To evaluate efficacy of helical tomotherapy (HT) for treatment of breast cancer with internal mammary lymph node involvement.

This is a retrospective clinical audit of planning, dosimetry, toxicity and short-term survival of a cohort of 65 patients. Patients were treated between November 2014 and May 2019. The primary and nodal region was prescribed a dose of 50 Gray (Gy) in 25 fractions, while all cases of breast conserving surgery received a simultaneous integrated boost to a dose of 61 Gy in 25 fractions.

The 95% coverage for the primary, supraclavicular, internal mammary node and tumour bed was 93·4%, 96·8%, 90·7% and 98·3%, respectively. Mean dose to total lung, heart and contra-lateral breast was 10·6 Gy, 6·92 Gy and 4·32 Gy, respectively. None developed grade III skin or oesophageal toxicity. Twenty-one patients had progression; of which eighteen developed only distant failure while three also had loco-regional recurrence. At a median follow-up of 36 months, the 3-year loco-regional control, disease-free survival and overall survival were 93·5, 73·9 and 85·9%, respectively.

We report encouraging clinical outcome for patients treated uniformly with HT. The predominant pattern of failure was distant metastases which suggests the need for systemic control intensification.

Therapeutic radiographers are an essential part of a cancer patient’s journey and play a vital and changing role in the delivery of radiotherapy services. This retrospective audit highlights the number of incidental abnormalities found by a Breast Advanced Practitioner on radiotherapy computed tomography (CT) planning scans and their subsequent management.

This retrospective audit investigated the incidental abnormalities found by the Breast Advanced Practitioner on routine CT planning scans for breast cancer patients 2016–2021. Any breast cancer patient found to have an abnormality had their planning scan uploaded to the national picture archiving and communication systems (PACS) system for radiology review. Further formal CT imaging was requested or direct referral to an appropriate multi-disciplinary team meeting.

Sixty-three significant abnormalities were found over the five-year period, of these thirty seven were malignant and the majority of these were lung lesions. Seven patients went on to have surgery alone, surgery plus chemoradiation or stereotactic ablative radiotherapy for their newly diagnosed lung primaries. Five patients were found to have liver metastases that unfortunately changed their treatment plan to palliative.

This retrospective audit has demonstrated that CT planning for radiotherapy offers an opportunity to identify malignant abnormalities at a potentially early stage, thereby improving prognosis and survival. Radiographers have a duty of care to appraise these CT scans to ensure any abnormalities can be addressed in a timely manner.

Sexual self-concept has an influence on the sexual behaviors of women with breast cancer. Supportive programs for these women have demonstrable empirical efficacy; however, their effectiveness has not been examined. The aim of this study was to investigate the effect of a supportive program based on social networks on the sexual self-concept of women with breast cancer.

In this randomized controlled single-blind trial, 60 women were assigned to the intervention (n = 30) and control (n = 30) groups using permuted block randomization. Overall, eight 45-min intervention sessions were held (twice a week). The primary outcome was sexual self-concept, and the secondary outcomes were women's sexual quality of life and participants’ satisfaction. The questionnaires were completed by patients before the intervention and immediately and 1 month after the intervention.

The generalized equation estimation test showed that the positive sexual self-concept score of the intervention group versus the control group had increased by 15.67 points (P < 0.001, effect size = 2.00) 1 month after the intervention. The negative sexual self-concept score had decreased by 2.65 points (P < 0.001, effect size = 0.74), and the situational sexual self-concept score had upturned by 6.82 points (P < 0.001, effect size = 2.08) in the intervention group at the same period. Also, the sexual quality of life score in the intervention group compared to the control group generally increased by 13.82 points (P < 0.001, Effect size = 2.08) 1 month following the intervention.

A social networking support program can be a promising approach to improve the sexual self-concept of women with breast cancer.

Iranian Clinical Trial Register, IRCT20150608022609N8. Registered on 2 July 2020.

During the SARS-CoV-2 virus pandemic, University Hospital Birmingham NHS Trust Oncology Department incorporated the ultrahypofractionated regime of 26Gy/5 fractions alongside the moderate hypofractionated regime of 40Gy/15 fractions as part of local adjuvant breast radiotherapy treatment (RT) for eligible patients. We conducted a local study to assess the real-life experience of patients undergoing ultrahypofractionated schedule to compare feasibility and toxicity to the fast-forward trial during the COVID − 19 pandemic.

