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Sample records for breast-conserving surgery interim

  1. Hypofractionated and Accelerated Radiotherapy With Subcutaneous Amifostine Cytoprotection as Short Adjuvant Regimen After Breast-Conserving Surgery: Interim Report

    SciTech Connect

    Koukourakis, Michael I.

    2009-07-15

    Purpose: Short radiotherapy schedules might be more convenient for patients and overloaded radiotherapy departments, provided late toxicity is not increased. We evaluated the efficacy and toxicity of a hypofractionated and highly accelerated radiotherapy regimen supported with cytoprotection provided by amifostine in breast cancer patients treated with breast-conserving surgery. Methods and Materials: A total of 92 patients received 12 consecutive fractions of radiotherapy (3.5 Gy/fraction for 10 fractions) to the breast and/or axillary/supraclavicular area and 4 Gy/fraction for 2 fractions to the tumor bed). Amifostine at a dose of 1,000 mg/d was administered subcutaneously. The follow-up of patients was 30-60 months (median, 39). Results: Using a dose individualization algorithm, 77.1% of patients received 1,000 mg and 16.3% received 750 mg of amifostine daily. Of the 92 patients, 13% interrupted amifostine because of fever/rash symptoms. Acute Grade 2 breast toxicity developed in 6.5% of patients receiving 1,000 mg of amifostine compared with 46.6% of the rest of the patients (p < .0001). The incidence of Grade 2 late sequelae was less frequent in the high amifostine dose group (3.2% vs. 6.6%; p = NS). Grade 1 lung fibrosis was infrequent (3.3%). The in-field relapse rate was 3.3%, and an additional 2.2% of patients developed a relapse in the nonirradiated supraclavicular area. c-erbB-2 overexpression was linked to local control failure (p = .01). Distant metastasis appeared in 13% of patients, and this was marginally related to more advanced T/N stage (p = .06). Conclusion: Within a minimal follow-up of 2.5 years after therapy, hypofractionated and accelerated radiotherapy with subcutaneous amifostine cytoprotection has proved a well-tolerated and effective regimen. Longer follow-up is required to assess the long-term late sequelae.

  2. Additional Surgery after Breast-Conserving Surgery Varies Widely

    Cancer.gov

    A study published in the Feb. 1, 2012, issue of JAMA found that the number of women who have one or more additional surgeries to remove suspected residual tumor tissue (re-excisions) following breast-conserving surgery (BCS) for breast cancer varies widely across surgeons and hospitals.

  3. Periareolar Approach in Oncoplastic Breast Conservative Surgery.

    PubMed

    Klinger, Marco; Giannasi, Silvia; Klinger, Francesco; Caviggioli, Fabio; Bandi, Valeria; Banzatti, Barbara; Forcellini, Davide; Maione, Luca; Catania, Barbara; Vinci, Valeriano; Lisa, Andrea; Cornegliani, Guido; Siliprandi, Mattia; Tinterri, Corrado

    2016-07-01

    Breast cancer represents the most frequent cancer in female population. Nowadays breast conservative surgery (BCS) is an accepted option for breast malignancies, and its indications has been extended thanks to the advent of oncoplastic surgery, reducing both mastectomy and re-excision rate, avoiding at the same time breast deformities. From January 2008 to November 2011, 84 women underwent BCS with periareolar approach for oncoplastic volume replacement. We divided patients into four groups analyzing breast size and resection volume (Group 1: small-moderate sized breast with resection <20%; Group 2: small-moderate sized breast with resection >20%; Group 3: big sized breast with resection <20%; Group 4: big sized breast with resection >20%). We evaluated patients' satisfaction regarding final esthetic outcome using the specific module "Satisfaction with outcome" of the Breast-Q questionnaire 1 year after surgery. The mean age was 52.1 years, and the mean follow-up was 11.2 months. During the follow-up, 12 patients have been lost. We obtained high satisfaction mean value with Breast-Q questionnaire in each group: 75.8 in group 1, 63.4 in group 2, 81.1 in group 3, 69.7 in group 4. Periareolar approach as oncoplastic volume replacement technique is useful in correction of breast deformity after BCS: it is a versatile technique that can be easily adapted for any breast tumor location and for wide glandular resection. PMID:27088898

  4. Surgical resection margins after breast-conserving surgery: Senonetwork recommendations.

    PubMed

    Galimberti, Viviana; Taffurelli, Mario; Leonardi, Maria Cristina; Aristei, Cynthia; Trentin, Chiara; Cassano, Enrico; Pietribiasi, Francesca; Corso, Giovanni; Munzone, Elisabetta; Tondini, Carlo; Frigerio, Alfonso; Cataliotti, Luigi; Santini, Donatella

    2016-06-01

    This paper reports findings of the "Focus on Controversial Areas" Working Party of the Italian Senonetwork, which was set up to improve the care of breast cancer patients. After reviewing articles in English on the MEDLINE system on breast conserving surgery for invasive carcinoma, the Working Party presents their recommendations for identifying risk factors for positive margins, suggests how to manage them so as to achieve the highest possible percentage of negative margins, and proposes standards for investigating resection margins and therapeutic approaches according to margin status. When margins are positive, approaches include re-excision, mastectomy, or, as second-line treatment, radiotherapy with a high boost dose. When margins are negative, boost administration and its dose depend on the risk of local recurrence, which is linked to biopathological tumor features and surgical margin width. Although margin status does not affect the choice of systemic therapy, it may delay the start of chemotherapy when further surgery is required. PMID:27103209

  5. Oncoplastic breast conserving surgery: Volume replacement vs. volume displacement.

    PubMed

    Noguchi, M; Yokoi-Noguchi, M; Ohno, Y; Morioka, E; Nakano, Y; Kosaka, T; Kurita, T

    2016-07-01

    Oncoplastic breast conserving surgery (BCS) has emerged as a third option between conventional BCS and mastectomy. Oncoplastic BCS includes two fundamentally different approaches: volume replacement and volume displacement. The former involves partial mastectomy and immediate reconstruction of the breast with the transposition of autologous tissue from elsewhere, while the latter involves partial mastectomy and using the remaining breast tissue to fill the defect resulting from extirpation of the tumor. There are several benefits associated with oncoplastic BCS. First, it allows partial mastectomy without cosmetic penalties, and can achieve better cosmetic outcomes than total mastectomy with immediate breast reconstruction. Second, it avoids the need for total mastectomy in an increasing number of patients without compromising local control. Third, partial breast reconstruction is less extensive and has fewer complications than conventional procedures. Partial mastectomy and partial breast reconstruction can be carried out either simultaneously as a one-stage procedure, or using a two-stage approach. Although patients prefer a one-stage procedure, it requires intraoperative confirmation of complete tumor excision using frozen-section analysis. Moreover, oncoplastic BCS requires combined skills, knowledge, and understanding of both oncological and plastic surgeries, which may be optimally achieved by an oncoplastic surgeon. PMID:26988623

  6. Margins in breast conserving surgery: A practice-changing process.

    PubMed

    Rubio, I T; Ahmed, M; Kovacs, T; Marco, V

    2016-05-01

    Margins in breast conserving surgery (BCS) have been a long standing subject debate. This largely arises from the absence of a consensus on what constitutes an adequate margin width, resulting in re-excision rates of 25-40% for close or positive margins and its consequent impact upon cosmesis, economic costs, patient dissatisfaction and lack of bearing on survival. Accepting that the increased risk of local recurrences (LR) has its influence on survival, the decrease in LR in BCS in the last decade have been motivated by better surgical techniques for assessing negative margins, use of targeted therapies and in general with the multimodal treatment in the management of breast cancer patients. Since the publication of the consensus guidelines on margins there has evolved a trend of changing attitudes towards re-excision. Surgeons are considering margins in the context of all factors including not only patient and tumor characteristics but also the regional and systemic treatment the patient is receiving. PMID:26880017

  7. Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery.

    PubMed Central

    Johantgen, M E; Coffey, R M; Harris, D R; Levy, H; Clinton, J J

    1995-01-01

    Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery. PMID:7573632

  8. Endoscopy-assisted breast-conserving surgery for breast cancer patients

    PubMed Central

    Ohara, Masahiro

    2014-01-01

    Breast-conserving surgery (BCS) combined with postoperative radiotherapy is a standard therapy for early-stage breast cancer patients. In addition, recent developments in oncoplastic surgery have improved cosmetic outcomes and patient satisfaction. Therefore, a breast surgeon’s current role in BCS is not only to perform a curative resection of cancerous lesions with adequate surgical margins, but also to preserve the shape and appearance of the treated breast. Endoscopy-assisted breast-conserving surgery (EBCS), which has the advantage of a less noticeable scar, was developed more than ten years ago. Recently, some clinical studies have reported the feasibility, oncological outcomes, aesthetic outcomes, and patient satisfaction of EBCS. Herein, we will review the EBCS clinical studies that have been conducted so far and discuss current issues regarding this operative method. PMID:25083503

  9. Acquired Lymphangiectasia of the Breast After Breast Conserving Surgery.

    PubMed

    Kılıç, Murat Özgür; Dener, Cenap

    2015-12-01

    Lymphangiectasia is characterized by vesicular dilation of lymphatic vessels and is generally a complication of radiotherapy or surgery of various malignant tumors such as breast and cervical cancers. Although it is not a precancerous disease, correct diagnosis is important to rule out Stewart-Treves syndrome which is defined as lymphangiosarcoma that develops in long-standing chronic postmastectomy lymphedema. Observation alone or many therapeutic options including cryosurgery, electrocauterization, sclerotherapy, and excision have been widely used in the management. Herein, a case of breast lymphangiectasia was presented as a late and rare complication of breast cancer-related therapies. PMID:27011587

  10. Breast conservative surgery: is it appropriate for locally advanced breast cancer following downstaging by neoadjuvant chemotherapy? A pathological assessment.

    PubMed

    Moneer, M; El-Didi, M; Khaled, H

    1999-12-01

    The application of breast conserving surgery to down-staged cases with locally advanced breast cancer (LABC) after neoadjuvant chemotherapy (NACT) is still a controversial issue with a variable incidence of locoregional failures. In this study, the response of LABC to NACT was assessed pathologically and the eligible candidates for breast conserving surgery were identified retrospectively. The efficacy of preoperative clinical examination and mammography in detecting these pathological changes were also evaluated. The study included 41 LABC cases. They received NACT (FAC) and were then subjected to a mastectomy. The cases were examined clinically and by mammography before starting treatment and immediately before surgery. Residual tumours in the mastectomy specimens were correlated with the pretreatment and preoperative clinical and mammographic findings in order to assess the efficacy of these tools for detection of NACT-induced changes. After 3 cycles of NACT, 78% of women showed an objective response. However, only 25% of them would have been eligible for breast conserving surgery. The remaining responders had an increased incidence of either multifocality and or peritumoural in situ carcinoma. Both clinical examination and mammography were inadequate for detection of these chemotherapy-induced changes and hence for selecting suitable candidates for breast conservation. This study has shown that tumour regression by NACT is probably induced by a process of tumour segmentation and is associated with an increased incidence of ductal in situ lesions in the original tumour bearing area. PMID:14731459

  11. Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation

    SciTech Connect

    Alpert, Tracy E.; Kuerer, Henry M.; Arthur, Douglas W.; Lannin, Donald R.; Haffty, Bruce G. . E-mail: hafftybg@umdnj.edu

    2005-11-01

    Purpose: To compare outcomes of salvage mastectomy (SM) and salvage breast-conserving surgery (SBCS) and study the feasibility of SBCS. Methods and Materials: Of 2,038 patients treated with breast-conserving therapy at Yale-New Haven Hospital before 1999, 166 sustained an ipsilateral breast tumor recurrence (IBTR). Outcomes and prognostic factors of patients treated with SM or SBCS were compared. Patients were considered amenable to SBCS if the recurrence was localized on mammogram and physical examination, and had pathologic size <3 cm, confined to the biopsy site, without skin or lymphovascular invasion, and with {<=}3 positive nodes. Results: Of the 146 patients definitively managed at IBTR, surgery was SM (n = 116) or SBCS (n 30). The median length of follow-up after IBTR was 13.8 years. The SM and SBCS cohorts had no significant differences, except at IBTR the SM cohort had a greater tumor size (p = 0.049). Of the SM cohort, 65.5% were considered appropriate for SBCS, and a localized relapse was predicted by estrogen-receptor positive, diploid, and detection of recurrence by mammogram. Multicentric disease correlated with BRCA1/2 mutation, estrogen-receptor negative, lymph node positive at relapse, and detection of recurrence by physical examination. Survival after IBTR was 64.5% at 10 years, with no significant difference between SM (65.7%) and SBCS (58.0%). Only 2 patients in the SBCS cohort subsequently had a second IBTR, and were salvaged with mastectomy. Conclusions: While mastectomy is considered the standard surgical salvage of IBTR, SBCS is feasible and prognostic factors are related to favorable tumor biology and early detection. Patients with BRCA1/2 germline mutations may be less appropriate for SBCS, as multicentric disease was more prevalent. Patients who underwent SBCS had comparable outcomes as those who underwent SM, but remain at continued risk for IBTR. A prospective trial evaluating repeat lumpectomy and partial breast reirradiation is

  12. Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?

    PubMed Central

    Houvenaeghel, Gilles; Tallet, Agnès; Jalaguier-Coudray, Aurélie; Cohen, Monique; Bannier, Marie; Jauffret-Fara, Camille; Lambaudie, Eric

    2016-01-01

    The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. Therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCT) of MC/MF tumors. It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A meta-analysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists. PMID:27081646

  13. Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?

    PubMed

    Houvenaeghel, Gilles; Tallet, Agnès; Jalaguier-Coudray, Aurélie; Cohen, Monique; Bannier, Marie; Jauffret-Fara, Camille; Lambaudie, Eric

    2016-04-10

    The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. Therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCT) of MC/MF tumors. It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A meta-analysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists. PMID:27081646

  14. Radiation recall dermatitis occurring 6 years and 4 months after breast-conserving surgery: A case report

    PubMed Central

    UBUKATA, MAMIKO; KAMIO, TAKAKO; OHCHI, TETSUYA; NOGUCHI, EIICHIRO; TSUKADA, HIROKO; KAMEOKA, SHINGO

    2016-01-01

    Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of invasive breast cancer. It has been demonstrated that radiation therapy not only prevents recurrence in the preserved breast, but that it also contributes to improved patient survival. The present study describes the case of a 37-year-old woman with radiation recall dermatitis that occurred 6 years and 4 months after breast-conserving surgery. Erythema with a relatively distinct border was observed at the irradiated site on the left breast; eczema was diagnosed by a dermatologist. Inflammatory breast cancer was ruled out, since chest X-ray, abdominal ultrasound and bone scintigraphy were negative. Following ~1 month of topical corticosteroid application and oral second generation antihistamine treatment, the erythema was alleviated and the subjective symptoms also disappeared. Only a few cases of radiation recall dermatitis have been described in the fields of radiology and dermatology, but not yet in the surgical field. In the future, the incidence of radiation recall dermatitis is predicted to increase due to the increasing number of patients undergoing breast-conserving therapy. Whether in the surgical, radiological or dermatological field, if erythema is detected at the irradiated site during post-operative follow-up, routine care should be provided, keeping in mind the possibility of radiation recall dermatitis and inflammatory breast cancer. PMID:27123065

  15. The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery

    PubMed Central

    Zhang, Huiyu; Tan, Hongna; Gao, Jianbo; Wei, Yan; Yu, Zhan; Zhou, Yan

    2016-01-01

    The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects

  16. Combining supine MRI and 3D optical scanning for improved surgical planning of breast conserving surgeries

    NASA Astrophysics Data System (ADS)

    Pallone, Matthew J.; Poplack, Steven P.; Barth, Richard J., Jr.; Paulsen, Keith D.

    2012-02-01

    Image-guided wire localization is the current standard of care for the excision of non-palpable carcinomas during breast conserving surgeries (BCS). The efficacy of this technique depends upon the accuracy of wire placement, maintenance of the fixed wire position (despite patient movement), and the surgeon's understanding of the spatial relationship between the wire and tumor. Notably, breast shape can vary significantly between the imaging and surgical positions. Despite this method of localization, re-excision is needed in approximately 30% of patients due to the proximity of cancer to the specimen margins. These limitations make wire localization an inefficient and imprecise procedure. Alternatively, we investigate a method of image registration and finite element (FE) deformation which correlates preoperative supine MRIs with 3D optical scans of the breast surface. MRI of the breast can accurately define the extents of very small cancers. Furthermore, supine breast MR reduces the amount of tissue deformation between the imaging and surgical positions. At the time of surgery, the surface contour of the breast may be imaged using a handheld 3D laser scanner. With the MR images segmented by tissue type, the two scans are approximately registered using fiducial markers present in both acquisitions. The segmented MRI breast volume is then deformed to match the optical surface using a FE mechanical model of breast tissue. The resulting images provide the surgeon with 3D views and measurements of the tumor shape, volume, and position within the breast as it appears during surgery which may improve surgical guidance and obviate the need for wire localization.

  17. Impact of intraoperative specimen mammography on margins in breast-conserving surgery

    PubMed Central

    Hisada, Tomoka; Sawaki, Masataka; Ishiguro, Junko; Adachi, Yayoi; Kotani, Haruru; Yoshimura, Akiyo; Hattori, Masaya; Yatabe, Yasushi; Iwata, Hiroji

    2016-01-01

    A positive resection margin is one of the most significant risk factors for local breast cancer recurrence following breast-conserving surgery (BCS). Intraoperative specimen mammography (SMMG) is routinely used to evaluate the surgical margin at our institution. The aim of the present study was to assess the adequacy of SMMG for margin assessment. The patient cohort included 174 women who underwent BCS in 2006. The sensitivity and specificity of SMMG were assessed by comparing the margins assessed by histological and radiological methods. It was also examined whether the rate of positive histological margins was decreased by re-excision following SMMG evaluation. A total of 23 false-negatives and 6 false-positives were determined by SMMG. The sensitivity and specificity of SMMG margin assessment for patients with primary breast cancer were 20.6 and 94.6%, respectively. The positive predictive value was 50% and the negative predictive value was 82.2%. A subgroup analysis revealed that the sensitivity and specificity of SMMG in cases with ductal carcinoma in situ (DCIS) were higher compared with those in invasive ductal carcinoma. Furthermore, the positive histological margin rate was not affected by re-excision. Although the general usefulness of intraoperative SMMG was not proven, this procedure may be useful in specific cases, particularly those with DCIS and those diagnosed by stereotactic biopsy. A prospective study with exact criteria and a standard procedure is required. PMID:27588192

  18. True Local Recurrences after Breast Conserving Surgery have Poor Prognosis in Patients with Early Breast Cancer

    PubMed Central

    Sarsenov, Dauren; Ilgun, Serkan; Ordu, Cetin; Alco, Gul; Bozdogan, Atilla; Elbuken, Filiz; Nur Pilanci, Kezban; Agacayak, Filiz; Erdogan, Zeynep; Eralp, Yesim; Dincer, Maktav

    2016-01-01

    Background: This study was aimed at investigating clinical and histopathologic features of ipsilateral breast tumor recurrences (IBTR) and their effects on survival after breast conservation therapy. Methods: 1,400 patients who were treated between 1998 and 2007 and had breast-conserving surgery (BCS) for early breast cancer (cT1-2/N0-1/M0) were evaluated. Demographic and pathologic parameters, radiologic data, treatment, and follow-up related features of the patients were recorded. Results: 53 patients (3.8%) had IBTR after BCS within a median follow-up of 70 months. The mean age was 45.7 years (range, 27-87 years), and 22 patients (41.5%) were younger than 40 years. 33 patients (62.3%) had true recurrence (TR) and 20 were classified as new primary (NP). The median time to recurrence was shorter in TR group than in NP group (37.0 (6-216) and 47.5 (11-192) months respectively; p = 0.338). Progesterone receptor positivity was significantly higher in the NP group (p = 0.005). The overall 5-year survival rate in the NP group (95.0%) was significantly higher than that of the TR group (74.7%, p < 0.033). Multivariate analysis showed that younger age (<40 years), large tumor size (>20 mm), high grade tumor and triple-negative molecular phenotype along with developing TR negatively affected overall survival (hazard ratios were 4.2 (CI 0.98-22.76), 4.6 (CI 1.07-13.03), 4.0 (CI 0.68-46.10), 6.5 (CI 0.03-0.68), and 6.5 (CI 0.02- 0.80) respectively, p < 0.05). Conclusions: Most of the local recurrences after BCS in our study were true recurrences, which resulted in a poorer outcome as compared to new primary tumors. Moreover, younger age (<40), large tumor size (>2 cm), high grade, triple negative phenotype, and having true recurrence were identified as independent prognostic factors with a negative impact on overall survival in this dataset of patients with recurrent breast cancer. In conjunction with a more intensive follow-up program, the role of adjuvant therapy

  19. Using surface markers for MRI guided breast conserving surgery: a feasibility survey.

    PubMed

    Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Holloway, Claire M B; Plewes, Donald B; Martel, Anne L

    2014-04-01

    Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient's position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient's arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient's arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient's arm is above the patient's head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm(3) in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM

  20. Using surface markers for MRI guided breast conserving surgery: a feasibility survey

    NASA Astrophysics Data System (ADS)

    Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Holloway, Claire M. B.; Plewes, Donald B.; Martel, Anne L.

    2014-04-01

    Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM

  1. Prognostic Impact of Time to Ipsilateral Breast Tumor Recurrence after Breast Conserving Surgery

    PubMed Central

    Gosset, Marie; Hamy, Anne-Sophie; Mallon, Peter; Delomenie, Myriam; Mouttet, Delphine; Pierga, Jean-Yves; Lae, Marick; Fourquet, Alain; Rouzier, Roman; Reyal, Fabien; Feron, Jean-Guillaume

    2016-01-01

    Background The poor prognosis of patients who experience ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) is established. A short time between primary cancer and IBTR is a prognostic factor but no clinically relevant threshold was determined. Classification of IBTR may help tailor treatment strategies. Purpose We determined a specific time frame, which differentiates IBTR into early and late recurrence, and identified prognostic factors for patients with IBTR at time of the recurrence. Methods We analyzed 2209 patients with IBTR after BCS. We applied the optimal cut-points method for survival data to determine the cut-off times to IBTR. A subgroup analysis was performed by hormone receptor (HR) status. Survival analyses were performed using a Cox proportional hazard model to determine clinical features associated with distant-disease-free survival (DDFS) after IBTR. We therefor built decision trees. Results On the 828 metastatic events observed, the majority occurred within the first 3 months after IBTR: 157 in the HR positive group, 98 in the HR negative group. We found different prognostic times to IBTR: 49 months in the HR positive group, 33 in the HR negative group. After multivariate analysis, time to IBTR was the first discriminant prognostic factor in both groups (HR 0.65 CI95% [0.54–0.79] and 0.42 [0.30–0.57] respectively). The other following variables were significantly correlated with the DDFS: the initial number of positive lymph nodes for both groups, the initial tumor size and grade for HR positive tumors. Conclusion A short interval time to IBTR is the strongest factor of poor prognosis and reflects occult distant disease. It would appear that prognosis after IBTR depends more on clinical and histological parameters than on surgical treatment. A prospective trial in a low-risk group of patients to validate the safety of salvage BCS instead of mastectomy in IBTR is needed. PMID:27494111

  2. Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

    SciTech Connect

    Vaidya, Jayant S.; Baum, Michael; Tobias, Jeffrey S.; Wenz, Frederik; Massarut, Samuele; Keshtgar, Mohammed; Hilaris, Basil; Saunders, Christobel; Williams, Norman R.; Brew-Graves, Chris; Corica, Tammy; Roncadin, Mario; Kraus-Tiefenbacher, Uta; Suetterlin, Marc; Bulsara, Max; Joseph, David

    2011-11-15

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  3. Patient preferences regarding intraoperative versus external beam radiotherapy following breast-conserving surgery.

    PubMed

    Alvarado, Michael D; Conolly, Jay; Park, Catherine; Sakata, Theadora; Mohan, Aron J; Harrison, Brittany L; Hayes, Mitchell; Esserman, Laura J; Ozanne, Elissa M

    2014-01-01

    The TARGIT-A Trial is an international randomized, prospective trial comparing intraoperative radiotherapy (IORT) for equivalence to external beam radiotherapy (EBRT) following lumpectomy for invasive breast cancer in selected low-risk patients; early results suggest that outcomes are similar. In addition to effectiveness data and cost considerations, the preferences of patients should help inform practice. This study was undertaken to explore and quantify preference in choosing between IORT and the current standard, EBRT. Eligible subjects were current or past candidates for breast-conserving surgery and radiation being seen at the University of California, San Francisco Breast Care Center. A trade-off technique varying the risk of local recurrence for IORT was used to quantify any additional accepted risk that these patients would accept to receive either treatment. Patients were first presented with a slideshow comparing EBRT with the experimental IORT option before being asked their preferences given hypothetical 10-year local recurrence risks. Patients were then given a questionnaire on demographic, social and clinical factors. Data from 81 patients were analyzed. The median additional accepted risk to have IORT was 2.3 % (-9 to 39 %), mean 3.2 %. Only 7 patients chose to accept additional risk for EBRT; 22 accepted IORT at no additional risk; and the remaining 52 chose IORT with some additional risk. Patients weigh trade-offs of risks and benefits when presented with medical treatment choices. Our results show that the majority of breast cancer patients will accept a small increment of local risk for a simpler delivery of radiation. Further studies that incorporate outcome and side effect data from the TARGIT-A trial clarify the expected consequences of a local recurrence, and include an expanded range of radiation options that could help guide clinical decision making in this area. PMID:24292868

  4. Impact of Neoadjuvant Chemotherapy in Stage II–III Triple Negative Breast Cancer on Eligibility for Breast-conserving Surgery and Breast Conservation Rates

    PubMed Central

    Golshan, Mehra; Cirrincione, Constance T.; Sikov, William M.; Berry, Donald A.; Jasinski, Sara; Weisberg, Tracey F.; Somlo, George; Hudis, Clifford; Winer, Eric; Ollila, David W.

    2016-01-01

    Objective To assess the efficacy of neoadjuvant systemic therapy (NST) at increasing the rate of successful breast-conserving therapy (BCT) in triple negative breast cancer. Background Inducing tumor regression to permit BCT is often cited to support administration of NST. To quantify this benefit, we conducted a surgical companion study to CALGB40603, a randomized phase II, 2×2 factorial trial of neoadjuvant paclitaxel ± carboplatin ± bevacizumab (B) followed by doxorubicin plus cyclophosphamide ± B in stage II–III triple negative breast cancer. Methods Before and after NST, treating surgeons evaluated BCT candidacy by clinico-radiographic criteria; surgery performed was at surgeon and patient discretion. We measured (1) conversion rates from BCT-ineligible to BCT-eligible, (2) surgical choices in BCT candidates, and (3) rates of successful BCT with tumor-free margins. Results Four hundred four patients were assessable for surgical outcomes. Two hundred nineteen (54%) were BCT candidates before NST. One hundred ninety-seven (90%) remained BCT candidates after NST, of whom 138 (70%) chose BCT, which was successful in 130 (94%). Of 185 (46%) who were not BCT candidates before NST, 78 (42%) converted to candidates with NST. Of these, 53 (68%) chose BCT with a 91% (48/53) success rate. The overall BCT-eligibility rate rose from 54% to 68% (275/404) with NST. Addition of carboplatin, B, or both increased conversion rates. Conclusions This is the first study to document prospectively a 42% conversion rate from BCT-ineligible to BCT-eligible, resulting in a 14% absolute increase in BCT eligibility. BCT was successful in 93% of patients who opted for it, but 31% of BCT-eligible patients still chose mastectomy. PMID:26222764

  5. Use of autologous fat grafting for reconstruction postmastectomy and breast conserving surgery: a systematic review protocol

    PubMed Central

    Agha, Riaz A; Goodacre, Tim; Orgill, Dennis P

    2013-01-01

    Introduction There is growing interest in the potential use of autologous fat grafting (AFG) for the purposes of breast reconstruction. However, concerns have been raised regarding the technique's clinical effectiveness, safety and interference with screening mammography. The objective of this systematic review was to determine the oncological, clinical, aesthetic and functional, patient reported, process and radiological outcomes for AFG. Methods and analysis All original studies, including randomised controlled trials, cohorts studies, case–control studies, case series and case reports involving women undergoing breast reconstruction. All AFG techniques performed for the purposes of reconstruction in the postmastectomy or breast conserving surgery setting will be considered. Outcomes are defined within this protocol along; oncological, clinical, aesthetic and functional, patient reported, process and radiological domains. The search strategy has been devised to find papers about ‘fat grafting and breast reconstruction’ and is outlined within the body of this protocol. The full search strategy is outlined within the body of the protocol. The following electronic databases will be searched from 1 January 1986 to 6 June 2013: PubMed, MEDLINE, EMBASE, SCOPUS, CINAHL, PsycINFO, SciELO, The Cochrane Library, including the Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups, ClinicalTrials.gov, Current Controlled Trials Database, the World Health Organisation (WHO) International Clinical Trials Registry Platform, UpToDate.com, NHS Evidence and the York Centre for Reviews and Dissemination. Grey literature searches will also be conducted as detailed in our review protocol. Eligibility assessment occurred in two stages, title and

  6. Patient, hospital, and surgeon factors associated with breast conservation surgery. A statewide analysis in North Carolina.

    PubMed Central

    Kotwall, C A; Covington, D L; Rutledge, R; Churchill, M P; Meyer, A A

    1996-01-01

    OBJECTIVE: The objective of this study was to determine the trend of breast conservation surgery (BCS) in North Carolina over a 6-year period and to identify patient, hospital, and surgeon factors associated with the use of BCS. SUMMARY BACKGROUND DATA: Despite evidence that BCS is an appropriate method of treatment for early stage breast cancer, surgeons in the United States have been slow to adopt this treatment method. METHODS: Cases of primary breast cancer surgery in all 157 hospitals in the state from 1988 to 1993, inclusive (N = 20,760), were obtained from the State Medical Database Commission, Area Resource File, American Hospital Association and State Board of Medical Examiner's Databases. Multiple logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) to determine factors associated with BCS. RESULTS: The rate of BCS doubled from 7.3% in 1988 to 14.3% in 1993, with an overall rate of 10.2% (2117/ 20.760). Multiple logistic regression identified the following factors associated with BCS: patient age younger than 50 years of age (OR = 1.7, 95% CI = 1.4, 2.1), patient age 50 to 69 years of age (OR = 1.2, 95% CI = 1.1, 1.4), private insurance (OR = 1.2, 95% CI = 1.0, 1.4), hospital bed size 401+(OR = 2.0, 95% CI = 1.6, 2.5), bed size 101 to 400 (OR = 1.7, 95% CI = 1.3, 2.1), and surgeon graduation from medical school since 1981 (OR = 1.6, 95% CI = 1.2, 2.0). CONCLUSIONS: Rates of BCS in North Carolina are low. Least likely to have BCS were women older than 70 years of age, without private insurance, treated at small hospitals by older surgeons. To increase the use of BCS, widespread education of surgeons, other health care providers, policy makers, and the general public is warranted. Images Figure 1. PMID:8857847

  7. Identification of the boundary between normal breast tissue and invasive ductal carcinoma during breast-conserving surgery using multiphoton microscopy

    NASA Astrophysics Data System (ADS)

    Deng, Tongxin; Nie, Yuting; Lian, Yuane; Wu, Yan; Fu, Fangmeng; Wang, Chuan; Zhuo, Shuangmu; Chen, Jianxin

    2014-11-01

    Breast-conserving surgery has become an important way of surgical treatment for breast cancer worldwide nowadays. Multiphoton microscopy (MPM) has the ability to noninvasively visualize tissue architectures at the cellular level using intrinsic fluorescent molecules in biological tissues without the need for fluorescent dye. In this study, MPM is used to image the microstructures of terminal duct lobular unit (TDLU), invasive ductal carcinoma and the boundary region between normal and cancerous breast tissues. Our study demonstrates that MPM has the ability to not only reveal the morphological changes of the cuboidal epithelium, basement membrane and interlobular stroma but also identify the boundary between normal breast tissue and invasive ductal carcinoma, which correspond well to the Hematoxylin and Eosin (H and E) images. Predictably, MPM can monitor surgical margins in real time and provide considerable accuracy for resection of breast cancerous tissues intraoperatively. With the development of miniature, real-time MPM imaging technology, MPM should have great application prospects during breast-conserving surgery.

  8. Sequence of Radiotherapy and Chemotherapy in Breast Cancer After Breast-Conserving Surgery

    SciTech Connect

    Jobsen, Jan J.; Palen, Job van der; Brinkhuis, Marieel; Ong, Francisca; Struikmans, Henk

    2012-04-01

    Purpose: The optimal sequence of radiotherapy and chemotherapy in breast-conserving therapy is unknown. Methods and Materials: From 1983 through 2007, a total of 641 patients with 653 instances of breast-conserving therapy (BCT), received both chemotherapy and radiotherapy and are the basis of this analysis. Patients were divided into three groups. Groups A and B comprised patients treated before 2005, Group A radiotherapy first and Group B chemotherapy first. Group C consisted of patients treated from 2005 onward, when we had a fixed sequence of radiotherapy first, followed by chemotherapy. Results: Local control did not show any differences among the three groups. For distant metastasis, no difference was shown between Groups A and B. Group C, when compared with Group A, showed, on univariate and multivariate analyses, a significantly better distant metastasis-free survival. The same was noted for disease-free survival. With respect to disease-specific survival, no differences were shown on multivariate analysis among the three groups. Conclusion: Radiotherapy, as an integral part of the primary treatment of BCT, should be administered first, followed by adjuvant chemotherapy.

  9. Oncoplastic Surgical Techniques for Personalized Breast Conserving Surgery in Breast Cancer Patient with Small to Moderate Sized Breast

    PubMed Central

    Yang, Jung Dug; Lee, Jeong Woo; Kim, Wan Wook; Jung, Jin Hyang

    2011-01-01

    Oncoplastic surgery has revolutionized the field of breast conserving surgery (BCS). The final aims of this technique are to obtain an adequate resection margin that will reduce the rate of local recurrence while simultaneously improving cosmetic outcomes. To obtain successful results after oncoplastic surgery, it is imperative that patients be risk-stratified based on risk factors associated with positive margins, that relevant imaging studies be reviewed, and that the confirmation of negative margins be confirmed during the initial operation. Patients who had small- to moderate-sized breasts are the most likely to be dissatisfied with the cosmetic outcome of surgery, even if the defect is small; therefore, oncoplastic surgery in this population is warranted. Reconstruction of the remaining breast tissue is divided into volume displacement and volume replacement techniques. The use of the various oncoplastic surgeries is based on tumor location and excised breast volume. If the excised volume is less than 100 g, the tumor location is used to determine which technique should be used, with the most commonly used technique being volume displacement. However, if the excised volume is greater than 100 g, the volume replacement method is generally used, and in cases where more than 150 g is excised, the latissimus dorsi myocutaneous flap may be used to obtain a pleasing cosmetic result. The local recurrence rate after oncoplastic surgery was lower than that of conventional BCS, as oncoplastic surgery reduced the rate of positive resection margins by resecting a wider section of glandular tissue. If the surgeon understands the advantages and disadvantages of oncoplastic surgery, and the multidisciplinary breast team is able to successfully collaborate, then the success rate of BCS with partial breast reconstruction can be increased while also yielding a cosmetically appealing outcome. PMID:22323910

  10. Mammotome-assisted endoscopic breast-conserving surgery: a novel technique for early-stage breast cancer

    PubMed Central

    2014-01-01

    Background Because of its minimally invasive and highly accurate nature, the use of Mammotome, a vacuum-assisted breast biopsy device has proven beneficial to the treatment of benign breast lesions. Taking advantage of endoscopic and Mammotome techniques together, we utilized the Mammotome device for therapeutic excision of malignant lesions in breast-conserving surgery (BCS). Methods Between December 2009 and January 2010, two patients with early breast cancer received Mammotome-assisted endoscopic BCSs. Under ultrasound monitoring, the Mammotome system dissected the surrounding tissue and freed the tumor en bloc leaving negative margins; endoscopic axillary lymph node dissection then followed. Results The operation time was less than 180 minutes and the mean blood loss was 60 ml. The post-operative pathology report confirmed two patients to have invasive ductal carcinoma, one without axillary lymph nodes metastasis (0/11) and the other with one lymph node metastasis (1/21). No adverse events were noted. During a mean follow-up of 26.5 months, no evidence of recurrence or metastasis was found. The patients were satisfied with the cosmetic results. Conclusions Mammotome-assisted endoscopic surgery appears to be a valuable option for early breast cancer. The long-term therapeutic effect remains to be confirmed. PMID:24742110

  11. Identification of Patients at Very Low Risk of Local Recurrence After Breast-Conserving Surgery

    SciTech Connect

    Smith, Sally L.; Truong, Pauline T.; Lu, Linghong; Lesperance, Mary; Olivotto, Ivo A.

    2014-07-01

    Purpose: To identify clinical and pathological factors that identify groups of women with stage I breast cancer with a 5-year risk of local recurrence (LR) ≤1.5% after breast-conserving therapy (BCS) plus whole-breast radiation therapy (RT). Methods and Materials: Study subjects were 5974 patients ≥50 years of age whose cancer was diagnosed between 1989 and 2006, and were referred with pT1 pN0 invasive breast cancer treated with BCS and RT. Cases of 5- and 10-year LR were examined using Kaplan-Meier methods. Recursive partitioning analysis was performed in patients treated with and without endocrine therapy to identify combinations of factors associated with a 5-year LR risk ≤1.5%. Results: The median follow-up was 8.61 years. Median age was 63 years of age (range, 50 to 91). Overall 5-year LR was 1.5% (95% confidence interval [CI], 1.2%-1.9%) and 10-year LR was 3.4% (95% CI, 2.8%-4.0%). Of 2830 patients treated with endocrine therapy, patient subsets identified with 5-year LR ≤1.5% included patients with grade 1 histology (n=1038; LR, 0.2%; 95% CI, 0%-0.5%) or grade 2 histology plus ≥60 years of age (n=843; LR, 0.5%; 95% CI, 0%-1.0%). Ten-year LR for these groups were 0.8% (95% CI, 0.1%-1.6%) and 0.9% (95% CI, 0.2%-1.6%), respectively. Of 3144 patients treated without endocrine therapy, patients with grade 1 histology plus clear margins had 5-year LR ≤1.5% (n=821; LR, 0.6%; 95% CI, 0.1%-1.2%). Ten-year LR for this group was 2.2% (95% CI, 1.0%-3.4%). Conclusions: Histologic grade, age, margin status, and use of endocrine therapy identified 45% of a population-based cohort of female patients over age 50 with stage I breast cancer with a 5-year LR risk ≤1.5% after BCS plus RT. Prospective study is needed to evaluate the safety of omitting RT in patients with such a low risk of LR.

  12. Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

    PubMed Central

    Beck, Robert E.; Kim, Leonard; Yue, Ning J.; Haffty, Bruce G.; Khan, Atif J.; Goyal, Sharad

    2014-01-01

    Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery. PMID:25452938

  13. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

    SciTech Connect

    Senthi, Sashendra; Link, Emma; Chua, Boon H.; University of Melbourne, Melbourne

    2012-10-01

    Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

  14. Breast conserving surgery with preservation of the nipple-areola complex as a feasible and safe approach in male breast cancer: a case report

    PubMed Central

    Lanitis, Sophocles; Filippakis, George; Al Mufti, Ragheed; Hadjiminas, Dimitri J

    2008-01-01

    Introduction Breast cancer in men is rare. The evidence about treatment has been derived from data on the management of the disease in women. The usual treatment is for male patients to undergo modified radical mastectomy. There is insufficient experience of breast conserving surgery with preservation of the nipple. The management of patients who demand such an approach for personal reasons remains a challenge for both the surgeon and oncologist. Case presentation A 50-year-old man with a breast cancer was successfully managed with breast conserving surgery with nipple preservation combined with axillary clearance and postoperative radiotherapy, chemotherapy and hormone treatment. Since there are no similar cases in the literature, we discuss the feasibility, safety and possible indications of such an approach. Conclusion Despite the limited indications and evidence about the safety and efficacy of breast conserving surgery with nipple preservation in men with breast cancer, it is a feasible approach if other options are declined by the patient. More studies are necessary to reach firm conclusions about the safety of such an approach. PMID:18442386

  15. The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer

    PubMed Central

    McGuire, Kandace; Alco, Gul; Nur Pilanci, Kezban; Koksal, Ulkuhan I; Elbüken, Filiz; Erdogan, Zeynep; Agacayak, Filiz; Ilgun, Serkan; Sarsenov, Dauren; Öztürk, Alper; İğdem, Şefik; Okkan, Sait; Eralp, Yeşim; Dincer, Maktav; Ozmen, Vahit

    2016-01-01

    Background Premenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women. Methods Three hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS). Results Most patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24–252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35–40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015). Conclusion Young age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35–40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival. PMID:27433412

  16. Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery – A case series

    PubMed Central

    Rassu, Pier Carlo

    2015-01-01

    Background Oxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP. Patients and methods 18 patients with early breast cancer and with proliferative benign lesions underwent BCS with ORCP that was layered in three-dimensional wafer, and placed into the Chassaignac space between the mammary gland and the fascia of pectoralis major with no fixation. After surgery, patients started a clinical and instrumental 36-month follow-up with mammography, ultrasonography, magnetic resonance imaging (MRI) and cytological examination with fine needle aspiration when seroma occurred. Results Below the median age of 66 years old no complications were observed even in case both of overweight, and large breasts with low density. Over the median age seromas occurred with either small or large skin retraction, with the exception of 1 patient having quite dense breasts and low BMI, which had no complications. In elderly patients, 1 case with quite dense breasts and high BMI showed severe seroma and skin retraction, while 1 case with low BMI and less dense breasts highlighted milder complications. Conclusion During 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients. PMID:26865976

  17. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    SciTech Connect

    Nelson, Carl; Bai, Harrison; Neboori, Hanmanth; Takita, Cristiane; Motwani, Sabin; Wright, Jean L.; Hobeika, Georges; Haffty, Bruce G.; Jones, Tiffanie; Goyal, Sharad; Moran, Meena S.

    2012-11-01

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  18. Towards intra-operative diagnosis of tumours during breast conserving surgery by selective-sampling Raman micro-spectroscopy

    NASA Astrophysics Data System (ADS)

    Kong, Kenny; Zaabar, Fazliyana; Rakha, Emad; Ellis, Ian; Koloydenko, Alexey; Notingher, Ioan

    2014-10-01

    Breast-conserving surgery (BCS) is increasingly employed for the treatment of early stage breast cancer. One of the key challenges in BCS is to ensure complete removal of the tumour while conserving as much healthy tissue as possible. In this study we have investigated the potential of Raman micro-spectroscopy (RMS) for automated intra-operative evaluation of tumour excision. First, a multivariate classification model based on Raman spectra of normal and malignant breast tissue samples was built and achieved diagnosis of mammary ductal carcinoma (DC) with 95.6% sensitivity and 96.2% specificity (5-fold cross-validation). The tumour regions were discriminated from the healthy tissue structures based on increased concentration of nucleic acids and reduced concentration of collagen and fat. The multivariate classification model was then applied to sections from fresh tissue of new patients to produce diagnosis images for DC. The diagnosis images obtained by raster scanning RMS were in agreement with the conventional histopathology diagnosis but were limited to long data acquisition times (typically 10 000 spectra mm-2, which is equivalent to ~5 h mm-2). Selective-sampling based on integrated auto-fluorescence imaging and Raman spectroscopy was used to reduce the number of Raman spectra to ~20 spectra mm-2, which is equivalent to an acquisition time of ~15 min for 5 × 5 mm2 tissue samples. This study suggests that selective-sampling Raman microscopy has the potential to provide a rapid and objective intra-operative method to detect mammary carcinoma in tissue and assess resection margins.

  19. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    SciTech Connect

    Min, Sun Young; Lee, Seung Ju; Shin, Kyung Hwan; Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won; Kim, Tae Hyun; Kang, Han-Sung; Cho, Kwan Ho

    2011-12-01

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  20. Postoperative Seroma Formation After Intraoperative Radiotherapy Using Low-Kilovoltage X-Rays Given During Breast-Conserving Surgery

    SciTech Connect

    Kraus-Tiefenbacher, Uta; Welzel, Grit; Brade, Joachim

    2010-07-15

    Purpose: To determine the frequency and volume of seroma after breast-conserving surgery (BCS) with or without intraoperative radiotherapy (IORT). Methods and Materials: Seventy-one patients with 73 breast cancers (IORT group) treated with IORT (20 Gy Intrabeam) as a boost during BCS were compared with 86 patients with 88 breast tumors (NO-IORT group) treated without IORT. Clinical examination and measurement of seroma volume on treatment-planning CT (CT-seroma) was done at median interval of 35 days after BCS. Results: Seroma were found on palpation in 37 patients (23%) and on CT in 105 patients (65%; median volume, 26.3 mL). Interval between BCS and CT was significantly shorter in patients with palpable seroma (median, 33 days) or CT-seroma (33 days) compared with those with no palpable seroma (36.5 days; p = 0.027) or CT-seroma (52 days, p < 0.001). The rate of palpable seroma was not different (IORT n = 17, 23%; NO-IORT n = 20, 23%; p = 0.933), whereas fewer patients required puncture in the IORT group [3 (4%) vs. 10 (11%)]. In contrast, more patients showed CT-seroma after IORT (IORT n = 59, 81%; NO-IORT n = 46, 52%; p < 0.001). The interval between BCS and CT was significantly shorter in patients with IORT as compared with the NO-IORT patients (median, 33 days vs. 41.5 days; p = 0.036). Conclusion: Intraoperative radiotherapy with low-kilovoltage X-rays during BCS is not associated with an increased rate of palpable seroma or seroma requiring treatment. The rate of seroma formation on CT was higher after IORT compared with the NO-IORT group, which might be because of the shorter interval between BCS and CT.

