at 45-years-of-age, 4 years before risk reducing surgery. The patient received left radical nephrectomy and left partial mastectomy with axillary lymph node dissection. After pretest counseling, the patient underwent genetic testing that identified BRCA1 and BRCA2 mutations. After post-test counseling, the patient decided on intensive surveillance. At 49-years-of-age, the patient was newly diagnosed with contralateral breast cancer. Treatment options were discussed once again. We performed bilateral total mastectomy with immediate reconstruction and prophylactic bilateral salpingo-oophorectomy after multidisciplinary discussion. The patient has been satisfied with the results of surgery. We think this procedure is a recommendable treatment option for BRCA mutation carriers.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3257-3265
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• 2015

Background: Radiotherapy is an important treatment of choice for breast cancer patients after breast-conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. Materials and Methods: Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. Results: All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left-sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. Conclusions: Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.

• Archives of Plastic Surgery
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• v.45 no.2
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• pp.171-176
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• 2018

Central venous stenosis is a rare cause of unilateral breast edema occurring in hemodialysis patients that needs to be differentiated from other differential diagnoses, including, but not limited to, inflammatory breast carcinoma, mastitis, lymphedema, and congestive heart failure. All reports of similar cases in the available literature have described improvement or resolution of the edema after treatment. Herein, we report and discuss the pathophysiology of breast edema formation in a patient who presented with massive left-sided breast edema 7 years after being diagnosed with central venous stenosis. Medical and minimally invasive therapy had not been successful, so she underwent reduction mammoplasty to relieve the symptoms.

• Journal of Physiology & Pathology in Korean Medicine
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• v.27 no.6
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• pp.818-822
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• 2013

This report is aimed to investigate the effect of Traditional Korean Therapy (TKT) in treating recurred breast cancer metastasized to lung. A 53-year-old woman who was diagnosed as left breast cancer and underwent surgery, adjuvant chemotherapy and radiotherapy in early 2009 was admitted for the treatment of recurred, metastatic lung cancer in late 2012. She was treated with TKT including acupuncture, moxibustion and pharmacopuncture. The effect was evaluated with positron emission tomogram and computed tomogram (PET-CT). The metastatic tumors in both lungs were disappeared after the treatment for about 2 months. These results suggest that TKT is a therapeutic method to treat metastatic lung cancer originated from breast cancer.

• Investigative Magnetic Resonance Imaging
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• v.23 no.1
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• pp.75-80
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• 2019

Metastasis of rhabdomysarcoma to the breast is a very rare manifestation in adult males. Herein, we report a case of metastasis from embryonal rhabdomyosarcoma in the left hypothenar muscle that presented as a breast mass in a 38-year-old man, who four months later expired because of multiple bone metastases related to pancytopenia. We describe the various imaging findings, including mammograms, ultrasonography, computerized tomography (CT), positron emission tomography-computed tomography (PET-CT), and magnetic resonance imaging (MRI) of this rare disease. The various imaging findings of this lesion could be helpful for future diagnosis of male breast lesions.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.4
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• pp.1633-1636
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• 2015

Background: The advantages of Rapid Arc plans versus Intensity modulated radiotherapy plans for Carcinoma left breast were analyzed. Materials and Methods: In this study 20 Post mastectomy carcinoma left breast patients were analyzed. Both Intensity modulated Radiotherapy and Rapid Arc plans were generated for these patients. IMRT plans with 7 beams in an arc fashion and VMAT plans with two semi arcs were made to achieve 95% dose coverage to 100% volume. The plans were evaluated using Dose volume Histograms. Results: The mean Conformity and Homogeneity index in VMAT is found to be 1.05 and 0.065 respectively whereas in IMRT it was 1.07 and 0.069. The 20% volume of Heart received a mean dose of 960cGy in VMAT and 1300cGy in IMRT. The mean dose was 1236cGy in VMAT and 1870cGy in IMRT. The ipsilateral Lung received 3395cGy to 5% volume and 1840cGy to 20% volume on an average and the mean dose was 1205cGy in VMAT, while the same were found to be 3525cGy, 2012cGy and 1435cGy respectively in IMRT. The Contralateral Lung received a mean dose of 505cGy in VMAT and 553cGy in IMRT. The mean Monitor units in VMAT were 512MU and 1170MU in IMRT. The NTID in VMAT is $108.8{\times}10^5Gycm^3$ and $110.1{\times}10^5Gycm^3$ in IMRT. Conclusions: The target coverage, homogeneity and Conformity index were better in VMAT plans. The Ipsilateral Lung and heart dose were very less in VMAT plans. The Contralateral Lung dose and the Normal Tissue Integral Dose were also lesser in VMAT plans however the difference is not very appreciable. The MU in VMAT plans is almost 50% that of the IMRT plans which results in the reduction of treatment time. On the whole VMAT proves to be a better modality for treating Ca. Left Breast Patients.

• Journal of the Korean Society of Radiology
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• v.10 no.4
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• pp.271-278
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• 2016

This study was fulfilled to evaluate the absorbed dose of breast and adjacent organs using MIRD type phantom in brachytherapy of breast cancer. The absorbed dose was analyzed assuming left or right breast is source organ which is $^{103}Pd$ or $^{192}Ir$. As a result, $^{192}Ir$ dose is higher than $^{103}Pd$ in source organ and also in contralateral breast. Particularly, significant adjacent organs are lung, liver, heart and contralateral breast in brachytherapy of breast cancer.