A single institution, retrospective, qualitative study. Patients included had early-stage breast cancer and received adjuvant radiotherapy between 23 March 2020 and 31 May 2020, a total of 211 patients. Inclusion was irrespective of any other neoadjuvant/adjuvant treatments. Data were collected retrospectively for treatment dose, boost dose and toxicity.

Of the total 211 patients, 85 were treated with 26Gy in 5# and 19 patients received a boost as per the fast-forward protocol. Of these 85 patients, 15·9% did not report any skin toxicity post-treatment. 63·5% of patients reported RTOG Grade 1, 15·9% had RTOG Grade 2, and 1·6% reported RTOG Grade 3 skin toxicity. 3·2% of the patients could not be contacted for follow-up. Of the 19 patients who received a breast boost, 10·53% reported no skin changes. 78·9% reported Grade 1 skin toxicity. Both Grades 2a and 2b skin toxicity were reported by 5·26% each. The patient demographics and tumour characteristics in our study cohort were comparable to those within the fast-forward trial. In terms of post-RT skin toxicity, fewer patients reported any toxicity in the UHB patient cohort versus those in the trial, and the number of Grade 2/3 toxicities reported was also low. A delay in toxicity reporting from 2 weeks for 40Gy/15 to 3 weeks for 26Gy/5 was observed.

Our study concluded that offering ultrahypofractionation was convenient for patients; reducing the number of hospital visits during the SARS-CoV-2 virus pandemic appeared safe in terms of acute post-RT-related skin toxicity. The reduced hospital visits limited exposure of patients and staff to the SARS-CoV-2 virus while also ensuring efficient use of Radiotherapy Department resources. Local follow-up protocols have been amended to ensure review at 3 weeks for the 26Gy/5 schedule to acknowledge the delay in acute toxicity development. To date, there is only 5-year toxicity and relapse data available from the fast-forward trial; therefore, hypofractionation schedules should be offered to patients as long as they fulfil the criteria and understand the limitations of the study as well as accelerated peer review processes in the face of the pandemic.

This study compares three different hybrid plans, for left-sided chest wall (CW) and nodal stations irradiation using a hypofractionated dose regimen.

Planning target volumes (PTVs) of 25 breast cancer patients that included CW, supraclavicular (SCL) and internal mammary node (IMN) were planned with 3 different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT and IMRT+VMAT. All hybrid plans were generated with a hypofractionated dose prescription of 40·5 Gy in 15 fractions. Seventy per cent of the dose was planned with the base-dose component and remaining 30% of the dose was planned with the hybrid component. All plans were evaluated based on the PTVs and organs at risk (OARs) dosimetric parameters.

The results for PTVs parameters have shown that the 3DCRT+IMRT and 3DCRT+VMAT plans were superior in uniformity index to the IMRT+VMAT plan. The OARs dose parameters were comparable between hybrid plans. The IMRT+VMAT plan provided a larger low dose volume spread to the heart and ipsilateral lung (p < 0·001). The 3DCRT+VMAT plan required less monitor units and treatment time (p = 0·005) than other plans.

The 3DCRT+VMAT hybrid plan showed superior results with efficient treatment delivery and provide clinical benefit by reducing both low and high dose levels.

Few studies claimed that dynamic jaw (DJ) mode in Helical TomoTherapy® (HT) could improve the cranio-caudal dose distribution without prolonging the treatment time in treating different types of cancer. Also, studies suggested that DJ with a wider 5 cm field width (FW) could replace fixed jaws (FJ) with 2.5 cm FW to reduce the delivery time with the sustainable plan quality. Yet, the study on breast cancer with supraclavicular fossa (SCF) nodal involvement using DJ mode in HT is limited. This study aims to evaluate the DJ mode retrospectively by comparing their dosimetric quality with normal tissue complication probability (NTCP) of organs at risk and treatment delivery time with FJ mode on treating left-side breast with SCF nodal involvement.

All post-mastectomy patients, who had been irradiated for left-side breast with SCF nodal involvement were selected retrospectively in this study. With the same dose constraint and prescription as the treated DJ2.5 plan, two extra plans using DJ mode with 5 cm FW(DJ5.0) and FJ mode with 2.5 cm FW (FJ2.5) were computed for plan comparison.

No statistical significance was found in all the parameters of PTV and OARs, except for V20 of whole lung. DJ5.0 received V20 in ipsilateral left lung than FJ2.5 and DJ2.5. However, the average delivery time of DJ5.0 was significantly lower than that of DJ2.5 and FJ2.5 by almost 40%.