  1. Long-term toxicity of an intraoperative radiotherapy boost using low energy X-rays during breast-conserving surgery

    SciTech Connect

    Kraus-Tiefenbacher, Uta . E-mail: uta.kraus-tiefenbacher@radonk.ma.uni-heidelberg.de; Bauer, Lelia; Scheda, Antonella; Fleckenstein, Katharina; Keller, Anke; Herskind, Carsten; Steil, Volker; Melchert, Frank; Wenz, Frederik

    2006-10-01

    Purpose: Intraoperative radiotherapy (IORT) as a boost for breast cancer delivers a high single dose of radiation to a late-reacting tissue; therefore late toxicity is of particular interest, and long-term follow-up is warranted. To date there are only limited data available on breast cancer patients treated with IORT using low energy X-rays. We analyzed toxicity and cosmesis after IORT as a boost with a minimum follow-up of 18 months. Methods and Materials: A total of 73 patients treated with IORT (20 Gy/50 kV X-rays; INTRABEAM [Carl Zeiss Surgical, Oberkochen, Germany]) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT, 46 Gy) underwent a prospective, predefined follow-up (median, 25 months; range 18-44 months), including clinical examination and breast ultrasound at 6-months and mammographies at 1-year intervals. Toxicities were documented using the common toxicity criteria (CTC)/European Organization for Research and Treatment of Cancer and the LENT-SOMA score. Cosmesis was evaluated with a score from 1 to 4. Results: The IORT in combination with WBRT was well tolerated, with no Grade 3 or 4 skin toxicities and no telangiectasias. Fibrosis of the entire breast was observed in 5% of the patients. A circumscribed fibrosis around the tumor bed was palpable in up to 27% with a peak around 18 months after therapy and a decline thereafter. The observed toxicitiy rates were not influenced by age, tumor stage, or systemic therapy. The cosmetic outcome was good to excellent in {>=}90% of cases. Conclusions: After IORT of the breast using low-energy X-rays, no unexpected toxicity rates were observed during long-term-follow-up.

  2. Radiation Therapy After Breast-Conserving Surgery: Does Hospital Surgical Volume Matter? A Population-Based Study in Taiwan

    SciTech Connect

    Chien, Chun-Ru; Pan, I-Wen; Tsai, Yi-Wen; Tsai, Teressa; Liang, Ji-An; Buchholz, Thomas A.; Shih, Ya-Chen Tina

    2012-01-01

    Purpose: To examine the association between hospital surgical volume and the use of radiation therapy (RT) after breast-conserving surgery (BCS) in Taiwan. Methods and Materials: We used claims data from the National Health Insurance program in Taiwan (1997-2005) in this retrospective population-based study. We identified patients with breast cancer, receipt of BCS, use of radiation, and the factors that could potentially associated with the use of RT from enrollment records, and the ICD-9 and billing codes in claims. We conducted logistic regression to examine factors associated with RT use after BCS, and performed subgroup analyses to examine whether the association differs by medical center status or hospital volumes. Results: Among 5,094 patients with newly diagnosed invasive breast cancer who underwent BCS, the rate of RT was significantly lower in low-volume hospitals (74% vs. 82%, p < 0.01). Patients treated in low-volume hospitals were less likely to receive RT after BCS (odds ratio = 0.72, 95% confidence interval = 0.62-0.83). In addition, patients treated after the implementation of the voluntary pay-for-performance policy in 2001 were more likely to receive RT (odds ratio = 1.23; 95% confidence interval = 1.05-1.45). Subgroup analyses indicated that the high-volume effect was limited to hospitals accredited as non-medical centers, and that the effect of the pay-for-performance policy was most pronounced among low-volume hospitals. Conclusions: Using population-based data from Taiwan, our study concluded that hospital surgical volume and pay-for-performance policy are positively associated with RT use after BCS.

  3. Predictors of Recurrent Ductal Carcinoma In Situ after Breast-Conserving Surgery

    PubMed Central

    Kim, Jung Yeon; Kang, Guhyun; Kim, Hyun-Jung; Gwak, Geumhee; Shin, Young-Joo

    2016-01-01

    Purpose Local recurrence is a major concern in patients who have undergone surgery for ductal carcinoma in situ (DCIS). The present study assessed whether the expression levels of hormone receptors, human epidermal growth factor receptor 2 (HER2), and Ki-67, as well as resection margin status, tumor grade, age at diagnosis, and adjuvant hormonal therapy and radiotherapy (RT) are associated with recurrence in women with DCIS. Methods In total, 111 patients with DCIS were included in the present study. The invasive and noninvasive recurrence events were recorded. The clinicopathological features; resection margins; administration of hormonal therapy and RT; expression statuses of estrogen receptor (ER), progesterone receptor (PR), and HER2; Ki-67 expression; and molecular subtypes were evaluated. Logistic regression analysis was performed to examine the risk factors for recurrence. Results Recurrence was noted in 27 of 111 cases (24.3%). Involvement of resection margins, low tumor grade, high Ki-67 expression, and RT were independently associated with an increase in the recurrence rate (p<0.05, Pearson chi-square test). The recurrence rate was not significantly associated with patient age; ER, PR, and HER2 statuses; molecular subtype; and hormonal therapy. Conclusion The results of the present study suggested that the involvement of resection margins, low tumor grade, high Ki-67 index, and the absence of adjuvant RT were independently associated with increased recurrence in patients with DCIS. Future studies should be conducted in a larger cohort of patients to further improve the identification of patients at high-risk for DCIS recurrence. PMID:27382395

  4. Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival

    SciTech Connect

    Hershman, Dawn L. . E-mail: dlh23@columbia.edu; Wang Xiaoyan; McBride, Russell

    2006-08-01

    Purpose: Delays in the diagnosis of breast cancer are associated with advanced stage and poor survival, but the importance of the time interval between lumpectomy and initiation of radiation therapy (RT) has not been well studied. We investigated factors that influence the time interval between lumpectomy and RT, and the association between that interval and survival. Patients and Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database on women aged 65 years and older, diagnosed with Stages I-II breast cancer, between 1991 and 1999. Among patients who did not receive chemotherapy, we studied factors associated with the time interval between lumpectomy and the initiation of RT, and the association of delay with survival, using linear regression and Cox proportional hazards modeling. Results: Among 24,833 women with who underwent lumpectomy, 13,907 (56%) underwent RT. Among those receiving RT, 97% started treatment within 3 months; older age, black race, advanced stage, more comorbidities, and being unmarried were associated with longer time intervals between surgery and RT. There was no benefit to earlier initiation of RT; however, delays >3 months were associated with higher overall mortality (hazard ratio, 1.92; 95% confidence interval, 1.64-2.24) and cancer-specific mortality (hazard ratio, 3.84; 95% confidence interval 3.01-4.91). Conclusions: Reassuringly, early initiation of RT was not associated with survival. Although delays of >3 months are uncommon, they are associated with poor survival. Whether this association is causal or due to confounding factors, such as poor health behaviors, is unknown; until it is better understood, efforts should be made to initiate RT in a timely fashion.

  5. Does Concurrent Radiochemotherapy Affect Cosmetic Results in the Adjuvant Setting After Breast-Conserving Surgery? Results of the ARCOSEIN Multicenter, Phase III Study: Patients' and Doctors' Views

    SciTech Connect

    Toledano, Alain H. . E-mail: alain.toledano@gmail.com; Bollet, Marc A.; Fourquet, Alain; Azria, David; Gligorov, Joseph; Garaud, Pascal; Serin, Daniel; Bosset, Jean-Francois; Miny-Buffet, Joelle; Favre, Anne; Le Foch, Olivier; Calais, Gilles

    2007-05-01

    Purpose: To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians. Methods and Materials: From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation. Results: Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair ({kappa} = 0.62). Conclusion: After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis.

  6. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: Long-term results of the ARCOSEIN multicenter randomized study

    SciTech Connect

    Toledano, Alain . E-mail: alain.toledano@gmail.com; Garaud, Pascal; Serin, Daniel; Fourquet, Alain; Bosset, Jean-Francois; Breteau, Noel; Body, Gilles; Azria, David; Le Floch, Olivier; Calais, Gilles

    2006-06-01

    Purpose: In 1996, a multicenter randomized study was initiated that compared sequential vs. concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) after breast-conserving surgery (ARCOSEIN study). After a median follow-up of 6.7 years (range, 4.3-9 years), we decided to prospectively evaluate the late effects of these 2 strategies. Methods and Materials: A total of 297 patients from the 5 larger participating institutions were asked to report for a follow-up examination. Seventy-two percent (214 patients) were eligible for evaluation of late toxicity. After breast-conserving surgery, patients were treated either with sequential treatment with CT first followed by RT (Arm A) or CT administered concurrently with RT (Arm B). In all patients, CT regimen consisted of mitoxantrone (12 mg/m{sup 2}), 5-FU (500 mg/m{sup 2}), and cyclophosphamide (500 mg/m{sup 2}), 6 cycles (Day 1 to Day 21). Conventional RT was delivered to the whole breast by administration of a 2 Gy per fraction protocol to a total dose of 50 Gy ({+-} boost to the primary tumor bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist, according to the LENT/SOMA scale. Skin pigmentation was also evaluated according to a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results: Among the 214 evaluable patients, 107 were treated in each arm. The 2 populations were homogeneous for patient, tumor, and treatment characteristics. Subcutaneous fibrosis (SF), telangectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in Arm B. No statistical difference was observed between the 2 arms of the study concerning Grade 2 or higher pain, breast edema, or lymphedema. No deaths were caused by late toxicity. Conclusion: After breast-conserving surgery, the concurrent use of CT with RT is significantly associated with an increase incidence of Grade 2 or greater late side effects.

  7. Considerations arising from requests from patients for a bilateral mastectomy who are eligible for breast-conserving surgery: Factors weighing for and against performing the operation

    PubMed Central

    FANCELLU, ALESSANDRO

    2016-01-01

    Rates of mastectomy and contralateral prophylactic mastectomy (CPM) are increasing in patients with unilateral breast cancer who would be candidates for receiving breast-conserving surgery, according to recent studies. One reason for this finding is the entitlement of patients to choose to undergo a bilateral mastectomy as a surgery option. The present case report details the case of a 52-year-old woman, eligible for breast conservation, who had no high risk of developing a contralateral breast cancer, but who asked for a bilateral mastectomy and immediate reconstruction instead of breast-conserving surgery. The request for a bilateral mastectomy was declined on the basis that it would be unnecessary for the patient, and an excessive intervention; the patient subsequently obtained an independent second opinion, and she underwent a bilateral mastectomy with implant reconstruction prior to receiving wound care and follow-up at our institution. At follow-up 1 year later, the patient complained of sensations of general discomfort, sexual difficulties and a loss of sensation in the nipples. On the basis of the clinical outcomes of the bilateral mastectomy and the patient's experience of the operation, the present case study highlights a need for surgeons to clearly inform patients presenting with unilateral breast cancer about the attendant risks and real benefits of bilateral mastectomy, in order to reach a mutual decision in terms of health care that is not fuelled by anxiety or an overestimation of the risk of developing secondary cancer. Bilateral mastectomy should be attentively evaluated as an option only in patients with a higher-than-average risk of developing contralateral breast cancer. PMID:27347213

  8. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

    SciTech Connect

    Wen Bixiu; Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080 ; Hsu, Howard; Formenti-Ujlaki, George F.; Lymberis, Stella; Magnolfi, Chiara; Zhao Xuan; Chang Jenghwa; DeWyngaert, J. Keith; Jozsef, Gabor; Formenti, Silvia C.

    2012-11-15

    Purpose: The dosimetric results from our institution's trials of prone accelerated partial breast irradiation are compared with the dosimetric requirements of RTOG-0413. Methods and Materials: Trial 1 and Trial 2 are 2 consecutive trials of prone-accelerated partial breast irradiation. Eligible for both trials were stage I breast cancer patients with negative margins after breast-conserving surgery. The planning target tumor volume (PTV) was created by extending the surgical cavity 2.0 cm for Trial 1 and 1.5 cm for Trial 2, respectively. Contralateral breast, heart, lungs, and thyroid were contoured. Thirty Gray was delivered in five daily fractions of 6 Gy by a three-dimensional conformal radiation therapy technique in Trial 1 and were by image-guided radiation therapy/intensity-modulated radiation therapy in Trial 2. Dosimetric results from the trials are reported and compared with RTOG 0413 requirements. Results: One hundred forty-six consecutive plans were analyzed: 67 left and 79 right breast cancers. The plans from the trials complied with the required >90% of prescribed dose covering 90% of PTV{sub E}VAL (=generated from the PTV by cropping 0.5 cm from the skin edge and excluding the chest wall): V90% was 98.1 {+-} 3.0% (with V100% and V95%, 89.4 {+-} 12.8%, 96.4 {+-} 5.1%, respectively). No significant difference between laterality was found (Student's t test). The dose constraints criteria of the RTOG-0413 protocol for ipsilateral and contralateral lung (V30 <15% and Dmax <3%), heart (V5 <40%), and thyroid (Dmax <3%) were satisfied because the plans showed an average V5% of 0.6% (range, 0-13.4) for heart, an average V30% of 0.6% (range, 0-9.1%) for ipsilateral lung, and <2% maximum dose to the thyroid. However, our partial breast irradiation plans demonstrated a higher dose to contralateral breast than that defined by RTOG constraints, with a median value of maximum doses of 4.1% (1.2 Gy), possibly as a result of contouring differences. Conclusions: Our

  9. Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

    SciTech Connect

    Vujovic, Olga; Yu, Edward; Cherian, Anil; Dar, A. Rashid; Stitt, Larry; Perera, Francisco

    2015-02-01

    Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distant disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone.

  10. Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery

    PubMed Central

    Bellavance, Emily Catherine; Kesmodel, Susan Beth

    2016-01-01

    One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area. PMID:27066455

  11. Is Short-Interval Mammography Necessary After Breast Conservation Surgery and Radiation Treatment in Breast Cancer Patients?

    SciTech Connect

    Hymas, Richard V.; Gaffney, David K.; Parkinson, Brett T.; Belnap, Thomas W.; Sause, William T.

    2012-06-01

    Purpose: The optimum timing and frequency of mammography in breast cancer patients after breast-conserving therapy (BCT) are controversial. The American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis but no earlier than 6 months after completion of radiotherapy. The National Comprehensive Cancer Network recommends annual mammography. Intermountain Healthcare currently follows a more frequent mammography schedule during the first 2 years in BCT patients. This retrospective study was undertaken to determine the cancer yield mammography during the first 2 years after BCT. Methods and Materials: 1,435 patients received BCT at Intermountain Healthcare between 2003 and 2007, inclusive. Twenty-three patients had bilateral breast cancer (1,458 total breasts). Patients were followed up for 24 months after diagnosis. The 1- and 2-year mammography yields were determined and compared with those of the general screening population. Results: 1,079 breasts had mammography at less than 1 year, and two ipsilateral recurrences (both noninvasive) were identified; 1,219 breasts had mammography during the second year, and nine recurrences (three invasive, six noninvasive) were identified. Of the 11 ipsilateral recurrences during the study, three presented with symptoms and eight were identified by mammography alone. The mammography yield was 1.9 cancers per 1,000 breasts the first year and 4.9 per 1,000 the second year. Conclusions: These data demonstrate that the mammography yield during the first 2 years after BCT is not greater than that in the general population, and they support the policy for initiating followup mammography at 1 year after BCT.

  12. Comparison of Treatment Outcome Between Breast-Conservation Surgery With Radiation and Total Mastectomy Without Radiation in Patients With One to Three Positive Axillary Lymph Nodes

    SciTech Connect

    Kim, Seung Il; Park, Seho; Park, Hyung Seok; Kim, Yong Bae; Suh, Chang Ok; Park, Byeong-Woo

    2011-08-01

    Purpose: To test the difference in treatment outcome between breast-conservation surgery with radiation and total mastectomy without radiation, to evaluate the benefits of adjuvant radiotherapy in patients with one to three positive axillary lymph nodes. Methods and Materials: Using the Severance Hospital Breast Cancer Registry, we divided the study population of T1, T2 and one to three axillary node-positive patients into two groups: breast-conservation surgery with radiation (BCS/RT) and total mastectomy without radiation (TM/no-RT). Data related to locoregional recurrence, distant recurrence, and death were collected, and survival rates were calculated. Results: The study population consisted of 125 patients treated with BCS/RT and 365 patients treated with TM/no-RT. With a median follow-up of 68.4 months, the 10-year locoregional recurrence-free survival rate with BCS/RT and TM/no-RT was 90.5% and 79.2%, respectively (p = 0.056). The 10-year distant recurrence-free survival rate was 78.8% for patients treated with BCS/RT vs. 68.0% for those treated with TM/no-RT (p = 0.012). The 10-years overall survival rate for patients treated with BCT/RT and TM/no-RT was 87.5% and 73.9%, respectively (p = 0.035). After multivariate analysis, patients treated with BCT/RT had better distant recurrence-free survival (hazard ratio [HR], 0.527; 95% confidence interval [CI], 0.297-0.934; p = 0.028), with improving locoregional recurrence-free survival (HR, 0.491; 95% CI, 0.231-1.041; p = 0.064) and overall survival trend (HR, 0.544; 95% CI, 0.277-1.067; p = 0.076). Conclusions: This study provides additional evidence that adjuvant radiation substantially reduces local recurrence, distant recurrence, and mortality for patients with one to three involved nodes.

  13. Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy

    SciTech Connect

    Lupe, Krystine; Truong, Pauline T.; Alexander, Cheryl; Lesperance, Mary; Speers, Caroline; Tyldesley, Scott

    2011-11-15

    Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast {+-} boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with {>=}4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, {>=}4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). Conclusions: On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and {>=}4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for

  14. A systematic review and meta-analysis of Harmonic technology compared with conventional techniques in mastectomy and breast-conserving surgery with lymphadenectomy for breast cancer

    PubMed Central

    Cheng, Hang; Clymer, Jeffrey W; Ferko, Nicole C; Patel, Leena; Soleas, Ireena M; Cameron, Chris G; Hinoul, Piet

    2016-01-01

    Background Mastectomy and breast-conserving surgery (BCS) are important treatment options for breast cancer patients. A previous meta-analysis demonstrated that the risk of certain complications can be reduced with the Harmonic technology compared with conventional methods in mastectomy. However, the meta-analysis did not include studies of BCS patients and focused on a subset of surgical complications. The objective of this study was to compare Harmonic technology and conventional techniques for a range of clinical outcomes and complications in both mastectomy and BCS patients, including axillary lymph node dissection. Methods A comprehensive literature search was performed for randomized controlled trials comparing Harmonic technology and conventional methods in breast cancer surgery. Outcome measures included blood loss, drainage volume, total complications, seroma, necrosis, wound infections, ecchymosis, hematoma, hospital length of stay, and operating time. Risk of bias was analyzed for all studies. Meta-analysis was performed using random-effects models for mean differences of continuous variables and a fixed-effects model for risk ratios of dichotomous variables. Results Twelve studies met the inclusion criteria. Across surgery types, compared to conventional techniques, Harmonic technology reduced total complications by 52% (P=0.002), seroma by 46% (P<0.0001), necrosis by 49% (P=0.04), postoperative chest wall drainage by 46% (P=0.0005), blood loss by 38% (P=0.0005), and length of stay by 22% (P=0.007). Although benefits generally appeared greatest in mastectomy patients with lymph node dissection, Harmonic technology showed significant reductions in complications in the BCS study subgroup. Conclusion In this meta-analysis of both mastectomy and BCS procedures, the use of Harmonic technology reduced the risk of most complications by about half across breast cancer surgery patients. These benefits may be due to superior hemostatic capabilities of Harmonic

  15. From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy

    PubMed Central

    Kaviani, Ahmad; Sodagari, Nassim; Sheikhbahaei, Sara; Eslami, Vahid; Hafezi-Nejad, Nima; Safavi, Amin; Noparast, Maryam; Fitoussi, Alfred

    2013-01-01

    Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view. PMID:24167743

  16. The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy

    PubMed Central

    Bantema-Joppe, E J; de Bock, G H; Woltman-van Iersel, M; Busz, D M; Ranchor, A V; Langendijk, J A; Maduro, J H; van den Heuvel, E R

    2015-01-01

    Background: The purpose of the study was to determine the impact of young age on health-related quality of life (HRQoL) by comparing HRQoL of younger and older breast cancer patients, corrected for confounding, and of young patients and a general Dutch population. Methods: The population consisted of breast cancer survivors (stage 0-III) after breast-conserving surgery and radiotherapy. Health-related quality of life was prospectively assessed using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. The association between age (⩽50; 51–70; ⩾70 years) and HRQoL over time was analysed with mixed modelling. The clinical relevance of differences between/within age groups was estimated with Cohen's D and consensus-based guidelines. The HRQoL data from the young patient cohort were compared with Dutch reference data at 3 years after radiotherapy. Results: A total of 1420 patients completed 3200 questionnaires. Median follow-up was 34 (range 6–70) months. Median age was 59 (range 28–85) years. Compared with older subjects, young women reported worse HRQoL in the first year after radiotherapy, but clinical relevance was limited. Three years after radiotherapy, HRQoL values in the younger group were equal to those in the reference population. Pain and fatigue after radiotherapy improved, with medium clinical relevance. Conclusions: Three years after radiotherapy for breast cancer, young age was not a risk factor for decreased HRQoL. PMID:25602967

  17. 2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography after breast conserving surgery: Correlation with molecular markers of breast cancer

    PubMed Central

    Ozguven, Salih; Inanir, Sabahat; Turoglu, Halil Turgut; Erdil, Tanju Yusuf; Ugurlu, Mustafa Umit; Gulluoglu, Bahadir

    2016-01-01

    Aim: To investigate the role of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) early after breast-conserving surgery (BCS) in patients with breast cancer (BC) and whether we can determine which molecular biomarkers of breast carcinoma put the patients at risk. Materials and Methods: This retrospective study involved 88 patients with histologically proven T1 or T2 BC, who were treated with BCS and underwent 18F-FDG PET/CT study. The correlation between biological markers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2], and Ki-67) of the primary tumor and 18F-FDG PET/CT findings was analyzed. Results: 18F-FDG PET/CT demonstrated the presence of BC disease (locoregional disease [LRD], distant metastases, or contralateral BC) in 26 of 88 patients (29.5%). Regarding immunohistochemical profiles, BC expressing high levels of Ki-67 were associated with an increased percentage of LRD, which was the major recurrence pattern on 18F-FDG PET/CT. Although the BC disease was observed more commonly in patients with HER2 positivity compared to those of HER2 negative, the difference did not reach statistical significance. The patients with T2 tumor or a higher histopathological grade had a higher percentage of BC disease. Conclusions: This study demonstrated that patients with early stage BC treated with BCS have a remarkable risk of the presence of BC even early after surgery, and there was a clinically important relationship between 18F-FDG PET/CT findings and biological markers of BC. These findings suggest that high-risk molecular biomarkers (Ki-67, HER2) can be taken into account in the decision-making the process for both preoperative imaging and planning of the surgical approach. PMID:27385883

  18. Evaluation the consistency of location of moist desquamation and skin high dose area for breast cancer patients receiving adjuvant radiotherapy after breast conservative surgery

    PubMed Central

    2013-01-01

    Background To evaluate whether the location of moist desquamation matches high dose area for breast cancer patients receiving adjuvant radiotherapy (RT) after breast conservative surgery. Methods One hundred and nine breast cancer patients were enrolled to this study. Their highest skin dose area (the hot spot) was estimated from the treatment planning. We divided the irradiated field into breast; sternal/parasternal; axillary; and inframammary fold areas. The location for moist desquamation was recorded to see if it matches the hot spot. We also analyzed other possible risk factors which may be related to the moist desquamation. Results Forty-eight patients with 65 locations developed moist desquamation during the RT course. Patients with larger breast sizes and easy to sweat are two independent risk factors for moist desquamation. The distribution of moist desquamation occurred most in the axillary area. All nine patients with the hot spots located at the axillary area developed moist desquamation at the axillary area, and six out of seven patients with the hot spots located at the inframammary fold developed moist desquamation there. The majority of patients with moist desquamation over the breast or sternal/parasternal areas had the hot spots located at these areas. Conclusions For a patient with moist desquamation, if a hot spot is located at the axillary or inframammary fold areas, it is very likely to have moist desquamation occur there. On the other hand, if moist desquamation occurs over the breast or sternal/parasternal areas, we can highly expect these two areas are also the hot spot locations. PMID:23497574

  19. Intraoperative Radiotherapy as a Boost During Breast-Conserving Surgery Using Low-Kilovoltage X-Rays: The First 5 Years of Experience With a Novel Approach

    SciTech Connect

    Wenz, Frederik; Welzel, Grit; Blank, Elena; Hermann, Brigitte; Steil, Volker; Suetterlin, Marc; Kraus-Tiefenbacher, Uta

    2010-08-01

    Purpose: Intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS) has been recently introduced using different devices. We report the first 5 years of a single-center experience after introduction of a novel approach to deliver IORT as a tumor bed boost during BCS for breast cancer. Methods and Materials: A total of 155 breast cancers in 154 women (median age, 63 years; range, 30-83 years; T1/T2 = 100/55; N0/N+ = 108/47) were treated between February 2002 and December 2007 at the University Medical Center Mannheim, in whom IORT as tumor bed boost was applied using 50-kV X-rays (20 Gy) followed by 46-50 Gy whole-breast external-beam radiotherapy (EBRT). Chemotherapy, if indicated, was given before EBRT. The median interval between BCS plus IORT and EBRT was 40 days. Median follow-up was 34 months (maximum 80 months, 1 patient lost to follow-up). Overall survival and local relapse-free survival were calculated at 5 years using the Kaplan-Meier method. Seventy-nine patients were evaluated at 3-year follow-up for late toxicity according to the Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic system. Results: Ten patients died, 2 had in-breast relapse, and 8 developed distant metastases (5-year overall survival = 87.0%; 5-year local relapse-free survival = 98.5%). Grade 3 fibroses of the tumor bed were detected in 5% of the patients after 3 years. Skin toxicity was mild (telangiectases and hyperpigmentations in approximately 6% each). Conclusions: Intraoperative radiotherapy as a tumor bed boost during BCS for breast cancer using low-kilovoltage X-rays followed by EBRT yields low recurrence and toxicity rates.

  20. Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

    PubMed Central

    Cutuli, B; Lemanski, C; Fourquet, A; de Lafontan, B; Giard, S; Meunier, A; Pioud-Martigny, R; Campana, F; Marsiglia, H; Lancrenon, S; Mery, E; Penault-Llorca, F; Fondrinier, E; Tunon de Lara, C

    2009-01-01

    From March 2003 to April 2004, 77 physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30–84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS+RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS+RT and mastectomy, respectively, P<0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS+RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20–37%; adjuvant RT, 84–96%; hormone treatment, 6–34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies. PMID:19277037

  1. Simultaneous Integrated Boost Irradiation After Breast-Conserving Surgery: Physician-Rated Toxicity and Cosmetic Outcome at 30 Months' Follow-Up

    SciTech Connect

    Bantema-Joppe, Enja J.; Schilstra, Cornelis; Bock, Geertruida H. de; Dolsma, Wil V.; Busz, Dianne M.; Langendijk, Johannes A.; Maduro, John H.

    2012-07-15

    Purpose: To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age. Methods and Materials: Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0-III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed. Results: At 3 years, toxicity scores of 436 patients were available. Grade {>=}2 fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7% of cases. Radiotherapy before chemotherapy was significantly associated with grade {>=}2 boost fibrosis at 3 years (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.3-6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95% CI 1.2-4.0) and larger tumors (OR 1.1, 95% CI 1.0-1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95% CI 1.2-3.7) and younger age (OR 0.4, 95% CI 0.2-0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95% CI 2.4-8.5), after regional radiotherapy (OR 2.9, 95% CI 1.2-7.1), and in larger tumors (OR 1.1, 95% CI 1.0-1.1). Conclusions: Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.

  2. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    SciTech Connect

    Neboori, Hanmanth J.R.; Haffty, Bruce G.; Wu Hao; Yang Qifeng; Aly, Amal; Goyal, Sharad; Schiff, Devora; Moran, Meena S.; Golhar, Ryan; Chen Chunxia; Moore, Dirk; and others

    2012-08-01

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log-rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence-free survival (IBRFS), distant metastasis-free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their clinical

  3. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    SciTech Connect

    Lalani, Nafisha; Paszat, Lawrence; Sutradhar, Rinku; Thiruchelvam, Deva; Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta; Done, Susan J.; Miller, Naomi; Youngson, Bruce; Tuck, Alan; Sengupta, Sandip; Elavathil, Leela; Chang, Martin C.; Jani, Prashant A.; Bonin, Michel; and others

    2014-12-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  4. A Case of Secondary Angiosarcoma of the Breast after Breast-conserving Surgery and Radiation: Review of Radiologic and Pathologic Findings

    PubMed Central

    Eppelheimer, Christine N; Marti, Jennifer L; Eisenberg, Amanda; Gan, Qiong; Shabalova, Rena; Cohen, Jean-Marc; Fulop, Tamara

    2015-01-01

    Angiosarcoma of the breast is a rare and potentially life-threatening disease. It can present as a palpable mass or subtle erythematous lesion, depending on the predisposing clinical factors. Erythematous skin lesions may be confused for a benign process, which may lead to a delay in diagnosis. We present a case of an 80-year-old woman who developed secondary angiosarcoma after undergoing breast-conserving therapy for Stage IA breast cancer. In this article, we review our experience with a case of secondary angiosarcoma of the breast and discuss the presentation, evaluation, and treatment of this disease. This case demonstrates the importance of vigilance regarding erythematous or papular breast lesions in the setting of prior local radiation. PMID:26430538

  5. The Use of Contrast-Enhanced Computed Tomography Before Neoadjuvant Chemotherapy to Identify Patients Likely to Be Treated Safely With Breast-Conserving Surgery

    PubMed Central

    Akashi-Tanaka, Sadako; Fukutomi, Takashi; Sato, Natsuko; Iwamoto, Eriko; Watanabe, Toru; Katsumata, Noriyuki; Ando, Masashi; Miyakawa, Kunihisa; Hasegawa, Tadashi

    2004-01-01

    Objective: To select suitable candidates for breast-conserving treatment (BCT) after neoadjuvant chemotherapy (NAC), based on the classification of tumors into localized or diffuse types using contrast-enhanced computed tomography (CE-CT). Summary Background Data: A relatively high rate of loco-regional failure after BCT has been reported with breast cancer downstaged by NAC. Accurate assessment of the suitability of BCT and the response to NAC, before the initiation of NAC, will allow the optimal selection of an appropriate therapeutic course. Methods: We evaluated 110 consecutive patients with operable breast carcinomas measuring 3-cm or more in diameter by CE-CT after NAC treatment with doxorubicin and docetaxel at National Cancer Center Hospital, Tokyo, from May 1998 to November 2001. Lesions were classified as either localized or diffuse types by mammography (MMG), ultrasonography (US), and CE-CT. Results: Tumors designated as localized type by MMG, US, and CE-CT were reduced to tumors less than 3.0 cm (P < 0.0001) in a concentric circle (P < 0.0001). Localized tumors by CE-CT were treated safely with BCT maintaining a negative margin status (P = 0.01). In contrast, diffuse type tumors shrunk into a mosaic pattern consisting of tumors larger than 3.1 cm. Tumors classified as localized by CE-CT responded better pathologically than diffuse tumors (P = 0.0365). Multivariate analysis demonstrated that morphologic type by CE-CT and histologic type were significant predictors of candidates for safe BCT. Conclusions: The classification of tumors into either localized or diffuse types, using CE-CT before NAC administration, accurately predicts which tumors will be suitable candidates for BCT after NAC. PMID:14745332

  6. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    SciTech Connect

    Moran, Meena S.; Schnitt, Stuart J.; Giuliano, Armando E.; Harris, Jay R.; Khan, Seema A.; Horton, Janet; Klimberg, Suzanne; Chavez-MacGregor, Mariana; Freedman, Gary; Houssami, Nehmat; Johnson, Peggy L.; Morrow, Monica

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  7. 1998-1999 Patterns of Care Study process survey of national practice patterns using breast-conserving surgery and radiotherapy in the management of Stage I-II breast cancer

    SciTech Connect

    Pierce, Lori J. . E-mail: ljpierce@umich.edu; Moughan, Jennifer; White, Julia; Winchester, David P.; Owen, Jean; Wilson, J. Frank

    2005-05-01

    Purpose: The Patterns of Care Study survey process evaluation has been an effective means of assessing the evaluation and treatment practices used by radiation oncologists in the United States for Stage I-II breast cancer. The current 1998-1999 report updates the previous 1989 and 1993-1994 analyses and reflects the recent changes in surgery and systemic therapy observed nationally in the management of early-stage disease. Methods and Materials: A weighted sample size of 71,877 patient records of women treated with breast-conserving surgery and radiotherapy (RT) was obtained from a stratified two-stage sampling of 353 patient records. These cases were centrally reviewed from academic and private radiation oncology practices across the United States. The data collected included patient characteristics, clinical and pathologic factors, and surgical and RT details. The results were compared with those of previous Patterns of Care Study survey reports. Results: Of the patients in the current survey, 97% had undergone mammography before biopsy. A review of the primary tumor pathologic findings indicated improved quantification of an intraductal component from 7.0% in 1993-1994 to 20.4% in 1998-1999 (p = 0.01). The tumor characteristics were better defined, with estrogen and progesterone receptor measurement performed in 91.4% and 91.3% in the 1998-1999 survey vs. 83.7% and 80.3% in the 1989 survey, respectively (p = 0.03 and p = 0.002, respectively). Axillary dissection was performed in 82.2% in the present survey compared with 93.6% in the 1993-1994 survey (p = 0.0004); sentinel node biopsy was performed in 20.1% of the present cases. The use of CT for planning was increased in the current survey, with 22.9% cases CT planned vs. 9% in 1993-1994 (p = 0.10). In the present survey, 100% had received whole breast RT. When a supraclavicular field was added, the dose was prescribed to a specified depth in 67.5% of cases, most commonly 3 cm. When an axillary field was added

  8. Evaluation of Single Nucleotide Polymorphisms (SNPs) in the p53 Binding Protein 1 (TP53BP1) Gene in Breast Cancer Patients Treated With Breast-Conserving Surgery and Whole-Breast Irradiation (BCS + RT)

    SciTech Connect

    Haffty, Bruce G.; Goyal, Sharad; Kulkarni, Diptee; Green, Camille; Vazquez, Alexi; Schiff, Devora; Moran, Meena S.; Yang Qifeng; Ganesan, Shridar; Hirsfield, Kim M.

    2011-06-01

    Purpose: TP53BP1 is a key component of radiation-induced deoxyribonucleic acid damage repair. The purpose of this study was to evaluate the significance of a known common single nucleotide polymorphism in this gene (rs560191) in patients treated with breast-conserving surgery and whole-breast irradiation (BCS + RT). Methods and Materials: The population consisted of 176 premenopausal women treated with BCS + RT (median follow-up, 12 years). Genomic deoxyribonucleic acid was processed by use of TaqMan assays. Each allele for rs560191 was either C or G, so each patient was therefore classified as CC, CG, or GG. Patients were grouped as GG if they were homozygous for the variant G allele or CC-CG if they carried at least one copy of the common C allele (CC or CG). Results: Of the 176 women, 124 (71%) were CC-CG and 52 (29%) were GG. The mean age was 44 years for GG vs. 38 years for CC-CG (p < 0.001). GG was more common in African-American women than white women (69% vs. 13%, p < 0.001) and more commonly estrogen receptor negative (70% vs. 49%, p = 0.02). There were no significant correlations of rs560191 with other critical variables. Despite the fact that GG patients were older, the 10-year rate of local relapses was higher (22% for GG vs. 12% for CC-CG, p = 0.04). Conclusions: This novel avenue of investigation of polymorphisms in radiation repair/response genes in patients treated with BCS + RT suggests a correlation to local relapse. Additional evaluation is needed to assess the biological and functional significance of these single nucleotide polymorphisms, and larger confirmatory validation studies will be required to determine the clinical implications.

  9. IOERT as anticipated tumor bed boost during breast-conserving surgery after neoadjuvant chemotherapy in locally advanced breast cancer--results of a case series after 5-year follow-up.

    PubMed

    Fastner, Gerd; Reitsamer, Roland; Ziegler, Ingrid; Zehentmayr, Franz; Fussl, Christoph; Kopp, Peter; Peintinger, Florentia; Greil, Richard; Fischer, Thorsten; Deutschmann, Heinrich; Sedlmayer, Felix

    2015-03-01

    To evaluate retrospectively rates of local (LCR) and locoregional tumor control (LRCR) in patients with locally advanced breast cancer (LABC) who were treated with preoperative chemotherapy (primary systemic treatment, PST) followed by breast-conserving surgery (BCS) and either intraoperative radiotherapy with electrons (IOERT) preceding whole-breast irradiation (WBI) (Group 1) or with WBI followed by an external tumor bed boost (electrons or photons) instead of IOERT (Group 2). From 2002 to 2007, 83 patients with clinical Stage II or III breast cancer were enrolled in Group 1 and 26 in Group 2. All patients received PST followed by BCS and axillary lymph node dissection. IOERT boosts were applied by single doses of 9 Gy (90% reference isodose) versus external boosts of 12 Gy (median dose range, 6-16) in 2 Gy/fraction (ICRU). WBI in both groups was performed up to total doses of 51-57 Gy (1.7-1.8 Gy/fraction). The respective median follow-up times for Groups 1 and 2 amount 59 months (range, 3-115) and 67.5 months (range, 13-120). Corresponding 6-year rates for LCR, LRCR, metastasis-free survival, disease-specific survival and overall survival were 98.5, 97.2, 84.7, 89.2 and 86.4% for Group 1 and 88.1, 88.1, 74, 92 and 92% for Group 2, respectively, without any statistical significances. IOERT as boost modality during BCS in LABC after PST shows a trend to be superior in terms of LCR and LRCR in comparison with conventional boosts. PMID:24995409

  10. Estrogen-Dependent Prognostic Significance of Cyclooxygenase-2 Expression in Early-Stage Invasive Breast Cancers Treated With Breast-Conserving Surgery and Radiation

    SciTech Connect

    Haffty, Bruce G. Yang Qifeng; Moran, Meena S.; Tan, Antoinette R.; Reiss, Michael

    2008-07-15

    Purpose: To evaluate the prognostic significance of cyclooxygenase-2 (COX-2) in breast cancer patients treated with conservative surgery and radiation therapy (CS+RT). Methods and Materials: Between 1975 and 2003, we retrieved specimens from 504 breast cancer patients treated with CS+RT. The specimens were constructed into tissue microarrays processed and stained for estrogen receptor (ER), progesterone receptor, Her2/neu, and COX-2. Each core was scored as positive or negative. All data including demographics, clinical, pathologic, staging, and outcome variables were entered into a computerized database. Results: Expression of COX-2 was positive in 58% of cases and correlated with younger age (p = 0.01) and larger tumor size (p 0.001). Expression of COX-2 was predictive of local relapse (relative risk[RR], 3.248; 95% confidence interval [CI], 1.340-7.871; p = 0.0091), distant metastasis (RR, 2.21; 95% CI, 1.259-3.896; p = 0.0058), and decreased survival (RR, 2.321; 95% CI, 1.324-4.071; p = 0.0033). Among ER-positive patients, COX-2 expression was predictive of worse local control (85% vs. 93%, p = 0.04), distant metastasis (75% vs. 95%, p = 0.002) and worse survival (65% vs. 94%, p = 0.002). Among ER-negative tumors COX-2 expression was not significantly correlated with local control (87 vs. 95%, p = 0.12), distant metastasis (73% vs. 78%, p = 0.39), or survival (77% vs. 87%, p 0.15). Conclusions: In breast cancer patients treated with CS+RT, COX-2 expression is associated with younger age, larger tumor size, worse local control, distant metastasis, and worse overall survival. The significance is limited to hormone receptor-positive tumors, consistent with the known effect of COX-2/PGE2 on aromatase activity. Use of COX-2 inhibitors in estrogen-dependent breast cancers warrants further investigation.

  11. Interim Cosmetic Results and Toxicity Using 3D Conformal External Beam Radiotherapy to Deliver Accelerated Partial Breast Irradiation in Patients With Early-Stage Breast Cancer Treated With Breast-Conserving Therapy

    SciTech Connect

    Vicini, Frank A. Chen, Peter; Wallace, Michelle; Mitchell, Christina; Hasan, Yasmin; Grills, Inga; Kestin, Larry; Schell, Scott; Goldstein, Neal S.; Kunzman, Jonathan; Gilbert, Sam; Martinez, Alvaro

    2007-11-15

    Purpose: We present our ongoing clinical experience utilizing three-dimensional (3D)-conformal radiation therapy (3D-CRT) to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer treated with breast-conserving therapy. Methods and Materials: Ninety-one consecutive patients were treated with APBI using our previously reported 3D-CRT technique. The clinical target volume consisted of the lumpectomy cavity plus a 10- to 15 -mm margin. The prescribed dose was 34 or 38.5 Gy in 10 fractions given over 5 consecutive days. The median follow-up was 24 months. Twelve patients have been followed for {>=}4 years, 20 for {>=}3.5 years, 29 for >3.0 years, 33 for {>=}2.5 years, and 46 for {>=}2.0 years. Results: No local recurrences developed. Cosmetic results were rated as good/excellent in 100% of evaluable patients at {>=} 6 months (n = 47), 93% at 1 year (n = 43), 91% at 2 years (n = 21), and in 90% at {>=}3 years (n = 10). Erythema, hyperpigmentation, breast edema, breast pain, telangiectasias, fibrosis, and fat necrosis were evaluated at 6, 24, and 36 months after treatment. All factors stabilized by 3 years posttreatment with grade I or II rates of 0%, 0%, 0%, 0%, 9%, 18%, and 9%, respectively. Only 2 patients (3%) developed grade III toxicity (breast pain), which resolved with time. Conclusions: Delivery of APBI with 3D-CRT resulted in minimal chronic ({>=}6 months) toxicity to date with good/excellent cosmetic results. Additional follow-up is needed to assess the long-term efficacy of this form of APBI.

  12. Small-arc volumetric-modulated arc therapy: A new approach that is superior to fixed-field IMRT in optimizing dosimetric and treatment-relevant parameters for patients undergoing whole-breast irradiation following breast-conserving surgery.

    PubMed

    Yu, Jing; Hu, Tao; Chen, Yeshan

    2016-08-01

    Volumetric-modulated arc therapy (VMAT) is considered to deliver a better dose distribution and to shorten treatment time. There is a lack of research regarding breast irradiation after breast-conserving surgery (BCS) using VMAT with prone positioning. We developed a new small-arc VMAT methodology and compared it to conventional (fixed-field) intensity-modulated radiation therapy (IMRT) in the dosimetric and treatment relevant parameters for breast cancer patients in the prone position.Ten early-stage breast cancer patients were included in this exploratory study. All patients underwent computed tomography (CT) simulation scan in the prone position and for each patient, IMRT and VMAT plans were generated using the Monaco planning system. Two symmetrical partial arcs were applied in the VMAT plans. The angle ranges of the 2 arcs were set to approximately 60° to 100° and 220° to 260°, with small adjustments to maximize target coverage, while minimizing lung and heart exposure. The IMRT plans used 4 fixed fields. Prescribed doses were 50 Gy in 25 fractions. The target coverage, homogeneity, conformity, dose to organs at risk (OAR), treatment time, and monitor units (MU) were evaluated.Higher median conformal index (CI) and lower homogeneity index (HI) of the planning target volume (PTV) were respectively observed in VMAT and plans group (CI, 95% vs 91%; HI, 0.09 vs 0.12; P < 0.001). The volumes of ipsilateral lung receiving 30, 20, 10, and 5 Gy were lower for VMAT (P < 0.01), being 10%, 14.9%, 25.9%, and 44.9%, respectively, compared to 11.79%, 17.32%, 30.27%, and 50.58% for the IMRT plans. The mean lung dose was also reduced from 10.6 ± 1.8 to 9.6 ± 1.4 Gy (P = 0.001). The volumes of the heart receiving 30 and 40 Gy were similar for the 2 methods. In addition, the median treatment time (161 vs 412 seconds; P < 0.001) and the mean MU (713 vs 878; P < 0.001) were lower for VMAT.Small-arc VMAT plan improved CI and HI for the

  13. Surgery for Breast Cancer

    MedlinePlus

    ... Next Topic Breast-conserving surgery (lumpectomy) Surgery for breast cancer Most women with breast cancer have some type ... Relieve symptoms of advanced cancer Surgery to remove breast cancer There are two main types of surgery to ...

  14. Delayed breast cellulitis: An evolving complication of breast conservation

    SciTech Connect

    Indelicato, Daniel J.; Grobmyer, Stephen R.; Newlin, Heather; Morris, Christopher G.; Haigh, Linda S.; Copeland, Edward M.; Mendenhall, Nancy Price . E-mail: mendenan@shands.ufl.edu

    2006-12-01

    Purpose: Delayed breast cellulitis (DBC) is characterized by the late onset of breast erythema, edema, tenderness, and warmth. This retrospective study analyzes the risk factors and clinical course of DBC. Methods and Materials: From 1985 through 2004, 580 sequential women with 601 stage T0-2N0-1 breast cancers underwent breast conserving therapy. Cases of DBC were identified according to accepted clinical criteria: diffuse breast erythema, edema, tenderness, and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy. Potential risk factors analyzed included patient comorbidity, operative technique, acute complications, and details of adjunctive therapy. Response to treatment and long-term outcome were analyzed to characterize the natural course of this syndrome. Results: Of the 601 cases, 16%, 52%, and 32% were Stage 0, I, and II, respectively. The overall incidence of DBC was 8% (50/601). Obesity, ecchymoses, T stage, the presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema were significantly associated with DBC. The median time to onset of DBC from the date of definitive surgery was 226 days. Ninety-two percent of DBC patients were empirically treated with antibiotics. Fourteen percent required more invasive intervention. Twenty-two percent had recurrent episodes of DBC. Ultimately, 2 patients (4%) underwent mastectomy for intractable breast pain related to DBC. Conclusion: Although multifactorial, we believe DBC is primarily related to a bacterial infection in the setting of impaired lymphatic drainage and may appear months after completion of radiotherapy. Invasive testing before a trial of antibiotics is generally not recommended.

  15. Management of the regional lymph nodes following breast-conservation therapy for early-stage breast cancer: an evolving paradigm.

    PubMed

    Warren, Laura E G; Punglia, Rinaa S; Wong, Julia S; Bellon, Jennifer R

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit. PMID:25585780

  16. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    SciTech Connect

    Warren, Laura E.G.; Punglia, Rinaa S.; Wong, Julia S.; Bellon, Jennifer R.

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  17. The Association Between Biological Subtype and Isolated Regional Nodal Failure After Breast-Conserving Therapy

    SciTech Connect

    Wo, Jennifer Y.; Taghian, Alphonse G.; Nguyen, Paul L.; Raad, Rita Abi; Sreedhara, Meera B.A.; Bellon, Jennifer R.; Wong, Julia S.; Gadd, Michele A.; Smith, Barbara L.; Harris, Jay R.

    2010-05-01

    Purpose: To evaluate the risk of isolated regional nodal failure (RNF) among women with invasive breast cancer treated with breast-conserving surgery (BCS) and radiation therapy (RT) and to determine factors, including biological subtype, associated with RNF. Methods and Materials: We retrospectively studied 1,000 consecutive women with invasive breast cancer who received breast-conserving surgery and RT from 1997 through 2002. Ninety percent of patients received adjuvant systemic therapy; none received trastuzumab. Sentinel lymph node biopsy was done in 617 patients (62%). Of patients with one to three positive nodes, 34% received regional nodal irradiation (RNI). Biological subtype classification into luminal A, luminal B, HER-2, and basal subtypes was based on estrogen receptor status-, progesterone receptor status-, and HER-2-status of the primary tumor. Results: Median follow-up was 77 months. Isolated RNF occurred in 6 patients (0.6%). On univariate analysis, biological subtype (p = 0.0002), lymph node involvement (p = 0.008), lymphovascular invasion (p = 0.02), and Grade 3 histology (p = 0.01) were associated with significantly higher RNF rates. Compared with luminal A, the HER-2 (p = 0.01) and basal (p = 0.08) subtypes were associated with higher RNF rates. The 5-year RNF rate among patients with one to three positive nodes treated with tangents alone was 2.4%; we could not identify a subset of these patients with a substantial risk of RNF. Conclusions: Isolated RNF is a rare occurrence after breast-conserving therapy. Patients with the HER-2 (not treated with trastuzumab) and basal subtypes appear to be at higher risk of developing RNF although this risk is not high enough to justify the addition of RNI. Low rates of RNF in patients with one to three positive nodes suggest that tangential RT without RNI is reasonable in most patients.

  18. Problems with the use of breast conservation therapy for breast cancer in a patient with neurofibromatosis type 1: a case report.

    PubMed

    Hasson, Danielle M; Khera, Samira Y; Meade, Tammi L; Dupont, Elisabeth L; Greenberg, Harvey M; Diaz, Nils M; Romilly, A Pat; Cox, Charles E

    2008-01-01

    Patients with neurofibromatosis type I and breast cancer represent a subset of people who may be considered at high risk for secondary cancers after conventional whole breast radiation therapy and breast conservation surgery. A case of a 49-year-old woman with neurofibromatosis type I is presented. She was diagnosed with a 1.1-cm right breast infiltrating ductal carcinoma. Clinical, diagnostic imaging, and pathologic features are discussed. Her initial treatment plan of breast conserving therapy was thwarted when her sentinel node biopsy was positive for micrometastatic disease in 1/14 lymph nodes. She elected to have a bilateral simple mastectomy. This case addresses the rare dilemma of offering breast conservation therapy as a viable option for patients with neurofibromatosis type I. Current data on radiation-induced secondary cancers such as sarcoma after treatment for breast and other cancers are reviewed. PMID:18248558

  19. Tumour-adapted Reduction Mammoplasty – a New (Old) Breast Conserving Strategy: Review

    PubMed Central

    Eichbaum, M.; Dietrich, A.; Reinhard, J.; Steinwasser, R.; Eichbaum, C.

    2016-01-01

    Today over 70 % of patients treated for primary breast carcinoma in certified breast centres are managed with breast conserving surgery. The classical semicircular incision directly above the tumour, though in many cases easily carried out and associated with good cosmetic results, does have limitations. Unsatisfactory aesthetic results often occur when tumour location is unfavourable or when there is unfavourable tumour size relative to breast size. Distortion of the nipple, changes to breast shape and retraction of skin overlying surgical defects can occur. Tumour-adapted reduction mammoplasty/mastopexy or the “modified B technique” offer excellent chances of combining the oncological demands of breast surgery with satisfactory symmetrical cosmetic results. This article reviews a traditional, old operative technique that has been re-embraced in various new forms. PMID:26855438

  20. Breast conservation treatment with perioperative interstitial irradiation

    SciTech Connect

    Krishnan, L.; Mansfield, C.M.; Jewell, W.R.; Reddy, E.K.; Thomas, J.H.; Krishnan, E.C.

    1987-10-01

    Limited resection of the breast combined with radiation has proved to be as effective as more radical surgery in treating early breast cancer. At the University of Kansas Medical Center, the radiotherapy consists of an interstitial implant at the time of lumpectomy to deliver an interstitial boost dose to the tumor bed with iridium-192 immediately following the surgical procedure. An axillary node dissection is also performed at the time of lumpectomy. A dose of 2000 cGy is delivered to the tumor bed between 40 and 60 h. Two to three weeks later, 4500-5000 cGy is delivered to the entire breast with external beam radiation over 5-5.5 weeks. One hundred breasts in 98 patients were so treated between June 1982 and February 1986, with 2 carcinomas in situ, 40 stage I, 51 stage II, and 7 stage III cancers, consisting of 2 TIS, 54 T1, 39 T2, and 5 T3 lesions. Locoregional control with a median follow-up of 31 months was 98%. One recurrence was in a different quadrant, and the other revealed predominantly the in situ component. Immediate implant did not compromise wound healing or cosmesis. The cosmetic result was graded as good to excellent in 88% of the breasts. Our preliminary results appear to suggest a better local control with immediate interstitial irradiation.

  1. Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy

    SciTech Connect

    Katayama, Norihisa Sato, Shuhei; Katsui, Kuniaki; Takemoto, Mitsuhiro; Tsuda, Toshihide; Yoshida, Atsushi; Morito, Tsuneharu; Nakagawa, Tomio; Mizuta, Akifumi; Waki, Takahiro; Niiya, Harutaka; Kanazawa, Susumu

    2009-03-15

    Purpose: To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. Methods and Materials: A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for {>=}2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause. Results: Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age ({>=}50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was {>=}50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. Conclusions: Age ({>=}50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy.

  2. In Search of a Gold Standard Scoring System for the Subjective Evaluation of Cosmetic Outcomes Following Breast-Conserving Therapy.

    PubMed

    Racz, Jennifer M; Hong, Nicole Look; Latosinsky, Steven

    2015-01-01

    The absence of a widely accepted method for aesthetic evaluation following breast-conserving surgery for breast cancer limits the ability to evaluate cosmetic outcomes. In this study, two different panel scoring approaches were compared in an attempt to identify a gold standard scoring system for subjectively assessing cosmetic outcomes following breast-conserving therapy. Standardized photographs of each participant were evaluated independently by twelve health care professionals involved in breast cancer diagnosis and treatment using the Danoff four-point scale. Individual Danoff scores were combined using two methods, a random sample "three-panel" score and an iterative "Delphi-panel" score, in order to create a final cosmetic score for each patient. Agreement between these two aggregative approaches was assessed with a weighted kappa (wk) statistic. Patient and professional recruitment occurred at two separate tertiary care multi-disciplinary breast health centers. Women with unilateral breast cancer who underwent breast-conserving therapy (segmental mastectomy or lumpectomy and radiotherapy) and were at least 2 years after radiotherapy were asked to participate. Ninety-seven women were evaluated. The Delphi approach required three rounds of evaluation to obtain greater than 50% agreement in all photographs. The wk statistic between scores generated from the "three-panel" and "Delphi-panel" approaches was 0.80 (95% CI: 0.71-0.89), thus demonstrating substantial agreement. Evaluation of cosmetic outcomes following breast-conserving therapy using a "three-panel" and "Delphi-panel" score provide similar results, confirming the reliability of either approach for subjective evaluation. Simplicity of use and interpretation favors the "three-panel" score. Future work should concentrate on the integration of the three-panel score with objective and patient-reported scales to generate a comprehensive cosmetic evaluation platform. PMID:25940058

  3. Locoregional Treatment for Breast Carcinoma After Hodgkin's Lymphoma: The Breast Conservation Option

    SciTech Connect

    Haberer, Sophie; Belin, Lisa; Le Scodan, Romuald; Kirova, Youlia M.; Savignoni, Alexia; Stevens, Denise; Moisson, Patricia; Decaudin, Didier; Pierga, Jean-Yves; Reyal, Fabien; Campana, Francois; Fourquet, Alain; Bollet, Marc A.

    2012-02-01

    Purpose: To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. Methods and Materials: Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. Results: Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). Conclusions: Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart and

  4. Cone beam computed tomography imaging as a primary diagnostic tool for computer-guided surgery and CAD-CAM interim removable and fixed dental prostheses.

    PubMed

    Charette, Jyme R; Goldberg, Jack; Harris, Bryan T; Morton, Dean; Llop, Daniel R; Lin, Wei-Shao

    2016-08-01

    This article describes a digital workflow using cone beam computed tomography imaging as the primary diagnostic tool in the virtual planning of the computer-guided surgery and fabrication of a maxillary interim complete removable dental prosthesis and mandibular interim implant-supported complete fixed dental prosthesis with computer-aided design and computer-aided manufacturing technology. Diagnostic impressions (conventional or digital) and casts are unnecessary in this proposed digital workflow, providing clinicians with an alternative treatment in the indicated clinical scenario. PMID:27086108

  5. Trends and Patterns of Breast Conservation Treatment in Hong Kong: 1994-2007

    SciTech Connect

    Yau, T.-K. Soong, Inda S.; Sze, Henry; Choi, C.-W.; Yeung, M.-W.; Ng, W.-T.; Lee, Anne W.M.

    2009-05-01

    Purpose: Breast conservation treatment (BCT) was quite unpopular in Hong Kong until the early 1990s, but the trends and patterns of BCT use in the past 14 years have not been studied since. The purpose of this study was to identify the latest trends and patterns. Methods and Materials: All consecutive cases of female breast cancer referred to a community oncology center in Hong Kong between 1994 and 2007 were retrospectively reviewed. Of the 2,375 women with T1-2 invasive breast cancer who underwent surgery, 1,137 (48%) had T1 ({<=}2 cm) disease and 1,238 (52%) had T2 (>2 cm-{<=}5 cm) disease. Median patient age was 51 years (range, 24-95 years); 65% patients had their surgery in public hospitals. Results: Of the total patient cohort, 2,153 (91%) patients presented with palpable breast masses and only 104 (4%) with mammographically detected cancers. Overall, 721 (30%) and 1,654 (70%) patients underwent BCT and mastectomy, respectively. There was no significant increase in the BCT rates (31%, SD 5%; p = 0.804) or mammographic detection rates (5%, SD 1%; p = 0.125) in Hong Kong between 1994 and 2007. In multivariate analyses, age {<=}50 years (OR 2.479; p < 0.001), mammographically detected tumors (OR 1.868; p = 0.007), T1 tumors (OR 3.159; p < 0.001), surgeries in private hospitals (OR 1.288; p = 0.018), and negative nodal status (OR 1.886; p < 0.001) were independent factors predictive of a higher likelihood of a woman having BCT. Conclusions: Our results indicate a satisfactory acceptance of BCT by patients who are young and have small tumors, node-negative disease, or surgery in private hospitals. However, the continuing unpopularity of breast screening is likely a major factor limiting the broad use of BCT.

  6. The Dynamic Tumor Bed: Volumetric Changes in the Lumpectomy Cavity During Breast-Conserving Therapy

    SciTech Connect

    Prendergast, Brendan; Indelicato, Daniel J. Grobmyer, Stephen R.; Saito, Anneyuko I.; Lightsey, Judith L.; Snead, Felicia E.; Morris, Christopher G.; Copeland, Edward M.; Mendenhall, Nancy P.

    2009-07-01

    Purpose: To characterize the magnitude of volume change in the postoperative tumor bed before and during radiotherapy, and to identify any factors associated with large volumetric change. Methods and Materials: Thirty-six consecutive patients with early-stage or preinvasive breast cancer underwent breast-conserving therapy at our institution between June 2006 and October 2007. Computed tomography (CT) scans of the breast were obtained shortly after surgery, before the start of radiotherapy (RT) for treatment planning, and, if applicable, before the tumor bed boost. Postoperative changes, seroma, and surgical clips were used to define the tumor bed through consensus agreement of 3 observers (B.P., D.I., and J.L.). Multiple variables were examined for correlation with volumetric change. Results: Between the first and last scan obtained (median time, 7.2 weeks), the tumor bed volume decreased at least 20% in 86% of patients (n = 31) and at least 50% in 64% of patients (n = 23). From the postoperative scan to the planning scan (median time, 3 weeks), the tumor bed volume decreased by an average of 49.9%, or approximately 2.1% per postoperative day. From planning scan to boost scan (median interval, 7 weeks), the median tumor bed volume decreased by 44.6%, at an average rate of 0.95% per postoperative day. No single factor was significantly associated with a change in tumor bed volume greater than 20%. Conclusions: The average postlumpectomy cavity undergoes dramatic volumetric change after surgery and continues this change during RT. The rate of change is inversely proportional to the duration from surgery. In this study no factors studied predicted large volumetric change.

  7. Interrogating a Multifactorial Model of Breast Conserving Therapy with Clinical Data

    PubMed Central

    Salmon, Remi; Garbey, Marc; Moore, Linda W.; Bass, Barbara L.

    2015-01-01

    Most women with early stage breast cancer do not require removal of the entire breast to treat their cancer; instead, up to 70% of women can be effectively and safely treated by breast conserving therapy (BCT) with surgical removal of the tumor only (lumpectomy) followed by radiation treatment of the remaining breast tissue. Unfortunately, the final contour and cosmesis of the treated breast is suboptimal in approximately 30% of patients. The ability to accurately predict breast contour after BCT for breast cancer could significantly improve patient decision-making regarding the choice of surgery for breast cancer. Our overall hypothesis is that the complex interplay among mechanical forces due to gravity, breast tissue constitutive law distribution, inflammation induced by radiotherapy and internal stress generated by the healing process play a dominant role in determining the success or failure of lumpectomy in preserving the breast contour and cosmesis. We have shown here from a first patient study that even in the idealistic situation of excellent cosmetic outcome this problem requires multiscale modeling. We propose a method to decide which component of the model works best for each phase of healing and what parameters should be considered dominant and patient specific. This patient study is part of a clinical trial registered on ClinicalTrial.gov, identifier NCT02310711. PMID:25906048

  8. Patient-Reported Quality of Life and Satisfaction with Cosmetic Outcomes After Breast Conservation and Mastectomy with and without Reconstruction: Results of a Survey of Breast Cancer Survivors

    PubMed Central

    Jagsi, Reshma; Li, Yun; Morrow, Monica; Janz, Nancy; Alderman, Amy; Graff, John; Hamilton, Ann; Katz, Steven; Hawley, Sarah

    2014-01-01

    Purpose Although breast conservation is therapeutically equivalent to mastectomy for most early-stage breast cancer patients, an increasing number are pursuing mastectomy, which may be followed by breast reconstruction. We sought to evaluate long-term quality of life (QOL) and cosmetic outcomes after different locoregional management approaches, as perceived by patients themselves. Methods We surveyed women diagnosed with non-metastatic breast cancer from 2005-07, as reported to the Los Angeles and Detroit population-based SEER registries. We received responses from 2290 women approximately 9 months after diagnosis (73% response rate) and from 1536 of these 4 years later. We evaluated QOL and patterns and correlates of satisfaction with cosmetic outcomes overall, and more specifically within the subgroup undergoing mastectomy with reconstruction, using multivariable linear regression. Results Of the 1450 patients who responded to both surveys and had not recurred, 963 underwent breast conserving surgery, 263 mastectomy without reconstruction, and 222 mastectomy with reconstruction. Cosmetic satisfaction was similar between those receiving breast conservation and those receiving mastectomy with reconstruction. Among patients receiving mastectomy with reconstruction, reconstruction type and radiation receipt were associated with satisfaction (p<0.001), with an adjusted scaled satisfaction score of 4.7 for patients receiving autologous reconstruction without radiation, 4.4 for patients receiving autologous reconstruction and radiation therapy, 4.1 for patients receiving implant reconstruction without radiation, and 2.8 for patients receiving implant reconstruction and radiation. Discussion Patient-reported cosmetic satisfaction was similar after breast conservation and after mastectomy with reconstruction. In patients undergoing post-mastectomy radiation, use of autologous reconstruction may mitigate radiation's deleterious impact on cosmetic outcomes. PMID:25654742

  9. Sentinel lymph node biopsy can be omitted in DCIS patients treated with breast conserving therapy.

    PubMed

    van Roozendaal, L M; Goorts, B; Klinkert, M; Keymeulen, K B M I; De Vries, B; Strobbe, L J A; Wauters, C A P; van Riet, Y E; Degreef, E; Rutgers, E J T; Wesseling, J; Smidt, M L

    2016-04-01

    Breast cancer guidelines advise sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) on core biopsy at high risk of invasive cancer or in case of mastectomy. This study investigates the incidence of SLNB and SLN metastases and the relevance of indications in guidelines and literature to perform SLNB in order to validate whether SLNB is justified in patients with DCIS on core biopsy in current era. Clinically node negative patients diagnosed from 2004 to 2013 with only DCIS on core needle biopsy were selected from a national database. Incidence of SLN biopsy and metastases was calculated. With Fisher exact tests correlation between SLNB indications and actual presence of SLN metastases was studied. Further, underestimation rate for invasive cancer and correlation with SLN metastases was analysed. 910 patients were included. SLNB was performed in 471 patients (51.8 %): 94.5 % had pN0, 3.0 % pN1mi and 2.5 % pN1. Patients undergoing mastectomy had 7 % SLN metastases versus 3.5 % for breast conserving surgery (BCS) (p = 0.107). The only factors correlating to SLN metastases were smaller core needle size (p = 0.01) and invasive cancer (p < 0.001). Invasive cancer was detected in 16.7 % by histopathology with 15.6 % SLN metastases versus only 2 % in pure DCIS. SLNB showed metastases in 5.5 % of patients; 3.5 % in case of BCS (any histopathology) and 2 % when pure DCIS was found at definitive histopathology (BCS and mastectomy). Consequently, SLNB should no longer be performed in patients diagnosed with DCIS on core biopsy undergoing BCS. If definitive histopathology shows invasive cancer, SLNB can still be considered after initial surgery. PMID:27083179

  10. Interim Principals.

    ERIC Educational Resources Information Center

    Beem, Kate

    2003-01-01

    An interim principal can buy a school district time to land a permanent successor. Also lists where to find an interim principal; the interim's steadying influence; Bob Wallace's wild ride as an interim principal in post-retirement; and Roger Prosise's rationale for turning to an interim appointment. (MLF)

  11. Note: Utilization of polymer gel as a bolus compensator and a dosimeter in the near-surface buildup region for breast-conserving therapy

    NASA Astrophysics Data System (ADS)

    Fuse, Hiraku; Shinoda, Kazuya; Inohira, Masaya; Kawamura, Hiraku; Miyamoto, Katsumi; Sakae, Takeji; Fujisaki, Tatsuya

    2015-09-01

    Tangential beam radiotherapy is routinely used for radiation therapy after breast conserving surgery. A tissue-equivalent bolus placed on the irradiated area shifts the depth of the dose distribution; this bolus provides uniform dose distribution to the breast. The gel bolus made by the BANG-Pro® polymer gel and in an oxygen non-transmission pack was applicable as a dosimeter to measure dose distribution in near-surface buildup region. We validated the use of the gel bolus to improve in the whole-breast/chest wall, including the near-surface buildup region.

  12. Note: Utilization of polymer gel as a bolus compensator and a dosimeter in the near-surface buildup region for breast-conserving therapy

    SciTech Connect

    Fuse, Hiraku Inohira, Masaya; Kawamura, Hiraku; Fujisaki, Tatsuya; Shinoda, Kazuya; Miyamoto, Katsumi; Sakae, Takeji

    2015-09-15

    Tangential beam radiotherapy is routinely used for radiation therapy after breast conserving surgery. A tissue-equivalent bolus placed on the irradiated area shifts the depth of the dose distribution; this bolus provides uniform dose distribution to the breast. The gel bolus made by the BANG-Pro{sup ®} polymer gel and in an oxygen non-transmission pack was applicable as a dosimeter to measure dose distribution in near-surface buildup region. We validated the use of the gel bolus to improve in the whole-breast/chest wall, including the near-surface buildup region.

  13. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    SciTech Connect

    Demirci, Senem; Broadwater, Gloria; Marks, Lawrence B.; Clough, Robert; Prosnitz, Leonard R.

    2012-07-01

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985-2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18-89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  14. Hypofractionation with no boost after breast conservation in early-stage breast cancer patients.

    PubMed

    Arcadipane, Francesca; Franco, Pierfrancesco; De Colle, Chiara; Rondi, Nadia; Di Muzio, Jacopo; Pelle, Emanuela; Martini, Stefania; Ala, Ada; Airoldi, Mario; Donadio, Michela; De Sanctis, Corrado; Castellano, Isabella; Ragona, Riccardo; Ricardi, Umberto

    2016-10-01

    The aim of this study was to evaluate local control, survival and toxicity profile of a consecutive cohort of early-stage breast cancer (EBC) patients treated with adjuvant hypofractionated radiotherapy (HF) with no boost delivered to the lumpectomy cavity, after breast-conserving surgery (BCS). Between 2005 and 2015, a total of 493 women affected with EBC were treated with HF (46 Gy/20 fractions or 40.05 Gy/15 fractions) to the whole breast without boost to tumor bed, because of age and/or favorable tumor characteristics. The primary endpoint was 5-year actuarial local control (LC); secondary endpoints included survival, toxicity profile and cosmesis. Median follow-up was 57 months (range 6-124). Actuarial 5-year overall, cancer-specific, disease-free survival and LC were 96.3, 98.9, 97.8 and 98.6 %, respectively. On multivariate analysis, tumor stage (T1 vs. T2) and hormonal status (positive vs. negative estrogen receptors) were significantly correlated with LC. Only 2 % of patients experienced ≥G3 acute skin toxicity. Late toxicity was mild with only 1 case of G3 fibrosis. Most of the patients (95 %) had good-excellent cosmetic results. HF to the whole breast with no boost delivered to the tumor bed is a safe and effective option for a population of low-risk breast cancer patients after BCS, with excellent 5-year LC, mild toxicity profile and promising cosmetic outcome. A subgroup of patients with larger tumors and/or with no estrogen receptor expression may potentially benefit from treatment intensification with a boost dose to the lumpectomy cavity. PMID:27573380

  15. Factors associated with patients in the Scottish Highlands who chose mastectomy when suitable for breast conservation

    PubMed Central

    Rashid, Majid; Hubbard, Gill; Abbott, Nick; Daltrey, Ian; Mullen, Russell

    2016-01-01

    Background Despite being suitable for breast conservation surgery (BCS) a proportion of women choose mastectomy. This study aimed to assess the pre-operative pathological and geographic factors associated with choosing mastectomy rather than BCS in a single centre that serves a large geographical area encompassing urban, rural and remote island populations. Methods A retrospective analysis of all patients suitable for BCS between January 2011 and December 2013 was undertaken. Pre-operative pathological features were compared using the Pearson chi squared test as was distance to the treatment centre from the patient’s home. A questionnaire was sent to all those who chose mastectomy to identify the factors that influenced their decision. Results A total of 446 patients suitable for BCS were identified of which 46 (11%) chose to undergo mastectomy. Patients choosing mastectomy were more likely to present symptomatically (P=0.009), have tumours larger than 20 mm at diagnostic imaging (P=0.001) and have positive axillary staging (P=0.004). Patients choosing mastectomy were more likely to live remotely (P=0.051). Those patients who chose mastectomy felt this gave a better long-term outcome (18 patients, 44%) and peace of mind (14 patients, 34%). Conclusions Adverse pre-operative pathological features were associated with patients choosing mastectomy rather than BCS. There was a trend for patients who chose mastectomy to live remotely from the treatment centre. Patients choosing mastectomy most commonly cited a better long-term outcome and peace of mind as the reason behind their decision. Understanding what influences a patient’s surgical choice will allow clinicians and patients to engage in a fully informed pre-operative decision making process. PMID:27563559

  16. Outcomes After Breast Conservation Treatment With Radiation in Women With Prior Nonbreast Malignancy and Subsequent Invasive Breast Carcinoma

    SciTech Connect

    Nemani, Deepika; Vapiwala, Neha Hwang, W.-T.; Solin, Lawrence J.

    2009-03-15

    Purpose: Little information has been reported regarding outcomes after treatment for patients with early-stage invasive breast cancer and a prior nonbreast malignancy. This report analyzes the outcomes in patients with Stage I and II breast cancer after breast conservation treatment (BCT) with a prior nonbreast malignancy. Methods and Materials: The study cohort comprised 66 women with invasive breast cancer and a prior nonbreast malignancy. All patients were treated with breast conservation surgery followed by definitive breast irradiation between 1978 and 2003. Median ages at diagnosis of invasive breast cancer and prior malignancy were 57 and 50 years, respectively. The median interval between the prior malignancy and breast cancer was 7.0 years. Median and mean follow-up times after BCT were 5.3 and 7.0 years. Results: The 5-year and 10-year overall survival rates were 94% (95% confidence interval [CI], 82-98%) and 78% (95% CI, 59-89%), respectively. There were 4 patients (6%) with local failure and 10 patients (15%) with distant metastases. The 10-year rate of local failure rate was 5% (95% CI, 2-16%) and freedom from distant metastases was 78% (95% CI, 61-88%). No obvious differences in survival or local control were noted compared with the reported results in the literature for patients with invasive breast cancer alone. Conclusions: Both overall survival and local control at 5 and 10 years were comparable to rates observed in early-stage breast cancer patients without a prior malignancy. Prior nonbreast malignancy is not a contraindication to BCT, if the primary cancer is effectively controlled.

  17. A Phase II Study of Radiotherapy and Concurrent Paclitaxel Chemotherapy in Breast-Conserving Treatment for Node-Positive Breast Cancer

    SciTech Connect

    Chen, William C.; Kim, Janice; Kim, Edward; Silverman, Paula; Overmoyer, Beth; Cooper, Brenda W.; Anthony, Sue; Shenk, Robert; Leeming, Rosemary; Hanks, Shelli H.; Lyons, Janice A.

    2012-01-01

    Purpose: Administering adjuvant chemotherapy before breast radiotherapy decreases the risk of systemic recurrence, but delays in radiotherapy could yield higher local failure. We assessed the feasibility and efficacy of placing radiotherapy earlier in the breast-conserving treatment course for lymph node-positive breast cancer. Methods and Materials: Between June 2000 and December 2004, 44 women with node-positive Stage II and III breast cancer were entered into this trial. Breast-conserving surgery and 4 cycles of doxorubicin (60 mg/m{sup 2})/cyclophosphamide (600 mg/m{sup 2}) were followed by 4 cycles of paclitaxel (175 mg/m{sup 2}) delivered every 3 weeks. Radiotherapy was concurrent with the first 2 cycles of paclitaxel. The breast received 39.6 Gy in 22 fractions with a tumor bed boost of 14 Gy in 7 fractions. Regional lymphatics were included when indicated. Functional lung volume was assessed by use of the diffusing capacity for carbon monoxide as a proxy. Breast cosmesis was evaluated with the Harvard criteria. Results: The 5-year actuarial rate of disease-free survival is 88%, and overall survival is 93%. There have been no local failures. Median follow-up is 75 months. No cases of radiation pneumonitis developed. There was no significant change in the diffusing capacity for carbon monoxide either immediately after radiotherapy (p = 0.51) or with extended follow-up (p = 0.63). Volume of irradiated breast tissue correlated with acute cosmesis, and acute Grade 3 skin toxicity developed in 2 patients. Late cosmesis was not adversely affected. Conclusions: Concurrent paclitaxel chemotherapy and radiotherapy after breast-conserving surgery shortened total treatment time, provided excellent local control, and was well tolerated.

  18. A technique for fabricating single screw-retained implant-supported interim crowns in conjunction with implant surgery.

    PubMed

    McRory, M Eric; Cagna, David R

    2014-06-01

    This article presents an intraoral technique for fabricating single screw-retained implant-supported interim crowns immediately after surgical implant placement in extraction sites. The technique may be used with any implant system that provides a provisional abutment or an open-tray impression coping that can be modified for use as a provisional abutment. PMID:24461941

  19. 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.

    PubMed

    Głowacka, Iwona; Nowikiewicz, Tomasz; Siedlecki, Zygmunt; Hagner, Wojciech; Nowacka, Krystyna; Zegarski, Wojciech

    2016-01-01

    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. PMID:26510430

  20. Interim Expertise

    ERIC Educational Resources Information Center

    Anyaso, Hilary Hurd

    2009-01-01

    The Registry for College and University Presidents places former executives in interim presidential and other senior-level posts and is familiar with the challenges interim executives and institutions encounter in times of leadership transitions. However, the one big advantage interims bring to institutions, says Registry Vice President Kevin J.…

  1. True Recurrence Versus New Primary: An Analysis of Ipsilateral Breast Tumor Recurrences After Breast-Conserving Therapy

    SciTech Connect

    Panet-Raymond, Valerie; Truong, Pauline T.; McDonald, Rachel E.; Alexander, Cheryl; Ross, Louetta; Ryhorchuk, Aleata; Watson, Peter H.

    2011-10-01

    Purpose: Ipsilateral breast tumor recurrence (IBTR) can occur in 5-20% of women with early-stage breast cancer treated with breast-conserving therapy. Two entities of IBTR have been described: true recurrence (TR), suggested to be regrowth of disease at the tumor bed, and new primary (NP), distinct from the index lesion in histology and location. This study compared survival outcomes between two patient cohorts classified clinically as having either TR or NP. Methods and Materials: Between 1989 and 1999, 6,020 women were referred to the BC Cancer Agency with newly diagnosed pT1-2, N0-1, M0 invasive breast cancer, treated with breast-conserving surgery. Of these, 289 patients had pathologically confirmed IBTR. Retrospective analysis was performed, and a set of decision rules was applied to classify cases as TR or NP based on change in histology, grade, hormone receptor status, and tumor location. Of 289 patients, 129 (45%) were classified as having TR and 139 (48%) as having NP; 21 (7%) were unclassified. Results: The distributions of age at diagnosis, age at recurrence, and histopathologic factors were similar in the TR and NP cohorts (all p > 0.05). The mean time to recurrence was shorter in TR patients than in NP patients (4.8 years vs. 6.3 years, p = 0.001). Treatment of the IBTR did not differ between the two groups. In the TR and NP cohorts, breast cancer-specific survival was 55.7% vs. 61.3% (p = 0.93), and overall survival was 43.7% vs. 54.8% (p = 0.53). Conclusions: Time to recurrence is significantly shorter in patients with IBTR classified as true recurrence compared to new primary. Non-statistically significant trends for less favorable survival were observed for patients with TR. Further investigation of the hypothesis that TR and NP tumors are distinct entities with different survival prognoses will require standardized pathology review and molecular analyses.

  2. Time Course of Mild Arm Lymphedema After Breast Conservation Treatment for Early-Stage Breast Cancer

    SciTech Connect

    Bar Ad, Voichita; Cheville, Andrea; Solin, Lawrence J.; Dutta, Pinaki; Both, Stefan; Harris, Eleanor

    2010-01-15

    Purpose: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer. Methods and Materials: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms. Results: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema. Conclusions: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients.

  3. Contralateral breast cancer and other second malignancies in patients treated by breast-conserving therapy with radiation

    SciTech Connect

    Kurtz, J.M.; Amalric, R.; Brandone, H.; Ayme, Y.; Spitalier, J.M.

    1988-08-01

    Metachronous contralateral breast cancers and other second malignancies were evaluated in 2,850 patients treated between 1960 and 1981 primarily with radiotherapy (RT) either alone or following breast-conserving surgery. One hundred eighty-four contralateral cancers were observed in 22,491 patient-years of observation (818 per 10(5) patient-years), with a cumulative probability of 4.5% at 5, 7.9% at 10, and 11% at 15 and 20 years. Compared to patients with unilateral tumors, those destined to develop contralateral cancers were younger (mean age 51.9 vs 56.6) and more often gave a family history of breast cancer. Contralateral breast cancers were more frequent for more extensive tumors (T3 10% vs T1-26%; with inflammatory signs 10.6% without 6%), and in patients with ipsilateral local recurrence (with 9.1%, without 5.6%). Patients with contralateral cancers had a significantly less favorable survival experience (15-year actuarial survival after primary therapy 42%) than patients without contralateral cancer (15-year survival 65.5%). In early stage patients treated with conservative surgery and RT, contralateral cancer was not prognostically more favorable than ipsilateral breast recurrence. Among 72 other second malignancies (320 per 10(5) patient-years) were 2 soft tissue sarcomas in the irradiated area. This corresponds to an incidence of 21 cases per 10(5) patient-years for survivors beyond the fifth year. The possible influence of RT on contralateral cancers and other second malignancies is discussed.

  4. Positive anterior margins in breast conserving surgery: Does it matter? A systematic review of the literature.

    PubMed

    Ang, Su C; Tapia, Grace; Davidson, Emily J; Kahramangil, Bora; Mak, Cindy; Carmalt, Hugh; Warrier, Sanjay

    2016-06-01

    Positive margins are associated with an increased risk of ipsilateral breast tumor recurrence (IBTR); therefore re-excision of positive margins is recommended. Involvement of anatomically non-breast margins, such as anterior margins, has been associated to a lower risk of IBTR than radial margins. Although many surgeons do not re-excise positive anterior margins (PAM); there is no consensus regarding this approach. The objective of this study is to find evidence that assesses this practice. A systemic literature review was performed through six databases from January 1995 to July 2014. Studies that discussed anatomical location of involved margins in BCS were included. Six studies were identified evaluating PAM. One study reported a 2.5% rate of IBTR in patients with non-negative margins treated with radiotherapy (of which 23% had a PAM). Another study showed 4% of residual disease after re-excision of PAM, but did not report IBTR rates. A later observational study reported that 87.5% of positive anterior and posterior margins were re-excised. One survey from America and one from the UK showed that 47% and 71% of surgeons would not re-excise PAM, respectively. A later survey in the UK reported that 43.8% of surgeons would not re-excise PAM in DCIS, whilst 29.2% would not for invasive carcinoma. Common surgical practices to not re-excise PAM contradict current guidelines that recommend obtaining negative margins to reduce the risk of IBTR. However, there is little evidence detailing the relationship between PAM and IBTR rates. Low residual disease after re-excision of PAM supports the limited benefit of re-excise this margin; however further studies are required to evaluate this topic. PMID:27060552

  5. Impact of the Radiation Boost on Outcomes After Breast-Conserving Surgery and Radiation

    SciTech Connect

    Murphy, Colin; Anderson, Penny R.; Li Tianyu; Bleicher, Richard J.; Sigurdson, Elin R.; Goldstein, Lori J.; Swaby, Ramona; Denlinger, Crystal; Dushkin, Holly; Nicolaou, Nicos; Freedman, Gary M.

    2011-09-01

    Purpose: We examined the impact of radiation tumor bed boost parameters in early-stage breast cancer on local control and cosmetic outcomes. Methods and Materials: A total of 3,186 women underwent postlumpectomy whole-breast radiation with a tumor bed boost for Tis to T2 breast cancer from 1970 to 2008. Boost parameters analyzed included size, energy, dose, and technique. Endpoints were local control, cosmesis, and fibrosis. The Kaplan-Meier method was used to estimate actuarial incidence, and a Cox proportional hazard model was used to determine independent predictors of outcomes on multivariate analysis (MVA). The median follow-up was 78 months (range, 1-305 months). Results: The crude cosmetic results were excellent in 54%, good in 41%, and fair/poor in 5% of patients. The 10-year estimate of an excellent cosmesis was 66%. On MVA, independent predictors for excellent cosmesis were use of electron boost, lower electron energy, adjuvant systemic therapy, and whole-breast IMRT. Fibrosis was reported in 8.4% of patients. The actuarial incidence of fibrosis was 11% at 5 years and 17% at 10 years. On MVA, independent predictors of fibrosis were larger cup size and higher boost energy. The 10-year actuarial local failure was 6.3%. There was no significant difference in local control by boost method, cut-out size, dose, or energy. Conclusions: Likelihood of excellent cosmesis or fibrosis are associated with boost technique, electron energy, and cup size. However, because of high local control and rare incidence of fair/poor cosmesis with a boost, the anatomy of the patient and tumor cavity should ultimately determine the necessary boost parameters.

  6. Hypofractionated whole breast irradiation: new standard in early breast cancer after breast-conserving surgery

    PubMed Central

    Kim, Kyung Su; Shin, Kyung Hwan; Choi, Noorie; Lee, Sea-Won

    2016-01-01

    Hypofractionated whole breast irradiation (HF-WBI) has been proved effective and safe and even better for late or acute radiation toxicity for early breast cancer. Moreover, it improves patient convenience, quality of life and is expected to be advantageous in the medical care system by reducing overall cost. In this review, we examined key randomized trials of HF-WBI, focusing on adequate patient selection as suggested by the American Society of Therapeutic Radiology and Oncology (ASTRO) guideline and the radiobiologic aspects of HF-WBI in relation to its adoption into clinical settings. Further investigation to identify the current practice pattern or cost effectiveness is warranted under the national health insurance service system in Korea. PMID:27306774

  7. Patterns of Utilization of Adjuvant Radiotherapy and Outcomes in Black Women After Breast Conservation at a Large Multidisciplinary Cancer Center;Black women; Breast cancer; Radiotherapy; RT; Breast conservation

    SciTech Connect

    Edwards-Bennett, Sophia M.; Jacks, Lindsay M.; McCormick, Beryl; Zhang, Zhigang; Azu, Michelle; Ho, Alice; Powell, Simon; Brown, Carol

    2011-07-15

    Purpose: Population-based studies have reported that as many of 35% of black women do not undergo radiotherapy (RT) after breast conservation surgery (BCS). The objective of the present study was to determine whether this trend persisted at a large multidisciplinary cancer center, and to identify the factors that predict for noncompliance with RT and determine the outcomes for this subset of patients. Methods and Materials: Between January 2002 and December 2007, 83 black women underwent BCS at Memorial Sloan-Kettering Cancer Center and were therefore eligible for the present study. Of the 83 women, 38 (46%) had Stage I, 38 (46%) Stage II, and 7 (8%) Stage III disease. Of the study cohort, 31 (37%) had triple hormone receptor-negative tumors. RT was recommended for 81 (98%) of the 83 patients (median dose, 60 Gy). Results: Of the 81 women, 12 (15%) did not receive the recommended adjuvant breast RT. Nonreceipt of chemotherapy (p = .003) and older age (p = .009) were associated with nonreceipt of RT. With a median follow-up of 70 months, the 3-year local control, locoregional control, recurrence-free survival, disease-free survival, and overall survival rate was 99% (actuarial 5-year rate, 97%), 96% (actuarial 5-year rate, 93%), 95% (actuarial 5-year rate, 92%), 92% (actuarial 5-year rate, 89%), and 95% (actuarial 5-year rate, 91%), respectively. Conclusion: We found a greater rate of utilization adjuvant breast RT (85%) among black women after BCS than has been reported in recent studies, indicating that excellent outcomes are attainable for black women after BCS when care is administered in a multidisciplinary cancer center.

  8. Double-edged sword of radiotherapy: a cause of secondary angiosarcoma after breast conservation therapy.

    PubMed

    Iqbal, Fahad Mujtaba; Ahmed, Balen; Vidya, Raghavan

    2016-01-01

    Angiosarcomas are rare and aggressive malignant tumours of vascular or endothelial origin that can originate in the breast. They can be classified as primary or secondary, with the latter most commonly due to postoperative radiotherapy as part of breast conservation therapy (wide local excision and adjuvant radiotherapy) for breast cancer. We report a case of postirradiation secondary angiosarcoma in a 56-year-old woman, alongside a review of the current literature, to inform clinicians of its clinical presentation and characteristics as a high index of clinical suspicion is required for an accurate diagnosis. PMID:27113794

  9. Breast-Conserving Treatment in the Elderly: Long-Term Results of Adjuvant Hypofractionated and Normofractionated Radiotherapy

    SciTech Connect

    Kirova, Youlia M. Campana, Francois; Savignoni, Alexia; Laki, Fatima; Muresan, Marius; Dendale, Remi; Bollet, Marc A.; Salmon, Remy J.; Fourquet, Alain

    2009-09-01

    Purpose: To evaluate the long-term cause-specific survival (CSS), locoregional recurrence-free survival (LRFS), and metastases-free survival (MFS) in elderly breast cancer patients receiving adjuvant normofractionated (NF) or hypofractionated (HF) radiotherapy (RT). Methods and Materials: Between 1995 and 1999, 367 women aged {>=}70 years with nonmetastatic Stage T1 or T2 tumors were treated by breast-conserving surgery and adjuvant RT at the Institut Curie. They underwent wide tumor excision with or without lymph node dissection followed by RT. They received either a NF-RT schedule, which delivered a total dose of 50 Gy (25 fractions, 5 fractions weekly) to the whole breast, followed by a boost to the tumor bed when indicated, or a HF-RT schedule, which delivered a total dose of 32.5 Gy (five fractions of 6.5 Gy, once weekly) with no subsequent boost. The HF-RT schedule was indicated for the more elderly patients. Results: A total of 317 patients were in the NF-RT group, with 50 in the HF-RT group. The median follow-up was 93 months (range, 9-140). The 5- and 7-year CSS, LRFS, and MFS rates were similar in both groups. The 5-year NF-RT and HF-RT rate was 96% and 95% for CSS, 95% and 94% for LRFS, and 94% and 95% for MFS, respectively. The 7-year NF-RT and HF-RT rate was 93% and 87% for CSS, 93% and 91% for LRFS, and 92% and 93% for MFS, respectively. Conclusion: According to the findings from this retrospective study, the HF-RT schedule is an acceptable alternative to NF-RT for elderly patients. However, large-scale prospective randomized trials are needed to confirm these results.

  10. Outcomes of Low-Risk Ductal Carcinoma In Situ in Southeast Asian Women Treated With Breast Conservation Therapy

    SciTech Connect

    Wong, Fuh Yong; Wang, Fuqiang; Chen, John Ju; Tan, Chiew Har; Tan, Puay Hoon

    2014-04-01

    Purpose: To examine the outcomes of Southeast Asian (SEA) women with low-risk ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and adjuvant radiation therapy. Methods and Materials: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 were performed. Patients meeting the selection criteria from Eastern Cooperative Oncology Group 5194 were included. Most patients received adjuvant radiation therapy (RT) consisting of whole-breast RT delivered to 50 Gy followed by a 10-Gy boost to the tumor bed. Results: Of 744 patients with pathologic diagnosis of pure DCIS identified, 273 met the selection criteria: low-intermediate grade (LIG), n=219; high grade (HG), n=54. Median follow-up for these patients was 60 months. There were 8 ipsilateral breast tumor recurrences (IBTRs) in total, 7 of which were DCIS. The estimated actuarial IBTR rates at 5 and 10 years for the entire cohort are 1.8% and 4.3%, respectively. Of the 219 patients with LIG DCIS, 210 received RT and 9 did not. There were 7 IBTRs in LIG DCIS, 2 among the 9 patients who did not receive RT. The IBTR rates in LIG DCIS at 5 and 10 years are 2.3% and 4.2%, respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years, giving an estimated IBTR rate of 4.5% at 10 years. Conclusions: SEA women with screen-detected DCIS have exceedingly low rates of IBTR after BCS, comparable to that observed in reports of similar patients with low-risk DCIS treated with adjuvant radiation.

  11. Long-Term Clinical and Cosmetic Outcomes After Breast Conservation Treatment for Women With Early-Stage Breast Carcinoma According to the Type of Breast Boost

    SciTech Connect

    Hill-Kayser, Christine E.; Chacko, David; Hwang, Wei-Ting; Vapiwala, Neha; Solin, Lawrence J.

    2011-03-15

    Purpose: The present study was performed to compare outcomes after breast conservation treatment with iridium-192 implant boost vs. electron boost. Methods and Materials: From 1977 to 1983, 141 patients were treated with whole breast radiotherapy followed by iridium-192 boost after breast-conserving surgery. They were matched 1:1 to patients treated with electron boost. Outcome measures included survival, local recurrence, cosmesis, and complications. Results: Median follow-up was 16.7 and 12.6 years for the implant vs. electron groups (p < 0.001). Rates of local recurrence, freedom from distant metastases, and overall survival at 10/20 years did not differ between the groups, nor did patterns of first failure. Patients in the electron group were more likely to have excellent/good cosmesis than those in the implant group 1 year after radiotherapy (p = 0.014); this trend continued through 10 years but did not reach statistical significance at years 5/10. Complication rates were similar, although patients receiving electron boost seemed less likely to develop breast fibrosis than did those receiving implant boost (23/141 vs. 58/141, respectively, incidence rate ratio 0.7, p = 0.17). Conclusions: Twenty-year data demonstrate no difference in rates of local recurrence, freedom from distant metastases, overall survival, or patterns of failure between groups treated with these two well-described radiotherapy boost techniques. Better cosmesis was observed in the electron group 1 year after radiotherapy, with a trend continuing for 10 years. The incidence of complications was similar between the groups, with a trend toward increased fibrosis in patients receiving implant boost.

  12. Clinical-Pathologic Features and Long-Term Outcomes of Tubular Carcinoma of the Breast Compared With Invasive Ductal Carcinoma Treated With Breast Conservation Therapy

    SciTech Connect

    Liu, Gene-Fu F.; Yang Qifeng; Haffty, Bruce G.; Moran, Meena S.

    2009-12-01

    Purpose: To evaluate our institutional experience of treating tubular carcinoma of the breast (TC) and invasive ductal carcinoma (IDC) with conservative surgery and radiation therapy, to compare clinical-pathologic features and long-term outcomes. Methods and Materials: A review of our institution's tumor registry from 1975 to 2007, followed by a central pathology review of available slides, yielded 71 cases of Stage I/II TC and 2,238 cases of Stage I/II IDC treated with breast conservation therapy. Clinical-pathologic features and outcomes were analyzed by subtype to detect significant differences. Results: The median follow-up was 7 years. The TC cohort presented more frequently with pT1 disease (97% vs. 80%, p = 0.0007), pN0 disease (95% vs. 74%, p = 0.0004), hormone-receptor positivity (ER+, 89% vs. 62%, p = 0.0001; PR+, 81% vs. 52%, p = 0.0001), and HER-2 negativity (89% vs. 71%, p = 0.04). Clinical outcomes also favored the TC cohort, with lower rates of breast cancer-related death (1% vs. 10%; p = 0.0109) and distant metastasis (1% vs. 13%; p = 0.0028) and higher rates of 10-year overall (90% vs. 80%; p = 0.033), cause-specific (99% vs. 86%; p = 0.011), and disease-free (99% vs. 82%; p = 0.003) survival. There was a nonsignificant trend toward improved breast cancer relapse-free survival for the TC cohort (95% vs. 87%; p = 0.062) but no difference in nodal relapse-free survival or contralateral breast cancer relapse-free survival (all p values >0.05) between the cohorts. Conclusion: Our institutional experience suggests that TC, when compared with IDC, is associated with more favorable clinical-pathologic features and comparable, if not superior, outcomes after breast conservation therapy, suggesting the appropriateness of a conservative approach to this rare subtype.