No statistical significance was found in those dosimetric and radiobiological parameters among three modes while the delivery time has greatly reduced by using DJ5.0. A shorter treatment time can minimise intra-fractional error and better the patient’s experience during treatment.

Previous studies on the association between glycaemic index (GI) and glycaemic load (GL) in relation to breast cancer risk are contradictory. The aim of this study was to examine the association between dietary GI and GL and risk of breast cancer in Iranian women.

Population-based case–control study. Dietary GI and GL were assessed using a validated Willett-format 106-item semi-quantitative FFQ.

Isfahan, Iran.

Cases were 350 patients with newly diagnosed stage I–IV breast cancer, for whom the status of breast cancer was confirmed by physical examination and mammography. Controls were 700 age-matched apparently healthy individuals who were randomly selected from general population.

After controlling for potential confounders, individuals in the highest tertile of dietary GI had 47 % higher odds of breast cancer than women in the lowest tertile (OR: 1·47; (95 % CI 1·02, 2·12)). Stratified analysis by menopausal status showed such association among postmenopausal women (OR: 1·51; (95 % CI 1·02, 2·23)). We found no significant association between dietary GL and odds of breast cancer either before (OR: 1·35; (95 % CI 0·99, 1·84)) or after adjustment for potential confounders (OR: 1·24; (95 % CI 0·86, 1·79)). In addition, stratified analysis by menopausal status revealed no significant association between dietary GL and odds of breast cancer.

Our findings showed a significant positive association between dietary GI and odds of breast cancer. However, we observed no significant association between dietary GL and odds of breast cancer.

This follow-up study on perceived self-image and psychophysical distress/psychic symptoms was based on a ranomized contolled study of art therapy on women with breast cancer.

The aim was to examine the long-term effects of time-limited art therapy using the instruments of Structural Analysis of Social Behavior (SASB) and Symptom Check List-90 (SCL-90).

Three attachment clusters of the SASB showed significant changes post therapy: Autonomous self (cluster 1), Accepting self (cluster 2), and Loving self (cluster 3). Clusters 2 and 3 continued to change in favor of the intervention group at the 5-year follow-up. There were no significant differences in the SCL-90 results between the intervention group and the control group in the follow-up study.

The art therapy intervention was both therapeutic and psycho-educative. The conclusion of this study is that approaching emotions through time-limited art therapy seems to have a long-lasting effect on the attachment behavioral system shown in the SASB model post intervention, and this effect remained 5 years later.

To explore whether emotional expressivity and the patterns of language use could predict benefits from expressive writing (EW) of breast cancer (BC) patients in a culture that strongly discourages emotional disclosure.

Data were obtained from a recent trial in which we compared the health outcomes between a prolonged EW group (12 sessions) and a standard EW group (four sessions) (n = 56 per group) of BC patients receiving chemotherapy. The Chinese texts were tokenized using the THU Lexical Analyser for Chinese. Then, LIWC2015 was used to quantify positive and negative affect word use.

Our first hypothesis that BC patients with higher levels of emotional expressivity tended to use higher levels of positive and negative affect words in texts was not supported (r = 0.067, p = 0.549 and r = 0.065, p = 0.559, respectively). The level of emotional expressivity has a significant effect on the quality of life (QOL), and those who used more positive or fewer negative affective words in texts had a better QOL (all p < 0.05). However, no significant difference was identified in physical and psychological well-being (all p > 0.05). Furthermore, the patterns of affective word use during EW did not mediate the effects of emotional expressivity on health outcomes (all p > 0.05).

Our findings suggest that the level of emotional expressivity and the pattern of affective word use could be factors that may moderate the effects of EW on QOL, which may help clinicians identify the individuals most likely to benefit from such writing exercises in China.

To evaluate the prevalence and risk factors of arm lymphedema in patients with breast cancer.

Between 2006 and 2017, we investigated patients with breast cancer after breast surgery who received adjuvant radiotherapy at the breast or chest wall, and/or adjuvant radiotherapy at regional lymph nodes, and standard systemic chemotherapy depending on disease stage and risk factors. We assessed arm lymphedema using arm circumference measurement differences on the treated side compared with the opposite arm (≥2 cm measurements at any one position). Associations between arm lymphedema and potential risk factors were identified using statistical analysis.