  13. Is there an Ideal Breast Conservation Rate for the Treatment of Breast Cancer?

    PubMed

    Tan, M P

    2016-09-01

    Since the results of randomised controlled trials in the last quarter of the twentieth century were reported, it has been conventionally accepted that breast conservation treatment (BCT) provides equivalent survival to mastectomy for early breast cancer. As expected, there was an initial fall in the use of mastectomy. The first decade of the twenty-first century, however, witnessed a trend of increasing mastectomy rates in some regions. This perplexing circumstance served as an impetus for a relook at survival outcomes with each surgical modality. Recent studies have demonstrated higher survival rates and improved local control associated with BCT. Such findings warrant a re-evaluation of treatment strategies, beginning with whether there is an optimum BCT rate. PMID:27177489

  14. Three-Dimensional Conformal Simultaneously Integrated Boost Technique for Breast-Conserving Radiotherapy

    SciTech Connect

    Laan, Hans Paul van der

    2007-07-15

    Purpose: To compare the target coverage and normal tissue dose with the simultaneously integrated boost (SIB) and the sequential boost technique in breast cancer, and to evaluate the incidence of acute skin toxicity in patients treated with the SIB technique. Methods and Materials: Thirty patients with early-stage left-sided breast cancer underwent breast-conserving radiotherapy using the SIB technique. The breast and boost planning target volumes (PTVs) were treated simultaneously (i.e., for each fraction, the breast and boost PTVs received 1.81 Gy and 2.3 Gy, respectively). Three-dimensional conformal beams with wedges were shaped and weighted using forward planning. Dose-volume histograms of the PTVs and organs at risk with the SIB technique, 28 x (1.81 + 0.49 Gy), were compared with those for the sequential boost technique, 25 x 2 Gy + 8 x 2 Gy. Acute skin toxicity was evaluated for 90 patients treated with the SIB technique according to Common Terminology Criteria for Adverse Events, version 3.0. Results: PTV coverage was adequate with both techniques. With SIB, more efficiently shaped boost beams resulted in smaller irradiated volumes. The mean volume receiving {>=}107% of the breast dose was reduced by 20%, the mean volume outside the boost PTV receiving {>=}95% of the boost dose was reduced by 54%, and the mean heart and lung dose were reduced by 10%. Of the evaluated patients, 32.2% had Grade 2 or worse toxicity. Conclusion: The SIB technique is proposed for standard use in breast-conserving radiotherapy because of its dose-limiting capabilities, easy implementation, reduced number of treatment fractions, and relatively low incidence of acute skin toxicity.

  15. A new surgical strategy for breast conservation in locally advanced breast cancer that achieves a good locoregional control rate: preliminary report.

    PubMed

    Moneer, M; Ismael, S; Khaled, H; El-Gantery, M; Zaghloul, M S; El-Didi, M

    2001-06-01

    The scope of breast conserving surgery has recently expanded to include locally advanced breast cancer (LABC) patients who are downstaged following neoadjuvant chemotherapy (NACT). However, the efficacy of this approach in achieving adequate locoregional control of disease is in doubt. Some reports have attributed the failure to the association of NACT-induced tumour downstaging which can leave multifocal in situ and invasive lesions around the main tumour mass. In the present study, in order to eradicate all possible tumour satellites, a very wide local excision that included the whole original tumour-bearing area was performed regardless of the expected wide defect. This defect was then immediately reconstructed by an ipsilateral pedicled latissimus dorsi myocutaneous (LDM) flap. The study included 26 patients with LABC without evidence of primary tumour-multicentricity. Tumours were downstaged following NACT. The early cosmetic outcome was good in the majority of cases. Early complications were minimal. Twenty-two patients had a mean follow up period of 30.2 (range 7-50) months. In those evaluable cases, locoregional control of the disease was excellent (100%) but distant metastases occurred in seven cases (31.8%). PMID:14965588

  16. Is Ki-67 Expression Prognostic for Local Relapse in Early-Stage Breast Cancer Patients Treated With Breast Conservation Therapy (BCT)?

    SciTech Connect

    Hafeez, Farhaan; Neboori, Hanmanth J.; Harigopal, Malini; Wu, Hao; Haffty, Bruce G.; Yang, Qifeng; Schiff, Devora; Moran, Meena S.

    2013-10-01

    Purpose: Ki-67 is a human nuclear protein whose expression is strongly up-regulated in proliferating cells and can be used to determine the growth fraction in clonal cell populations. Although there are some data to suggest that Ki-67 overexpression may be prognostic for endpoints such as survival or postmastectomy recurrence, further elucidation of its prognostic significance is warranted. Specifically after breast conservation therapy (BCT) (defined in this setting as breast-conserving surgery and adjuvant radiation therapy), whether Ki-67 predicts for locoregional recurrence has not been investigated. The purpose of this study was to assess Ki-67 expression in a cohort of early-stage breast cancer patients to determine whether a significant independent association between Ki-67 and locoregional relapse exists. Methods and Materials: Ki-67 staining was conducted on a tissue microarray of 438 patients previously treated with BCT, and expression was analyzed with clinicopathologic features and outcomes from our database. Results: Ki-67 expression was more prevalent in black patients (37% of black patients vs 17% of white patients, P<.01), younger patients (27% of patients aged ≤50 years vs 15% of patients aged >50 years, P<.01), estrogen receptor (ER)–negative tumors (25% of ER-negative tumors vs 17% of ER-positive tumors, P=.04), human epidermal growth factor receptor 2 (HER2)/neu–positive tumors (35% of HER2-positive tumors vs 18% of HER2-negative tumors, P=.01), and larger tumors (26% of T2 tumors vs 16% of T1 tumors, P=.03). On univariate/multivariate analysis, Ki-67 did not predict for overall survival (74.4% vs 72.6%), cause-specific survival (82.9% vs 82.1%), local relapse-free survival (83.6% vs 88.5%), distant metastasis-free survival (76.1% vs 81.4%), recurrence-free survival (65.5% vs 74.6%), and locoregional recurrence-free survival (81.6% vs 84.7%): P>.05 for all. Conclusions: Ki-67 appears to be a surrogate marker for aggressive disease and

  17. Breast conservation is an effective option in Black, medically indigent patients.

    PubMed Central

    Burri, Stuart H.; Landry, Jerome C.; Davis, Lawrence W.

    2002-01-01

    The purpose of the study was to evaluate the efficacy of lumpectomy and postoperative radiotherapy in an African-American, medically indigent population. From 1980 through 1996, a retrospective chart review was undertaken of the patients treated with radiotherapy after lumpectomy at an inner city hospital, whose patients are primarily African American and uninsured. One hundred and one patients were treated with breast conservation during this time. Of those, 72 were African American and with invasive carcinoma. The data were analyzed using JMP IN (SAS Institute). The study found that African-American patients with invasive carcinoma had 95.2% local control at 5 years and 87.9% at 10 years. The disease-free survival was 84.6% at 5 years and 65.3% at 10 years. Patients that received less than 50 Gray to the tumor bed had inferior local control, disease-free survival, and overall survival (p < 0.0001 for all three). The 5-year and 10-year local control for DCIS, in a limited number of patients, was 95.2%. We conclude that lumpectomy followed by radiotherapy is an effective treatment strategy in the high-risk population of African-American, medically indigent patients. The local control and disease-free survival compare favorably to published controls in this traditionally high-risk patient population. PMID:12078926

  18. Breast Conservation Therapy Versus Mastectomy: Shared Decision-Making Strategies and Overcoming Decisional Conflicts in Your Patients.

    PubMed

    Margenthaler, Julie A; Ollila, David W

    2016-10-01

    Although breast-conserving therapy is considered the preferred treatment for the majority of women with early-stage breast cancer, mastectomy rates in this group remain high. The patient, physician, and systems factors contributing to a decision for mastectomy are complicated. Understanding the individual patient's values and goals when making this decision is paramount to providing a shared decision-making process that will yield the desired outcome. The cornerstones of this discussion include education of the patient, access to decision-aid tools, and time to make an informed decision. However, it is also paramount for the physician to understand that a significant majority of women with an informed and complete understanding of their surgical choices will still prefer mastectomy. The rates of breast conservation versus mastectomy should not be considered a quality measure alone. Rather, the extent by which patients are informed, involved in decision-making, and undergoing treatments that reflect their goals is the true test of quality. Here we explore some of the factors that impact the patient preference for breast conservation versus mastectomy and how shared decision-making can be maximized for patient satisfaction. PMID:27464606

  19. Prognosis for Mammographically Occult, Early-Stage Breast Cancer Patients Treated With Breast-Conservation Therapy

    SciTech Connect

    Yang, Tzu-I. J.; Yang Qifeng; Haffty, Bruce G.; Moran, Meena S.

    2010-01-15

    Purpose: To compare mammographically occult (MamOcc) and mammographically positive (MamPos) early-stage breast cancer patients treated with breast-conservation therapy (BCT), to analyze differences between the two cohorts. Methods and Materials: Our two cohorts consisted of 214 MamOcc and 2168 MamPos patients treated with BCT. Chart reviews were conducted to assess mammogram reports and method of detection. All clinical-pathologic and outcome parameters were analyzed to detect differences between the two cohorts. Results: Median follow-up was 7 years. There were no differences in final margins, T stage, nodal status, estrogen/progesterone receptor status, or 'triple-negative' status. Significant differences included younger age at diagnosis (p < 0.0001), more positive family history (p = 0.0033), less HER-2+ disease (p = 0.0294), and 1{sup o} histology (p < 0.0001). At 10 years, the differences in overall survival, cause-specific survival, and distant relapse between the two groups did not differ significantly. The MamOcc cohort had more breast relapses (15% vs. 8%; p = 0.0357), but on multivariate analysis this difference was not significant (hazard ratio 1.0, 95% confidence interval 0.993-1.007, p = 0.9296). Breast relapses were mammographically occult in 32% of the MamOcc and 12% of the MamPos cohorts (p = 0.0136). Conclusions: Although our study suggests that there are clinical-pathologic variations for the MamOcc cohort vs. MamPos patients that may ultimately affect management, breast relapse after BCT was not significantly different. Breast recurrences were more often mammographically occult in the MamOcc cohort; consideration should be given to closer follow-up and alternative imaging strategies (ultrasound, breast MRI) for routine posttreatment examination. To our knowledge, this represents the largest series addressing the prognostic significance of MamOcc cancers treated with BCT.

  20. Cosmetic Outcomes and Complications Reported by Patients Having Undergone Breast-Conserving Treatment

    SciTech Connect

    Hill-Kayser, Christine E.; Vachani, Carolyn; Hampshire, Margaret K.; Di Lullo, Gloria A.; Metz, James M.

    2012-07-01

    Purpose: Over the past 30 years, much work in treatment of breast cancer has contributed to improvement of cosmetic and functional outcomes. The goal of breast-conservation treatment (BCT) is avoidance of mastectomy through use of lumpectomy and adjuvant radiation. Modern data demonstrate 'excellent' or 'good' cosmesis in >90% of patients treated with BCT. Methods and Materials: Patient-reported data were gathered via a convenience sample frame from breast cancer survivors using a publically available, free, Internet-based tool for creation of survivorship care plans. During use of the tool, breast cancer survivors are queried as to the cosmetic appearance of the treated breast, as well as perceived late effects. All data have been maintained anonymously with internal review board approval. Results: Three hundred fifty-four breast cancer survivors having undergone BCT and voluntarily using this tool were queried with regard to breast cosmesis and perceived late effects. Median diagnosis age was 48 years, and median current age 52 years. 'Excellent' cosmesis was reported by 27% (n = 88), 'Good' by 44% (n = 144), 'Fair' by 24% (n = 81), and 'Poor' by 5% (n = 18). Of the queries posted to survivors after BCT, late effects most commonly reported were cognitive changes (62%); sexual concerns (52%); changes in texture and color of irradiated skin (48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in the irradiated area (30%). Survivors also described osteopenia/osteoporosis (35%), cardiopulmonary problems (12%), and lymphedema (19%). Conclusions: This anonymous tool uses a convenience sample frame to gather patient reported assessments of cosmesis and complications after breast cancer. Among the BCT population, cosmetic assessment by survivors appears less likely to be 'excellent' or 'good' than would be expected, with 30% of BCT survivors reporting 'fair' or 'poor' cosmesis. Patient reported incidence of chronic pain, as well as cognitive and

  1. Does Axillary Boost Increase Lymphedema Compared With Supraclavicular Radiation Alone After Breast Conservation?

    SciTech Connect

    Hayes, Shelly B. Freedman, Gary M.; Li Tianyu; Anderson, Penny R.; Ross, Eric

    2008-12-01

    Purpose: To determine independent predictors of lymphedema (LE) after breast radiotherapy and to quantify added risks of LE from regional node irradiation (RNI). Materials and Methods: A total of 2,579 women with T1-2, N 0-3, M0 breast cancer treated with breast conservation between 1970 and 2005 were studied. A total of 2,169 patients (84%) received radiation to the breast (B), 226 (8.8%) to the breast and supraclavicular LNs (B+SC), and 184 (7.1%) to the breast, supraclavicular LNs, and a posterior axillary boost (B+SC+PAB). Median follow-up was 81 months (range, 3-271). Results: Eighteen percent of patients developed LE. LE risks were as follows: 16% (B), 23% (B+SC), and 31% (B+SC+PAB) (p < 0.0001). LE severity was greater in patients who had RNI (p = 0.0002). On multivariate analysis, RT field (p < 0.0001), obesity index (p = 0.0157), systemic therapy (p = 0.0013), and number of LNs dissected (p < 0.0001) independently predicted for LE. In N1 patients, the addition of a SC to tangents (p < 0.0001) and the addition of a PAB to tangents (p = 0.0017) conferred greater risks of LE, but adding a PAB to B+SC RT did not (p = 0.8002). In the N2 patients, adding a PAB increased the risk of LE 4.5-fold over B+SC RT (p = 0.0011). Conclusions: LE predictors included number of LNs dissected, RNI, obesity index, and systemic therapy. LE risk increased when a SC or PAB were added in the N1 subgroup. In the N2 patients, a PAB increased the risk over B+SC. The decision to boost the axilla must be weighed against the increased risk of LE that it imposes.

  2. Outcomes in Black Patients With Early Breast Cancer Treated With Breast Conservation Therapy

    SciTech Connect

    Nichols, Michael A.; Mell, Loren K.; Hasselle, Michael D.; Karrison, Theodore G.; MacDermed, Dhara; Meriwether, Amber; Witt, Mary Ellyn; Weichselbaum, Ralph R.; Chmura, Steven J.

    2011-02-01

    Background: The race-specific impact of prognostic variables for early breast cancer is unknown for black patients undergoing breast conservation. Methods and Materials: This was a retrospective study of 1,231 consecutive patients {>=}40 years of age with Stage I-II invasive breast cancer treated with lumpectomy and radiation therapy at the University of Chicago Hospitals and affiliates between 1986 and 2004. Patients were classified as either black or nonblack. Cox proportional hazards regression was used to model the effects of known prognostic factors and interactions with race. Results: Median follow-up for surviving patients was 82 months. Thirty-four percent of patients were black, and 66% were nonblack (Caucasian, Hispanic, and Asian). Black patients had a poorer 10-year overall survival (64.6% vs. 80.8%; adjusted hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.23-2.06) and 10-year disease-free survival (58.1% vs. 75.4%; HR 1.49; 95% CI, 1.18-1.89) compared with nonblack patients. Tumor sizes were similar between nonblack and black patients with mammographically detected tumors (1.29 cm vs. 1.20 cm, p = 0.20, respectively). Tumor size was significantly associated with overall survival (HR 1.48; 95% CI, 1.12-1.96) in black patients with mammographically detected tumors but not in nonblack patients (HR 1.09; 95% CI, 0.78-1.53), suggesting that survival in black patients depends more strongly on tumor size in this subgroup. Tests for race-size method of detection interactions were statistically significant for overall survival (p = 0.049), locoregional control (p = 0.036), and distant control (p = 0.032) and borderline significant for disease-free survival (p = 0.067). Conclusion: Despite detection at comparable sizes, the prognostic effect of tumor size in patients with mammographically detected tumors is greater for black than in nonblack patients.

  3. Pattern of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy

    SciTech Connect

    Jobsen, Jan; Palen, Job van der; Riemersma, Sietske; Heijmans, Harald; Ong, Francisca; Struikmans, Henk

    2014-08-01

    Purpose: To analyze the incidence and prognostic factors of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) in a large, population-based, single-center study with long-term follow-up. Methods and Materials: We analyzed 3595 cases in which BCT was performed in 3824 women with stage I or II breast cancer. The incidence of IBTR was analyzed over time and was based on IBTR as first event. Results: The 15-year local relapse-free survival was 90.9%. The hazard estimates for IBTR showed a time course with 2 peaks, the first at approximately 5 years and the second, twice as high, at 12 years. Stratifying subjects by age and margin status showed that, for women ≤40 years old with negative margins, adjuvant systemic therapy led to a 5-fold reduced risk of recurrence compared to none, and the presence of lymph vascular space invasion (LVSI) had a 3-fold increased risk compared to its absence. For women >40 years old, the presence of LVSI (hazard ratio [HR] 2.5) and the presence of lobular carcinoma in situ in the lumpectomy specimen (HR 2.3) were the only 2 risk factors. Conclusions: We demonstrated a pattern in risk of IBTR over time, with 2 peaks, first at approximately 5 years and a second, much higher peak at approximately 12 years, especially for women ≤40 years old. For women ≤40 years old with tumor-free resection margins, we noted that the absence of adjuvant systemic therapy and the presence of LVSI were independent prognostic factors of IBTR. For women >40 years old, the presence of LVSI and the presence of lobular carcinoma in situ were independent risk factors.

  4. Mammographic compression after breast conserving therapy: Controlling pressure instead of force

    SciTech Connect

    Groot, J. E. de Branderhorst, W.; Grimbergen, C. A.; Broeders, M. J. M.; Heeten, G. J. den

    2014-02-15

    Purpose: X-ray mammography is the primary tool for early detection of breast cancer and for follow-up after breast conserving therapy (BCT). BCT-treated breasts are smaller, less elastic, and more sensitive to pain. Instead of the current force-controlled approach of applying the same force to each breast, pressure-controlled protocols aim to improve standardization in terms of physiology by taking breast contact area and inelasticity into account. The purpose of this study is to estimate the potential for pressure protocols to reduce discomfort and pain, particularly the number of severe pain complaints for BCT-treated breasts. Methods: A prospective observational study including 58 women having one BCT-treated breast and one untreated nonsymptomatic breast, following our hospital's 18 decanewton (daN) compression protocol was performed. Breast thickness, applied force, contact area, mean pressure, breast volume, and inelasticity (mean E-modulus) were statistically compared between the within-women breast pairs, and data were used as predictors for severe pain, i.e., scores 7 and higher on an 11-point Numerical Rating Scale. Curve-fitting models were used to estimate how pressure-controlled protocols affect breast thickness, compression force, and pain experience. Results: BCT-treated breasts had on average 27% smaller contact areas, 30% lower elasticity, and 30% higher pain scores than untreated breasts (allp < 0.001). Contact area was the strongest predictor for severe pain (p < 0.01). Since BCT-treatment is associated with an average 0.36 dm{sup 2} decrease in contact area, as well as increased pain sensitivity, BCT-breasts had on average 5.3 times higher odds for severe pain than untreated breasts. Model estimations for a pressure-controlled protocol with a 10 kPa target pressure, which is below normal arterial pressure, suggest an average 26% (range 10%–36%) reduction in pain score, and an average 77% (range 46%–95%) reduction of the odds for severe pain

  5. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy

    SciTech Connect

    Vargas, Carlos; Kestin, Larry; Go, Nel; Krauss, Daniel; Chen, Peter; Goldstein, Neal; Martinez, Alvaro; Vicini, Frank A. . E-mail: fvicini@beaumont.edu

    2005-12-01

    Purpose: We reviewed our institution's experience treating patients with ductal carcinoma in situ (DCIS) of the breast to determine risk factors for ipsilateral breast tumor recurrence (IBTR) and cause-specific survival (CSS) after breast-conserving therapy (BCT) or mastectomy. Materials and Methods: Between 1981 and 1999, 410 cases of DCIS (405 patients) were treated at our institution; 367 were managed with breast-conserving surgery (54 with lumpectomy alone and 313 with adjuvant radiation therapy (RT) [median dose, 45 Gy]). Of these 313 patients, 298 received also a supplemental boost of RT to the lumpectomy cavity (median dose, 16 Gy). Forty-three patients underwent mastectomy; 2 (5%) received adjuvant RT to the chest wall. A true recurrence/marginal miss (TR/MM) IBTR was defined as failure within or adjacent to the tumor bed in patients undergoing BCT. Median follow-up for all patients was 7 years (mean: 6.1 years). Results: Thirty patients (8.2%) experienced an IBTR after BCT (25 [8%] after RT, 5 [9.3%] after no RT), and 2 patients (4.7%) developed a chest wall recurrence after mastectomy. Of the 32 local failures, 20 (63%) were invasive (18/30 [60%] after BCT and 2/2 [100%] after mastectomy), and 37% were DCIS alone. Twenty-four (80%) of the IBTRs were classified as TR/MM. The 10-year freedom from local failure, CSS, and overall survival after BCT or mastectomy were 89% vs. 90% (p = 0.4), 98% vs. 100% (p = 0.7), and 89% vs. 100% (p = 0.3), respectively. Factors associated with IBTR on Cox multivariate analysis were younger age (p = 0.02, hazard ratio [HR] 1.06 per year), electron boost energy {<=}9 MeV (p = 0.03, HR 1.41), final margins {<=}2 mm (p = 0.007; HR, 3.65), and no breast radiation (p = 0.002, HR 5.56). On Cox univariate analysis for BCT patients, IBTR, TR/MM failures, and predominant nuclear Grade 3 were associated with an increased risk of distant metastases and a reduced CSS. Conclusions: After treatment for DCIS, 10-year rates of local control

  6. Improving size, lymph node metastatic rate, breast conservation, and mortality of invasive breast cancer in Rhode Island women, a well-screened population.

    PubMed

    Coburn, Natalie G; Cady, Blake; Fulton, John P; Law, Calvin; Chung, Maureen A

    2012-10-01

    The beneficial impact of screening mammography on breast cancer outcome continues to be debated as demonstrated by guidelines published by the United States Preventive Services Task Force. A previous report from Rhode Island, which has a very high rate of mammographic screening, demonstrated significant improvements in invasive breast cancer presentation and mortality through 2001. This report updates data through 2008 to determine whether previous favorable trends continued. Rhode Island Cancer Registry data regarding invasive breast cancer presentation and mortality in 17,522 female residents diagnosed between 1987 and 2008, inclusive, were analyzed for demographic and pathological factors. Data were analyzed by four time periods: 1987-1992, 1993-1998, 1999-2003, and 2004-2008 and overall. Statistically significant improvements occurred over the four successive time periods, in mean cancer size (23.7, 20.9, 19.6, and 19.3 mm, p < 0.0001), pathologic grade (Grade I: 12, 15, 19, and 17 %; Grade III 57, 41, 36, and 35 %, p < 0.0001), breast conserving surgery (38, 56, 67, and 71 %, p < 0.0001) and mortality (37.3, 31.4, 25.1, and 22.6 per 100,000/year, p < 0.0001). The results showed that high screening rates favorably impacted presentation of and mortality from invasive breast cancer in Rhode Island. From 1987 to 2008, there has been a 39 % decline in breast cancer mortality considering 5 year periods (37.3 vs. 22.6 deaths per 100,000) and 41 % comparing the period from 1990 to 2008, which may exceed the goal of 50 % mortality reduction by 2015 established by the American Cancer Society. PMID:22933028

  7. Molecular dyes used for surgical specimen margin orientation allow for intraoperative optical assessment during breast conserving surgery

    PubMed Central

    McClatchy, David M.; Krishnaswamy, Venkataramanan; Kanick, Stephen C.; Elliott, Jonathan T.; Wells, Wendy A.; Barth, Richard J.; Paulsen, Keith D.; Pogue, Brian W.

    2015-01-01

    Abstract. A variety of optical techniques utilizing near-infrared (NIR) light are being proposed for intraoperative breast tumor margin assessment. However, immediately following a lumpectomy excision, the margins are inked, which preserves the orientation of the specimen but prevents optical interrogation of the tissue margins. Here, a workflow is proposed that allows for both NIR optical assessment following full specimen marking using molecular dyes which have negligible absorption and scattering in the NIR. The effect of standard surgical inks in contrast to molecular dyes for an NIR signal is shown. Further, the proposed workflow is demonstrated with full specimen intraoperative imaging on all margins directly after the lumpectomy has been excised and completely marked. This work is an important step in the path to clinical feasibility of intraoperative breast tumor margin assessment using NIR optical methods without having to compromise on the current clinical practice of inking resected specimens for margin orientation. PMID:25901654

  8. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Five-year Results of 100 Patients

    SciTech Connect

    Formenti, Silvia C.; Hsu, Howard; Fenton-Kerimian, Maria; Roses, Daniel; Guth, Amber; Jozsef, Gabor; Goldberg, Judith D.; DeWyngaert, J. Keith

    2012-11-01

    Purpose: To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position. Methods and Materials: Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded. Results: One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36 months follow-up. Conclusions: Five-year efficacy and toxicity of 3D-CRT delivered in prone partial breast irradiation are comparable to other experiences with similar follow-up.

  9. Molecular dyes used for surgical specimen margin orientation allow for intraoperative optical assessment during breast conserving surgery

    NASA Astrophysics Data System (ADS)

    McClatchy, David M., III; Krishnaswamy, Venkataramanan; Kanick, Stephen C.; Elliott, Jonathan T.; Wells, Wendy A.; Barth, Richard J., Jr.; Paulsen, Keith D.; Pogue, Brian W.

    2015-04-01

    A variety of optical techniques utilizing near-infrared (NIR) light are being proposed for intraoperative breast tumor margin assessment. However, immediately following a lumpectomy excision, the margins are inked, which preserves the orientation of the specimen but prevents optical interrogation of the tissue margins. Here, a workflow is proposed that allows for both NIR optical assessment following full specimen marking using molecular dyes which have negligible absorption and scattering in the NIR. The effect of standard surgical inks in contrast to molecular dyes for an NIR signal is shown. Further, the proposed workflow is demonstrated with full specimen intraoperative imaging on all margins directly after the lumpectomy has been excised and completely marked. This work is an important step in the path to clinical feasibility of intraoperative breast tumor margin assessment using NIR optical methods without having to compromise on the current clinical practice of inking resected specimens for margin orientation.

  10. Multiple Cutaneous Angiosarcomas after Breast Conserving Surgery and Bilateral Adjuvant Radiotherapy: An Unusual Case and Review of the Literature

    PubMed Central

    Meattini, Icro; Santi, Raffaella; Scartoni, Daniele; Giacomelli, Irene; De Luca Cardillo, Carla; Scotti, Vieri; Casella, Donato; Simoncini, Roberta; Orzalesi, Lorenzo; Nori, Jacopo; Paglierani, Milena; Livi, Lorenzo

    2014-01-01

    Breast angiosarcomas (BAs) are rare but serious events that may arise after radiation exposure. Disease outcome is poor, with high risk of local and distant failure. Recurrences are frequent also after resection with negative margins. The spectrum of vascular proliferations associated with radiotherapy in the setting of breast cancer has expanded, including radiation-associated atypical vascular lesions (AVLs) of the breast skin as a rare, but well-recognized, entity. Although pursuing a benign behavior, AVLs have been regarded as possible precursors of postradiation BAs. We report an unusual case of a 71-year-old woman affected by well-differentiated bilateral cutaneous BA, diagnosed 1.9 years after adjuvant RT for synchronous bilateral breast cancer. Whole-life clinical followup is of crucial importance in breast cancer patients. PMID:24744928

  11. Breast-Conserving Surgery Followed by Radiation Therapy With MRI-Detected Stage I or Stage II Breast Cancer

    ClinicalTrials.gov

    2011-12-07

    Ductal Breast Carcinoma in Situ; Estrogen Receptor-negative Breast Cancer; Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; HER2-positive Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Male Breast Cancer; Medullary Ductal Breast Carcinoma With Lymphocytic Infiltrate; Mucinous Ductal Breast Carcinoma; Papillary Ductal Breast Carcinoma; Progesterone Receptor-negative Breast Cancer; Progesterone Receptor-positive Breast Cancer; Stage I Breast Cancer; Stage II Breast Cancer; Tubular Ductal Breast Carcinoma

  12. Interim report

    SciTech Connect

    1985-06-01

    This Interim Report summarizes the research and development activities of the Superconducting Super Collider project carried out from the completion of the Reference Designs Study (May 1984) to June 1985. It was prepared by the SSC Central Design Group in draft form on the occasion of the DOE Annual Review, June 19--21, 1985. Now largely organized by CDG Divisions, the bulk of each chapter documents the progress and accomplishments to date, while the final section(s) describe plans for future work. Chapter 1, Introduction, provides a basic brief description of the SSC, its physics justification, its origins, and the R&D organization set up to carry out the work. Chapter 2 gives a summary of the main results of the R&D program, the tasks assigned to the four magnet R&D centers, and an overview of the future plans. The reader wishing a quick look at the SSC Phase I effort can skim Chapter 1 and read Chapter 2. Subsequent chapters discuss in more detail the activities on accelerator physics, accelerator systems, magnets and cryostats, injector, detector R&D, conventional facilities, and project planning and management. The magnet chapter (5) documents in text and photographs the impressive progress in successful construction of many model magnets, the development of cryostats with low heat leaks, and the improvement in current-carrying capacity of superconducting strand. Chapter 9 contains the budgets and schedules of the COG Divisions, the overall R&D program, including the laboratories, and also preliminary projections for construction. Appendices provide information on the various panels, task forces and workshops held by the CDG in FY 1985, a bibliography of COG and Laboratory reports on SSC and SSC-related work, and on private industrial involvement in the project.

  13. Mediators of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients: Response Expectancies and Emotional Distress

    ERIC Educational Resources Information Center

    Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

    2010-01-01

    Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years;…

  14. Oncoplastic breast surgery: current strategies

    PubMed Central

    Piper, Merisa; Peled, Anne Warren

    2015-01-01

    The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction and result in better control of tumor margins. This article will detail the approach to evaluating and treating patients undergoing oncoplastic reconstruction. Different oncoplastic approaches will be described and applied to an oncoplastic reconstructive algorithm. Surgical complications, oncologic outcomes and aesthetic outcomes are reviewed. PMID:26005647

  15. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.

    PubMed

    Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina

    2016-01-01

    Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery. PMID:27140865

  16. Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years

    PubMed Central

    2010-01-01

    Background Accelerated hypofractionation is an attractive approach for adjuvant whole breast radiotherapy. In this study we evaluated the adverse effects at least 3 years post an accelerated hypofractionated whole breast radiotherapy schedule. Methods From October 2004 to March 2006, 39 consecutive patients aged over 18 years with pTis, pT1-2, pN0-1 breast adenocarcinoma who underwent conservative surgery were treated with an adjuvant accelerated hypofractionated radiotherapy schedule consisting of 34 Gy in 10 daily fractions over 2 weeks to the whole breast, followed after 1 week by an electron boost dose of 8 Gy in a single fraction to the tumour bed. Skin and lung radiation toxicity was evaluated daily during therapy, once a week for one month after radiotherapy completion, every 3 months for the first year and from then on every six months. In particular lung toxicity was investigated in terms of CT density evaluation, pulmonary functional tests, and clinical and radiological scoring. Paired t-test, Chi-square test and non-parametric Wilcoxon test were performed. Results After a median follow-up of 43 months (range 36-52 months), all the patients are alive and disease-free. None of the patients showed any clinical signs of lung toxicity, no CT-lung toxicity was denoted by radiologist on CT lung images acquired about 1 year post-radiotherapy, no variation of pulmonary density evaluated in terms of normalised Hounsfield numbers was evident. Barely palpable increased density of the treated breast was noted in 9 out of 39 patients (in 2 patients this toxicity was limited to the boost area) and teleangectasia (<1/cm2) limited to the boost area was evident in 2 out of 39 patients. The compliance with the treatment was excellent (100%). Conclusion The radiotherapy schedule investigated in this study (i.e 34 Gy in 3.4 Gy/fr plus boost dose of 8 Gy in single fraction) is a feasible and safe treatment and does not lead to adjunctive acute and late toxicities. A longer

  17. The Intentional Interim

    ERIC Educational Resources Information Center

    Nugent, Patricia A.

    2011-01-01

    The author spent years in central-office administration, most recently in an interim position. Some interim administrators simply see themselves as placeholders until the real deal is hired, giving the organization the opportunity to coast. There are others who see themselves as change agents and cannot wait to undo or redo what their predecessor…

  18. Results of breast conservation therapy from a single-institution community hospital in Hawaii with a predominantly Japanese population

    SciTech Connect

    Kanemori, Mark . E-mail: mtkanemori@aol.com; Prygrocki, Maria C.T.R.

    2005-05-01

    Purpose: To evaluate the outcome data from breast conservation therapy performed at the Kuakini Medical Center in Honolulu, Hawaii. The remarkably low rates of recurrence found in this study prompted a review of the literature and evaluation of the prognostic factors that may explain these results. Methods and materials: The data from patients with Tis, T1 or T2 breast tumors, treated with lumpectomy and radiotherapy during the 12-year period between January 1990 and December 2001 were retrospectively reviewed and compared to results found in national publications. Results: Current follow-up data was available in 97.1% of patients who met these criteria, identifying a total of 896 patients who were analyzed in this study. With a median follow-up exceeding 6 years, the local in-breast failure rate was 0.67%. Survival data was superior to the National Cancer Data Base for each stage of disease. Conclusion: This low rate of local relapse is extraordinary and unmatched by the published results generally cited in the literature. The findings are consistent with other studies reporting unusually low rates of breast cancer recurrence in patients of Japanese ancestry.

  19. Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

    PubMed Central

    Richters, Lisa; Fridrich, Claudius; Markiefka, Birgid; Bongartz, Rudolf; Semrau, Robert; Mallmann, Peter; Kraemer, Stefan

    2014-01-01

    Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT) can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy) in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer. PMID:25587453

  20. Comparison of risk of local-regional recurrence after mastectomy or breast conservation therapy for patients treated with neoadjuvant chemotherapy and radiation stratified according to a prognostic index score

    SciTech Connect

    Huang, Eugene H.; Strom, Eric A.; Perkins, George H.; Oh, Julia L.; Chen, Allen M.; Meric-Bernstam, Funda; Hunt, Kelly K.; Sahin, Aysegul A.; Hortobagyi, Gabriel N.; Buchholz, Thomas A. . E-mail: tbuchhol@mdanderson.org

    2006-10-01

    Purpose: We previously developed a prognostic index that stratified patients treated with breast conservation therapy (BCT) after neoadjuvant chemotherapy into groups with different risks for local-regional recurrence (LRR). The purpose of this study was to compare the rates of LRR as a function of prognostic index score for patients treated with BCT or mastectomy plus radiation after neoadjuvant chemotherapy. Methods and Materials: We retrospectively analyzed 815 patients treated with neoadjuvant chemotherapy, surgery, and radiation. Patients were assigned an index score from 0 to 4 and given 1 point for the presence of each factor: clinical N2 to N3 disease, lymphovascular invasion, pathologic size >2 cm, and multifocal residual disease. Results: The 10-year LRR rates were very low and similar between the mastectomy and BCT groups for patients with an index score of 0 or 1. For patients with a score of 2, LRR trended lower for those treated with mastectomy vs. BCT (12% vs. 28%, p = 0.28). For patients with a score of 3 to 4, LRR was significantly lower for those treated with mastectomy vs. BCT (19% vs. 61%, p = 0.009). Conclusions: This analysis suggests that BCT can provide excellent local-regional treatment for the vast majority of patients after neoadjuvant chemotherapy. For the few patients with a score of 3 to 4, LRR was >60% after BCT and was <20% with mastectomy. If these findings are confirmed in larger randomized studies, the prognostic index may be useful in helping to select the type of surgical treatment for patients treated with neoadjuvant chemotherapy, surgery, and radiation.

  1. Continuing Risk of Ipsilateral Breast Relapse After Breast-Conserving Therapy at Long-Term Follow-up

    SciTech Connect

    Kreike, Bas; Hart, Augustinus A.M.; Velde, Tony van de; Borger, Jacques; Peterse, Hans; Rutgers, Emiel; Bartelink, Harry; Vijver, Marc J. van de

    2008-07-15

    Purpose: Currently, the local treatment of most patients with early invasive breast cancer consists of breast-conserving therapy (BCT). We have previously reported on the risk factors for ipsilateral breast relapse (IBR) in 1,026 patients treated with BCT after a median follow-up of 5.5 years. In the present study, we evaluated the IBR incidence and the risk factors for IBR after prolonged follow-up. Methods and Materials: We updated the disease outcome for all 1,026 patients using the clinical information collected from the medical registration of The Netherlands Cancer Institute and performed step-wise proportional hazard Cox regression analysis to identify the risk factors associated with an increased risk of IBR after BCT at long-term follow-up. Results: After a median follow-up of 13.3 years, 114 patients had developed an IBR as the first event. The IBR rate was 9.3% and 13.8%, respectively, at 10 and 15 years. Also, the increase in IBR was continuous without reaching a plateau, even after 15 years. Univariate analysis showed that involved surgical resection margins, young age, vascular invasion, and the presence and quantity of an in situ component are risk factors for IBR. Multivariate analysis showed that tumor-positive surgical resection margins (hazard ratio, 2.9; 95% confidence interval, 1.7-5.2, p = 0.0002) or the presence of vascular invasion (hazard ratio, 2.0; 95% confidence interval, 1.2-3.2, p = 0.004) is the major independent risk factor for IBR. Conclusions: The data from long-term follow-up showed a constant increase in IBR among patients treated by BCT, even after 15 years, without reaching a plateau. Involved surgical resection margins and vascular invasion were the most important risk factors for IBR.

  2. The Impact of Comorbidities on Outcomes for Elderly Women Treated With Breast-Conservation Treatment for Early-Stage Breast Cancer

    SciTech Connect

    Harris, Eleanor E.R. Hwang, W.-T.; Urtishak, Sandra L.; Plastaras, John; Kinosian, Bruce; Solin, Lawrence J.

    2008-04-01

    Purpose: Breast cancer incidence increases with age and is a major cause of morbidity and mortality in elderly women, but is not well studied in this population. Comorbidities often impact on the management of breast cancer in elderly women. Methods and Materials: From 1979 to 2002, a total of 238 women aged 70 years and older with Stage I or II invasive carcinoma of the breast underwent breast-conservation therapy. Outcomes were compared by age groups and comorbidities. Median age at presentation was 74 years (range, 70-89 years). Age distribution was 122 women (51%) aged 70-74 years, 71 women (30%) aged 75-79 years, and 45 women (19%) aged 80 years or older. Median follow-up was 6.2 years. Results: On outcomes analysis by age groups, 10-year cause-specific survival rates for women aged 70-74, 75-79, and 80 years or older were 74%, 81%, and 82%, respectively (p = 0.87). Intercurrent deaths at 10 years were significantly higher in older patients: 20% in those aged 70-74 years, 36% in those aged 75-79 years, and 53% in those 80 years and older (p = 0.0005). Comorbidities were not significantly more common in the older age groups and did not correlate with cause-specific survival adjusted for age. Higher comorbidity scores were associated with intercurrent death. Conclusions: Older age itself is not a contraindication to standard breast-conservation therapy, including irradiation. Women of any age with low to moderate comorbidity indices should be offered standard breast-conservation treatment if otherwise clinically eligible.

  3. Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT)

    SciTech Connect

    Ha Vu-Nishino; Tavassoli, Fattaneh A.; Ahrens, Willam A.; Haffty, Bruce G. . E-mail: hafftybg@umdnj.edu

    2005-07-15

    Purpose: The purpose of this study is to compare the clinical characteristics and outcome of medullary carcinoma to infiltrating ductal carcinoma of the breast in a large cohort of conservatively managed patients with long-term follow-up. Methods and Materials: Chart records of patients with invasive breast cancer managed with breast-conserving therapy (BCT) at the therapeutic radiology facilities of Yale University School of Medicine before 2001 were reviewed. Forty-six cases (1971-2001) were identified with medullary histology; 1,444 patients with infiltrating ductal carcinoma served as a control group. Results: The medullary cohort presented at a younger age with a higher percentage of patients in the 35 years or younger age group (26.1% vs. 6.6%, p < 0.00001). Twelve patients with medullary histology underwent genetic screening, and 6 patients were identified with deleterious mutations. This group showed greater association with BRCA1/2 mutations compared with screened patients in the control group (50.0% vs. 15.8%, p 0.0035). The medullary cohort was also significantly associated with greater T stage and tumor size (37.0% vs. 17.2% T2, mean size 3.2 vs. 2.5 cm, p 0.00097) as well as negative ER (84.9% vs. 37.6%, p < 0.00001) and PR (87.5% vs. 48.1%, p = 0.00001) status. As of February 2003, median follow-up times for the medullary and control groups were 13.9 and 14.0 years, respectively. Although breast relapse-free rates were not significantly different (76.7% vs. 85.2%), 10-year distant relapse-free survival in the medullary cohort was significantly better than in the control group (94.9% vs. 77.5%, p = 0.028). Conclusions: Despite poor clinicopathologic features, patients with medullary histology demonstrate favorable long-term distant relapse-free survival. Local control rates of patients with medullary and infiltrating ductal carcinoma are comparable. These findings suggest that patients diagnosed with medullary carcinoma are appropriate candidates for

  4. Similar Survival With Breast Conservation Therapy or Mastectomy in the Management of Young Women With Early-Stage Breast Cancer

    SciTech Connect

    Mahmood, Usama; Morris, Christopher; Neuner, Geoffrey; Koshy, Matthew; Kesmodel, Susan; Buras, Robert; Chumsri, Saranya; Bao Ting; Tkaczuk, Katherine; Feigenberg, Steven

    2012-08-01

    Purpose: To evaluate survival outcomes of young women with early-stage breast cancer treated with breast conservation therapy (BCT) or mastectomy, using a large, population-based database. Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all female patients, ages 20 to 39 years old, diagnosed with T1-2 N0-1 M0 breast cancer between 1990 and 2007, who underwent either BCT (lumpectomy and radiation treatment) or mastectomy. Multivariable and matched pair analyses were performed to compare overall survival (OS) and cause-specific survival (CSS) of patients undergoing BCT and mastectomy. Results: A total of 14,764 women were identified, of whom 45% received BCT and 55% received mastectomy. Median follow-up was 5.7 years (range, 0.5-17.9 years). After we accounted for all patient and tumor characteristics, multivariable analysis found that BCT resulted in OS (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.83-1.04; p = 0.16) and CSS (HR, 0.93; CI, 0.83-1.05; p = 0.26) similar to that of mastectomy. Matched pair analysis, including 4,644 BCT and mastectomy patients, confirmed no difference in OS or CSS: the 5-, 10-, and15-year OS rates for BCT and mastectomy were 92.5%, 83.5%, and 77.0% and 91.9%, 83.6%, and 79.1%, respectively (p = 0.99), and the 5-, 10-, and 15-year CSS rates for BCT and mastectomy were 93.3%, 85.5%, and 79.9% and 92.5%, 85.5%, and 81.9%, respectively (p = 0.88). Conclusions: Our analysis of this population-based database suggests that young women with early-stage breast cancer have similar survival rates whether treated with BCT or mastectomy. These patients should be counseled appropriately regarding their treatment options and should not choose a mastectomy based on the assumption of improved survival.

  5. Objective and Longitudinal Assessment of Dermatitis After Postoperative Accelerated Partial Breast Irradiation Using High-Dose-Rate Interstitial Brachytherapy in Patients With Breast Cancer Treated With Breast Conserving Therapy: Reduction of Moisture Deterioration by APBI

    SciTech Connect

    Tanaka, Eiichi; Yamazaki, Hideya; Yoshida, Ken; Takenaka, Tadashi; Masuda, Norikazu; Kotsuma, Tadayuki; Yoshioka, Yasuo; Inoue, Takehiro

    2011-11-15

    Purpose: To objectively evaluate the radiation dermatitis caused by accelerated partial breast irradiation (APBI) using high-dose-rate interstitial brachytherapy. Patients and Methods: The skin color and moisture changes were examined using a newly installed spectrophotometer and corneometer in 22 patients who had undergone APBI using open cavity implant high-dose-rate interstitial brachytherapy (36 Gy in six fractions) and compared with the corresponding values for 44 patients in an external beam radiotherapy (EBRT) control group (50-60 Gy in 25-30 fractions within 5-6 weeks) after breast conserving surgery. Results: All values changed significantly as a result of APBI. The extent of elevation in a Asterisk-Operator (reddish) and reduction in L Asterisk-Operator (black) values caused by APBI were similar to those for EBRT, with slightly delayed recovery for 6-12 months after treatment owing to the surgical procedure. In contrast, only APBI caused a change in the b Asterisk-Operator values, and EBRT did not, demonstrating that the reduction in b Asterisk-Operator values (yellowish) depends largely on the surgical procedure. The changes in moisture were less severe after APBI than after EBRT, and the recovery was more rapid. The toxicity assessment using the Common Toxicity Criteria, version 3, showed that all dermatitis caused by APBI was Grade 2 or less. Conclusion: An objective analysis can quantify the effects of APBI procedures on color and moisture cosmesis. The radiation dermatitis caused by APBI using the present schedule showed an equivalent effect on skin color and a less severe effect on moisture than the effects caused by standard EBRT.

  6. Interim Budget Plan.

    ERIC Educational Resources Information Center

    Office of Student Financial Assistance (ED), Washington, DC.

    This report provides the interim budget plan of the U.S. Department of Education's Office of Student Financial Assistance (OSFA) for fiscal year 2000. It reviews factors influencing OSFA's budget request, including legislative requirements, recent accomplishments, the need to maintain both the Direct Loan and Federal Family Education Loan…

  7. CMM Interim Check (U)

    SciTech Connect

    Montano, Joshua Daniel

    2015-03-23

    Coordinate Measuring Machines (CMM) are widely used in industry, throughout the Nuclear Weapons Complex and at Los Alamos National Laboratory (LANL) to verify part conformance to design definition. Calibration cycles for CMMs at LANL are predominantly one year in length. Unfortunately, several nonconformance reports have been generated to document the discovery of a certified machine found out of tolerance during a calibration closeout. In an effort to reduce risk to product quality two solutions were proposed – shorten the calibration cycle which could be costly, or perform an interim check to monitor the machine’s performance between cycles. The CMM interim check discussed makes use of Renishaw’s Machine Checking Gauge. This off-the-shelf product simulates a large sphere within a CMM’s measurement volume and allows for error estimation. Data was gathered, analyzed, and simulated from seven machines in seventeen different configurations to create statistical process control run charts for on-the-floor monitoring.

  8. Surgery for breast cancer.

    PubMed

    Dooley, W C

    1998-11-01

    Women with breast cancer today have many more therapeutic options available to them for their surgical therapy. Almost all patients with breast cancer have some options for breast conservation. Active patient involvement in analyzing and understanding the pros and cons of each of these options seems extremely important to the long-term emotional and psychological outcome of their breast cancer therapy. Several reports this year have reintroduced the issue of adequate local control. The common philosophy a decade ago was that because systematic therapy (adjuvant chemotherapy) was improving, local therapy would become of lesser importance. Several studies this year have indicated the extreme importance of local control in maximizing survival advantage because of the relationship of increasing local failure and deteriorating survival from systemic disease. Despite significant improvements in treatment, our screening and diagnostic approaches have still failed to identify the majority of lesions prior to the patient's own palpation of the tumor. Using new diagnostic modalities that do not involve surgery, the biopsy of lower probability lesions with great accuracy is expected to improve the efficacy of the current screening measures. Despite all the improvements, the most important therapeutic step in the management of breast cancer remains earlier diagnosis and earlier extirpation of the initial invasive focus of malignancy. PMID:9818228

  9. Feasibility Evaluation of Radioimmunoguided Surgery of Breast Cancer

    PubMed Central

    Ravi, Ananth; Reilly, Raymond M.; Holloway, Claire M. B.; Caldwell, Curtis B.

    2012-01-01

    Breast-conserving surgery involves completely excising the tumour while limiting the amount of normal tissue removed, which is technically challenging to achieve, especially given the limited intraoperative guidance available to the surgeon. This study evaluates the feasibility of radioimmunoguided surgery (RIGS) to guide the detection and delineation of tumours intraoperatively. The 3D point-response function of a commercial gamma-ray-detecting probe (GDP) was determined as a function of radionuclide (131I, 111In, 99mTc), energy-window threshold, and collimator length (0.0–3.0-cm). This function was used to calculate the minimum detectable tumour volumes (MDTVs) and the minimum tumour-to-background activity concentration ratio (T:B) for effective delineation of a breast tumour model. The GDP had larger MDTVs and a higher minimum required T:B for tumour delineation with 131I than with 111In or 99mTc. It was shown that for 111In there was a benefit to using a collimator length of 0.5-cm. For the model used, the minimum required T:B required for effective tumour delineation was 5.2 ± 0.4. RIGS has the potential to significantly improve the accuracy of breast-conserving surgery; however, before these benefits can be realized, novel radiopharmaceuticals need to be developed that have a higher specificity for cancerous tissue in vivo than what is currently available. PMID:22518303

  10. Accelerated Partial Breast Irradiation: 5-Year Results of the German-Austrian Multicenter Phase II Trial Using Interstitial Multicatheter Brachytherapy Alone After Breast-Conserving Surgery

    SciTech Connect

    Strnad, Vratislav; Hildebrandt, Guido; Poetter, Richard; Hammer, Josef; Hindemith, Marion; Resch, Alexandra; Spiegl, Kurt; Lotter, Michael; Uter, Wolfgang; Bani, Mayada; Kortmann, Rolf-Dieter; Beckmann, Matthias W.; Fietkau, Rainer; Ott, Oliver J.

    2011-05-01

    Purpose: To evaluate the impact of accelerated partial breast irradiation on local control, side effects, and cosmesis using multicatheter interstitial brachytherapy as the sole method for the adjuvant local treatment of patients with low-risk breast cancer. Methods and Materials: 274 patients with low-risk breast cancer were treated on protocol. Patients were eligible for the study if the tumor size was < 3 cm, resection margins were clear by at least 2 mm, no lymph node metastases existed, age was >35 years, hormone receptors were positive, and histologic grades were 1 or 2. Of the 274 patients, 175 (64%) received pulse-dose-rate brachytherapy (D{sub ref} = 50 Gy). and 99 (36%) received high-dose-rate brachytherapy (D{sub ref} = 32.0 Gy). Results: Median follow-up was 63 months (range, 9-103). Only 8 of 274 (2.9%) patients developed an ipsilateral in-breast tumor recurrence at the time of analysis. The 5-year actuarial local recurrence-free survival probability was 98%. The 5- year overall and disease-free survival probabilities of all patients were 97% and 96%, respectively. Contralateral in-breast malignancies were detected in 2 of 274 (0.7%) patients, and distant metastases occurred in 6 of 274 (2.2%). Late side effects {>=}Grade 3 (i.e., breast tissue fibrosis and telangiectasia) occurred in 1 patient (0.4%, 95%CI:0.0-2.0%) and 6 patients (2.2%, 95%CI:0.8-4.7%), respectively. Cosmetic results were good to excellent in 245 of 274 patients (90%). Conclusions: The long-term results of this prospective Phase II trial confirm that the efficacy of accelerated partial breast irradiation using multicatheter brachytherapy is comparable with that of whole breast irradiation and that late side effects are negligible.

  11. Four types of ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery: classification of IBTR based on precise pathological examination.

    PubMed

    Sakai, Takehiko; Nishimura, Seiichiro; Ogiya, Akiko; Tanabe, Masahiko; Kimura, Kiyomi; Morizono, Hidetomo; Iijima, Kotaro; Miyagi, Yumi; Makita, Masujiro; Ito, Yoshinori; Oguchi, Masahiko; Horii, Rie; Akiyama, Futoshi; Iwase, Takuji

    2015-03-01

    We classified ipsilateral breast tumor recurrences (IBTRs) based on strict pathological rules. Ninety-six women who were surgically treated for IBTR were included. IBTRs were classified according to their origins and were distinguished based on strict pathological rules: relationship between the IBTR and the primary lumpectomy scar, surgical margin status of the primary cancer, and the presence of in situ lesions of IBTR. The prognosis of these subgroups were compared to that of new primary tumors (NP) in the narrow sense (NPn) that occurred far from the scar. Distant-disease free survival of IBTR that occurred close to the scar with in situ lesions and a negative surgical margin of the primary cancer (NP occurred close to the scar, NPcs) was similar to that of NPn. In contrast, IBTR that occurred close to the scar without in situ lesions (true recurrence (TR) that arose from residual invasive carcinoma foci, TRinv) had significantly poorer prognosis than NPn. IBTR that occurred close to the scar with in situ lesions and a positive surgical margin of the primary cancer (TR arising from a residual in situ lesion, TRis) had more late recurrences than NPcs. Precise pathological examinations indicated four distinct IBTR subtypes with different characteristics. PMID:25600703

  12. Cosmetic Analysis Following Breast-Conserving Surgery and Adjuvant High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer: A Prospective Clinical Study

    SciTech Connect

    Garsa, Adam A.; Ferraro, Daniel J.; DeWees, Todd; Margenthaler, Julie A.; Naughton, Michael; Aft, Rebecca; Gillanders, William E.; Eberlein, Timothy; Matesa, Melissa A.; Zoberi, Imran

    2013-03-15

    Purpose: To prospectively evaluate cosmetic outcomes in women treated with accelerated partial breast irradiation using high-dose-rate interstitial brachytherapy for early-stage breast cancer. Methods and Materials: Between 2004 and 2008, 151 patients with early-stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients had stage Tis-T2 tumors of ≤3 cm that were excised with negative margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. Both the patients and the treating radiation oncologist qualitatively rated cosmesis as excellent, good, fair, or poor over time and ascribed a cause for changes in cosmesis. Cosmetic outcome was evaluated quantitatively by percentage of breast retraction assessment (pBRA). Patients also reported their satisfaction with treatment over time. Results: Median follow-up was 55 months. The rates of excellent-to-good cosmesis reported by patients and the treating radiation oncologist were 92% and 97% pretreatment, 91% and 97% at 3 to 4 months' follow-up, 87% and 94% at 2 years, and 92% and 94% at 3 years, respectively. Breast infection and adjuvant chemotherapy were independent predictors of a fair-to-poor cosmetic outcome at 3 years. Compared to pretreatment pBRA (7.35), there was no significant change in pBRA over time. The volume receiving more than 150 Gy (V150) was the only significant predictor of pBRA. The majority of patients (86.6%) were completely satisfied with their treatment. Conclusions: Patients and the treating physician reported a high rate of excellent-to-good cosmetic outcomes at all follow-up time points. Acute breast infection and chemotherapy were associated with worse cosmetic outcomes. Multicatheter interstitial brachytherapy does not significantly change breast size as measured by pBRA.

  13. A cost comparison analysis of partial versus whole-breast irradiation after breast-conserving surgery for early-stage breast cancer

    SciTech Connect

    Suh, W. . E-mail: wsuh@lroc.harvard.edu; Pierce, Lori J.; Vicini, Frank A.; Hayman, James A.

    2005-07-01

    Purpose: To assess, if and for whom, there are cost savings associated with alternate breast radiotherapy (RT) techniques when compared with the conventional external beam-based whole-breast RT with a boost (WBRT-B). Methods and Materials: Treatment planning and delivery utilization data were modeled for eight different breast RT techniques: (1) WBRT-B: 60 Gy in 30 fractions; (2) WBRT: 50 Gy in 25 fractions; (3) WBRT-accelerated (AC): 42.5 Gy in 16 fractions; (4) WBRT-intensity-modulated RT (IMRT): 60 Gy in 30 fractions; (5) accelerated partial breast irradiation (APBI)-IC, MammoSite: 34 Gy in 10 twice-daily fractions; (6) APBI-IT, HDR interstitial: 34 Gy in 10 twice-daily fractions; (7) APBI three-dimensional conformal RT (3D-CRT): 38.5 Gy in 10 twice-daily fractions; or (8) APBI-IMRT: 38.5 Gy in 10 twice-daily fractions. Costs incurred by payer (i.e., direct medical costs; 2003 Medicare Fee Schedule) and patient (i.e., direct nonmedical costs; time and travel) were estimated. Total societal costs were then calculated for each treatment approach. Results: Not all efforts to reduce overall treatment time result in total cost savings. The least expensive partial breast-based RT approaches were the external beam techniques (APBI-3D-CRT, APBI-IMRT). Any reduced cost to patients for the HDR brachytherapy-based APBI regimens were overshadowed by substantial increases in cost to payers, resulting in higher total societal costs; the cost of HDR treatment delivery was primarily responsible for the increased direct medical cost. For the whole breast-based RT approaches, treating without a boost (WBRT) or with WBRT-AC reduced total costs. Overall, WBRT-AC was the least costly of all the regimens, in terms of costs to society; APBI approaches, in general, were favored over whole-breast techniques when only considering costs to patients. Conclusions: Based on societal cost considerations, WBRT-AC appears to be the preferred approach. If one were to pursue a partial-breast RT regimen to minimize patient costs, it would be more advantageous from a societal perspective to pursue external beam-based approaches such as APBI-3D-CRT or APBI-IMRT in lieu of the brachytherapy-based regimens.

  14. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS)

    PubMed Central

    2012-01-01

    Purpose/Objectives Standard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy. Materials/Methods Between 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24–77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19. Results After 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema. In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005). Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade skin toxicity were larger breast target volume (p=0,003), smoking (p=0,034) and absence of allergies (p=0,002). Conclusion Patients treated in this study showed less objectively documented skin toxicity after 50 Gy 3D-CRT compared to similar patient cohorts. Factors associated with higher grade skin toxicity were smoking during 3D-CRT, absence of allergies and larger breast volumes. PMID:23249653

  15. A Prospective Longitudinal Clinical Trial Evaluating Quality of Life After Breast-Conserving Surgery and High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer

    SciTech Connect

    Garsa, Adam A.; Ferraro, Daniel J.; DeWees, Todd A.; Deshields, Teresa L.; Margenthaler, Julie A.; Cyr, Amy E.; Naughton, Michael; Aft, Rebecca; Gillanders, William E.; Eberlein, Timothy; Matesa, Melissa A.; Ochoa, Laura L.; Zoberi, Imran

    2013-12-01

    Purpose: To prospectively examine quality of life (QOL) of patients with early stage breast cancer treated with accelerated partial breast irradiation (APBI) using high-dose-rate (HDR) interstitial brachytherapy. Methods and Materials: Between March 2004 and December 2008, 151 patients with early stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients included those with Tis-T2 tumors measuring ≤3 cm excised with negative surgical margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, version 3.0, and QLQ-BR23 questionnaires. The QLQ-C30 and QLQ-BR23 questionnaires were evaluated during pretreatment and then at 6 to 8 weeks, 3 to 4 months, 6 to 8 months, and 1 and 2 years after treatment. Results: The median follow-up was 55 months. Breast symptom scores remained stable in the months after treatment, and they significantly improved 6 to 8 months after treatment. Scores for emotional functioning, social functioning, and future perspective showed significant improvement 2 years after treatment. Symptomatic fat necrosis was associated with several changes in QOL, including increased pain, breast symptoms, systemic treatment side effects, dyspnea, and fatigue, as well as decreased role functioning, emotional functioning, and social functioning. Conclusions: HDR multicatheter interstitial brachytherapy was well tolerated, with no significant detrimental effect on measured QOL scales/items through 2 years of follow-up. Compared to pretreatment scores, there was improvement in breast symptoms, emotional functioning, social functioning, and future perspective 2 years after treatment.

  16. Quality of Life After Breast Cancer Surgery With or Without Reconstruction

    PubMed Central

    Stavrou, Demetris; Weissman, Oren; Polyniki, Anna; Papageorgiou, Neofytos; Haik, Joseph; Farber, Nimrod; Winkler, Eyal

    2009-01-01

    In the modern era, where breast-conserving surgery is a viable alternative to mastectomy, breast cancer patients and their healthcare providers have to consider the issue of quality of life in regards to the type of surgery. The choice of surgical procedure should consider the perceptions of women diagnosed with breast cancer as well as their functional and emotional well-being. A more holistic approach to the patient should be implemented with proper psychological evaluation before and psychological support after the crisis. PMID:19572009

  17. Interim storage study report

    SciTech Connect

    Rawlins, J.K.

    1998-02-01

    High-level radioactive waste (HLW) stored at the Idaho Chemical Processing Plant (ICPP) in the form of calcine and liquid and liquid sodium-bearing waste (SBW) will be processed to provide a stable waste form and prepare the waste to be transported to a permanent repository. Because a permanent repository will not be available when the waste is processed, the waste must be stored at ICPP in an Interim Storage Facility (ISF). This report documents consideration of an ISF for each of the waste processing options under consideration.

  18. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  19. Quality of Online Information to Support Patient Decision-Making in Breast Cancer Surgery

    PubMed Central

    Bruce, Jordan G.; Tucholka, Jennifer L.; Steffens, Nicole M.; Neuman, Heather B.

    2015-01-01

    Background Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. Methods Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites’ structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered “good”. Results 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0–4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1–4.7]), with 24% rated as “good”. Scores on supporting decision-making questions were lower (2.6 [1.3–4.4]), with only 7% scoring “good”. Conclusion Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily-accessible, high-quality online information has the potential to significantly improve patients’ experiences with decision-making. PMID:26417898

  20. Long-Term Outcome in Patients With Ductal Carcinoma In Situ Treated With Breast-Conserving Therapy: Implications for Optimal Follow-up Strategies

    SciTech Connect

    Shaitelman, Simona F.; Wilkinson, J. Ben; Kestin, Larry L.; Ye Hong; Goldstein, Neal S.; Martinez, Alvaro A.; Vicini, Frank A.

    2012-07-01

    Purpose: To determine 20-year rates of local control and outcome-associated factors for ductal carcinoma in situ (DCIS) after breast-conserving therapy (BCT). Methods and Materials: All DCIS cases receiving BCT between 1980 and 1993 were reviewed. Patient demographics and pathologic factors were analyzed for effect on outcomes, including ipsilateral breast tumor recurrence (IBTR) and survival. Results: One hundred forty-five cases were evaluated; the median follow-up time was 19.3 years. IBTR developed in 25 patients, for 5-, 10-, 15-, and 20-year actuarial rates of 9.9%, 12.2%, 13.7%, and 17.5%, respectively. One third of IBTRs were elsewhere failures, and 68% of IBTRs occurred <10 years after diagnosis. Young age and cancerization of lobules predicted for IBTR at <10 years, and increased slide involvement and atypical ductal hyperplasia were associated with IBTR at later time points. Conclusions: Patients with DCIS treated with BCT have excellent long-term rates of local control. Predictors of IBTR vary over time, and the risk of recurrence seems highest within 10 to 12 years after diagnosis.

  1. The Effect of Biofeedback Therapy on Anorectal Function After the Reversal of Temporary Stoma When Administered During the Temporary Stoma Period in Rectal Cancer Patients With Sphincter-Saving Surgery: The Interim Report of a Prospective Randomized Controlled Trial.

    PubMed

    Kye, Bong-Hyeon; Kim, Hyung-Jin; Kim, Gun; Yoo, Ri Na; Cho, Hyeon-Min

    2016-05-01

    We evaluated the effect of biofeedback therapy (BFT) on anorectal function after stoma closure when administered during the interval of temporary stoma after sphincter-preserving surgery for rectal cancer.Impaired anorectal function is common after lower anterior resections, though no specific treatment options are currently available to prevent this adverse outcome.Fifty-six patients who underwent neoadjuvant chemoradiation therapy after sphincter-preserving surgery with temporary stoma were randomized into 2 groups: group 1 (received BFT during the temporary stoma period) and group 2 (did not receive BFT). To evaluate anorectal function, anorectal manometry was performed in all patients and subjective symptoms were evaluated using the Cleveland Clinic Incontinence Score. The present study is a report at 6 months after rectal resection.Forty-seven patients, including 21 in group 1 and 26 in group 2, were evaluated by anorectal manometry. Twelve patients (57.1%) in group 1 and 13 patients (50%) in group 2 were scored above 9 points of Cleveland Clinic Incontinence Score, which is the reference value for fecal incontinence (P = 0.770). With time, there was a significant difference (P = 0.002) in the change of mean resting pressure according to time sequence between the BFT and control groups.BFT during the temporary stoma interval had no effect on preventing anorectal dysfunction after temporary stoma reversal at 6 months after rectal resection. However, BFT might be helpful for maintaining resting anal sphincter tone (NCT01661829). PMID:27149496

  2. Cosmetic Surgery

    MedlinePlus

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face ...

  3. Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Kennedy, Brendan F.; Wijesinghe, Philip; Allen, Wes M.; Chin, Lixin; Latham, Bruce; Saunders, Christobel M.; Sampson, David D.

    2016-03-01

    Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

  4. The timing of breast and axillary surgery after neoadjuvant chemotherapy for breast cancer.

    PubMed

    Al-Hilli, Zahraa; Boughey, Judy C

    2016-06-01

    Neoadjuvant chemotherapy (NAC) has traditionally been used in locally advanced and inflammatory breast cancer, allowing for a reduction in disease volume and therefore optimizing surgical resection of disease in the breast. NAC impacts both the tumor in the breast and the lymph nodes and may allow for the option of breast-conserving surgery and avoiding an axillary dissection. The aim of this review is to discuss the considerations and timing of surgical treatment of the breast and the axilla following NAC in patients with breast cancer. PMID:27164853

  5. Is standard breast-conserving therapy (BCT) in elderly breast cancer patients justified? A prospective measurement of acute toxicity according CTC-classification

    PubMed Central

    2010-01-01

    Background Breast conserving therapy (BCT) is an accepted treatment for early-stage breast cancer. This study aimed to measure prospectively acute radiation-related toxicity and to create a comprehensive data base for long-term temporal analyses of 3D conformal adjuvant radiotherapy. The specific aspect of age has been neglected by traditional research. Therefore, the impact of age on acute BCT toxicity should be also specifically adressed. Methods Toxicity was measured in 109 patients at initiation (t1), during radiotherapy (t2-t7), and 6 weeks after treatment completion (t8) using a new topographic module. Organ systems were recorded in 15 scales and scored according to symptom intensity (grade 0-5) based on CTC (Common Toxicity Criteria) -classification. Radiotherapy was virtually CT-based planned and applied with 6-MeV-photons. Mean total dose was 60.1 Gy. Patients were stratified by age in 3 Groups: <50, 50-60, and >60 years. Results Registered toxicity was generally low. Mean overall-grade climbed from 0.29-0.40 (t1-t7), and dropped to 0.23 (t8). Univariate analyses revealed slightly higher toxicity in older (> 60 years) versus young patients (< 50 years) in 2 scales only: breast-symmetry (p = 0.033), and arm function (p = 0.007). However, in the scale "appetite" toxicity was higher in younger (< 50 years) versus older (> 60 years) patients (p = 0.039). Toxicity differences in all other scales were not significant. Between older (> 60 years) and midaged patients (50-60 years) no significant differences in toxicity were found. This was also true for the comparison between young (< 50 years) versus midaged patient groups (50-60 years). Conclusion The treatment concept of BCT for breast cancer is generally well tolerated. The toxicity-measurement with the new topographic module is feasible. Not modified standard treatment for BC should be performed in elderly women. PMID:21050439

  6. Boron Neutron Capture Therapy for HER2+ breast cancers: A feasibility study evaluating BNCT for potential role in breast conservation therapies

    NASA Astrophysics Data System (ADS)

    Jenkins, Peter Anthony

    A novel Boron Neutron Capture Therapy (BNCT) regimen for the treatment of HER2+ breast cancers has been proposed as an alternative to whole breast irradiation for breast conservation therapy patients. The proposed therapy regimen is based on the assumed production of boron delivery agents that would be synthesized from compounds of Trastuzumab (Herceptin ®) and oligomeric phosphate diesters (OPDs). The combination of the anti-HER2 monoclonal antibody and the high boron loading capability of OPDs has led to the assumption that boron could be delivered to the HER2+ cancer cells at Tumor to Healthy Tissue ratios (T:H) of up to 35:1 and boron concentrations above 50 μg/g. This significantly increased boron delivery efficiency has opened new BNCT possibilities. This proof of concept study examined treatment parameters derived as the results in previous efforts in the context of patient-specific geometry and compared calculated dose results to those observed during actual patient therapy. These results were based on dose calculations performed with a set of calculated Kerma coefficients derived from tissues specific to the regions of interest for breast cancer. A comparison was made of the dose to the tumor region, the patient's skin, and the peripheral organs. The results of this study demonstrated that, given the performance of the proposed boron delivery agent, the BNCT treatment regimen is feasible. The feasibility is based on the findings that the equivalent dose could be delivered to the treatment volume with less dose to the skin and peripheral organs. This is anticipated to improve the treatment outcomes by maintaining local control of tumor cells while reducing dose to healthy tissues.

  7. Clinical Outcome of Breast Conservation Therapy for Breast Cancer in Hong Kong: Prognostic Impact of Ipsilateral Breast Tumor Recurrence and 2005 St. Gallen Risk Categories

    SciTech Connect

    Yau, T.-K. . E-mail: tkokyau@gmail.com; Soong, Inda S.; Chan, K.; Chan, M.; Cheung, P.; Lau, H.W.; Chang, Amy T.Y.; Lee, Anne W.M.

    2007-07-01

    Purpose: The aim of this study was to evaluate the clinical outcome of breast conservation therapy (BCT) for invasive breast cancers in our predominantly Chinese population. Methods and Materials: Clinical outcomes of 412 T1-2 invasive breast cancers treated by wide local excision and external radiotherapy from 1994 to 2003 were retrospectively analyzed. Only 7% lesions were first detected by mammograms. Adjuvant tamoxifen and chemotherapy were added in 74% and 45% patients, respectively. Results: The median follow-up was 5.4 years. The 5-year actuarial ipsilateral breast tumor recurrence (IBTR) rate, distant failure-free survival, cause-specific survival, and overall survival were 4%, 92%, 96%, and 98%, respectively. The 5-year distant failure-free survival for the low-risk, intermediate-risk, and high-risk categories (2005 St. Gallen) were 98%, 91%, and 80%, respectively (p 0.0003). Cosmetic results were good to excellent in more than 90% of the assessable patients. Grade 3 histology (hazard ratio [HR], 4.461; 95% CI, 1.216-16.360; p = 0.024), age (HR, 0.915; 95% CI, 0.846-0.990; p = 0.027), and close/positive final margins (HR, 3.499; 95% CI, 1.141-10.729; p = 0.028) were significant independent risk factors for IBTR. Both St. Gallen risk categories (p = 0.003) and IBTR (HR, 5.885; 95% CI, 2.494-13.889; p < 0.0005) were independent prognostic factors for distant failure-free survival. Conclusions: Despite the low percentage of mammographically detected lesions, the overall clinical outcome of BCT for invasive breast cancers in the Chinese population is comparable to the Western series. The 2005 St. Gallen risk category is a promising clinical tool, but further validation by large studies is warranted.

  8. Clinical Factors Associated With Seroma Volume Reduction in Breast-Conserving Therapy for Early-Stage Breast Cancer: A Multi-Institutional Analysis

    SciTech Connect

    Yang, Tzu-I J.; Elkhuizen, Paula H.M.; Minkema, Danny; Heemsbergen, Wilma; Mourik, Anke M. van; Cassee, Jorien; Hurkmans, Coen; Vliet-Vroegindeweij, Corine van

    2010-04-15

    Purpose: To correlate clinical factors with seroma volume and reduction; and to determine whether cone-beam CT (CBCT) could be used clinically to monitor seroma reduction. Patients and Methods: This investigation included 102 women from five institutions with stage T1-2 breast cancer treated with breast-conserving therapy. Two CT scans were acquired: the planning CT (CT1) and a second CT (CT2) during radiotherapy (RT). Seroma was contoured on all scans, and correlations between seroma characteristics and clinical factors were investigated by univariate and multivariate analyses. In a substudy, 10 of the 102 patients received multiple CBCT scans during RT. Seroma were contoured by two observers in the substudy. Fifteen time points at which CT and CBCT were performed within 2 days were identified. The levels of correlation in seroma contours between CBCT and CT and between the two observers were examined. Results: The mean relative seroma reduction from CT1 to CT2 was 54% (p < 0.001). A significant inverse relationship was found between relative seroma reduction per week and number of RT fractions given by univariate and multivariate analyses (p = 0.01, 0.03). The mean difference in contoured seroma volumes between CT and CBCT was 12% (3.3 cm{sup 3}). When assessing the relative difference in seroma contours between Observer 1 and Observer 2, an interobserver difference of 12% was demonstrated. Neither discrepancy was clinically significant. Conclusions: Radiotherapy seems to hinder seroma reduction. Volume discrepancies between CBCT and CT were minor, with low interobserver variation, indicating that CBCT might be useful in monitoring seroma reduction.

  9. Central waste complex interim operational safety requirements

    SciTech Connect

    Bendixsen, R.B.; Ames, R.R., Fluor Daniel Hanford

    1997-03-20

    This Interim Operational Safety Requirements document supports the authorization basis for interim operations and identifies restrictions on interim operations for the disposal and storage of solid waste in the Central Waste Complex. The Central Waste Complex Interim Operational Safety Requirements provide the necessary controls on operations in the Central Waste Complex to ensure the radiological and hazardous material exposure will be acceptable from an overall health and safety standpoint to the worker, the onsite personnel, 1327 the public and the environment.

  10. 19 CFR 207.106 - Interim measures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 3 2012-04-01 2012-04-01 false Interim measures. 207.106 Section 207.106 Customs... and Committee Proceedings § 207.106 Interim measures. (a) At any time after proceedings are initiated... that would otherwise be kept confidential, or to take other appropriate interim measures. (b)...

  11. 19 CFR 207.106 - Interim measures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 3 2014-04-01 2014-04-01 false Interim measures. 207.106 Section 207.106 Customs... and Committee Proceedings § 207.106 Interim measures. (a) At any time after proceedings are initiated... that would otherwise be kept confidential, or to take other appropriate interim measures. (b)...

  12. 19 CFR 207.106 - Interim measures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 3 2011-04-01 2011-04-01 false Interim measures. 207.106 Section 207.106 Customs... and Committee Proceedings § 207.106 Interim measures. (a) At any time after proceedings are initiated... that would otherwise be kept confidential, or to take other appropriate interim measures. (b)...

  13. 19 CFR 207.106 - Interim measures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 3 2010-04-01 2010-04-01 false Interim measures. 207.106 Section 207.106 Customs... and Committee Proceedings § 207.106 Interim measures. (a) At any time after proceedings are initiated... that would otherwise be kept confidential, or to take other appropriate interim measures. (b)...

  14. 19 CFR 207.106 - Interim measures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 3 2013-04-01 2013-04-01 false Interim measures. 207.106 Section 207.106 Customs... and Committee Proceedings § 207.106 Interim measures. (a) At any time after proceedings are initiated... that would otherwise be kept confidential, or to take other appropriate interim measures. (b)...

  15. An Interim President Sets the Stage

    ERIC Educational Resources Information Center

    Guardo, Carol J.

    2006-01-01

    An interim president often plays a crucial role in leading a college or university. In some instances, the interim can address and resolve troublesome issues and thus clear the way for the new president to generate progress. In others, the interim stays the course so that the institution maintains its momentum and seizes strategic opportunities to…

  16. Cataract Surgery

    MedlinePlus

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ...

  17. Loss of interim status (LOIS) under RCRA

    SciTech Connect

    Not Available

    1992-09-01

    The Resource Conservation and Recovery Act (RCRA) requires owners and operators of facilities that treat, store, or dispose of hazardous waste (TSDFs) to obtain an operating permit. Recognizing that it would take EPA many years to issue operating permits to all RCRA facilities, Congress created ``interim status`` under Section 3005(e) of the Act. Interim status allows facilities to operating permits to all RCRA facilities to operate under Subtitle C of RCRA until their permits are issued or denied. This information brief defines interim status and describes how failure to meet interim status requirements may lead to loss of interim status (LOIS).

  18. Data breaches. Interim final rule.

    PubMed

    2007-06-22

    This document establishes regulations to address data breaches regarding sensitive personal information that is processed or maintained by the Department of Veterans Affairs (VA). The regulations implement certain provisions of Title IX of the Veterans Benefits, Health Care, and Information Technology Act of 2006, which require promulgation of these regulations as an interim final rule. PMID:17674483

  19. Innovative Approach for Interim Facial Prosthesis Using Digital Technology.

    PubMed

    Yoshioka, Fumi; Ozawa, Shogo; Hyodo, Ikuo; Tanaka, Yoshinobu

    2016-08-01

    Despite the important role of facial prosthetic treatment in the rehabilitation of head and neck cancer patients, delay in its implementation can be unavoidable, preventing patients from receiving a prompt facial prosthesis and resuming a normal social life. Here, we introduce an innovative method for the fabrication of an interim facial prosthesis. Using a 3D modeling system, we simplified the fabrication method and used a titanium reconstruction plate for facial prosthesis retention. The patient received the facial prosthesis immediately after surgery and resumed a normal social life earlier than is typically observed with conventional facial prosthetic treatment. PMID:26295755

  20. Evaluation of Vascular Endothelial Growth Factor as a Prognostic Marker for Local Relapse in Early-Stage Breast Cancer Patients Treated With Breast-Conserving Therapy

    SciTech Connect

    Moran, Meena S.; Yang Qifeng; Goyal, Sharad; Harris, Lyndsay; Chung, Gina; Haffty, Bruce G.

    2011-12-01

    Purpose: Vascular endothelial growth factor (VEGF) is an important protein involved in the process of angiogenesis that has been found to correlate with relapse-free and overall survival in breast cancer, predominantly in locally advanced and metastatic disease. A paucity of data is available on the prognostic implications of VEGF in early-stage breast cancer; specifically, its prognostic value for local relapse after breast-conserving therapy (BCT) is largely unknown. The purpose of our study was to assess VEGF expression in a cohort of early-stage breast cancer patients treated with BCT and to correlate the clinical and pathologic features and outcomes with overexpression of VEGF. Methods and Materials: After obtaining institutional review board approval, the paraffin specimens of 368 patients with early-stage breast cancer treated with BCT between 1975 and 2005 were constructed into tissue microarrays with twofold redundancy. The tissue microarrays were stained for VEGF and read by a trained pathologist, who was unaware of the clinical details, as positive or negative according the standard guidelines. The clinical and pathologic data, long-term outcomes, and results of VEGF staining were analyzed. Results: The median follow-up for the entire cohort was 6.5 years. VEGF expression was positive in 56 (15%) of the 368 patients. Although VEGF expression did not correlate with age at diagnosis, tumor size, nodal status, histologic type, family history, estrogen receptor/progesterone receptor status, or HER-2 status, a trend was seen toward increased VEGF expression in the black cohort (26% black vs. 13% white, p = .068). Within the margin-negative cohort, VEGF did not predict for local relapse-free survival (RFS) (96% vs. 95%), nodal RFS (100% vs. 100%), distant metastasis-free survival (91% vs. 92%), overall survival (92% vs. 97%), respectively (all p >.05). Subset analysis revealed that VEGF was highly predictive of local RFS in node-positive, margin

  1. Non-Surgical Breast-Conserving Treatment (KORTUC-BCT) Using a New Radiosensitization Method (KORTUC II) for Patients with Stage I or II Breast Cancer

    PubMed Central

    Ogawa, Yasuhiro; Kubota, Kei; Aoyama, Nobutaka; Yamanishi, Tomoaki; Kariya, Shinji; Hamada, Norihiko; Nogami, Munenobu; Nishioka, Akihito; Onogawa, Masahide; Miyamura, Mitsuhiko

    2015-01-01

    The purpose of the present study was to establish a non-surgical breast-conserving treatment (BCT) using KORTUC II radiosensitization treatment. A new radiosensitizing agent containing 0.5% hydrogen peroxide and 0.83% sodium hyaluronate (a CD44 ligand) has been developed for intra-tumoral injection into various tumors. This new method, named KORTUC II, was approved by our local ethics committee for the treatment of breast cancer and metastatic lymph nodes. A total of 72 early-stage breast cancer patients (stage 0, 1 patient; stage I, 23; stage II, 48) were enrolled in the KORTUC II trial after providing fully informed consent. The mean age of the patients was 59.7 years. A maximum of 6 mL (usually 3 mL for tumors of less than approximately 3 cm in diameter) of the agent was injected into breast tumor tissue twice a week under ultrasonographic guidance. For radiotherapy, hypofraction radiotherapy was administered using a tangential fields approach including an ipsilateral axillary region and field-in-field method; the energy level was 4 MV, and the total radiation dose was 44 Gy administered as 2.75 Gy/fraction. An electron boost of 3 Gy was added three times. Treatment was well tolerated with minimal adverse effects in all 72 patients. No patients showed any significant complications other than mild dermatitis. A total of 24 patients under 75 years old with stage II breast cancer underwent induction chemotherapy (EC and/or taxane) prior to KORTUC II treatment, and 58 patients with estrogen receptor-positive tumors also received hormonal therapy following KORTUC II. The mean duration of follow-up as of the end of September 2014 was 51.1 months, at which time 68 patients were alive without any distant metastases. Only one patient had local recurrence and died of cardiac failure at 6.5 years. Another one patient had bone metastases. For two of the 72 patients, follow-up ended after several months following KORTUC II treatment. In conclusion, non-surgical BCT can be

  2. Basal Subtype of Invasive Breast Cancer Is Associated With a Higher Risk of True Recurrence After Conventional Breast-Conserving Therapy

    SciTech Connect

    Hattangadi-Gluth, Jona A.; Wo, Jennifer Y.; Nguyen, Paul L.; Sreedhara, Meera; Freer, Phoebe E.; Georgian-Smith, Dianne; Bellon, Jennifer R.; Wong, Julia S.; Harris, Jay R.

    2012-03-01

    Purpose: To determine whether breast cancer subtype is associated with patterns of ipsilateral breast tumor recurrence (IBTR), either true recurrence (TR) or elsewhere local recurrence (ELR), among women with pT1-T2 invasive breast cancer (IBC) who receive breast-conserving therapy (BCT). Methods and Materials: From Jan 1998 to Dec 2003, 1,223 women with pT1-T2N0-3 IBC were treated with BCT (lumpectomy plus whole-breast radiation). Ninety percent of patients received adjuvant systemic therapy, but none received trastuzumab. Biologic cancer subtypes were approximated by determining estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and human epidermal growth factor receptor-2-positive (HER-2+) expression, classified as luminal A (ER+ or PR+ and HER-2 negative [HER-2-]), luminal B (ER+ or PR+ and HER-2+), HER-2 (ER- and PR- and HER-2+), and basal (ER- and PR- and HER-2- ) subtypes. Imaging, pathology, and operative reports were reviewed by two physicians independently, including an attending breast radiologist. Readers were blinded to subtype and outcome. TR was defined as IBTR within the same quadrant and within 3 cm of the primary tumor. All others were defined as ELR. Results: At a median follow-up of 70 months, 24 patients developed IBTR (5-year cumulative incidence of 1.6%), including 15 TR and 9 ELR patients. At 5 years, basal (4.4%) and HER-2 (9%) subtypes had a significantly higher incidence of TR than luminal B (1.2%) and luminal A (0.2%) subtypes (p < 0.0001). On multivariate analysis, basal subtype (hazard ratio [HR], 4.8, p = 0.01), younger age at diagnosis (HR, 0.97; p = 0.05), and increasing tumor size (HR, 2.1; p = 0.04) were independent predictors of TR. Only younger age (HR, 0.95; p = 0.01) significantly predicted for ELR. Conclusions: Basal and HER-2 subtypes are significantly associated with higher rates of TR among women with pT1-T2 IBC after BCT. Younger age predicts for both TR and ELR. Strategies to reduce TR in basal

  3. Preoperative Localization and Surgical Margins in Conservative Breast Surgery

    PubMed Central

    Corsi, F.; Sorrentino, L.; Bossi, D.; Sartani, A.; Foschi, D.

    2013-01-01

    Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies. PMID:23986868

  4. Cloud-Based Service Information System for Evaluating Quality of Life after Breast Cancer Surgery

    PubMed Central

    Kao, Hao-Yun; Wu, Wen-Hsiung; Liang, Tyng-Yeu; Lee, King-The; Hou, Ming-Feng; Shi, Hon-Yi

    2015-01-01

    Objective Although recent studies have improved understanding of quality of life (QOL) outcomes of breast conserving surgery, few have used longitudinal data for more than two time points, and few have examined predictors of QOL over two years. Additionally, the longitudinal data analyses in such studies rarely apply the appropriate statistical methodology to control for censoring and inter-correlations arising from repeated measures obtained from the same patient pool. This study evaluated an internet-based system for measuring longitudinal changes in QOL and developed a cloud-based system for managing patients after breast conserving surgery. Methods This prospective study analyzed 657 breast cancer patients treated at three tertiary academic hospitals. Related hospital personnel such as surgeons and other healthcare professionals were also interviewed to determine the requirements for an effective cloud-based system for surveying QOL in breast cancer patients. All patients completed the SF-36, Quality of Life Questionnaire (QLQ-C30) and its supplementary breast cancer measure (QLQ-BR23) at baseline, 6 months, 1 year, and 2 years postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation before and after surgery. Results All breast cancer surgery patients had significantly improved QLQ-C30 and QLQ-BR23 subscale scores throughout the 2-year follow-up period (p<0.05). During the study period, QOL generally had a negative association with advanced age, high Charlson comorbidity index score, tumor stage III or IV, previous chemotherapy, and long post-operative LOS. Conversely, QOL was positively associated with previous radiotherapy and hormone therapy. Additionally, patients with high scores for preoperative QOL tended to have high scores for QLQ-C30, QLQ-BR23 and SF-36 subscales. Based on the results of

  5. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

  6. Outpatient Surgery

    MedlinePlus

    Policymakers | Members | Patients | News Media Anesthesia 101 Patient Safety Stories Resources About Home » Patients » Preparing For Surgery » Types of Surgery » Outpatient Surgery Share this Page Preparing For ...

  7. Plastic Surgery

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  8. Lung surgery

    MedlinePlus

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  9. Foot Surgery

    MedlinePlus

    ... About Feet » Foot Health Information Surgery When is Foot Surgery Necessary? Many foot problems do not respond ... restore the function of your foot. Types of Foot Surgery Fusions: Fusions are usually performed to treat ...

  10. Burn site groundwater interim measures work plan.

    SciTech Connect

    Witt, Jonathan L.; Hall, Kevin A.

    2005-05-01

    This Work Plan identifies and outlines interim measures to address nitrate contamination in groundwater at the Burn Site, Sandia National Laboratories/New Mexico. The New Mexico Environment Department has required implementation of interim measures for nitrate-contaminated groundwater at the Burn Site. The purpose of interim measures is to prevent human or environmental exposure to nitrate-contaminated groundwater originating from the Burn Site. This Work Plan details a summary of current information about the Burn Site, interim measures activities for stabilization, and project management responsibilities to accomplish this purpose.

  11. Comparison of the efficacy and safety of different doses of propacetamol for postoperative pain control after breast surgery.

    PubMed

    Kang, Joo-Eun; Park, Sun-Kyung; Song, In-Kyung; Lee, Ji-Hyun; Kim, Jin-Tae; Kim, Hee-Soo

    2015-06-01

    Intravenous propacetamol has been shown to be effective for postoperative pain control. However, the recommendations regarding propacetamol doses for pain control are vague. The present study was performed to compare the efficacy and safety of propacetamol at a dose of 1 g or 2 g. After breast-conserving surgery, patients received 1 g or 2 g intravenous propacetamol. Treatment efficacy for pain control was assessed using a 100 mm visual analog scale at 15, 30, 45, and 60 minutes and 4 hours after surgery, and global evaluation was assessed by a 4-point categorical scale at the end of the 4-hour study period. Safety was monitored through adverse event reporting. Patients were allowed rescue analgesia, and the timing of requests was recorded. A total of 111 patients were enrolled in the study. There were no differences in efficacy variables, including visual analog scale, the 4-point categorical scale, and requests for rescue analgesia, between propacetamol doses of 1 g and 2 g. Adverse events were similar in the two groups. Intravenous propacetamol at a dose of 2 g is not superior to the lower dose of 1 g with regard to postoperative analgesia or the incidence of side effects in breast-conserving surgery. PMID:26025796

  12. Initial study of breast tissue retraction toward image guided breast surgery

    NASA Astrophysics Data System (ADS)

    Shannon, Michael J.; Meszoely, Ingrid M.; Ondrake, Janet E.; Pheiffer, Thomas S.; Simpson, Amber L.; Sun, Kay; Miga, Michael I.

    2012-02-01

    Image-guided surgery may reduce the re-excision rate in breast-conserving tumor-resection surgery, but image guidance is difficult since the breast undergoes significant deformation during the procedure. In addition, any imaging performed preoperatively is usually conducted in a very different presentation to that in surgery. Biomechanical models combined with low-cost ultrasound imaging and laser range scanning may provide an inexpensive way to provide intraoperative guidance information while also compensating for soft tissue deformations that occur during breast-conserving surgery. One major cause of deformation occurs after an incision into the tissue is made and the skin flap is pulled back with the use of retractors. Since the next step in the surgery would be to start building a surgical plane around the tumor to remove cancerous tissue, in an image-guidance environment, it would be necessary to have a model that corrects for the deformation caused by the surgeon to properly guide the application of resection tools. In this preliminary study, two anthropomorphic breast phantoms were made, and retractions were performed on both with improvised retractors. One phantom underwent a deeper retraction that the other. A laser range scanner (LRS) was used to monitor phantom tissue change before and after retraction. The surface data acquired with the LRS and retractors were then used to drive the solution of a finite element model. The results indicate an encouraging level of agreement between model predictions and data. The surface target error for the phantom with the deep retraction was 2.2 +/- 1.2 mm (n=47 targets) with the average deformation of the surface targets at 4.2 +/- 1.6mm. For the phantom with the shallow retraction, the surface target error was 2.1 +/- 1.0 mm (n=70 targets) with the average deformation of the surface targets at 4.0 +/- 2.0 mm.

  13. B Plant interim safety basis

    SciTech Connect

    Chalk, S.E.

    1996-09-01

    This interim safety basis (ISB-008) replaces the B Plant Safety Analysis Report, WHC-SD-WM-SAR-013, Rev. 2 (WHC 1993a). ISB-008 uses existing accident analyses, modified existing accident analyses, and new accident analyses to prove that B Plant remains within the safety envelope for transition, deactivation, standby, and shutdown activities. The analyses in ISB-008 are in accordance with the most current requirements for analytical approach, risk determination, and configuration management. This document and supporting accident analyses replace previous design-basis documents.

  14. Fusion Breeder Program interim report

    SciTech Connect

    Moir, R.; Lee, J.D.; Neef, W.

    1982-06-11

    This interim report for the FY82 Fusion Breeder Program covers work performed during the scoping phase of the study, December, 1981-February 1982. The goals for the FY82 study are the identification and development of a reference blanket concept using the fission suppression concept and the definition of a development plan to further the fusion breeder application. The context of the study is the tandem mirror reactor, but emphasis is placed upon blanket engineering. A tokamak driver and blanket concept will be selected and studied in more detail during FY83.

  15. 24 CFR 35.820 - Interim controls.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... completion of the risk assessment. In units in which a child of less than 6 years of age moves in after the completion of the risk assessment, interim controls shall be completed no later than 90 days after the move... property, interim controls shall be completed no later than 12 months after completion of the...

  16. 24 CFR 35.820 - Interim controls.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... completion of the risk assessment. In units in which a child of less than 6 years of age moves in after the completion of the risk assessment, interim controls shall be completed no later than 90 days after the move... property, interim controls shall be completed no later than 12 months after completion of the...

  17. 33 CFR 385.38 - Interim goals.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... section. (c) Principles for developing interim goals. (1) RECOVER, using best available science and... available science. These goals may be modified, based on best available science and the adaptive assessment...) Improvement in native plant and animal abundance. (3) In developing the interim goals based upon water...

  18. 33 CFR 385.38 - Interim goals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... section. (c) Principles for developing interim goals. (1) RECOVER, using best available science and... available science. These goals may be modified, based on best available science and the adaptive assessment...) Improvement in native plant and animal abundance. (3) In developing the interim goals based upon water...

  19. 20 CFR 801.202 - Interim appointments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Interim appointments. 801.202 Section 801.202 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Members of the Board § 801.202 Interim appointments. (a) Acting Chairman. In the event that the...

  20. 45 CFR 1623.6 - Interim funding.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Interim funding. 1623.6 Section 1623.6 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION SUSPENSION PROCEDURES § 1623.6 Interim funding. (a) Pending the completion of suspension proceedings under this...

  1. 45 CFR 1623.6 - Interim funding.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Interim funding. 1623.6 Section 1623.6 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION SUSPENSION PROCEDURES § 1623.6 Interim funding. (a) Pending the completion of suspension proceedings under this...

  2. 45 CFR 1623.6 - Interim funding.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Interim funding. 1623.6 Section 1623.6 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION SUSPENSION PROCEDURES § 1623.6 Interim funding. (a) Pending the completion of suspension proceedings under this...

  3. 45 CFR 1623.6 - Interim funding.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Interim funding. 1623.6 Section 1623.6 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION SUSPENSION PROCEDURES § 1623.6 Interim funding. (a) Pending the completion of suspension proceedings under this...

  4. 45 CFR 1623.6 - Interim funding.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Interim funding. 1623.6 Section 1623.6 Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION SUSPENSION PROCEDURES § 1623.6 Interim funding. (a) Pending the completion of suspension proceedings under this...

  5. 19 CFR 356.18 - Interim sanctions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 3 2014-04-01 2014-04-01 false Interim sanctions. 356.18 Section 356.18 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE PROCEDURES AND RULES FOR IMPLEMENTING ARTICLE 1904 OF THE NORTH AMERICAN FREE TRADE AGREEMENT Violation of a Protective Order or a Disclosure Undertaking § 356.18 Interim sanctions....