In 308 patients, arm lymphedema prevalence was 6·2%. Patients having ≥20 lymph nodes removed (hazard ratio (HR) = 3·29; 95% confidence interval (CI): 1·12–8·87), undergoing regional lymph node irradiation (HR = 1·81; 95% CI: 1·09–13·28), and no arm and shoulder exercises after treatment (HR = 3·16; 95% CI: 1·89–5·26) had a higher risk of arm lymphedema.

Arm lymphedema is a serious breast cancer complication and is a preventable morbidity. Planning arm and shoulder exercises in line with adjuvant treatments and increasing clinical awareness of early indications could help lower the risk of occurrence.

Breast cancer is a serious threat to people’s health. In addition to negative psychological disorders including depression, anxiety, and post-traumatic stress symptoms, positive changes such as post-traumatic growth (PTG) can be experienced.

The aim of this systematic review was to determine the variables related to PTG in people with breast cancer.

We searched five database (SCOPUS, Cochrane, Medline, Science Direct, and Pubmed) starting from 1990, by guidance of PRISMA criteria, using the keywords “breast cancer”, “post traumatic growth”, “stress related growth”, and “benefit finding”.

There were conflicting findings regarding the relationship between PTG and following variables: sociodemographic variables such as age, education level, marital status, disease-related variables such as cancer stage, time since diagnosis, type of treatment. We observed that these variables may have a low effect on PTG. In addition, personality characteristics such as optimism, spirituality, and hope were found to be associated with PTG. Functional or problem-focused coping such as positive restructuring, acceptance, and religious coping, and ruminative thoughts predict PTG as a part of cognitive processing. Besides, social support has an important role in experiencing PTG.

Psychosocial interventions for cancer patients are increasing day by day, but the scarcity of interventions which aims increase PTG is noteworthy. With this review, we recommend developing intervention programs that include functional coping strategies such as stress management, social skills training, cognitive techniques focused on ruminative thoughts, and positive restructuring.

No significant relationships.

Breast cancer (BC) is one of the leading causes of cancer death worldwide. The problem of mental health and quality of life of patients is currently particularly relevant. Most patients with breast cancer in the process of adapting to the disease experience certain mental disorders: depressive, anxiety-phobic and psychosomatic disorders.

To study the severity of anxiety-depressive disorders in the clinical picture in patients with breast cancer and evaluate the effectiveness of specialized pharmacotherapy using antidepressants in combination with antitumor therapy.

The study included 30 patients with a first established diagnosis of breast cancer and 52 patients with a follow-up history of 3-17 years. The main method of work was the clinical, psychopathological, and statistical research methods (a method using contingency tables and the Fechner coefficient, a method - Chi-square test).

To assess the severity in the clinical picture of anxiety-depressive tendencies and the effectiveness of treatment, special scales were used: hospital scale of anxiety and depression (HADS); general clinical impression scale (CGI) for assessing disease severity (CGI-S “severity”) and improvement (CGI-I “improvement”). High antidepressant therapy efficacy indicators were obtained in combination with benzodiazepine drugs and hypnotics in a group of patients with anxiety-depressive nosogenia (15 patients, 88% of respondents with reduction in starting anxiety and depression scores HADS more than 50%, CGI 85%), in the group with chronic hypochondriac dysthymia and cyclotymic endoform depression.

The data obtained in the study confirm the effectiveness of psychopharmacotherapy with antidepressants in breast cancer patients with identified disorders of the anxiety-depressive spectrum.

No significant relationships.

It has long been hypothesized that personality plays a causative role in incidence and outcome of breast cancer (BC), but epidemiological evidence of association between personality and BC is inconsistent.

We used two-sample Mendelian randomization analysis to estimate the impact of personality on the risk and survival of BC. In total, 109 single nucleotide polymorphisms (SNPs) were utilized as instruments of neuroticism from a large-scale Genome-Wide Association Studies (GWAS), and five SNPs were utilized as instruments of extraversion from Genetic of Personality Consortium and 23andMe. Genetic association with the risk and survival of overall and individual subtype BC were obtained from the Breast Cancer Association Consortium.

Neuroticism is significantly associated with the risk of overall BC [odds ratio (OR) 1.06; 95% confidence interval (CI) 1.01–1.11; p = 0.015] and the risk of luminal A BC (OR 1.09; 95% CI 1.03–1.16; p = 0.004). Extraversion is not associated with the risk of BC. None of neuroticism or extraversion is associated with the survival of BC.

Neuroticism was associated with a modest increased risk of BC and particularly luminal A BC.