  6. 15 CFR 904.322 - Interim action.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Interim action. 904.322 Section 904... Sanctions and Denials Permit Sanction for Violations § 904.322 Interim action. (a) To protect marine resources during the pendency of an action under this subpart, in cases of willfulness, or as...

  7. THESAURUS OF ERIC DESCRIPTORS (INTERIM) JANUARY 1967.

    ERIC Educational Resources Information Center

    1967

    THE "THESAURUS OF ERIC DESCRIPTORS (INTERIM)" SUPERSEDES, AND REPRESENTS A REFINEMENT OF, THE "THESAURUS OF ERIC DESCRIPTORS." THE INTERIM ISSUE IS A PRELIMINARY ERIC SYSTEM TOOL AND IS NOT TO BE CONSIDERED A COMPLETE REPRESENTATION OF THE FINAL PRODUCT. THIS REFINEMENT IS THE RESULT OF TWO MAJOR PROJECTS--(1) THE INCORPORATION OF SUGGESTIONS…

  8. 24 CFR 35.820 - Interim controls.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... completion of the risk assessment. In units in which a child of less than 6 years of age moves in after the completion of the risk assessment, interim controls shall be completed no later than 90 days after the move... property, interim controls shall be completed no later than 12 months after completion of the...

  9. 24 CFR 35.820 - Interim controls.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... completion of the risk assessment. In units in which a child of less than 6 years of age moves in after the completion of the risk assessment, interim controls shall be completed no later than 90 days after the move... property, interim controls shall be completed no later than 12 months after completion of the...

  10. 24 CFR 35.820 - Interim controls.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... completion of the risk assessment. In units in which a child of less than 6 years of age moves in after the completion of the risk assessment, interim controls shall be completed no later than 90 days after the move... property, interim controls shall be completed no later than 12 months after completion of the...

  11. Solid waste burial grounds interim safety analysis

    SciTech Connect

    Saito, G.H.

    1994-10-01

    This Interim Safety Analysis document supports the authorization basis for the interim operation and restrictions on interim operations for the near-surface land disposal of solid waste in the Solid Waste Burial Grounds. The Solid Waste Burial Grounds Interim Safety Basis supports the upgrade progress for the safety analysis report and the technical safety requirements for the operations in the Solid Waste Burial Grounds. Accident safety analysis scenarios have been analyzed based on the significant events identified in the preliminary hazards analysis. The interim safety analysis provides an evaluation of the operations in the Solid Waste Burial Grounds to determine if the radiological and hazardous material exposures will be acceptable from an overall health and safety standpoint to the worker, the onsite personnel, the public, and the environment.

  12. 40 CFR 270.73 - Termination of interim status.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Termination of interim status. 270.73... (CONTINUED) EPA ADMINISTERED PERMIT PROGRAMS: THE HAZARDOUS WASTE PERMIT PROGRAM Interim Status § 270.73 Termination of interim status. Interim status terminates when: (a) Final administrative disposition of...

  13. 13 CFR 120.890 - Source of interim financing.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Source of interim financing. 120... Development Company Loan Program (504) Interim Financing § 120.890 Source of interim financing. A Project may use interim financing for all Project costs except the Borrower's contribution. Any source...

  14. New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient

    PubMed Central

    FRANCESCHINI, G.; SANCHEZ, A. MARTIN; DI LEONE, A.; MAGNO, S.; MOSCHELLA, F.; ACCETTA, C.; MASETTI, R.

    2015-01-01

    The surgical management of breast cancer has undergone continuous and profound changes over the last 40 years. The evolution from aggressive and mutilating treatment to conservative approach has been long, but constant, despite the controversies that appeared every time a new procedure came to light. Today, the aesthetic satisfaction of breast cancer patients coupled with the oncological safety is the goal of the modern breast surgeon. Breast-conserving surgery with adjuvant radiotherapy is considered the gold standard approach for patients with early stage breast cancer and the recent introduction of “oncoplastic techniques” has furtherly increased the use of breast-conserving procedures. Mastectomy remains a valid surgical alternative in selected cases and is usually associated with immediate reconstructive procedures. New surgical procedures called “conservative mastectomies” are emerging as techniques that combine oncological safety and cosmesis by entirely removing the breast parenchyma sparing the breast skin and nipple-areola complex. Staging of the axilla has also gradually evolved toward less aggressive approaches with the adoption of sentinel node biopsy and new therapeutic strategies are emerging in patients with a pathological positivity in sentinel lymph node biopsy. The present work will highlight the new surgical treatment options increasingly efficacy and respectful of breast cancer patients. PMID:26712068

  15. Brain surgery

    MedlinePlus

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Before surgery, the hair on part of the scalp is shaved and the area is cleaned. The doctor makes ...

  16. After Surgery

    MedlinePlus

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  17. Turbinate surgery

    MedlinePlus

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  18. 76 FR 4369 - Interim Deputation Agreements; Interim BIA Adult Detention Facility Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-25

    ...This notice announces the online publication of the Interim BIA Adult Detention Facility Guidelines and the Interim Model Deputation Agreements that will be used by the Office of Justice Services following passage of the Tribal Law and Order Act of 2010. Three Interim Model Deputation Agreements will be used: one agreement for tribes in Public Law 83-280 States, one for tribes in Oklahoma, and......

  19. Orthopedic surgery.

    PubMed

    Gehrig, Laura M B

    2011-09-01

    Orthopedic surgery is a specialty of surgery dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system in all age groups. Careers in orthopedic surgery span the spectrum from general orthopedics to those of subspecialty expertise in orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology to name a few. PMID:21871990

  20. Immediate provisionalization with a CAD/CAM interim abutment and crown: a guided soft tissue healing technique.

    PubMed

    Proussaefs, Periklis

    2015-02-01

    A technique is described in which a single interim abutment and crown were fabricated in advance and placed the day of dental implant surgery. The contours of the interim crown were identical to the contours of a tentatively designed definitive prosthesis and allowed the tissue to heal and obtain contours that accommodated the contours of the definitive prosthesis. After osseointegration was established, a definitive impression was made with a custom computer-assisted design and computer-assisted manufacturing impression coping. The definitive prosthesis then was fabricated. PMID:25438739

  1. DOE UST interim subsurface barrier technologies workshop

    SciTech Connect

    1992-09-01

    This document contains information which was presented at a workshop regarding interim subsurface barrier technologies that could be used for underground storage tanks, particularly the tank 241-C-106 at the Hanford Reservation.

  2. Methods Data Qualification Interim Report

    SciTech Connect

    R. Sam Alessi; Tami Grimmett; Leng Vang; Dave McGrath

    2010-09-01

    The overall goal of the Next Generation Nuclear Plant (NGNP) Data Management and Analysis System (NDMAS) is to maintain data provenance for all NGNP data including the Methods component of NGNP data. Multiple means are available to access data stored in NDMAS. A web portal environment allows users to access data, view the results of qualification tests and view graphs and charts of various attributes of the data. NDMAS also has methods for the management of the data output from VHTR simulation models and data generated from experiments designed to verify and validate the simulation codes. These simulation models represent the outcome of mathematical representation of VHTR components and systems. The methods data management approaches described herein will handle data that arise from experiment, simulation, and external sources for the main purpose of facilitating parameter estimation and model verification and validation (V&V). A model integration environment entitled ModelCenter is used to automate the storing of data from simulation model runs to the NDMAS repository. This approach does not adversely change the why computational scientists conduct their work. The method is to be used mainly to store the results of model runs that need to be preserved for auditing purposes or for display to the NDMAS web portal. This interim report demonstrates the currently development of NDMAS for Methods data and discusses data and its qualification that is currently part of NDMAS.

  3. Strabismus Surgery

    MedlinePlus

    ... used. Some surgeons prescribe an antibiotic or combination antibiotic/steroid drop or ointment after surgery. More technical ... Screening Recommendations Loading... Most Common Searches Adult ...

  4. Rhabdomyosarcoma: Surgery

    MedlinePlus

    ... is and what type of operation is done. Physical changes after surgery can range from little more than a scar to changes in appearance or in how some parts of the body function, which may require physical rehabilitation. For more on surgery as a treatment ...

  5. The efficacy of 'Radio guided Occult Lesion Localization' (ROLL) versus 'Wire-guided Localization' (WGL) in breast conserving surgery for non-palpable breast cancer: A randomized clinical trial – ROLL study

    PubMed Central

    van Esser, Stijn; Hobbelink, Monique GG; Peeters, Petra HM; Buskens, Erik; van der Ploeg, Iris M; Mali, Willem PTHM; Rinkes, Inne H M Borel; van Hillegersberg, Richard

    2008-01-01

    Background With the increasing number of non palpable breast carcinomas, the need of a good and reliable localization method increases. Currently the wire guided localization (WGL) is the standard of care in most countries. Radio guided occult lesion localization (ROLL) is a new technique that may improve the oncological outcome, cost effectiveness, patient comfort and cosmetic outcome. However, the studies published hitherto are of poor quality providing less than convincing evidence to change the current standard of care. The aim of this study is to compare the ROLL technique with the standard of care (WGL) regarding the percentage of tumour free margins, cost effectiveness, patient comfort and cosmetic outcome. Methods/design The ROLL trial is a multi center randomized clinical trial. Over a period of 2–3 years 316 patients will be randomized between the ROLL and the WGL technique. With this number, the expected 15% difference in tumour free margins can be detected with a power of 80%. Other endpoints include cosmetic outcome, cost effectiveness, patient (dis)comfort, degree of difficulty of the procedures and the success rate of the sentinel node procedure. The rationale, study design and planned analyses are described. Trial Registration (, study protocol number NCT00539474) PMID:18495027

  6. EMCS Retrofit Analysis - Interim Report

    SciTech Connect

    Diamond, R.C.; Salsbury, T.I.; Bell, G.C.; Huang, Y.J.; Sezgen, A.O.; Mazzucchi, R.; Romberger, J.

    1999-03-01

    This report presents the interim results of analyses carried out in the Phillip Burton Federal Building in San Francisco from 1996 to 1998. The building is the site of a major demonstration of the BACnet communication protocol. The energy management and control systems (EMCS) in the building were retrofitted with BACnet compatible controllers in order to integrate certain existing systems on one common network. In this respect, the project has been a success. Interoperability of control equipment from different manufacturers has been demonstrated in a real world environment. Besides demonstrating interoperability, the retrofits carried out in the building were also intended to enhance control strategies and capabilities, and to produce energy savings. This report presents analyses of the energy usage of HVAC systems in the building, control performance, and the reaction of the building operators. The report does not present an evaluation of the performance capabilities of the BACnet protocol. A monitoring system was installed in the building that parallels many of the EMCS sensors and data were archived over a three-year period. The authors defined pre-retrofit and post-retrofit periods and analyzed the corresponding data to establish the changes in building performance resulting from the retrofit activities. The authors also used whole-building energy simulation (DOE-2) as a tool for evaluating the effect of the retrofit changes. The results of the simulation were compared with the monitored data. Changes in operator behavior were assessed qualitatively with questionnaires. The report summarizes the findings of the analyses and makes several recommendations as to how to achieve better performance. They maintain that the full potential of the EMCS and associated systems is not being realized. The reasons for this are discussed along with possible ways of addressing this problem. They also describe a number of new technologies that could benefit systems of the type

  7. Objective assessment of aesthetic outcome after breast conserving therapy: subjective third party panel rating and objective BCCT.core software evaluation.

    PubMed

    Heil, Joerg; Carolus, Anne; Dahlkamp, Julia; Golatta, Michael; Domschke, Christoph; Schuetz, Florian; Blumenstein, Maria; Rauch, Geraldine; Sohn, Christof

    2012-02-01

    We analysed intra- and inter-rater agreement of subjective third party assessment and agreement with a semi-automated objective software evaluation tool (BCCT.core). We presented standardized photographs of 50 patients, taken shortly and one year after surgery to a panel of five breast surgeons, six breast nurses, seven members of a breast cancer support group, five medical and seven non-medical students. In two turns they rated aesthetic outcome on a four point scale. Moreover the same photographs were evaluated by the BCCT.core software. Intra-rater agreement in the panel members was moderate to substantial (k = 0.4-0.5; wk = 0.6-0.7; according to different subgroups and times of assessment). In contrast inter-rater agreement was only slight to fair (mk = 0.1-0.3). Agreement between the panel participants and the software was fair (wk = 0.24-0.45). Subjective third party assessment only fairly agree with objective BCCT.core evaluation just as third party participants do not agree well among each other. PMID:21852135

  8. Refractive Surgery

    PubMed Central

    Kellum, Keith

    2000-01-01

    The concept of surgically altering the eye to correct refractive errors has been considered for hundreds of years, but only in the past 60 years has interest grown considerably due to the development of modern refractive surgery techniques such as astigmatic keratotomies to correct astigmatism induced by cataract surgery and future technologies currently being investigated. Modern refractive surgery is more involved than setting the correct parameters on the laser. Patient selection and examination, proper technique, and postoperative follow-up for potential complications are essential for a successful refractive procedure. Critical evaluation of new techniques is vital to avoid the pitfall of overly exuberant enthusiasm for new and unproven methods of refractive surgery. Kellum K. Refractive surgery. The Ochsner Journal 2000; 2:164-167. PMID:21765686

  9. Breast Augmentation after Conservation Surgery and Radiation Therapy

    PubMed Central

    Salinas, James; Hsieh, Frank; Boyages, John

    2016-01-01

    Background: There is a paucity of data regarding outcomes for patients undergoing breast augmentation with implants after breast conservation surgery (BCS) and radiotherapy. This retrospective study examined outcomes for patients with breast implant-only augmentation after BCS and radiotherapy. Methods: Between June 1998 and December 2010, 671 women underwent prosthetic breast reconstruction. Nineteen patients (2.8%) underwent an augmentation after BCS and radiotherapy. The mean age was 55.8 years (range, 40–69 years). Sixteen of these patients underwent one-stage implant-only breast augmentation, whereas 3 patients underwent two-stage expander and then implant augmentation. Results: All surgeries were successful. The average size of breast implant used was 258.7 g. Seven patients also received contralateral augmentation with an average implant size of 232.2 g. One patient received oral antibiotics for minor wound infection. Patients were judged to have an excellent (14/19; 73.7%), good (3/19; 15.8%), or fair (2/19; 10.5%) cosmetic result. Conclusion: The breasts of selected patients with breast cancer after BCS and radiotherapy. with asymmetry can be adequately augmented with breast implants alone. PMID:27536475

  10. Design review report FFTF interim storage cask

    SciTech Connect

    Scott, P.L.

    1995-01-03

    Final Design Review Report for the FFTF Interim Storage Cask. The Interim Storage Cask (ISC) will be used for long term above ground dry storage of FFTF irradiated fuel in Core Component Containers (CCC)s. The CCC has been designed and will house assemblies that have been sodium washed in the IEM Cell. The Solid Waste Cask (SWC) will transfer a full CCC from the IEM Cell to the RSB Cask Loading Station where the ISC will be located to receive it. Once the loaded ISC has been sealed at the RSB Cask Loading Station, it will be transferred by facility crane to the DSWC Transporter. After the ISC has been transferred to the Interim Storage Area (ISA), which is yet to be designed, a mobile crane will be used to place the ISC in its final storage location.

  11. CMM Interim Check Design of Experiments (U)

    SciTech Connect

    Montano, Joshua Daniel

    2015-07-29

    Coordinate Measuring Machines (CMM) are widely used in industry, throughout the Nuclear Weapons Complex and at Los Alamos National Laboratory (LANL) to verify part conformance to design definition. Calibration cycles for CMMs at LANL are predominantly one year in length and include a weekly interim check to reduce risk. The CMM interim check makes use of Renishaw’s Machine Checking Gauge which is an off-the-shelf product simulates a large sphere within a CMM’s measurement volume and allows for error estimation. As verification on the interim check process a design of experiments investigation was proposed to test a couple of key factors (location and inspector). The results from the two-factor factorial experiment proved that location influenced results more than the inspector or interaction.

  12. 12 CFR 541.18 - Interim Federal savings association.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Interim Federal savings association. 541.18... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.18 Interim Federal savings association. The term interim Federal savings association means a Federal savings association chartered by the Office...

  13. 12 CFR 541.18 - Interim Federal savings association.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Interim Federal savings association. 541.18... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.18 Interim Federal savings association. The term interim Federal savings association means a Federal savings association chartered by the Office...

  14. 12 CFR 541.19 - Interim state savings association.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Interim state savings association. 541.19... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.19 Interim state savings association. The term interim state savings association means a savings association, other than a Federal savings...

  15. 12 CFR 541.19 - Interim state savings association.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Interim state savings association. 541.19... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.19 Interim state savings association. The term interim state savings association means a savings association, other than a Federal savings...

  16. 33 CFR 1.05-45 - Interim rule.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Interim rule. 1.05-45 Section 1... PROVISIONS Rulemaking § 1.05-45 Interim rule. (a) An interim rule may be issued when it is in the public interest to promulgate an effective rule while keeping the rulemaking open for further refinement....

  17. 33 CFR 1.05-45 - Interim rule.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Interim rule. 1.05-45 Section 1... PROVISIONS Rulemaking § 1.05-45 Interim rule. (a) An interim rule may be issued when it is in the public interest to promulgate an effective rule while keeping the rulemaking open for further refinement....

  18. 33 CFR 1.05-45 - Interim rule.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Interim rule. 1.05-45 Section 1... PROVISIONS Rulemaking § 1.05-45 Interim rule. (a) An interim rule may be issued when it is in the public interest to promulgate an effective rule while keeping the rulemaking open for further refinement....

  19. 33 CFR 1.05-45 - Interim rule.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Interim rule. 1.05-45 Section 1... PROVISIONS Rulemaking § 1.05-45 Interim rule. (a) An interim rule may be issued when it is in the public interest to promulgate an effective rule while keeping the rulemaking open for further refinement....

  20. 33 CFR 1.05-45 - Interim rule.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Interim rule. 1.05-45 Section 1... PROVISIONS Rulemaking § 1.05-45 Interim rule. (a) An interim rule may be issued when it is in the public interest to promulgate an effective rule while keeping the rulemaking open for further refinement....

  1. 5 CFR 531.414 - Interim within-grade increase.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Interim within-grade increase. 531.414... UNDER THE GENERAL SCHEDULE Within-Grade Increases § 531.414 Interim within-grade increase. (a) An interim within-grade increase shall be granted to an employee who has: (1) Appealed a negative...

  2. 5 CFR 531.414 - Interim within-grade increase.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Interim within-grade increase. 531.414... UNDER THE GENERAL SCHEDULE Within-Grade Increases § 531.414 Interim within-grade increase. (a) An interim within-grade increase shall be granted to an employee who has: (1) Appealed a negative...

  3. 5 CFR 531.414 - Interim within-grade increase.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Interim within-grade increase. 531.414... UNDER THE GENERAL SCHEDULE Within-Grade Increases § 531.414 Interim within-grade increase. (a) An interim within-grade increase shall be granted to an employee who has: (1) Appealed a negative...

  4. 5 CFR 531.414 - Interim within-grade increase.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Interim within-grade increase. 531.414... UNDER THE GENERAL SCHEDULE Within-Grade Increases § 531.414 Interim within-grade increase. (a) An interim within-grade increase shall be granted to an employee who has: (1) Appealed a negative...

  5. 5 CFR 531.414 - Interim within-grade increase.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Interim within-grade increase. 531.414... UNDER THE GENERAL SCHEDULE Within-Grade Increases § 531.414 Interim within-grade increase. (a) An interim within-grade increase shall be granted to an employee who has: (1) Appealed a negative...

  6. 5 CFR 772.102 - Interim personnel actions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Interim personnel actions. 772.102 Section 772.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) INTERIM RELIEF General § 772.102 Interim personnel actions. When an employee or applicant for employment appeals an action to MSPB...

  7. 5 CFR 772.102 - Interim personnel actions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Interim personnel actions. 772.102 Section 772.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) INTERIM RELIEF General § 772.102 Interim personnel actions. When an employee...

  8. 5 CFR 772.102 - Interim personnel actions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Interim personnel actions. 772.102 Section 772.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) INTERIM RELIEF General § 772.102 Interim personnel actions. When an employee...

  9. 5 CFR 772.102 - Interim personnel actions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Interim personnel actions. 772.102 Section 772.102 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) INTERIM RELIEF General § 772.102 Interim personnel actions. When an employee or applicant for employment appeals an action to MSPB...

  10. 46 CFR 309.101 - Amendment of interim binders.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Amendment of interim binders. 309.101 Section 309.101... INSURANCE § 309.101 Amendment of interim binders. The interim binder for a vessel whose stated valuation is established pursuant to this part shall be deemed to have been amended on the first day of the...

  11. 47 CFR 73.404 - Interim hybrid IBOC DAB operation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Interim hybrid IBOC DAB operation. 73.404... RADIO BROADCAST SERVICES Digital Audio Broadcasting § 73.404 Interim hybrid IBOC DAB operation. (a) The... test operation pursuant to § 73.1620, may commence interim hybrid IBOC DAB operation with...

  12. An Approach for Evaluating the Technical Quality of Interim Assessments

    ERIC Educational Resources Information Center

    Li, Ying; Marion, Scott; Perie, Marianne; Gong, Brian

    2010-01-01

    Increasing numbers of schools and districts have expressed interest in interim assessment systems to prepare for summative assessments and to improve teaching and learning. However, with so many commercial interim assessments available, schools and districts are struggling to determine which interim assessment is most appropriate to their needs.…

  13. Transuranic storage and assay facility interim safety basis

    SciTech Connect

    Porten, D.R., Fluor Daniel Hanford

    1997-02-12

    The Transuranic Waste Storage and Assay Facility (TRUSAF) Interim Safety Basis document provides the authorization basis for the interim operation and restriction on interim operations for the TRUSAF. The TRUSAF ISB demonstrates that the TRUSAF can be operated safely, protecting the workers, the public, and the environment. The previous safety analysis document TRUSAF Hazards Identification and Evaluation (WHC 1987) is superseded by this document.

  14. 200 Area Interim Storage Area Technical Safety Requirements

    SciTech Connect

    CARRELL, R.D.

    2000-03-15

    The 200 Area Interim Storage Area Technical Safety Requirements define administrative controls and design features required to ensure safe operation during receipt and storage of canisters containing spent nuclear fuel. This document is based on the 200 Area Interim Storage Area, Annex D, Final Safety Analysis Report which contains information specific to the 200 Area Interim Storage Area.

  15. Positive margins prediction in breast cancer conservative surgery: Assessment of a preoperative web-based nomogram.

    PubMed

    Alves-Ribeiro, Lídia; Osório, Fernando; Amendoeira, Isabel; Fougo, José Luís

    2016-08-01

    Margin status of the surgical specimen has been shown to be a prognostic and risk factor for local recurrence in breast cancer surgery. It has been studied as a topic of intervention to diminish reoperation rates and reduce the probability of local recurrence in breast conservative surgery (BCS). This study aims to validate the Dutch BreastConservation! nomogram, created by Pleijhus et al., which predicts preoperative probability of positive margins in BCS. Patients with diagnosis of breast cancer stages cT1-2, who underwent BCS at the Breast Center of São João University Hospital (BC-CHSJ) in 2013-2014, were included. Association and correlation were evaluated for clinical, radiological, pathological and surgical variables. Multivariable logistic regression and ROC curves were used to assess nomogram parameters and discrimination. In our series of 253 patients, no associations were found between margin status and other studied variables (such as age or family history of breast cancer), except for weight (p-value = 0.045) and volume (p-value = 0.012) of the surgical specimen. Regarding the nomogram, a statistically significant association was shown between cN1 status and positive margins (p-value = 0.014). No differences were registered between the scores of patients with positive versus negative margins. Discrimination analysis showed an AUC of 0.474 for the basic and 0.508 for the expanded models. We cannot assume its external validation or its applicability to our cohort. Further studies are needed to determine the validity of this nomogram and achieve a broader view of currently available tools. PMID:27326978

  16. Interim Land Use Control Implementation Plan

    NASA Technical Reports Server (NTRS)

    Applegate, Joseph L.

    2014-01-01

    This Interim Land Use Control Implementation Plan (LUCIP) has been prepared to inform current and potential future users of the Kennedy Space Center (KSC) Contractors Road Heavy Equipment (CRHE) Area (SWMU 055; "the Site") of institutional controls that have been implemented at the Site1. Although there are no current unacceptable risks to human health or the environment associated with the CRHE Area, an interim institutional land use control (LUC) is necessary to prevent human health exposure to volatile organic compound (VOC)-affected groundwater at the Site. Controls will include periodic inspection, condition certification, and agency notification.

  17. Cosmetic Surgery

    MedlinePlus

    ... defect or cosmetic flaw that has diminished their self-esteem over time. It's important to remember that cosmetic ... can create both physical changes and changes in self-esteem. But if you are seeking surgery with the ...

  18. Maze Surgery

    MedlinePlus

    ... for Hemodialysis Ventricular Assist Devices Maze Surgery | Share Electrical impulses in your heart muscle (the myocardium) cause your heart to beat (contract). This electrical signal begins in the sinoatrial (SA) node, located ...

  19. Thyroid Surgery

    MedlinePlus

    ... thyroid surgery, requiring treatment with thyroid hormone (see Hypothyroidism brochure ). This is especially true if you had ... Nodules Goiter Graves’ Disease Hashimoto’s Thyroiditis Hyperthyroidism (Overactive) Hypothyroidism (Underactive) Iodine Deficiency Low Iodine Diet Radioactive Iodine ...

  20. Brain surgery

    MedlinePlus

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  1. Rodding Surgery

    MedlinePlus

    ... Rods can be made of stainless steel or titanium. Regular rods do not expand. They have many ... v regular), the rod materials (stainless steel v titanium) and the age for a first rodding surgery. ...

  2. Loss of interim status (LOIS) under RCRA. RCRA Information Brief

    SciTech Connect

    Not Available

    1992-09-01

    The Resource Conservation and Recovery Act (RCRA) requires owners and operators of facilities that treat store, or disposal of hazardous waste (TSDFs) to obtain an operating permit. Recognizing that it would take EPA many years to issue operating permits to all RCRA facilities, Congress created ``interim status`` under Section 3005(e) of the Act. Interim status allows facilities to operate under Subtitle C of RCRA until their permits are issued or denied. This information brief defines interim status and describes how failure to meet interim status requirements may lead to loss of interim status (LOIS).

  3. Open heart surgery

    MedlinePlus

    ... Heart bypass surgery (coronary artery bypass graft - CABG) Heart transplant Heart valve surgery Hypoplastic left heart repair Minimally ... Heart bypass surgery Heart bypass surgery - minimally invasive Heart transplant Heart valve surgery Hypoplastic left heart syndrome Patent ...

  4. Tennis elbow surgery

    MedlinePlus

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is usually an outpatient surgery. This means you will not stay in the hospital overnight. You will be ...

  5. FIP Interim Review Project. Final Report.

    ERIC Educational Resources Information Center

    Whitbeck, John K.

    The Family Independence Project (FIP) Interim Review Project in Washington was mounted in order to give preliminary information on the progress of the FIP program compared to Assistance for Families with Dependent Children (AFDC) site activity, for management planning, and to document short-term outcomes and trends for policy considerations. A…

  6. 12 CFR 268.505 - Interim relief.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Interim relief. 268.505 Section 268.505 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM RULES..., eligibility for a within-grade increase, or the completion of the service requirement for career tenure,...

  7. 40 CFR 1036.150 - Interim provisions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 34 2013-07-01 2013-07-01 false Interim provisions. 1036.150 Section... definition of spark-ignition, but regulated as diesel engines under 40 CFR part 86, must be certified to the... compression-ignition, but regulated as Otto-cycle under 40 CFR part 86 must be certified to the...

  8. 42 CFR 417.574 - Interim settlement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Interim settlement. 417.574 Section 417.574 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE...

  9. 29 CFR 1614.505 - Interim relief.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION FEDERAL SECTOR EQUAL EMPLOYMENT OPPORTUNITY Remedies and Enforcement § 1614.505 Interim relief. (a)(1) When the agency appeals and the case... the complainant, decline to return the complainant to his or her place of employment if it...

  10. INTERIM METHOD FOR DETERMINING ASBESTOS IN WATER

    EPA Science Inventory

    This manual describes an interim electron microscope (EM) procedure for measuring the concentration of asbestos in water samples. The main features of the method include filtering the sample through a sub-micron polycarbonate membrane filter, examining an EM specimen grid in a tr...

  11. Diversified Satellite Occupations Program. Interim Report.

    ERIC Educational Resources Information Center

    Call, John Reed

    This interim report, covering the period of September 1970 to June 1971, describes a program conducted for elementary, junior high, and senior high grades. The elementary program was designed to help students develop an understanding of occupational competence. The prevention of dropouts and individualizing instruction were concerns of the junior…

  12. Secretarial Science Occupational Performance Survey. Interim Report.

    ERIC Educational Resources Information Center

    Borcher, Sidney D.; Joyner, John W.

    Intended for the use of curriculum developers, instructors, and others concerned with planning and conducting vocational and technical education programs, this federally funded interim report presents the results of the task inventory analysis survey conducted by the project staff in the secretarial science occupations. In order to develop a…

  13. 33 CFR 385.38 - Interim goals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Interim goals. 385.38 Section 385.38 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE PROGRAMMATIC REGULATIONS FOR THE COMPREHENSIVE EVERGLADES RESTORATION PLAN Ensuring Protection of the Natural System and Water...

  14. Disposal facility data for the interim performance

    SciTech Connect

    Eiholzer, C.R.

    1995-05-15

    The purpose of this report is to identify and provide information on the waste package and disposal facility concepts to be used for the low-level waste tank interim performance assessment. Current concepts for the low-level waste form, canister, and the disposal facility will be used for the interim performance assessment. The concept for the waste form consists of vitrified glass cullet in a sulfur polymer cement matrix material. The waste form will be contained in a 2 {times} 2 {times} 8 meter carbon steel container. Two disposal facility concepts will be used for the interim performance assessment. These facility concepts are based on a preliminary disposal facility concept developed for estimating costs for a disposal options configuration study. These disposal concepts are based on vault type structures. None of the concepts given in this report have been approved by a Tank Waste Remediation Systems (TWRS) decision board. These concepts will only be used in th interim performance assessment. Future performance assessments will be based on approved designs.

  15. 33 CFR 385.38 - Interim goals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PROGRAMMATIC REGULATIONS FOR THE COMPREHENSIVE EVERGLADES RESTORATION PLAN Ensuring Protection of the Natural... restoration success of the Plan may be evaluated, and ultimately reported to Congress in accordance with § 385...) Purpose. (1) Interim goals are a means by which the restoration success of the Plan may be evaluated...

  16. The Sustaining Effects Study: An Interim Report.

    ERIC Educational Resources Information Center

    Carter, Launor F.

    This interim report summarizes the procedures and results of the Sustaining Effects Study (SES) on Compensatory Education, conducted at selected elementary schools during the 1967-77 school year. Data from the study are presented for the following findings: (1) poor and educationally needy children are the principal recipients of Compensatory…

  17. Chapter 1 Commission Issues Interim Report.

    ERIC Educational Resources Information Center

    Commission on Chapter 1, Baltimore, MD.

    This report presents an interim analysis by an independent commission of current moves to reform Chapter 1 of the Hawkins/Stafford Elementary and Secondary School Improvement Amendments of 1988. Chapter 1 is the largest federal assistance program to elementary school and secondary school education. The report responds to questions on strengthening…

  18. 24 CFR 35.1330 - Interim controls.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Interim controls. 35.1330 Section 35.1330 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development LEAD-BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES Methods and Standards for Lead-Paint Hazard Evaluation and...

  19. 24 CFR 7.44 - Interim relief.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Interim relief. 7.44 Section 7.44 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development EQUAL EMPLOYMENT OPPORTUNITY; POLICY, PROCEDURES AND PROGRAMS Equal Employment Opportunity Without Regard to...

  20. 24 CFR 7.44 - Interim relief.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Interim relief. 7.44 Section 7.44 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development EQUAL EMPLOYMENT OPPORTUNITY; POLICY, PROCEDURES AND PROGRAMS Equal Employment Opportunity Without Regard to...

  1. 24 CFR 7.44 - Interim relief.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Interim relief. 7.44 Section 7.44 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development EQUAL EMPLOYMENT OPPORTUNITY; POLICY, PROCEDURES AND PROGRAMS Equal Employment Opportunity Without Regard to...

  2. Models in Remedial English: An Interim Report.

    ERIC Educational Resources Information Center

    Larmouth, Donald W.

    1970-01-01

    The experimental program in remedial composition described in this interim report was designed on the assumption that students could best learn to write minimally acceptable compositions by imitating paragraph and essay models which have been divided into a series of incremental steps. The objectives of the program were to develop a heuristic…

  3. 29 CFR 1614.505 - Interim relief.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION FEDERAL SECTOR EQUAL EMPLOYMENT... interim relief. (2) Service under the temporary or conditional restoration provisions of paragraph (a)(1..., eligibility for a within-grade increase, or the completion of the service requirement for career tenure,...

  4. 340 waste handling facility interim safety basis

    SciTech Connect

    VAIL, T.S.

    1999-04-01

    This document presents an interim safety basis for the 340 Waste Handling Facility classifying the 340 Facility as a Hazard Category 3 facility. The hazard analysis quantifies the operating safety envelop for this facility and demonstrates that the facility can be operated without a significant threat to onsite or offsite people.

  5. 340 Waste handling facility interim safety basis

    SciTech Connect

    Stordeur, R.T.

    1996-10-04

    This document presents an interim safety basis for the 340 Waste Handling Facility classifying the 340 Facility as a Hazard Category 3 facility. The hazard analysis quantifies the operating safety envelop for this facility and demonstrates that the facility can be operated without a significant threat to onsite or offsite people.

  6. 15 CFR 908.5 - Interim reports.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SUBMITTING REPORTS ON WEATHER MODIFICATION ACTIVITIES § 908.5 Interim reports. (a) Any person engaged in a weather modification project or activity in the United States on January 1 in any year shall submit to the... actual modification activities took place; (2) Number of days on which weather modification...

  7. A Non-Traditional Interim Project.

    ERIC Educational Resources Information Center

    Brown, Diane; Ward, Dorothy

    1980-01-01

    Describes a project initiated by the Foreign Language Department of Birmingham-Southern College for their Interim term and discusses an interdisciplinary course focusing on Medieval Europe. The course included presentations on German and French language and literature, as well as lectures on the arts, philosophy, and family life of the period.…

  8. 15 CFR 908.5 - Interim reports.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 15 Commerce and Foreign Trade 3 2012-01-01 2012-01-01 false Interim reports. 908.5 Section 908.5 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE GENERAL REGULATIONS MAINTAINING REC- ORDS AND SUBMITTING REPORTS ON WEATHER...

  9. LANDFILL BIOREACTOR PERFORMANCE, SECOND INTERIM REPORT

    EPA Science Inventory

    A bioreactor landfill is a landfill that is operated in a manner that is expected to increase the rate and extent of waste decomposition, gas generation, and settlement compared to a traditional landfill. This Second Interim Report was prepared to provide an interpretation of fie...

  10. The impact of lobular carcinoma in situ in association with invasive breast cancer on the rate of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy

    SciTech Connect

    Jolly, Shruti; Kestin, Larry L. . E-mail: lkestin@beaumont.edu; Goldstein, Neal S.; Vicini, Frank A.

    2006-10-01

    Purpose: The significance of lobular carcinoma in situ (LCIS) associated with invasive breast cancer in patients undergoing breast-conserving therapy (BCT) remains controversial. We examined the impact of the presence and extent of LCIS associated with invasive breast cancer on clinical outcome in BCT patients. Methods and Materials: From 1980 to 1996, 607 cases of invasive breast cancer were treated with BCT. All slides were reviewed by a single pathologist. Positive margin was defined as presence of invasive carcinoma/ductal carcinoma in situ at the inked margin. Multiple clinical, pathologic, and treatment-related variables were analyzed for their association with ipsilateral breast tumor recurrence (IBTR) and true recurrence/marginal miss (TR/MM). Median follow-up was 8.7 years. Results: Fifty-six patients (9%) had LCIS in association with invasive cancer. On univariate analysis, positive final margin, positive/no reexcision, smaller maximum specimen dimension, and the presence of LCIS predicted for IBTR. The 10-year IBTR rate was 14% for cases with LCIS vs. 7% without LCIS (p = 0.04). On multivariate analysis, positive margin (p < 0.01), positive/no reexcision (p = 0.04), and presence of LCIS (p = 0.02) remained independently associated with IBTR; positive margin (p < 0.01) and LCIS (p = 0.04) were also associated with TR/MM failure. When examining only cases with negative final margins, the presence of LCIS remained associated with higher IBTR and TR/MM rates (p < 0.01). Conclusion: The presence of LCIS was independently associated with higher rate of IBTR and TR/MM after BCT for invasive breast cancer. LCIS may have significant premalignant potential and progress to an invasive IBTR at the site of index lesion. The adequacy of excision of LCIS associated with invasive carcinoma should be considered in patients undergoing BCT.

  11. Oncoplastic breast surgery: indications, techniques and perspectives

    PubMed Central

    Montag, Eduardo; Gemperli, Rolf

    2013-01-01

    Breast-conservation surgery (BCS) is established as a safe option for most women with early breast cancer. Recently, advances in oncoplastic techniques have reduced surgical trauma and thus are capable of preserving the breast form and quality of life. In spite of the most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Oncoplastic reconstruction may begin at the time of BCS (immediate), weeks (delayed-immediate) or months to years afterwards (delayed). With immediate reconstruction, the surgical process is smooth, since both procedures can be associated in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The oncoplastic techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/masthopexy. Regardless of the fact that there is no consensus concerning the best approach, the criteria are determined by the surgeon’s experience and the size of the defect in relation to the size of the remaining breast. On the basis of our 15-year experience, it is possible to identify trends in types of breast defects and to develop an algorithm for immediate BCS reconstruction on the basis of the initial breast volume, the extent/location of glandular tissue ressection and the remaining available breast tissue. The main advantages of the technique utilized should include reproducibility, low interference with the oncologic treatment and long-term results. Surgical planning should include the patients’s preferences, and chiefly addressing individual reconstructive requirements, enabling each patient to receive an individual “custom-made” reconstruction. PMID:25083476

  12. Robotic Surgery

    PubMed Central

    Lanfranco, Anthony R.; Castellanos, Andres E.; Desai, Jaydev P.; Meyers, William C.

    2004-01-01

    Objective: To review the history, development, and current applications of robotics in surgery. Background: Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving. Methods: A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications. Results: Several centers are currently using surgical robots and publishing data. Most of these early studies report that robotic surgery is feasible. There is, however, a paucity of data regarding costs and benefits of robotics versus conventional techniques. Conclusions: Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current practical uses are mostly confined to smaller surgical procedures. PMID:14685095

  13. Carotid artery surgery

    MedlinePlus

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  14. ECALS: loading studies interim report October 2013

    USGS Publications Warehouse

    Klymus, Katy; Richter, Cathy; Chapman, Duane; Paukert, Craig P.

    2013-01-01

    Here we follow up the loading studies interim report from July 2013 and include results from laboratory studies assessing the effects of diet on eDNA shedding rates by bigheaded carps(silver and bighead carp). In order to understand how eDNA behavesin the environment, we must understand how it enters the system. In our July interim report, we addressed three of our four hypotheses that could influence the shedding rate of eDNA by these fish (Table 1; hypotheses A, B and D). We now provide results from studies that tested the fourth hypothesis (C), cellular debris from the gut-lining shed via excrementis a major source of shed eDNA.

  15. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

  16. Preprosthetic Surgery.

    PubMed

    Ephros, Hillel; Klein, Robert; Sallustio, Anthony

    2015-08-01

    Preprosthetic oral and maxillofacial surgery has changed dramatically over the last 3 decades. Surgical preparation for dentures has been displaced by site development for implants. Nonetheless, there is still a role to play for several preprosthetic procedures. In this article, historical context is provided, enduring concepts are reviewed, and procedures that remain relevant are described and discussed. PMID:26231818

  17. Cosmetic surgery.

    PubMed Central

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks. PMID:2589786

  18. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  19. Tribal child welfare. Interim final rule.

    PubMed

    2012-01-01

    The Administration for Children and Families (ACF) is issuing this interim final rule to implement statutory provisions related to the Tribal title IV-E program. Effective October 1, 2009, section 479B(b) of the Social Security Act (the Act) authorizes direct Federal funding of Indian Tribes, Tribal organizations, and Tribal consortia that choose to operate a foster care, adoption assistance and, at Tribal option, a kinship guardianship assistance program under title IV-E of the Act. The Fostering Connections to Success and Increasing Adoptions Act of 2008 requires that ACF issue interim final regulations which address procedures to ensure that a transfer of responsibility for the placement and care of a child under a State title IV-E plan to a Tribal title IV-E plan occurs in a manner that does not affect the child's eligibility for title IV-E benefits or medical assistance under title XIX of the Act (Medicaid) and such services or payments; in-kind expenditures from third-party sources for the Tribal share of administration and training expenditures under title IV-E; and other provisions to carry out the Tribal-related amendments to title IV-E. This interim final rule includes these provisions and technical amendments necessary to implement a Tribal title IV-E program. PMID:22242232

  20. Determining Which Patients Require Irradiation of the Supraclavicular Nodal Area After Surgery for N1 Breast Cancer

    SciTech Connect

    Yu, Jeong Il; Park, Won; Huh, Seung Jae; Choi, Doo Ho; Lim, Young Hyuk; Ahn, Jin Suk; Yang, Jung Hyun; Nam, Suk Jin

    2010-11-15

    Purpose: We designed this study to determine which patients have a high risk of supraclavicular node recurrence in N1 breast cancer previously treated with surgery but not having received supraclavicular radiation therapy (SCRT) and to identify which patients needed SCRT. Methods and Materials: We performed a retrospective review of 448 pathologic N1 breast cancer patients treated with mastectomy or breast-conserving treatment, but without SCRT, between 1994 and 2003. Mastectomy was performed in 302 patients (67.4%). The median number of axillary nodes dissected was 17 (range, 5-53). Systemic chemotherapy was administered in 443 patients (98.9%), and 144 patients received radiation after breast-conserving surgery. The median follow-up was 88 months (range, 15-170 months). Results: At follow-up, the treatment failed in 101 patients (22.5%), and 39 patients (8.7%) had supraclavicular node recurrence. Prognostic factors in supraclavicular node recurrence included lymphovascular invasion (p < 0.0001), extracapsular extension (p < 0.0001), the number of involved axillary nodes (p = 0.0003), and the level of involved axillary nodes (p = 0.012) in univariate and multivariate analyses. The total number of prognostic factors correlated well with supraclavicular node recurrence. In the analysis of 5-year supraclavicular node recurrence-free survival, patients with two or more factors showed a significantly higher recurrence rate than did patients with fewer than two factors (96.8% and 72.9%, respectively; p < 0.0001). Conclusions: The prognostic factors associated with supraclavicular node recurrence were lymphovascular invasion, extracapsular extension, and the number and level of involved axillary nodes. Patients with two or more prognostic factors might benefit from SCRT.

  1. Scoliosis surgery - child

    MedlinePlus

    Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... Before surgery, your child will receive general anesthesia. This will make ... and unable to feel pain during the operation. During ...

  2. Lung Carcinoid Tumor: Surgery

    MedlinePlus

    ... for lung carcinoid tumor symptoms Surgery to treat lung carcinoid tumors Surgery is the main treatment for ... often be cured by surgery alone. Types of lung surgery Different operations can be used to treat ( ...

  3. LASIK - Laser Eye Surgery

    MedlinePlus

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ...

  4. Refractive corneal surgery - discharge

    MedlinePlus

    Nearsightedness surgery - discharge; Refractive surgery - discharge; LASIK - discharge; PRK - discharge ... You had refractive corneal surgery to help improve your vision. This surgery uses a laser to reshape your cornea. It corrects ...

  5. What Is Refractive Surgery?

    MedlinePlus

    ... Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center Global Ophthalmology Guide Academy Publications EyeNet Ophthalmology ... Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center Global Ophthalmology Guide Find an Ophthalmologist Advanced ...

  6. Bloodless surgery in geriatric surgery.

    PubMed

    Guarino, Salvatore; Di Matteo, Filippo; Sorrenti, Salvatore; Greco, Roberto; Nardi, Matteo; Favoriti, Pasqualino; De Antoni, Enrico; Filippini, Angelo; Catania, Antonio

    2014-01-01

    In bloodless surgery a series of measures has to be implemented to reduce the perioperative need for transfusion of whole blood or its components. Jehovah's Witness are the most representative group of patients opting for bloodless surgery as their faith follows strict believes that prohibits receiving blood. Geriatric patients requiring bloodless surgery are even more delicate and represent a challenge for surgeons. The physiological response of the over 65 year population to decreased hemoglobin level is slower and less effective than in young and adult patients. Herby we describe the perioperative protocol implemented in our surgical Department offered to geriatric Jehovah's Witness patients. Preoperative optimization of the patients is the key step in the preparation period. Intraoperative anesthetic and surgical measures are also required along with a strict postoperative follow-up. From our experience, bloodless surgery is feasible in the geriatric population as long as it is performed in specialized centers where a multidisciplinary team is prepared to specifically manage this scenario. Rigorous patients selection and preparation are mandatory. PMID:25183638

  7. [Tumor surgery].

    PubMed

    Hausamen, J E

    2000-05-01

    Surgery is still the primary therapeutic approach in treatment of tumors in the head and neck area, dating back to the early nineteenth century. More than 150 years ago, hemimaxillectomies and mandibular resections as well as hemiglossectomies were already performed by leading surgeons. The block principle we are now following dates back to Crile, who also established the principle of cervical lymph node dissection. Ablative oncologic surgery has always been closely linked with plastic and reconstructive surgery, rendering radical surgical interventions possible without disfiguring patients. The development of facial reconstructive surgery proceeded in stages, in the first instance as secondary reconstruction using tube pedicled flaps. The change to the concept of primary reconstruction occurred via arterialized skin flaps and myocutaneous flaps to the widely accepted and performed free tissue transfer. Free bone grafting, inaugurated earlier and still representing the majority of bone grafting, has been supplemented for certain reconstructive purposes by free vascularized bone transfer from various donor sites. Although the five-year-survival rate of carcinoma of the oral cavity has remained unchanged in the past 30 years, distinctive improvements in tumor surgery can be recorded. This is primarily based on improved diagnostics such as modern imaging techniques and the refinement of surgical techniques. The DOSAK has worked out distinctive guidelines for effective ablative oncologic surgery. Surgical approaches offering wide exposure and carrying low morbidity play a decisive role in radical resections. For this reason, midfacial degloving offers an essential improvement for the resection of midface tumors, especially from an aesthetic point of view. Tumors situated deep behind the viscerocranium at the skull base can be clearly exposed either through a lateral approach following a temporary osteotomy of the mandibular ramus or a transmandibular, transmaxillar, or

  8. Compilation of interim technical research memoranda. Volume I

    SciTech Connect

    Shanahan, W.R.

    1984-04-01

    Four interim technical research memoranda are presented that describe the results of numerical simulations designed to investigate the dynamics of energetic plasma beams propagating across magnetic fields.

  9. ERA-Interim/Land: A global land surface reanalysis dataset

    NASA Astrophysics Data System (ADS)

    Balsamo, Gianpaolo; Albergel, Clement; Beljaars, Anton; Boussetta, Souhail; Brun, Eric; Cloke, Hannah; Dee, Dick; Dutra, Emanuel; Muñoz-Sabater, Joaquín; Pappenberger, Florian; De Rosnay, Patricia; Stockdale, Tim; Vitart, Frederic

    2015-04-01

    ERA-Interim/Land is a global land-surface reanalysis dataset covering the period 1979-2010 recently made publicly available from ECMWF. It describes the evolution of soil moisture, soil temperature and snowpack. ERA-Interim/Land is the result of a single 32-year simulation with the latest ECMWF land surface model driven by meteorological forcing from the ERA-Interim atmospheric reanalysis and precipitation adjustments based on monthly GPCP v2.1 (Global Precipitation Climatology Project). The horizontal resolution is about 80km and the time frequency is 3-hourly. ERA-Interim/Land includes a number of parameterization improvements in the land surface scheme with respect to the original ERA-Interim dataset, which makes it more suitable for climate studies involving land water resources. The quality of ERA-Interim/Land is assessed by comparing with ground-based and remote sensing observations. In particular, estimates of soil moisture, snow depth, surface albedo, turbulent latent and sensible fluxes, and river discharges are verified against a large number of site measurements. ERA-Interim/Land provides a global integrated and coherent estimate of soil moisture and snow water equivalent, which can also be used for the initialization of numerical weather prediction and climate models. Current plans for the extension and improvements of ERA-Interim/Land in the framework of future reanalyses will be briefly presented. References and dataset download information at: http://www.ecmwf.int/en/research/climate-reanalysis/era-interim/land

  10. Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour

    PubMed Central

    2013-01-01

    Background Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women’s choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women’s surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB. Methods Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women’s intentions to choose mastectomy or BCS. Objective data were collected on women’s choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery. Results The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01). Conclusions These findings demonstrate the utility of an extended TPB in predicting and understanding women’s surgery intentions and choices for early breast cancer

  11. The Homestake Interim Laboratory and Homestake DUSEL

    NASA Astrophysics Data System (ADS)

    Lesko, Kevin T.

    2011-12-01

    The former Homestake gold mine in Lead South Dakota is proposed for the National Science Foundation's Deep Underground Science and Engineering Laboratory (DUSEL). The gold mine provides expedient access to depths in excess of 8000 feet below the surface (>7000 mwe). Homestake's long history of promoting scientific endeavours includes the Davis Solar Neutrino Experiment, a chlorine-based experiment that was hosted at the 4850 Level for more than 30 years. As DUSEL, Homestake would be uncompromised by competition with mining interests or other shared uses. The facility's 600-km of drifts would be available for conversion for scientific and educational uses. The State of South Dakota, under Governor Rounds' leadership, has demonstrated exceptionally strong support for Homestake and the creation of DUSEL. The State has provided funding totalling $46M for the preservation of the site for DUSEL and for the conversion and operation of the Homestake Interim Laboratory. Motivated by the strong educational and outreach potential of Homestake, the State contracted a Conversion Plan by world-recognized mine-engineering contractor to define the process of rehabilitating the facility, establishing the appropriate safety program, and regaining access to the facility. The State of South Dakota has established the South Dakota Science and Technology Authority to oversee the transfer of the Homestake property to the State and the rehabilitation and preservation of the facility. The Homestake Scientific Collaboration and the State of South Dakota's Science and Technology Authority has called for Letters of Interest from scientific, educational and engineering collaborations and institutions that are interested in hosting experiments and uses in the Homestake Interim Facility in advance of the NSF's DUSEL, to define experiments starting as early as 2007. The Homestake Program Advisory Committee has reviewed these Letters and their initial report has been released. Options for

  12. Effects of state-level medicaid policies and patient characteristics on time to breast cancer surgery among medicaid beneficiaries.

    PubMed

    Halpern, Michael T; Schrag, Deborah

    2016-08-01

    Medicaid beneficiaries with cancer are less likely to receive timely and high-quality care. This study examined whether differences in state-level Medicaid policies affect delays in time to surgery (TTS) among women diagnosed with breast cancer. Using 2006-2008 Medicaid data, we identified women aged 18-64 enrolled in Medicaid diagnosed with breast cancer. Analyses examined associations of state-specific Medicaid surgery reimbursements, Medicaid eligibility recertification period (annually vs. shorter) and required patient copayment on time from breast cancer diagnosis to receipt of breast surgery. Patients receiving neoadjuvant therapy were excluded. Separate multivariable regression analyses controlling for patient demographic characteristics and clustering by state were performed for breast conserving surgery (BCS), inpatient mastectomy, and outpatient mastectomy. The study included 7542 Medicaid beneficiaries with breast cancer: 3272 received BCS, 2156 outpatient mastectomy, and 2115 inpatient mastectomy. Higher Medicaid reimbursements for BCS were associated with decreased time from diagnosis to surgery. A 12-month (vs. <12 month) Medicaid eligibility recertification period was associated with decreased TTS for BCS and outpatient mastectomy. Black Medicaid beneficiaries (compared with non-Hispanic White beneficiaries) were more likely to experience delays for all three types of surgery, while Hispanic beneficiaries were more likely to experience delays only for outpatient mastectomy. State-level Medicaid policies and patient characteristics can affect receipt of timely surgery among Medicaid beneficiaries with breast cancer. As delays in surgery can increase morbidity and mortality, changes to state Medicaid policies and health system programs are needed to improve access to care for this vulnerable population. PMID:27422241

  13. Site development interim removable dental prosthesis.

    PubMed

    Pasquinelli, Kirk L; Sze, Alexander J; Matosian, Alex J

    2016-07-01

    Transitioning a patient with partial edentulism through hard and soft tissue grafting to an implant restoration with an interim removable dental prosthesis (IRDP) presents a challenge to the restorative dentist. The management of grafted sites requires care, and without the appropriate design, an IRDP may impede surgical outcomes and place the graft at risk for displacement or necrosis. A site development IRDP (SDIRDP) for a grafted site must fulfill restorative goals and promote the surgical objectives for site development. A technique is described for fabricating an SDIRDP that facilitates surgical procedures and maintains prosthetic goals. PMID:26831920

  14. Emergency Operating Procedures Tracking System: Interim report

    SciTech Connect

    Petrick, W.; Ng, K.B.

    1987-06-01

    This interim report describes the work performed in the Emergency Operating Procedure Tracking System project through December 1986. An Executive Summary (Part 1) provides a high level description of the application and project task description; Functional Specifications (Part II) and Detailed Design Specifications (Part III) give a detailed description of the form and function of the Emergency Operating Procedure Tracking System software. Appendices containing a complete compilation of the rules logic, output messages and version of the Kuo Sheng plant emergency operating procedures are used as a source in the full prototype implementation.

  15. Central waste complex interim safety basis

    SciTech Connect

    Cain, F.G.

    1995-05-15

    This interim safety basis provides the necessary information to conclude that hazards at the Central Waste Complex are controlled and that current and planned activities at the CWC can be conducted safely. CWC is a multi-facility complex within the Solid Waste Management Complex that receives and stores most of the solid wastes generated and received at the Hanford Site. The solid wastes that will be handled at CWC include both currently stored and newly generated low-level waste, low-level mixed waste, contact-handled transuranic, and contact-handled TRU mixed waste.

  16. National NIF Diagnostic Program Interim Management Plan

    SciTech Connect

    Warner, B

    2002-04-25

    The National Ignition Facility (NIF) has the mission of supporting Stockpile Stewardship and Basic Science research in high-energy-density plasmas. To execute those missions, the facility must provide diagnostic instrumentation capable of observing and resolving in time events and radiation emissions characteristic of the plasmas of interest. The diagnostic instrumentation must conform to high standards of operability and reliability within the NIF environment. These exacting standards, together with the facility mission of supporting a diverse user base, has led to the need for a central organization charged with delivering diagnostic capability to the NIF. The National NIF Diagnostics Program (NNDP) has been set up under the aegis of the NIF Director to provide that organization authority and accountability to the wide user community for NIF. The funds necessary to perform the work of developing diagnostics for NIF will be allocated from the National NIF Diagnostics Program to the participating laboratories and organizations. The participating laboratories and organizations will design, build, and commission the diagnostics for NIF. Restricted availability of funding has had an adverse impact, unforeseen at the time of the original decision to projectize NIF Core Diagnostics Systems and Cryogenic Target Handing Systems, on the planning and initiation of these efforts. The purpose of this document is to provide an interim project management plan describing the organizational structure and management processes currently in place for NIF Core Diagnostics Systems. Preparation of a Program Execution Plan for NIF Core Diagnostics Systems has been initiated and a current draft is provided as Attachment 1 to this document. The National NIF Diagnostics Program Interim Management Plan provides a summary of primary design criteria and functional requirements, current organizational structure, tracking and reporting procedures, and current planning estimates of project scope

  17. Interim Calibration Report for the SMMR Simulator

    NASA Technical Reports Server (NTRS)

    Gloersen, P.; Cavalieri, D.

    1979-01-01

    The calibration data obtained during the fall 1978 Nimbus-G underflight mission with the scanning multichannel microwave radiometer (SMMR) simulator on board the NASA CV-990 aircraft were analyzed and an interim calibration algorithm was developed. Data selected for the analysis consisted of in flight sky, first-year sea ice, and open water observations, as well as ground based observations of fixed targets with varied temperatures of selected instrument components. For most of the SMMR channels, a good fit to the selected data set was obtained with the algorithm.

  18. 47 CFR 51.715 - Interim transport and termination pricing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 3 2014-10-01 2014-10-01 false Interim transport and termination pricing. 51.715 Section 51.715 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Telecommunications Traffic § 51.715 Interim transport and termination pricing. (a) Upon request from...

  19. 47 CFR 51.715 - Interim transport and termination pricing.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 3 2013-10-01 2013-10-01 false Interim transport and termination pricing. 51.715 Section 51.715 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Telecommunications Traffic § 51.715 Interim transport and termination pricing. (a) Upon request from...

  20. 47 CFR 51.715 - Interim transport and termination pricing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 3 2011-10-01 2011-10-01 false Interim transport and termination pricing. 51.715 Section 51.715 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Telecommunications Traffic § 51.715 Interim transport and termination pricing. (a) Upon request from...

  1. 47 CFR 51.715 - Interim transport and termination pricing.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 3 2012-10-01 2012-10-01 false Interim transport and termination pricing. 51.715 Section 51.715 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER... Telecommunications Traffic § 51.715 Interim transport and termination pricing. (a) Upon request from...

  2. 17 CFR 210.8-03 - Interim financial statements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... CONSERVATION ACT OF 1975 Article 8 Financial Statements of Smaller Reporting Companies § 210.8-03 Interim... 1 to § 210.8-03: Where Article 8 is applicable to a Form 10-Q and the interim period is more than... must include all adjustments that, in the opinion of management, are necessary in order to make...

  3. 17 CFR 210.8-03 - Interim financial statements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... CONSERVATION ACT OF 1975 Article 8 Financial Statements of Smaller Reporting Companies § 210.8-03 Interim... 1 to § 210.8-03: Where Article 8 is applicable to a Form 10-Q and the interim period is more than... must include all adjustments that, in the opinion of management, are necessary in order to make...

  4. 17 CFR 210.8-03 - Interim financial statements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... CONSERVATION ACT OF 1975 Article 8 Financial Statements of Smaller Reporting Companies § 210.8-03 Interim... 1 to § 210.8-03: Where Article 8 is applicable to a Form 10-Q and the interim period is more than... must include all adjustments that, in the opinion of management, are necessary in order to make...

  5. 10 CFR 205.288 - Interim and ancillary orders.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Interim and ancillary orders. 205.288 Section 205.288 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Special Procedures for Distribution of Refunds § 205.288 Interim and ancillary orders. The Director of the Office of Hearings...

  6. 78 FR 49782 - Interim Staff Guidance on Changes During Construction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-15

    ... 52, in the Federal Register on January 11, 2012 (77 FR 1749). The period for submitting comments on... COMMISSION Interim Staff Guidance on Changes During Construction AGENCY: Nuclear Regulatory Commission... Guidance (ISG) COL-ISG-025 ``Interim Staff Guidance on Changes During Construction.'' This ISG...

  7. Staff Reactions to Interim Leadership in a Student Affairs Organization

    ERIC Educational Resources Information Center

    Jones, Robin D.

    2011-01-01

    Interim leadership appointments in higher education are a common strategy used to fill leadership gaps in executive positions. Because student affairs executives are particularly vulnerable to high turnover rates, interim appointments are becoming more widespread. Even with the prevalence of this trend, little attention has been given to the…

  8. 47 CFR 51.715 - Interim transport and termination pricing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Interim transport and termination pricing. 51... SERVICES (CONTINUED) INTERCONNECTION Reciprocal Compensation for Transport and Termination of Telecommunications Traffic § 51.715 Interim transport and termination pricing. (a) Upon request from...

  9. 14 CFR 136.41 - Interim operating authority.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Interim operating authority. 136.41 Section 136.41 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... technology, as appropriate, and (9) Shall allow for modifications of the interim operating authority based...

  10. Statistical Profile of Children and Mothers in Afghanistan. Interim Edition.

    ERIC Educational Resources Information Center

    United Nations Children's Fund, Kabul (Afghanistan).

    This interim report is an updating of the 1977 Statistical Profile of Children and Mothers in Afghanistan. The interim report reflects the significant changes in policies brought about by the Saur Revolution establishing the Democratic Republic of Afghanistan in 1978. A comprehensive revision of the report is expected when the new government's…

  11. 47 CFR 73.404 - Interim hybrid IBOC DAB operation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 4 2012-10-01 2012-10-01 false Interim hybrid IBOC DAB operation. 73.404 Section 73.404 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Digital Audio Broadcasting § 73.404 Interim hybrid IBOC DAB operation. (a) The licensee of an AM or FM station, or...

  12. 47 CFR 73.404 - Interim hybrid IBOC DAB operation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 4 2013-10-01 2013-10-01 false Interim hybrid IBOC DAB operation. 73.404 Section 73.404 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Digital Audio Broadcasting § 73.404 Interim hybrid IBOC DAB operation. (a) The licensee of an AM or FM station, or...

  13. 47 CFR 73.404 - Interim hybrid IBOC DAB operation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... RADIO BROADCAST SERVICES Digital Audio Broadcasting § 73.404 Interim hybrid IBOC DAB operation. (a) The... test operation pursuant to § 73.1620, may commence interim hybrid IBOC DAB operation with digital... No. 99-325. FM stations are permitted to operate with hybrid digital effective radiated power...

  14. 47 CFR 73.404 - Interim hybrid IBOC DAB operation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RADIO BROADCAST SERVICES Digital Audio Broadcasting § 73.404 Interim hybrid IBOC DAB operation. (a) The... test operation pursuant to § 73.1620, may commence interim hybrid IBOC DAB operation with digital... No. 99-325. FM stations are permitted to operate with hybrid digital effective radiated power...

  15. 17 CFR 210.10-01 - Interim financial statements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... independent public accountant. Prior to filing, interim financial statements included in quarterly reports on Form 10-Q (17 CFR 249.308(a)) must be reviewed by an independent public accountant using professional... interim financial statements have been reviewed by an independent public accountant, a report of...

  16. 17 CFR 210.10-01 - Interim financial statements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... independent public accountant. Prior to filing, interim financial statements included in quarterly reports on Form 10-Q (17 CFR 249.308(a)) must be reviewed by an independent public accountant using professional... interim financial statements have been reviewed by an independent public accountant, a report of...

  17. 17 CFR 210.10-01 - Interim financial statements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... independent public accountant. Prior to filing, interim financial statements included in quarterly reports on Form 10-Q (17 CFR 249.308(a)) must be reviewed by an independent public accountant using professional... interim financial statements have been reviewed by an independent public accountant, a report of...

  18. The Predictive and Instructional Value of Interim Assessments

    ERIC Educational Resources Information Center

    Pon, Kathleen

    2013-01-01

    This mixed design study investigated the predictive and instructional uses of two different types of interim mathematics assessments given in two different districts. One district administered the same summative type of assessment three times a year, while the other district administered a different interim assessment after six-week intervals of…

  19. 50 CFR 660.720 - Interim protection for sea turtles.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 13 2014-10-01 2014-10-01 false Interim protection for sea turtles. 660.720 Section 660.720 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OFF WEST COAST STATES Highly Migratory Fisheries § 660.720 Interim...

  20. 40 CFR 80.141 - Interim detergent gasoline program.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Interim detergent gasoline program. 80.141 Section 80.141 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Detergent Gasoline § 80.141 Interim detergent gasoline program. (a) Effective dates...

  1. 46 CFR 308.303 - Amounts insured under interim binder.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Amounts insured under interim binder. 308.303 Section 308.303 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.303 Amounts insured under interim binder. The...

  2. 46 CFR 308.203 - Amount insured under interim binder.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Amount insured under interim binder. 308.203 Section 308.203 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.203 Amount insured under interim binder....

  3. Into the Sunset: Reflections of an Interim Administrator.

    ERIC Educational Resources Information Center

    Marlowe, John

    2000-01-01

    One advantage to an interim administrative position is that the public cuts short-timers a little slack. Temporary administrators can learn on the job and become experts on specialized subjects. Personnel issues demand more time than interims possess. Such positions usually do not turn into long-term contracts. (MLH)

  4. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency...

  5. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency...

  6. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency...

  7. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency...

  8. 10 CFR 590.403 - Emergency interim orders.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... DEPARTMENT OF ENERGY (CONTINUED) NATURAL GAS (ECONOMIC REGULATORY ADMINISTRATION) ADMINISTRATIVE PROCEDURES WITH RESPECT TO THE IMPORT AND EXPORT OF NATURAL GAS Opinions and Orders § 590.403 Emergency interim... and issue an emergency interim order authorizing the import or export of natural gas. After...

  9. 10 CFR 590.403 - Emergency interim orders.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... DEPARTMENT OF ENERGY (CONTINUED) NATURAL GAS (ECONOMIC REGULATORY ADMINISTRATION) ADMINISTRATIVE PROCEDURES WITH RESPECT TO THE IMPORT AND EXPORT OF NATURAL GAS Opinions and Orders § 590.403 Emergency interim... and issue an emergency interim order authorizing the import or export of natural gas. After...

  10. 28 CFR 94.41 - Interim emergency payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Interim emergency payment. 94.41 Section 94.41 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Payment of Claims § 94.41 Interim emergency...

  11. Presidential Transition: The Experience of Two Community College Interim Presidents

    ERIC Educational Resources Information Center

    Thompson, Matthew; Cooper, Robyn; Ebbers, Larry

    2012-01-01

    The purpose of this case study was to understand the experiences of two community college interim presidents, their characteristics, and how they led institutions following an abrupt presidential departure. There were two fundamental questions framing this study: 1. How do two interim community college presidents lead community colleges during a…

  12. Faculty and Student Views of the Interim Term

    ERIC Educational Resources Information Center

    Centra, John A.; Sobol, Marion G.

    1974-01-01

    Evaluations of the interim term or 4-1-4 program at various colleges have been generally favorable. A detailed evaluation of the Rider College interim study program based on faculty and student reports indicated that the more nontraditionally oriented courses were rated higher than the more traditional offerings. (Editor/PG)

  13. [Robotic surgery].

    PubMed

    Sándor, József; Haidegger, Tamás; Kormos, Katalin; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

    2013-10-01

    Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures. PMID:24144815

  14. Bariatric Surgery

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Background Obesity is defined as a body mass index (BMI) of at last 30 kg/m2.1 Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m2 has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m2. An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999–2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25–29.9 kg/m2) or obese (BMI ≥ 30 kg/m2). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the “normal” range may begin at slightly above 18.5 kg/m2 and extend into the “overweight” range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their

  15. Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial

    SciTech Connect

    Wong, Julia S.; Winer, Eric P.

    2008-11-01

    Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results: For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion: In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.

  16. Robotic Surgery

    NASA Technical Reports Server (NTRS)

    2000-01-01

    The Automated Endoscopic System for Optimal Positioning, or AESOP, was developed by Computer Motion, Inc. under a SBIR contract from the Jet Propulsion Lab. AESOP is a robotic endoscopic positioning system used to control the motion of a camera during endoscopic surgery. The camera, which is mounted at the end of a robotic arm, previously had to be held in place by the surgical staff. With AESOP the robotic arm can make more precise and consistent movements. AESOP is also voice controlled by the surgeon. It is hoped that this technology can be used in space repair missions which require precision beyond human dexterity. A new generation of the same technology entitled the ZEUS Robotic Surgical System can make endoscopic procedures even more successful. ZEUS allows the surgeon control various instruments in its robotic arms, allowing for the precision the procedure requires.

  17. Pediatric heart surgery - discharge

    MedlinePlus

    ... reduced appetite Alternate Names Congenital heart surgery - discharge; Patent ductus arteriosus ligation - discharge; Hypoplastic left heart repair - ... of the aorta Congenital heart defect - corrective surgery Patent ductus arteriosus Pediatric heart surgery Tetralogy of Fallot ...

  18. Scoliosis surgery - child

    MedlinePlus

    Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... may also do the procedure using a special video camera. A surgical cut in the back is ...

  19. Coronary Artery Bypass Surgery

    MedlinePlus

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  20. Tennis elbow surgery - discharge

    MedlinePlus

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed ...

  1. Laser surgery - skin

    MedlinePlus

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  2. Pediatric heart surgery

    MedlinePlus

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... after the baby is born. For others, your child may be able to safely wait for months ...

  3. Retention of long-term interim restorations with sodium fluoride enriched interim cement

    NASA Astrophysics Data System (ADS)

    Strash, Carolyn

    Purpose: Interim fixed dental prostheses, or "provisional restorations", are fabricated to restore teeth when definitive prostheses are made indirectly. Patients undergoing extensive prosthodontic treatment frequently require provisionalization for several months or years. The ideal interim cement would retain the restoration for as long as needed and still allow for ease of removal. It would also avoid recurrent caries by preventing demineralization of tooth structure. This study aims to determine if adding sodium fluoride varnish to interim cement may assist in the retention of interim restorations. Materials and methods: stainless steel dies representing a crown preparation were fabricated. Provisional crowns were milled for the dies using CAD/CAM technology. Crowns were provisionally cemented onto the dies using TempBond NE and NexTemp provisional cements as well as a mixture of TempBond NE and Duraphat fluoride varnish. Samples were stored for 24h then tested or thermocycled for 2500 or 5000 cycles before being tested. Retentive strength of each cement was recorded using a universal testing machine. Results: TempBond NE and NexTemp cements performed similarly when tested after 24h. The addition of Duraphat significantly decreased the retention when added to TempBond NE. NexTemp cement had high variability in retention over all tested time periods. Thermocycling for 2500 and 5000 cycles significantly decreased the retention of all cements. Conclusions: The addition of Duraphat fluoride varnish significantly decreased the retention of TempBond NE and is therefore not recommended for clinical use. Thermocycling significantly reduced the retention of TempBond NE and NexTemp. This may suggest that use of these cements for three months, as simulated in this study, is not recommended.

  4. PROJECT W-551 INTERIM PRETREATMENT SYSTEM PRECONCEPTUAL CANDIDATE TECHNOLOGY DESCRIPTIONS

    SciTech Connect

    MAY TH

    2008-08-12

    The Office of River Protection (ORP) has authorized a study to recommend and select options for interim pretreatment of tank waste and support Waste Treatment Plant (WTP) low activity waste (LAW) operations prior to startup of all the WTP facilities. The Interim Pretreatment System (IPS) is to be a moderately sized system which separates entrained solids and 137Cs from tank waste for an interim time period while WTP high level waste vitrification and pretreatment facilities are completed. This study's objective is to prepare pre-conceptual technology descriptions that expand the technical detail for selected solid and cesium separation technologies. This revision includes information on additional feed tanks.

  5. Cosmetic Plastic Surgery Statistics

    MedlinePlus

    2014 Cosmetic Plastic Surgery Statistics Cosmetic Procedure Trends 2014 Plastic Surgery Statistics Report Please credit the AMERICAN SOCIETY OF PLASTIC SURGEONS when citing statistical data or using ...

  6. Cosmetic ear surgery

    MedlinePlus

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... 31. Thorne CH. Otoplasty. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap ...

  7. Interim prediction method for jet noise

    NASA Technical Reports Server (NTRS)

    Stone, J. R.

    1974-01-01

    A method is provided for predicting jet noise for a wide range of nozzle geometries and operating conditions of interest for aircraft engines. Jet noise theory, data and existing prediction methods was reviewed, and based on this information a interim method of jet noise prediction is proposed. Problem areas are idenified where further research is needed to improve the prediction method. This method predicts only the noise generated by the exhaust jets mixing with the surrounding air and does not include other noises emanating from the engine exhaust, such as combustion and machinery noise generated inside the engine (i.e., core noise). It does, however, include thrust reverser noise. Prediction relations are provided for conical nozzles, plug nozzles, coaxial nozzles and slot nozzles.

  8. Natural tooth as an interim prosthesis

    PubMed Central

    Dhariwal, Neha S.; Gokhale, Niraj S.; Patel, Punit; Hugar, Shivayogi M.

    2016-01-01

    A traumatic injury to primary maxillary anterior tooth is one of the common causes for problems with the succedaneous tooth leading to it noneruption. A missing anterior tooth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, sometimes, it is inevitable to save the natural tooth. This paper describes the immediate replacement of a right central incisor using a fiber-composite resin splint with the natural tooth crown as a pontic following surgical extraction of the dilacerated impacted permanent maxillary central incisor. The abutment teeth can be conserved with minimal or no preparation, thus keeping the technique reversible and can be completed at chair side thereby avoiding laboratory costs. It can be used as an interim measure until a definitive prosthesis can be fabricated as the growth is still incomplete. PMID:27433074

  9. AGR-1 Data Qualification Interim Report

    SciTech Connect

    Machael Abbott

    2009-08-01

    Projects for the very-high-temperature reactor (VHTR) program provide data in support of Nuclear Regulatory Commission licensing of the VHTR. Fuel and materials to be used in the reactor are tested and characterized to quantify performance in high temperature and high fluence environments. The VHTR Program has established the NGNP Data Management and Analysis System (NDMAS) to ensure that VHTR data are (1) qualified for use, (2) stored in a readily accessible electronic form, and (3) analyzed to extract useful results. This document focuses on the first NDMAS objective. It describes the data streams associated with the first Advanced Gas Reactor (AGR-1) experiment, the processing of these data within NDMAS, and reports the interim FY09 qualification status of the AGR-1 data to date. Data qualification activities within NDMAS for specific types of data are determined by the data qualification category, which is assigned by the data generator, and include: (1) capture testing, to confirm that the data stored within NDMAS are identical to the raw data supplied, (2) accuracy testing, to confirm that the data are an accurate representation of the system or object being measured, and (3) documentation that the data were collected under an NQA-1 or equivalent QA program. The interim qualification status of the following four data streams is reported in this document: (1) fuel fabrication data, (2) fuel irradiation data, (3) fission product monitoring system (FPMS) data, and (4) Advanced Test Reactor (ATR) operating conditions data. A final report giving the NDMAS qualification status of all AGR-1 data (including cycle 145A) is planned for February 2010.

  10. Transoral Surgery

    PubMed Central

    Rock, Jack P.; Tomecek, Frank J.; Ross, Lawrence

    1993-01-01

    The transoral approaches have become commonplace in modern neurosurgical practice for treatment of ventral midline lesions of the clivus and upper cervical spine. Although the standard technique of transoral surgery is conceptually simple, anatomic relationships are not so readily appreciated. The present study was undertaken in an effort to define more clearly the midline anatomic relationships as they pertain to the standard transoral and transpalatine operations. The anatomic relationships involved in planning microsurgical transoral approaches were examined in 15 human cadavers. Landmarks approximating the midline of the skull base and the upper cervical spinal canal were defined to assist the surgeon's orientation. Measurements were made in axial, sagital, and parasagittal planes to various neurovascular structures in the posterior cranial fossa and upper cervical spinal canal. The study revealed that, for the standard transoral and transoral-transpalatine dissections, the carotid arteries, abducens nerves, interior petrosal sinuses, hypoglossal nerves, and vertebral arteries would be a greatest risk being 0.76, 1.06, 1.51, 1.34, and 1.52 cm from the midline at specified locations. The measurements and the computed tomography images provide a useful reference for the surgeon. ImagesFigure 1Figure 9 PMID:17170899

  11. Conversion of an interim into a definitive speech aid: a predictable approach.

    PubMed

    Tapia, Gustavo; Casey, David; Schaaf, Norman G

    2002-01-01

    In patients with partial or total soft palatectomy, an interim prosthesis generally is inserted as soon as possible after surgery. Over the average postoperative healing period of 3 months, numerous clinical appointments are needed to shape the prosthesis. When the definitive prosthesis is completed, reshaping the pharyngeal portion of the speech aid unnecessarily involves duplication of work by the clinician. A laboratory procedure is described that can save clinic time, increase cost-effectiveness, and shift work normally performed by the maxillofacial prosthodontist to the maxillofacial laboratory technician. This technique is particularly useful with prostheses that are difficult to shape because of trismus or lack of residual lateral and posterior pharyngeal movement. PMID:11807493

  12. 40 CFR 155.56 - Interim registration review decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... required data, conducting the new risk assessment and completing the registration review. A FIFRA 3(c)(2)(B... registration review decision may require new risk mitigation measures, impose interim risk mitigation...

  13. Interim solar cell testing procedures for terrestrial applications

    NASA Technical Reports Server (NTRS)

    Brandhorst, H. W., Jr.; Hickey, J.; Curtis, H.

    1975-01-01

    This report presents an interim draft of procedures for testing solar cells for terrestrial applications that resulted from the terrestrial photovoltaic workshop sessions. A final version of the test procedures manual is planned for the summer of 1976.

  14. TANK FARM INTERIM SURFACE BARRIER MATERIALS AND RUNOFF ALTERNATIVES STUDY

    SciTech Connect

    HOLM MJ

    2009-06-25

    This report identifies candidate materials and concepts for interim surface barriers in the single-shell tank farms. An analysis of these materials for application to the TY tank farm is also provided.

  15. NCI Director Also to Be Interim FDA Commissioner

    Cancer.gov

    Andrew von Eschenbach, M.D., director of the NCI, was asked by President Bush on Friday, September 23, 2005, to assume the additional role of interim Commissioner of the U.S. Food and Drug Administration (FDA).

  16. 18 CFR 385.1113 - Interim relief (Rule 1113).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... interest to grant the interim relief. (c) A party may within 10 days after the filing of the request for... under Rule 1109 (orders). (2) The Commission may, on its own motion, at any time revoke, modify,...

  17. Fuel Supply Shutdown Facility Interim Operational Safety Requirements

    SciTech Connect

    BENECKE, M.W.

    2000-09-06

    The Interim Operational Safety Requirements for the Fuel Supply Shutdown (FSS) Facility define acceptable conditions, safe boundaries, bases thereof, and management of administrative controls to ensure safe operation of the facility.

  18. Fire Hazards Analysis for the 200 Area Interim Storage Area

    SciTech Connect

    JOHNSON, D.M.

    2000-01-06

    This documents the Fire Hazards Analysis (FHA) for the 200 Area Interim Storage Area. The Interim Storage Cask, Rad-Vault, and NAC-1 Cask are analyzed for fire hazards and the 200 Area Interim Storage Area is assessed according to HNF-PRO-350 and the objectives of DOE Order 5480 7A. This FHA addresses the potential fire hazards associated with the Interim Storage Area (ISA) facility in accordance with the requirements of DOE Order 5480 7A. It is intended to assess the risk from fire to ensure there are no undue fire hazards to site personnel and the public and to ensure property damage potential from fire is within acceptable limits. This FHA will be in the form of a graded approach commensurate with the complexity of the structure or area and the associated fire hazards.

  19. 10 CFR 590.403 - Emergency interim orders.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... WITH RESPECT TO THE IMPORT AND EXPORT OF NATURAL GAS Opinions and Orders § 590.403 Emergency interim... which time a final opinion and order shall be issued. The Assistant Secretary may attach necessary...

  20. TWRS HLW interim storage facility search and evaluation

    SciTech Connect

    Calmus, R.B., Westinghouse Hanford

    1996-05-16

    The purpose of this study was to identify and provide an evaluation of interim storage facilities and potential facility locations for the vitrified high-level waste (HLW) from the Phase I demonstration plant and Phase II production plant. In addition, interim storage facilities for solidified separated radionuclides (Cesium and Technetium) generated during pretreatment of Phase I Low-Level Waste Vitrification Plant feed was evaluated.

  1. K basins interim remedial action health and safety plan

    SciTech Connect

    DAY, P.T.

    1999-09-14

    The K Basins Interim Remedial Action Health and Safety Plan addresses the requirements of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), as they apply to the CERCLA work that will take place at the K East and K West Basins. The provisions of this plan become effective on the date the US Environmental Protection Agency issues the Record of Decision for the K Basins Interim Remedial Action, currently planned in late August 1999.

  2. Interim Safety Basis for Fuel Supply Shutdown Facility

    SciTech Connect

    BENECKE, M.W.

    2000-09-07

    This ISB, in conjunction with the IOSR, provides the required basis for interim operation or restrictions on interim operations and administrative controls for the facility until a SAR is prepared in accordance with the new requirements or the facility is shut down. It is concluded that the risks associated with tha current and anticipated mode of the facility, uranium disposition, clean up, and transition activities required for permanent closure, are within risk guidelines.

  3. Interim Basis for PCB Sampling and Analyses

    SciTech Connect

    BANNING, D.L.

    2001-01-18

    This document was developed as an interim basis for sampling and analysis of polychlorinated biphenyls (PCBs) and will be used until a formal data quality objective (DQO) document is prepared and approved. On August 31, 2000, the Framework Agreement for Management of Polychlorinated Biphenyls (PCBs) in Hanford Tank Waste was signed by the US. Department of Energy (DOE), the Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology) (Ecology et al. 2000). This agreement outlines the management of double shell tank (DST) waste as Toxic Substance Control Act (TSCA) PCB remediation waste based on a risk-based disposal approval option per Title 40 of the Code of Federal Regulations 761.61 (c). The agreement calls for ''Quantification of PCBs in DSTs, single shell tanks (SSTs), and incoming waste to ensure that the vitrification plant and other ancillary facilities PCB waste acceptance limits and the requirements of the anticipated risk-based disposal approval are met.'' Waste samples will be analyzed for PCBs to satisfy this requirement. This document describes the DQO process undertaken to assure appropriate data will be collected to support management of PCBs and is presented in a DQO format. The DQO process was implemented in accordance with the U.S. Environmental Protection Agency EPA QAlG4, Guidance for the Data Quality Objectives Process (EPA 1994) and the Data Quality Objectives for Sampling and Analyses, HNF-IP-0842, Rev. 1 A, Vol. IV, Section 4.16 (Banning 1999).

  4. Interim Basis for PCB Sampling and Analyses

    SciTech Connect

    BANNING, D.L.

    2001-03-20

    This document was developed as an interim basis for sampling and analysis of polychlorinated biphenyls (PCBs) and will be used until a formal data quality objective (DQO) document is prepared and approved. On August 31, 2000, the Framework Agreement for Management of Polychlorinated Biphenyls (PCBs) in Hanford Tank Waste was signed by the U.S. Department of Energy (DOE), the Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology) (Ecology et al. 2000). This agreement outlines the management of double shell tank (DST) waste as Toxic Substance Control Act (TSCA) PCB remediation waste based on a risk-based disposal approval option per Title 40 of the Code of Federal Regulations 761.61 (c). The agreement calls for ''Quantification of PCBs in DSTs, single shell tanks (SSTs), and incoming waste to ensure that the vitrification plant and other ancillary facilities PCB waste acceptance limits and the requirements of the anticipated risk-based disposal approval are met.'' Waste samples will be analyzed for PCBs to satisfy this requirement. This document describes the DQO process undertaken to assure appropriate data will be collected to support management of PCBs and is presented in a DQO format. The DQO process was implemented in accordance with the U.S. Environmental Protection Agency EPA QA/G4, Guidance for the Data Quality Objectives Process (EPA 1994) and the Data Quality Objectives for Sampling and Analyses, HNF-IP-0842, Rev. 1A, Vol. IV, Section 4.16 (Banning 1999).

  5. Alaska interim land cover mapping program

    USGS Publications Warehouse

    U.S. Geological Survey

    1987-01-01

    In order to meet the requirements of the Alaska National Interest Lands Conservation Act (ANILCA) for comprehensive resource and management plans from all major land management agencies in Alaska, the USGS has begun a program to classify land cover for the entire State using Landsat digital data. Vegetation and land cover classifications, generated in cooperation with other agencies, currently exist for 115 million acres of Alaska. Using these as a base, the USGS has prepared a comprehensive plan for classifying the remaining areas of the State. The development of this program will lead to a complete interim vegetation and land cover classification system for Alaska and allow the dissemination of digital data for those areas classified. At completion, 153 Alaska 1:250,000-scale quadrangles will be published and will include land cover from digital Landsat classifications, statistical summaries of all land cover by township, and computer-compatible tapes. An interagency working group has established an Alaska classification system (table 1) composed of 18 classes modified from "A land use and land cover classification system for use with remote sensor data" (Anderson and others, 1976), and from "Revision of a preliminary classification system for vegetation of Alaska" (Viereck and Dyrness, 1982) for the unique ecoregions which are found in Alaska.

  6. 340 Waste Handling Facility interim safety basis

    SciTech Connect

    Bendixsen, R.B.

    1995-04-03

    This document establishes the interim safety basis (ISB) for the 340 Waste Handling Facility (340 Facility). An ISB is a documented safety basis that provides a justification for the continued operation of the facility until an upgraded final safety analysis report is prepared that complies with US Department of Energy (DOE) Order 5480.23, Nuclear Safety Analysis Reports. The ISB for the 340 Facility documents the current design and operation of the facility. The 340 Facility ISB (ISB-003) is based on a facility walkdown and review of the design and operation of the facility, as described in the existing safety documentation. The safety documents reviewed, to develop ISB-003, include the following: OSD-SW-153-0001, Operating Specification Document for the 340 Waste Handling Facility (WHC 1990); OSR-SW-152-00003, Operating Limits for the 340 Waste Handling Facility (WHC 1989); SD-RE-SAP-013, Safety Analysis Report for Packaging, Railroad Liquid Waste Tank Cars (Mercado 1993); SD-WM-TM-001, Safety Assessment Document for the 340 Waste Handling Facility (Berneski 1994a); SD-WM-SEL-016, 340 Facility Safety Equipment List (Berneski 1992); and 340 Complex Fire Hazard Analysis, Draft (Hughes Assoc. Inc. 1994).

  7. An interim overview of LDEF materials findings

    SciTech Connect

    Stein, B.A.

    1992-12-01

    The flight and retrieval of the National Aeronautics and Space Administration's Long Duration Exposure Facility (LDEF) provided an opportunity for the study of the low-Earth orbit (LEO) environment and long-duration space environmental effects (SEE) on materials that is unparalleled in the history of the U.S. Space Program. The remarkable flight attitude stability of LDEF enables specific analyses of various individual and combined effects of LEO environmental parameters on identical materials on the same space vehicle. This paper provides an overview of the interim LDEF materials findings of the Principal Investigators and the Materials Special Investigation Group. In general, the LDEF data is remarkably consistent; LDEF will provide a benchmark for materials design data bases for satellites in low-Earth orbit. Some materials were identified to be encouragingly resistant to LEO SEE for 5.8 years; other space qualified materials displayed significant environmental degradation. Molecular contamination was widespread; LDEF offers an unprecedented opportunity to provide a unified perspective of unmanned LEO spacecraft contamination mechanisms. New material development requirements for long-term LEO missions have been identified and current ground simulation testing methods/data for new, durable materials concepts can be validated with LDEF results. LDEF findings are already being integrated into the design of Space Station Freedom.

  8. An interim overview of LDEF materials findings

    NASA Technical Reports Server (NTRS)

    Stein, Brad A.

    1992-01-01

    The flight and retrieval of the National Aeronautics and Space Administration's Long Duration Exposure Facility (LDEF) provided an opportunity for the study of the low-Earth orbit (LEO) environment and long-duration space environmental effects (SEE) on materials that is unparalleled in the history of the U.S. Space Program. The remarkable flight attitude stability of LDEF enables specific analyses of various individual and combined effects of LEO environmental parameters on identical materials on the same space vehicle. This paper provides an overview of the interim LDEF materials findings of the Principal Investigators and the Materials Special Investigation Group. In general, the LDEF data is remarkably consistent; LDEF will provide a 'benchmark' for materials design data bases for satellites in low-Earth orbit. Some materials were identified to be encouragingly resistant to LEO SEE for 5.8 years; other 'space qualified' materials displayed significant environmental degradation. Molecular contamination was widespread; LDEF offers an unprecedented opportunity to provide a unified perspective of unmanned LEO spacecraft contamination mechanisms. New material development requirements for long-term LEO missions have been identified and current ground simulation testing methods/data for new, durable materials concepts can be validated with LDEF results. LDEF findings are already being integrated into the design of Space Station Freedom.

  9. Space shuttle SRM interim contract, part 1

    NASA Technical Reports Server (NTRS)

    1974-01-01

    Essential studies and analyses required to integrate the SRM into the booster and overall space shuttle system. Emphasis was placed on the case, nozzle, insulation, and propellant components with resulting performance, weight, and structural load characteristics being generated. Effort conducted during the time period of this contract included studies, analyses, planning, and preliminary design activities. Technical requirements identified in the SRM Project Request for Proposal No. 8-1-4-94-98401 and Thiokol's proposed SRM design (designated Configuration 0) established the basis for this effort. The requirements were evaluated jointly with MSFC and altered where necessary to incorporate new information that evolved after issuance of the RFP and during the course of this interim contract. Revised water impact loads and load distributions were provided based on additional model test data and analytical effort conducted by NASA subsequent to the RFP release. Launch pad peaking loads into the SRM aft skirt were provided which also represented a change from RFP requirements. A modified SRM/External Tank (ET) attachment configuration with new structural load data was supplied by NASA, and direction was received to include a 2 percent inert weight contingency.

  10. The EMEFS model evaluation. An interim report

    SciTech Connect

    Barchet, W.R.; Dennis, R.L.; Seilkop, S.K.; Banic, C.M.; Davies, D.; Hoff, R.M.; Macdonald, A.M.; Mickle, R.E.; Padro, J.; Puckett, K.; Byun, D.; McHenry, J.N.; Karamchandani, P.; Venkatram, A.; Fung, C.; Misra, P.K.; Hansen, D.A.; Chang, J.S.

    1991-12-01

    The binational Eulerian Model Evaluation Field Study (EMEFS) consisted of several coordinated data gathering and model evaluation activities. In the EMEFS, data were collected by five air and precipitation monitoring networks between June 1988 and June 1990. Model evaluation is continuing. This interim report summarizes the progress made in the evaluation of the Regional Acid Deposition Model (RADM) and the Acid Deposition and Oxidant Model (ADOM) through the December 1990 completion of a State of Science and Technology report on model evaluation for the National Acid Precipitation Assessment Program (NAPAP). Because various assessment applications of RADM had to be evaluated for NAPAP, the report emphasizes the RADM component of the evaluation. A protocol for the evaluation was developed by the model evaluation team and defined the observed and predicted values to be used and the methods by which the observed and predicted values were to be compared. Scatter plots and time series of predicted and observed values were used to present the comparisons graphically. Difference statistics and correlations were used to quantify model performance. 64 refs., 34 figs., 6 tabs.

  11. Permitting plan for the high-level waste interim storage

    SciTech Connect

    Deffenbaugh, M.L.

    1997-04-23

    This document addresses the environmental permitting requirements for the transportation and interim storage of solidified high-level waste (HLW) produced during Phase 1 of the Hanford Site privatization effort. Solidified HLW consists of canisters containing vitrified HLW (glass) and containers that hold cesium separated during low-level waste pretreatment. The glass canisters and cesium containers will be transported to the Canister Storage Building (CSB) in a U.S. Department of Energy (DOE)-provided transportation cask via diesel-powered tractor trailer. Tri-Party Agreement (TPA) Milestone M-90 establishes a new major milestone, and associated interim milestones and target dates, governing acquisition and/or modification of facilities necessary for: (1) interim storage of Tank Waste Remediation Systems (TWRS) immobilized HLW (IHLW) and other canistered high-level waste forms; and (2) interim storage and disposal of TWRS immobilized low-activity tank waste (ILAW). An environmental requirements checklist and narrative was developed to identify the permitting path forward for the HLW interim storage (HLWIS) project (See Appendix B). This permitting plan will follow the permitting logic developed in that checklist.

  12. Current status of ultrasound-guided surgery in the treatment of breast cancer.

    PubMed

    Volders, José H; Haloua, Max H; Krekel, Nicole Ma; Meijer, Sybren; van den Tol, Petrousjka M

    2016-02-10

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast

  13. Current status of ultrasound-guided surgery in the treatment of breast cancer

    PubMed Central

    Volders, José H; Haloua, Max H; Krekel, Nicole MA; Meijer, Sybren; van den Tol, Petrousjka M

    2016-01-01

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing “blind” surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant

  14. High Temperature Materials Interim Data Qualification Report

    SciTech Connect

    Nancy Lybeck

    2010-08-01

    ABSTRACT Projects for the very high temperature reactor (VHTR) Technology Development Office provide data in support of Nuclear Regulatory Commission licensing of the VHTR. Fuel and materials to be used in the reactor are tested and characterized to quantify performance in high temperature and high fluence environments. The VHTR program has established the NGNP Data Management and Analysis System (NDMAS) to ensure that VHTR data are qualified for use, stored in a readily accessible electronic form, and analyzed to extract useful results. This document focuses on the first NDMAS objective. It describes the High Temperature Materials characterization data stream, the processing of these data within NDMAS, and reports the interim FY2010 qualification status of the data. Data qualification activities within NDMAS for specific types of data are determined by the data qualification category assigned by the data generator. The High Temperature Materials data are being collected under NQA-1 guidelines, and will be qualified data. For NQA-1 qualified data, the qualification activities include: (1) capture testing, to confirm that the data stored within NDMAS are identical to the raw data supplied, (2) accuracy testing to confirm that the data are an accurate representation of the system or object being measured, and (3) documenting that the data were collected under an NQA-1 or equivalent Quality Assurance program. Currently, data from two test series within the High Temperature Materials data stream have been entered into the NDMAS vault: 1. Tensile Tests for Sm (i.e., Allowable Stress) Confirmatory Testing – 1,403,994 records have been inserted into the NDMAS database. Capture testing is in process. 2. Creep-Fatigue Testing to Support Determination of Creep-Fatigue Interaction Diagram – 918,854 records have been processed and inserted into the NDMAS database. Capture testing is in process.

  15. NEXT GENERATION MELTER OPTIONEERING STUDY - INTERIM REPORT

    SciTech Connect

    GRAY MF; CALMUS RB; RAMSEY G; LOMAX J; ALLEN H

    2010-10-19

    The next generation melter (NOM) development program includes a down selection process to aid in determining the recommended vitrification technology to implement into the WTP at the first melter change-out which is scheduled for 2025. This optioneering study presents a structured value engineering process to establish and assess evaluation criteria that will be incorporated into the down selection process. This process establishes an evaluation framework that will be used progressively throughout the NGM program, and as such this interim report will be updated on a regular basis. The workshop objectives were achieved. In particular: (1) Consensus was reached with stakeholders and technology providers represented at the workshop regarding the need for a decision making process and the application of the D{sub 2}0 process to NGM option evaluation. (2) A framework was established for applying the decision making process to technology development and evaluation between 2010 and 2013. (3) The criteria for the initial evaluation in 2011 were refined and agreed with stakeholders and technology providers. (4) The technology providers have the guidance required to produce data/information to support the next phase of the evaluation process. In some cases it may be necessary to reflect the data/information requirements and overall approach to the evaluation of technology options against specific criteria within updated Statements of Work for 2010-2011. Access to the WTP engineering data has been identified as being very important for option development and evaluation due to the interface issues for the NGM and surrounding plant. WRPS efforts are ongoing to establish precisely data that is required and how to resolve this Issue. It is intended to apply a similarly structured decision making process to the development and evaluation of LAW NGM options.

  16. Interim Methadone Treatment: Impact on Arrests

    PubMed Central

    Schwartz, Robert P.; Jaffe, Jerome H.; O’Grady, Kevin E.; Kinlock, Timothy W.; Gordon, Michael S.; Kelly, Sharon M.; Wilson, Monique E.; Ahmed, Ashraf

    2009-01-01

    AIMS This study examines the frequency and severity of arrest charges among heroin addicts randomly assigned to either interim methadone maintenance (IM) or to remain on a waiting list for methadone treatment. It was hypothesized that IM participants would have a: 1) lower number of arrests at 6 and 12 months and 2) lower mean crime severity scores at 6 and 12 months post-baseline. METHODS Available official arrest data were obtained for all 319 study participants for a period of 2 years before and after study enrollment. Crime severity ratings of charges were made using an established measure of crime severity. FINDINGS Participants randomly assigned to IM as compared to those on a waiting list had a significant reduction in number of arrests at 6 but not at 12 months from study enrollment. There were no significant differences in whether participants were arrested for a more severe crime but frequency of severe crime was relatively low in both groups. Additional post hoc analyses based on whether participants were in methadone treatment at 4 and 10 months after original random assignment to treatment condition revealed that those participants not in treatment at these follow-up assessment points were significantly more likely to be arrested and to have a higher mean crime severity rating at 12 and 24 months post-baseline assessment. CONCLUSIONS IM as compared to the waiting list condition, had a significant reduction in number of officially- recorded arrests from baseline to 6 months post-baseline. Those who were enrolled in methadone treatment at the 4 and 10 month follow-up assessment, regardless of initial assignment, had fewer arrests at 12 and 24 months post-baseline. PMID:19443133

  17. Lasik eye surgery - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000525.htm Lasik eye surgery - discharge To use the sharing features on this page, please enable JavaScript. Lasik eye surgery permanently changes the shape of the cornea ( ...

  18. Ear Plastic Surgery

    MedlinePlus

    ... Meeting Calendar Find an ENT Doctor Near You Ear Plastic Surgery Ear Plastic Surgery Patient Health Information ... they may improve appearance and self-confidence. Can Ear Deformities Be Corrected? Formation of the ear during ...

  19. Plastic Surgery for Teenagers

    MedlinePlus

    ... or severe acne and scarring. Teens frequently gain self-esteem and confidence when their physical problems are corrected. ... art as a helpful index of anxiety and self-esteem with plastic surgery. Plastic and Reconstructive Surgery 2002. ...

  20. Refractive corneal surgery - discharge

    MedlinePlus

    ... after surgery, it should be okay to use artificial tears. Check with your doctor. Do NOT wear contact lenses on the eye that had surgery, even if you have blurry vision. Do NOT use any makeup, creams, or lotions ...

  1. Pediatric heart surgery - discharge

    MedlinePlus

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Keane JF, Lock JE, Fyler DC, eds. Nadas' Pediatric Cardiology . 2nd ed. St. Louis, MO; WB Saunders; ...

  2. Periodontal Plastic Surgery

    MedlinePlus

    ... Dental Implants Dentures Direct Bonding Implants versus Bridges Orthodontics and Aligners Periodontal Plastic Surgery Porcelain Crowns Porcelain ... Dental Implants Dentures Direct Bonding Implants versus Bridges Orthodontics and Aligners Periodontal Plastic Surgery Porcelain Crowns Porcelain ...

  3. American Board of Surgery

    MedlinePlus

    ... How to Apply Certifying Exam Specialty Definition Surgical Critical Care Related Policies Exam Admissibility Policy Leave Policy Certifying ... Surgery About the Exam How to Apply Surgical Critical Care About the Exam How to Apply Hand Surgery ...

  4. Carotid artery surgery - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000238.htm Carotid artery surgery - discharge To use the sharing features on this page, please enable JavaScript. You had carotid artery surgery to restore proper blood flow to your ...

  5. Complications of Sinus Surgery

    MedlinePlus

    ... further intracranial surgeries. Impaired sense of taste or smell : The sense of smell usually improves after the procedure because airflow is ... in their voice after sinus surgery. Impairment of smell or taste: (see above) Infection: The most common ...

  6. Cosmetic ear surgery

    MedlinePlus

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  7. Hip fracture surgery

    MedlinePlus

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  8. Cataract surgery - series (image)

    MedlinePlus

    Cataract surgery usually works very well. The operation has few risks, the pain and recovery period are short, ... improved. Ninety-five percent or more of all cataract surgeries result in improved vision.

  9. Cosmetic breast surgery - discharge

    MedlinePlus

    ... Higdon KK. Reduction mammoplasty. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 8. ... Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 2.

  10. 46 CFR 308.6 - Period of interim binders, updating application information and new applications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... with the American War Risk Agency, 14 Wall Street, New York, New York 10005. All interim binders on U.S... Wall Street, New York, New York 10005. All interim binders on foreign-flag vessels will...

  11. Complications in Eyelid Surgery.

    PubMed

    Karimnejad, Kaveh; Walen, Scott

    2016-05-01

    Eyelid surgery consists of challenging reconstructive and cosmetic procedures. Because of the complex anatomy and corresponding vital functions of the upper and lower eyelids, the avoidance of eyelid complications is of vital importance. Complications after eyelid surgery include basic complications (infection, granuloma) and vision-threatening complications. Preoperative history, physical examination, surgical planning, and meticulous surgical technique must be undertaken to prevent complications after eyelid surgery. In addition, patient knowledge, expectations, and motivations must be determined before surgery is performed. PMID:27105805

  12. Robotic liver surgery

    PubMed Central

    Leung, Universe

    2014-01-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  13. Refractive surgery and strabismus.

    PubMed

    Kowal, Lionel; Battu, Ravindra; Kushner, Burton

    2005-02-01

    This review discusses the potential for strabismic complications after refractive surgery for hyperopia, myopia, anisomyopia, astigmatism and monovision, and how to avoid these complications. Guidelines are given for assessing patients with strabismus seeking refractive surgery. Screening tests are suggested that lead to stratification of refractive surgery patients into different risk groups each warranting a different intensity of evaluation. PMID:15670088

  14. Pediatric heart surgery

    MedlinePlus

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  15. Infection after hand surgery.

    PubMed

    Eberlin, Kyle R; Ring, David

    2015-05-01

    Postoperative infections are uncommon after hand surgery. Infection can delay recovery and contribute to scarring and stiffness. Measures intended to reduce the risk of infection after hand surgery include hand washing, skin preparation, sterile technique, and prophylactic antibiotics. The role of prophylactic antibiotics for small, clean, elective hand surgery procedures lasting less than 2 hours is debated. PMID:25934209

  16. Cavus Foot Surgery

    MedlinePlus

    ... Toes All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A cavus or high-arched foot may have ... related problems. What are the goals of cavus foot surgery? The main goal of surgery is to ...

  17. Single-shell tank interim stabilization project plan

    SciTech Connect

    Ross, W.E.

    1998-03-27

    Solid and liquid radioactive waste continues to be stored in 149 single-shell tanks at the Hanford Site. To date, 119 tanks have had most of the pumpable liquid removed by interim stabilization. Thirty tanks remain to be stabilized. One of these tanks (C-106) will be stabilized by retrieval of the tank contents. The remaining 29 tanks will be interim stabilized by saltwell pumping. In the summer of 1997, the US Department of Energy (DOE) placed a moratorium on the startup of additional saltwell pumping systems because of funding constraints and proposed modifications to the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) milestones to the Washington State Department of Ecology (Ecology). In a letter dated February 10, 1998, Final Determination Pursuant to Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) in the Matter of the Disapproval of the DOE`s Change Control Form M-41-97-01 (Fitzsimmons 1998), Ecology disapproved the DOE Change Control Form M-41-97-01. In response, Fluor Daniel Hanford, Inc. (FDH) directed Lockheed Martin Hanford Corporation (LNMC) to initiate development of a project plan in a letter dated February 25, 1998, Direction for Development of an Aggressive Single-Shell Tank (SST) Interim Stabilization Completion Project Plan in Support of Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement). In a letter dated March 2, 1998, Request for an Aggressive Single-Shell Tank (SST) Interim Stabilization Completion Project Plan, the DOE reaffirmed the need for an aggressive SST interim stabilization completion project plan to support a finalized Tri-Party Agreement Milestone M-41 recovery plan. This project plan establishes the management framework for conduct of the TWRS Single-Shell Tank Interim Stabilization completion program. Specifically, this plan defines the mission needs and requirements; technical objectives and approach; organizational structure, roles, responsibilities

  18. A review of proposed Glen Canyon Dam interim operating criteria

    SciTech Connect

    LaGory, K.; Hlohowskyj, I.; Tomasko, D.; Hayse, J.; Durham, L.

    1992-04-01

    Three sets of interim operating criteria for Glen Canyon Dam on the Colorado River have been proposed for the period of November 1991, to the completion of the record of decision for the Glen Canyon Dam environmental impact statement (about 1993). These criteria set specific limits on dam releases, including maximum and minimum flows, up-ramp and down-ramp rates, and maximum daily fluctuation. Under the proposed interim criteria, all of these parameters would be reduced relative to historical operating criteria to protect downstream natural resources, including sediment deposits, threatened and endangered fishes, trout, the aquatic food base, and riparian plant communities. The scientific bases of the three sets of proposed operating criteria are evaluated in the present report:(1) criteria proposed by the Research/Scientific Group, associated with the Glen Canyon Environmental Studies (GCES); (2) criteria proposed state and federal officials charged with managing downstream resources; and (3) test criteria imposed from July 1991, to November 1991. Data from Phase 1 of the GCES and other sources established that the targeted natural resources are affected by dam operations, but the specific interim criteria chosen were not supported by any existing studies. It is unlikely that irreversible changes to any of the resources would occur over the interim period if historical operating criteria remained in place. It is likely that adoption of any of the sets of proposed interim operating criteria would reduce the levels of sediment transport and erosion below Glen Canyon Dam; however, these interim criteria could result in some adverse effects, including the accumulation of debris at tributary mouths, a shift of new high-water-zone vegetation into more flood-prone areas, and further declines in vegetation in the old high water zone.

  19. 75 FR 12217 - Notice of Availability for Comments Regarding the Planned Environmental Assessment Interim Report...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-15

    ... Environmental Assessment Interim Report IIIa Fish Deterrent Barriers, Illinois and Chicago Area Waterways AGENCY... Chicago Sanitary and Ship Canal Dispersal Barriers System. The study is structured as a series of interim reports. Interim Report IIIa, limited to the impacts of implementing additional in- stream...

  20. Interim safety basis for fuel supply shutdown facility

    SciTech Connect

    Brehm, J.R.; Deobald, T.L.; Benecke, M.W.; Remaize, J.A.

    1995-05-23

    This ISB in conjunction with the new TSRs, will provide the required basis for interim operation or restrictions on interim operations and administrative controls for the Facility until a SAR is prepared in accordance with the new requirements. It is concluded that the risk associated with the current operational mode of the Facility, uranium closure, clean up, and transition activities required for permanent closure, are within Risk Acceptance Guidelines. The Facility is classified as a Moderate Hazard Facility because of the potential for an unmitigated fire associated with the uranium storage buildings.

  1. The hazardous waste management system--Environmental Protection Agency. Interim final amendments to interim final and final rules.

    PubMed

    1982-06-24

    The Resource Conservation and Recovery Act (RCRA) requires that EPA set regulatory standards for all facilities which treat, store, or dispose of hazardous waste. In partial implementation of its requirement, on January 23, 1981, EPA set regulatory standards for incinerators that burn hazardous waste. These regulations were issued as "interim final," which means that, although they were issued in final form, the Agency invited public comment on them with a view to future amendment. Today, EPA is amending, on an interim final basis, certain of its regulations applicable to hazardous waste incineration facilities. Today's amendments include revisions to: the general standards for permitting hazardous waste incinerators (Part 264, Subpart O), published in the Federal Register on January 23, 1981; the interim status standards for hazardous waste incinerators (Part 265, Subpart O), revised on January 23, 1981; and the consolidated permit requirements for incinerators (Part 122), published on May 19, 1980 and January 23, 1981.U PMID:10255871

  2. Hazardous waste management program: phase I interim authorization for Nebraska--Environmental Protection Agency, region VII. Phase I interim authorization.

    PubMed

    1982-05-14

    The State of Nebraska has applied for interim authorization of its hazardous waste program under Subtitle C of the Resource Conservation and Recovery Act and EPA guidelines for the approval of State hazardous waste programs [40 CFR Part 123]. EPA has determined that the State's program meets all applicable statutory and regulatory requirements and is granting Phase I interim authorization to Nebraska to operate in its jurisdiction a hazardous waste program in lieu of Phase I of the Federal hazardous waste program. PMID:10255462

  3. 75 FR 984 - Draft Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at CERCLA and RCRA Sites

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-07

    ... AGENCY RIN 2050-ZA05 Draft Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at CERCLA...) developed in the Draft Recommended Interim Preliminary Remediation Goals for Dioxin in Soil at Comprehensive... draft recommended interim PRGs for dioxin in soil. These draft recommended interim PRGs were...

  4. Single-shell tank interim stabilization project plan

    SciTech Connect

    Ross, W.E.

    1998-05-11

    This project plan establishes the management framework for conduct of the TWRS Single-Shell Tank Interim Stabilization completion program. Specifically, this plan defines the mission needs and requirements; technical objectives and approach; organizational structure, roles, responsibilities, and interfaces; and operational methods. This plan serves as the project executional baseline.

  5. 48 CFR 301.603-3 - Interim appointments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Interim appointments. 301.603-3 Section 301.603-3 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL HHS ACQUISITION REGULATION SYSTEM Career Development, Contracting Authority, and Responsibilities...

  6. 48 CFR 301.603-3 - Interim appointments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Interim appointments. 301.603-3 Section 301.603-3 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL HHS ACQUISITION REGULATION SYSTEM Career Development, Contracting Authority, and Responsibilities...

  7. President's Information Technology Advisory Committee Interim Report to the President.

    ERIC Educational Resources Information Center

    National Coordination Office for Information Technology Research and Development, Arlington, VA.

    This document is the Interim Report on future directions for Federal support of research and development in high performance computing, communications, information technology, and the Next Generation Internet. This report provides a more detailed explanation of the findings and recommendations summarized by the President's Information Technology…

  8. 17 CFR 210.10-01 - Interim financial statements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...)(11) of Regulation S-K, (17 CFR 229.601(b)(11)). (3) If, during the most recent interim period... accordance with the provisions of Item 601 of Regulation S-K, 17 CFR 229.601) in the first Form 10-Q after... Form 10-Q (17 CFR 249.308(a)) must be reviewed by an independent public accountant using...

  9. 42 CFR 417.570 - Interim per capita payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Interim per capita payments. 417.570 Section 417.570 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH...

  10. 42 CFR 417.570 - Interim per capita payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Interim per capita payments. 417.570 Section 417.570 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH...

  11. Evaluation of hardness and wear resistance of interim restorative materials

    PubMed Central

    Savabi, Omid; Nejatidanesh, Farahnaz; Fathi, Mohamad Hossein; Navabi, Amir Arsalan; Savabi, Ghazal

    2013-01-01

    Background: The interim restorative materials should have certain mechanical properties to withstand in oral cavity. The aim of this study was to evaluate the hardness and wear resistance of interim restorative materials. Materials and Methods: Fifteen identical rectangular shape specimens with dimensions of 2 mm × 10 mm × 30 mm were made from 7 interim materials (TempSpan, Protemp 3 Garant, Revotek, Unifast LC, Tempron, Duralay, and Acropars). The Vickers hardness and abrasive wear of specimens were tested in dry conditions and after 1 week storage in artificial saliva. The depth of wear was measured using surface roughness inspection device. Data were subjected to Kruskal–Wallis and Mann–Whitney tests. The Pearson correlation coefficient was used to determine the relationship between hardness and wear (α =0.05). Results: TempSpan had the highest hardness. The wear resistance of TempSpan (in dry condition) and Revotek (after conditioning in artificial saliva) was significantly higher (P < 0.05). There was no statistically significant correlation between degree of wear and hardness of the materials (P = 0.281, r = −0.31). Conclusion: Hardness and wear resistance of interim resins are material related rather than category specified. PMID:23946734

  12. 45 CFR 689.8 - Interim administrative actions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....8 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION RESEARCH MISCONDUCT § 689.8 Interim administrative actions. (a) After an inquiry or during an external or... taken to protect Federal resources or to guard against continuation of any suspected or alleged...

  13. 45 CFR 689.8 - Interim administrative actions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....8 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION RESEARCH MISCONDUCT § 689.8 Interim administrative actions. (a) After an inquiry or during an external or... taken to protect Federal resources or to guard against continuation of any suspected or alleged...

  14. Pupil Inquiry Behavior Analysis and Change Activity. Interim Project Report.

    ERIC Educational Resources Information Center

    Manion, Raymond C.

    This interim report discusses progress toward three major goals of the Pupil Inquiry Behavior Analysis and Change Activity: increased pupil inquiry, changed teacher behavior to facilitate pupil inquiry, and the development of a 32-week course of instruction to provide for these behavioral changes. Data currently available deals with the emotional…

  15. 14 CFR 136.41 - Interim operating authority.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Interim operating authority. 136.41 Section 136.41 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR CARRIERS AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS COMMERCIAL AIR TOURS AND NATIONAL PARKS AIR TOUR...

  16. 42 CFR 418.307 - Periodic interim payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... interim payments (PIP) effective with claims received on or after July 1, 1987. Payment is made biweekly under the PIP method unless the hospice requests a longer fixed interval (not to exceed one month... circumstances that are described in § 413.64(g) of this chapter, a hospice that is not receiving PIP may...

  17. 42 CFR 418.307 - Periodic interim payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... interim payments (PIP) effective with claims received on or after July 1, 1987. Payment is made biweekly under the PIP method unless the hospice requests a longer fixed interval (not to exceed one month... circumstances that are described in § 413.64(g) of this chapter, a hospice that is not receiving PIP may...

  18. 42 CFR 418.307 - Periodic interim payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... interim payments (PIP) effective with claims received on or after July 1, 1987. Payment is made biweekly under the PIP method unless the hospice requests a longer fixed interval (not to exceed one month... circumstances that are described in § 413.64(g) of this chapter, a hospice that is not receiving PIP may...

  19. Report of the Michigan Interim Action Committee on Indian Problems.

    ERIC Educational Resources Information Center

    Adams, Doris; And Others

    Stressing the importance of American Indian involvement in affairs affecting Michigan's Indian population, this report by the Interim Action Committee on Indian Problems presents recommendations relative to education, employment, health, and the Commission on Indian Affairs. Recommendations for the commission emphasize: leadership at the local,…

  20. Study of the Voluntary Public School Choice Program. Interim Report

    ERIC Educational Resources Information Center

    Yin, Robert K.; Ahonen, Pirkko; Kim, Dawn

    2007-01-01

    The purpose of the Voluntary Public School Choice (VPSC) Program is to assist states and local school districts in the development of innovative strategies to expand options for students, and to encourage transfers of students from low-performing to higher-performing schools. This report presents interim findings from the National Evaluation of…

  1. 45 CFR 689.8 - Interim administrative actions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RESEARCH MISCONDUCT § 689.8 Interim administrative actions. (a) After an inquiry or during an external or... 2 CFR part 180, and the suspension procedures of 2 CFR part 180 will be followed, but the suspending... taken to protect Federal resources or to guard against continuation of any suspected or alleged...

  2. 45 CFR 689.8 - Interim administrative actions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... RESEARCH MISCONDUCT § 689.8 Interim administrative actions. (a) After an inquiry or during an external or... 2 CFR part 180, and the suspension procedures of 2 CFR part 180 will be followed, but the suspending... taken to protect Federal resources or to guard against continuation of any suspected or alleged...

  3. 45 CFR 689.8 - Interim administrative actions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RESEARCH MISCONDUCT § 689.8 Interim administrative actions. (a) After an inquiry or during an external or... 2 CFR part 180, and the suspension procedures of 2 CFR part 180 will be followed, but the suspending... taken to protect Federal resources or to guard against continuation of any suspected or alleged...

  4. 17 CFR 210.10-01 - Interim financial statements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...)(11) of Regulation S-K, (17 CFR 229.601(b)(11)). (3) If, during the most recent interim period... accordance with the provisions of Item 601 of Regulation S-K, 17 CFR 229.601) in the first Form 10-Q after... Form 10-Q (17 CFR 249.308(a)) must be reviewed by an independent public accountant using...

  5. Engineering Standards. U.S. Metric Study Interim Report.

    ERIC Educational Resources Information Center

    National Bureau of Standards (DOC), Washington, DC.

    This report is the 11th in a series of interim reports stemming from the U.S. Metric Study, which is being conducted by the National Bureau of Standards in accordance with the Metric Study Act of 1968 (Public Law 90-472). Although it mainly concerns the relationships of measurement units to engineering standards, the issue of international…

  6. 7 CFR 280.1 - Interim disaster procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 4 2014-01-01 2014-01-01 false Interim disaster procedures. 280.1 Section 280.1 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM EMERGENCY FOOD ASSISTANCE FOR VICTIMS OF DISASTERS §...

  7. 7 CFR 280.1 - Interim disaster procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 4 2011-01-01 2011-01-01 false Interim disaster procedures. 280.1 Section 280.1 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM EMERGENCY FOOD ASSISTANCE FOR VICTIMS OF DISASTERS §...

  8. 7 CFR 280.1 - Interim disaster procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 4 2012-01-01 2012-01-01 false Interim disaster procedures. 280.1 Section 280.1 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM EMERGENCY FOOD ASSISTANCE FOR VICTIMS OF DISASTERS §...

  9. 7 CFR 280.1 - Interim disaster procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 4 2013-01-01 2013-01-01 false Interim disaster procedures. 280.1 Section 280.1 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM EMERGENCY FOOD ASSISTANCE FOR VICTIMS OF DISASTERS §...

  10. 7 CFR 280.1 - Interim disaster procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Interim disaster procedures. 280.1 Section 280.1 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM EMERGENCY FOOD ASSISTANCE FOR VICTIMS OF DISASTERS §...

  11. 24 CFR 115.202 - Request for interim certification.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Request for interim certification. 115.202 Section 115.202 Housing and Urban Development Regulations Relating to Housing and Urban Development OFFICE OF ASSISTANT SECRETARY FOR EQUAL OPPORTUNITY, DEPARTMENT OF HOUSING AND URBAN...

  12. 24 CFR 115.202 - Request for interim certification.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Request for interim certification. 115.202 Section 115.202 Housing and Urban Development Regulations Relating to Housing and Urban Development OFFICE OF ASSISTANT SECRETARY FOR EQUAL OPPORTUNITY, DEPARTMENT OF HOUSING AND URBAN...

  13. 17 CFR 210.8-03 - Interim financial statements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... management, are necessary in order to make the financial statements not misleading. An affirmative statement... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Interim financial statements... AND CONTENT OF AND REQUIREMENTS FOR FINANCIAL STATEMENTS, SECURITIES ACT OF 1933, SECURITIES...

  14. 48 CFR 301.603-3 - Interim appointments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Interim appointments. 301.603-3 Section 301.603-3 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL HHS ACQUISITION REGULATION SYSTEM Career Development, Contracting Authority, and Responsibilities...

  15. "Intelligent" Computer Assisted Instruction (CAI) Applications. Interim Report.

    ERIC Educational Resources Information Center

    Brown, John Seely; And Others

    Interim work is documented describing efforts to modify computer techniques used to recognize and process English language requests to an instructional simulator. The conversion from a hand-coded to a table driven technique are described in detail. Other modifications to a simulation based computer assisted instruction program to allow a gaming…

  16. Performance Criteria for the Luminous Environment. Interim Report.

    ERIC Educational Resources Information Center

    State Univ. Construction Fund, Albany, NY.

    This interim report informs the eventual user of the direction of the long-term program; specific criteria are not provided. Five current guidelines in lighting practice were disavowed as follows--(1) that low levels of illumination cause organic harm to the eyes, (2) that the footcandle is the best criterion for determining the proper…

  17. 16 CFR 1203.53 - Interim safety standards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies of the standards may be... SAFETY STANDARD FOR BICYCLE HELMETS Requirements For Bicycle Helmets Manufactured From March 17, 1995, Through March 10, 1999 § 1203.53 Interim safety standards. (a) Bicycle helmets must comply with one...

  18. 16 CFR 1203.53 - Interim safety standards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies of the standards may be... SAFETY STANDARD FOR BICYCLE HELMETS Requirements For Bicycle Helmets Manufactured From March 17, 1995, Through March 10, 1999 § 1203.53 Interim safety standards. (a) Bicycle helmets must comply with one...

  19. 16 CFR 1203.53 - Interim safety standards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies of the standards may be... SAFETY STANDARD FOR BICYCLE HELMETS Requirements For Bicycle Helmets Manufactured From March 17, 1995, Through March 10, 1999 § 1203.53 Interim safety standards. (a) Bicycle helmets must comply with one...

  20. 16 CFR 1203.53 - Interim safety standards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. Copies of the standards may be... SAFETY STANDARD FOR BICYCLE HELMETS Requirements For Bicycle Helmets Manufactured From March 17, 1995, Through March 10, 1999 § 1203.53 Interim safety standards. (a) Bicycle helmets must comply with one...

  1. Comprehensive Illinois Occupational Education Demonstration Center. Second Interim Report.

    ERIC Educational Resources Information Center

    Illinois State Board of Vocational Education and Rehabilitation, Springfield. Div. of Vocational and Technical Education.

    The second interim report covers the time period from July 1, 1974 to June 30, 1975, phase two of the project. The document consists of four separate reports: a report summary, reports of the two demonstration centers, and a third party evaluation by Educational Management Services, Inc. The 13-page summary describes the overall project. A 39-page…

  2. Fuel supply shutdown facility interim operational safety requirements

    SciTech Connect

    Besser, R.L.; Brehm, J.R.; Benecke, M.W.; Remaize, J.A.

    1995-05-23

    These Interim Operational Safety Requirements (IOSR) for the Fuel Supply Shutdown (FSS) facility define acceptable conditions, safe boundaries, bases thereof, and management or administrative controls to ensure safe operation. The IOSRs apply to the fuel material storage buildings in various modes (operation, storage, surveillance).

  3. Effectiveness Monitoring Report, MWMF Tritium Phytoremediation Interim Measures.

    SciTech Connect

    Hitchcock, Dan; Blake, John, I.

    2003-02-10

    This report describes and presents the results of monitoring activities during irrigation operations for the calendar year 2001 of the MWMF Interim Measures Tritium Phytoremediation Project. The purpose of this effectiveness monitoring report is to provide the information on instrument performance, analysis of CY2001 measurements, and critical relationships needed to manage irrigation operations, estimate efficiency and validate the water and tritium balance model.

  4. 46 CFR 309.101 - Amendment of interim binders.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Amendment of interim binders. 309.101 Section 309.101 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK... provided therefor, or in substitution for any value appearing in such space, the stated valuation of...

  5. 46 CFR 309.101 - Amendment of interim binders.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Amendment of interim binders. 309.101 Section 309.101 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK... provided therefor, or in substitution for any value appearing in such space, the stated valuation of...

  6. 46 CFR 308.103 - Insured amounts under interim binder.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 308.103 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.103 Insured amounts under interim binder. (a... chapter. (b) Insurance risks. Insurance risks covered by the terms of the standard form of war risk...

  7. 46 CFR 308.103 - Insured amounts under interim binder.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 308.103 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.103 Insured amounts under interim binder. (a... chapter. (b) Insurance risks. Insurance risks covered by the terms of the standard form of war risk...

  8. 46 CFR 309.101 - Amendment of interim binders.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Amendment of interim binders. 309.101 Section 309.101 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK... provided therefor, or in substitution for any value appearing in such space, the stated valuation of...

  9. Interim Evaluation of the National Literacy Program. Final Report

    ERIC Educational Resources Information Center

    Human Resources and Social Development Canada, 2007

    2007-01-01

    The evaluation examined issues related to: (1) Rationale and Relevance; (2) Implementation; and (3) Success. In addition, the interim evaluation was intended to: (1) Determine whether sufficient data was being collected to inform the summative evaluation and identify opportunities for improvement to fill any potential gaps; (2) Assess whether the…

  10. Building an Interim Assessment System: A Workbook for School Districts

    ERIC Educational Resources Information Center

    Crane, Eric W.

    2010-01-01

    As someone with a stake in a school district's systems, a person probably does not have all the answers around what is necessary to build an effective interim assessment system. Neither does this workbook. But it is intended to have the right questions. More precisely, this workbook contains the vision, infrastructure, and resource questions…

  11. Interim Sanitary Landfill Groundwater Monitoring Report (1998 Annual Report)

    SciTech Connect

    Wells, D.

    1999-03-18

    The SRS Interim Sanitary Landfill opened in Mid-1992 and operated until 1998 under Domestic Waste Permit No. 025500-1120. Several contaminants have been detected in the groundwater beneath the unit.The well sampling and analyses were conducted in accordance with Procedure 3Q5, Hydrogeologic Data Collection.

  12. The Bigger Picture: Institutional Perspectives on Interim Assessment Technologies

    ERIC Educational Resources Information Center

    Burch, Patricia

    2010-01-01

    Drawing on a study of new forms of educational privatization, this article examines how ideas from institutional theory can be useful in analyzing the complex dynamics behind interim assessment technologies. The study was based on qualitative research methods and included interviews, a small-scale questionnaire, participant observation, and…

  13. SLIGHTLY IRRADIATED FUEL (SIF) INTERIM DISPOSITION PROJECT

    SciTech Connect

    NORTON SH

    2010-02-23

    CH2M HILL Plateau Remediation Company (CH2M HILL PRC) is proud to submit the Slightly Irradiated Fuel (SIF) Interim Disposition Project for consideration by the Project Management Institute as Project of the Year for 2010. The SIF Project was a set of six interrelated sub-projects that delivered unique stand-alone outcomes, which, when integrated, provided a comprehensive and compliant system for storing high risk special nuclear materials. The scope of the six sub-projects included the design, construction, testing, and turnover of the facilities and equipment, which would provide safe, secure, and compliant Special Nuclear Material (SNM) storage capabilities for the SIF material. The project encompassed a broad range of activities, including the following: Five buildings/structures removed, relocated, or built; Two buildings renovated; Structural barriers, fencing, and heavy gates installed; New roadways and parking lots built; Multiple detection and assessment systems installed; New and expanded communication systems developed; Multimedia recording devices added; and A new control room to monitor all materials and systems built. Project challenges were numerous and included the following: An aggressive 17-month schedule to support the high-profile Plutonium Finishing Plant (PFP) decommissioning; Company/contractor changeovers that affected each and every project team member; Project requirements that continually evolved during design and construction due to the performance- and outcome-based nature ofthe security objectives; and Restrictions imposed on all communications due to the sensitive nature of the projects In spite of the significant challenges, the project was delivered on schedule and $2 million under budget, which became a special source of pride that bonded the team. For years, the SIF had been stored at the central Hanford PFP. Because of the weapons-grade piutonium produced and stored there, the PFP had some of the tightest security on the Hanford

  14. Metabolic surgery: quo vadis?

    PubMed

    Ramos-Leví, Ana M; Rubio Herrera, Miguel A

    2014-01-01

    The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed. PMID:23911576

  15. [Single Port Thoracic Surgery and Reduced Port Thoracic Surgery].

    PubMed

    Onodera, Ken; Noda, Masafumi

    2016-07-01

    Single port thoracic surgery, reduced port surgery and needlescopic surgery attract attention as one of the minimally invasive surgery in thoracic surgery recently. Single port thoracic surgery was advocated by Rocco in 2004, it was reported usefulness of single port thoracic surgery for primary spontaneous pneumothorax. The surgical procedure as single (or reduced) port thoracic surgery is roughly divided into the following. One is operated with instruments inserted from the single extended incision, and the other is operated with instruments punctured without extending incision. It is not generally complicated procedures in single port thoracic surgery. Primary spontaneous pneumothorax and biopsy for lung and pleura are considered the surgical indication for single (or reduced) port surgery. It is revealed that single port surgery for primary spontaneous pneumothorax is less invasive than conventional surgery. Single port and reduced port thoracic surgery will spread furthermore in the future. PMID:27440029

  16. 50 CFR 259.30 - Application for Interim Capital Construction Fund Agreement (“Interim CCF Agreement”).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... for hire must be inspected and certified (under 46 CFR part 176) by the U.S. Coast Guard as qualified... Construction Fund Agreement (âInterim CCF Agreementâ). 259.30 Section 259.30 Wildlife and Fisheries NATIONAL... FISHERIES CAPITAL CONSTRUCTION FUND Capital Construction Fund Agreement § 259.30 Application for...

  17. 50 CFR 259.30 - Application for Interim Capital Construction Fund Agreement (“Interim CCF Agreement”).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... for hire must be inspected and certified (under 46 CFR part 176) by the U.S. Coast Guard as qualified... Construction Fund Agreement (âInterim CCF Agreementâ). 259.30 Section 259.30 Wildlife and Fisheries NATIONAL... FISHERIES CAPITAL CONSTRUCTION FUND Capital Construction Fund Agreement § 259.30 Application for...

  18. 50 CFR 259.30 - Application for Interim Capital Construction Fund Agreement (“Interim CCF Agreement”).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... for hire must be inspected and certified (under 46 CFR part 176) by the U.S. Coast Guard as qualified... Construction Fund Agreement (âInterim CCF Agreementâ). 259.30 Section 259.30 Wildlife and Fisheries NATIONAL... FISHERIES CAPITAL CONSTRUCTION FUND Capital Construction Fund Agreement § 259.30 Application for...

  19. Lung surgery - discharge

    MedlinePlus

    Thoracotomy - discharge; Lung tissue removal - discharge; Pneumonectomy - discharge; Lobectomy - discharge; Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge; Thoracoscopy - discharge

  20. Lung surgery - discharge

    MedlinePlus

    Thoracotomy - discharge; Lung tissue removal - discharge; Pneumonectomy - discharge; Lobectomy - discharge; Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - ...

  1. Complications of Strabismus Surgery

    PubMed Central

    Olitsky, Scott E.; Coats, David K.

    2015-01-01

    All surgeries carry risks of complications, and there is no way to avoid ever having a complication. Strabismus surgery is no different in this regard. There are methods to reduce the risk of a complication during or after surgery, and these steps should always be taken. When a complication occurs, it is important to first recognize it and then manage it appropriately to allow for the best outcome possible. This article will discuss some of the more common and/or most devastating complications that can occur during or after strabismus surgery as well as thoughts on how to avoid them and manage them should they happen. PMID:26180463

  2. Hyperoxaluria and Bariatric Surgery

    NASA Astrophysics Data System (ADS)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  3. Interim user's manual for the Advanced Scavenging Module Version 1. 2. Interim report

    SciTech Connect

    Hales, J.M.

    1985-03-01

    This report provides a user's manual for Version 1.2 of the Advanced Scavenging Module (ASM). It is an interim code and is intended primarily for coordinating development of the module with that of the evolving NCAR Regional Acid Deposition Model (RADM). The ASM is currently in an evolutionary stage; the general framework provided by Version 1.2 is sufficiently well-established to provide the basis for future versions. The code supplied with this manual is a complete, operational system, and was tested. The ASM is activated by two types of subroutine calls from the host code. Upon advancing to some ground-level position (x,y) on the host's numerical computation grid, the ASM is interrogated (using the first subroutine call) to produce the vertical distributions of storm features above that point. Following this, scavenging computations are performed repeatedly for each vertical grid position, using the second subroutine call. The primary outputs from these secondary ASM interrogations are the transformation rates associated with the physical and chemical components of the scavenging process. These rates are returned to the host code and incorporated with its normal numerical integration procedure.

  4. Interim assessment of the VAL automated guideway transit system. Interim report

    SciTech Connect

    Anagnostopoulos, G.

    1981-11-01

    This report describes an interim assessment of the VAL (Vehicules Automatiques Legers or Light Automated Vehicle) AGT system which is currently under construction in Lille, France, and which is to become fully operational in December 1983. This report contains a technical description and performance data resulting from a demonstration test program performed concurrently in August 1980. VAL is the first driverless AGT urban system application in France. The system operates at grade, elevated, and in tunnels on an exclusive concrete dual-lane guideway that is 12.7 kilometers long. The configuration of the system is a push-pull loop operating between 17 on-line stations. The system is designed to provide scheduled operation at 60-second headways and a normal one-way capacity of 7440 passengers per hour per direction with 55 percent of the passengers seated. Two pneumatic-tired vehicles are coupled into a single vehicle capable of carrying 124 passengers at line speeds of 60 km/hr. During the course of the demonstration test program, VAL demonstrated that it could achieve high levels of dependability and availability and could perform safely under all perceivable conditions.

  5. Surgery for malignant gliomas: mechanistic reasoning and slippery statistics.

    PubMed

    Mitchell, Patrick; Ellison, David W; Mendelow, A David

    2005-07-01

    Current surgical treatment of malignant gliomas largely depends on mechanistic reasoning and data collected in non-randomised studies. Technological advance has enabled more accurate resection of tumours and preservation of eloquent brain areas but ethical considerations have restricted randomised trials on the efficacy of surgery to one small trial that found a 3 month survival advantage for patients over age 65 years who received surgery and interim analysis of a larger trial. There is an argument for surgery as a palliative measure in patients with symptoms caused by mechanisms that are surgically remediable. Whether there is any survival advantage from surgery in patients other than those with immediately life-threatening, surgically remediable complications, such as raised intracranial pressure, is unclear. The available data show that if such an advantage does exist, it is modest at best. Adjuvant treatments given surgically are being studied. Chemotherapy wafers are the most prominent of the adjuvant treatments but the evidence available is insufficient to recommend their use in routine practice. In this review we examine the prevailing mechanistic model and observational data; we assess how these are applied and the priorities they indicate for future research. PMID:15963444

  6. Verification of the new ECMWF ERA-Interim reanalysis over France

    NASA Astrophysics Data System (ADS)

    Szczypta, C.; Calvet, J.-C.; Albergel, C.; Balsamo, G.; Boussetta, S.; Carrer, D.; Lafont, S.; Meurey, C.

    2011-02-01

    An evaluation of the global ECMWF atmospheric reanalysis ERA-Interim (with a 0.5° grid) is performed over France, based on the high resolution (8 km) SAFRAN atmospheric reanalysis. The ERA-Interim precipitation, Incoming Solar Radiation (ISR), air temperature, air humidity, and wind speed, are compared with their SAFRAN counterparts. Also, interpolated in situ ISR observations are used in order to consolidate the evaluation of this variable. The daily precipitation estimates produced by ERA-Interim over France correlate very well with SAFRAN. However, the values are underestimated by 27%. A GPCP-corrected version of ERA-Interim is less biased (13%). The ERA-Interim estimates of ISR correlate very well with SAFRAN and with in situ observations on a daily basis. Whereas SAFRAN underestimates the ISR by 6 Wm-2, ERA-Interim overestimates the ISR by 10 Wm-2. In order to assess the impact of the ERA-Interim errors, simulations of the ISBA-A-gs land surface model are performed over the SMOSREX grassland site in southwestern France using ERA-Interim (with and without GPCP rescaling) and SAFRAN. Latent and sensible heat fluxes are simulated, together with carbon dioxide fluxes. The rescaled ERA-Interim performs better than the original ERA-Interim and permits to achieve flux scores similar to those obtained with SAFRAN.

  7. Verification of the new ECMWF ERA-Interim reanalysis over France

    NASA Astrophysics Data System (ADS)

    Szczypta, C.; Calvet, J.-C.; Albergel, C.; Balsamo, G.; Boussetta, S.; Carrer, D.; Lafont, S.; Meurey, C.

    2010-09-01

    An evaluation of the global ECMWF atmospheric reanalysis ERA-Interim (with a 0.5° grid) is performed over France, based on the high resolution (8 km) SAFRAN atmospheric reanalysis. The ERA-Interim precipitation, Incoming Solar Radiation (ISR), air temperature, air humidity, and wind speed, are compared with their SAFRAN counterparts. Also, interpolated in situ ISR observations are used in order to consolidate the evaluation of this variable. The daily precipitation estimates produced by ERA-Interim over France correlate very well with SAFRAN. However, the values are underestimated by 26%. A GPCP-corrected version of ERA-Interim is less biased (10-15%). The ERA-Interim estimates of ISR correlate very well with SAFRAN and with in situ observations on a daily basis. Whereas SAFRAN underestimates the ISR by 6-8 W m-2, ERA-Interim overestimates the ISR by 9-10 W m-2. In order to assess the impact of the ERA-Interim errors, simulations of the ISBA-A-gs land surface model are performed over the SMOSREX grassland site in southwestern France using ERA-Interim (with and without GPCP rescaling) and SAFRAN. Latent and sensible heat fluxes are simulated, together with carbon dioxide fluxes. The rescaled ERA-Interim performs better than the original ERA-Interim and permits to achieve flux scores similar to those obtained with SAFRAN.

  8. Hemostasis in Laryngeal Surgery.

    PubMed

    Athanasiadis, Theodore; Allen, Jacqui

    2016-06-01

    The larynx is a highly vascularized organ supplied by the superior and inferior laryngeal arteries. Both microphonosurgery and external laryngeal surgery require excellent hemostasis. Topical agents including adrenalin and fibrin-based products as well as surgical instrumentation, such as coagulation devices or in some cases embolization, are in the surgeon's armamentarium and facilitate efficient and successful surgery. PMID:27267020

  9. Preparing for Surgery

    MedlinePlus

    ... ray, and an electrocardiogram. An electrocardiogram is a test of heart function with an instrument that prints out the results as a graph. What preparation may be necessary before surgery? Depending on the type of surgery, your health care provider may want you to use a laxative ...

  10. Advances in fetal surgery

    PubMed Central

    Pedreira, Denise Araujo Lapa

    2016-01-01

    ABSTRACT This paper discusses the main advances in fetal surgical therapy aiming to inform health care professionals about the state-of-the-art techniques and future challenges in this field. We discuss the necessary steps of technical evolution from the initial open fetal surgery approach until the development of minimally invasive techniques of fetal endoscopic surgery (fetoscopy). PMID:27074241

  11. Lasik eye surgery - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100206.htm Lasik eye surgery - series To use the sharing features ... A.M. Editorial team. Related MedlinePlus Health Topics Laser Eye Surgery A.D.A.M., Inc. is accredited by ...

  12. [Robotic surgery in gynecology].

    PubMed

    Csorba, Roland

    2012-06-24

    Minimally invasive surgery has revolutionized gynecological interventions over the past 30 years. The introduction of the da Vinci robotic surgery in 2005 has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. It can be utilized mainly in general gynecology and reproductive gynecology. The robot is being increasingly used for procedures such as hysterectomy, myomectomy, adnexal surgery, and tubal anastomosis. In urogynecology, the robot is being utilized for sacrocolopexy as well. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomy and lymphadenectomy in oncologic diseases. Despite the rapid and widespread adaption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. This article presents the development, technical aspects and indications of robotic surgery in gynecology, based on the previously published reviews. Robotic surgery can be highly advantageous with the right amount of training, along with appropriate patient selection. Patients will have less blood loss, less post-operative pain, faster recovery, and fewer complications compared to open surgery and laparoscopy. However, until larger randomized control trials are completed which report long-term outcomes, robotic surgery cannot be stated to have priority over other surgical methods. PMID:22714030

  13. What Is Heart Surgery?

    MedlinePlus

    ... Links Related Topics Aneurysm Coronary Artery Bypass Grafting Heart Transplant Pacemakers Ventricular Assist Device Send a link to NHLBI to someone by E-MAIL | PRINT | SHARE this page from the ... Is Heart Surgery? Heart surgery is done to correct problems ...

  14. Weight Loss Surgery

    MedlinePlus

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight through diet and exercise or have serious health problems caused by obesity. There are different types of weight loss surgery. They often limit the ...

  15. Plastic Surgery for Ethnic Patients

    MedlinePlus

    ... Briefing Papers > Plastic Surgery for Ethnic Patients Briefing Paper: Plastic Surgery for Ethnic Patients More than 3. ... 2067-2071. Share Related Links Plastic Surgery Briefing Papers Menu Cosmetic Reconstructive Patient Safety Before & After Find ...

  16. Limited-Access Heart Surgery

    MedlinePlus

    ... not have to be split open. What is robotic-assisted heart surgery? In yet another kind of ... perform videoscopic surgery with even greater precision. In robotic-assisted surgery, surgeons make several small incisions in ...

  17. Using your shoulder after surgery

    MedlinePlus

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... You had surgery on your shoulder to repair a muscle, tendon, or cartilage tear. The surgeon may have removed damaged tissue. You will need to know how ...

  18. Preparing for Breast Reconstruction Surgery

    MedlinePlus

    ... after breast reconstruction surgery Preparing for breast reconstruction surgery Your surgeon can help you know what to ... The plan for follow-up Costs Understanding your surgery costs Health insurance policies often cover most or ...

  19. Heart failure - surgeries and devices

    MedlinePlus

    ... surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist ... is weakened, gets too large, and does not pump blood very well, you are at high risk ...

  20. Cleft Lip and Palate Surgery

    MedlinePlus

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery ... to correct a physical defect caused by a cleft lip or cleft palate, which occur once in every ...