In a context of maximum autonomy, the great majority of the women chose IBR. The patients' choices were explained mainly by their psychosocial characteristics. The indication for BR should be properly discussed between patients and surgeons before mastectomy.

This study shows the great physical burden often associated with tamoxifen treatment and brings to light women's own complex representations of the treatment and their interpretation of the side-effects. Better communication between health-care providers and patients should ultimately help to prevent refusal or discontinuation of tamoxifen treatment.

The objective is to prospectively determine the factors responsible for reconstruction failure and capsular contracture in mastectomized breast cancer patients who underwent immediate two-stage breast reconstruction with a tissue expander and implant, followed by radiotherapy. This is a multicenter, prospective, non-randomized study. Between February 1998 and September 2006, we prospectively examined 141 consecutive patients, each of which received an implant after mastectomy, followed by chest wall radiotherapy at 46-50 Gy in 23-25 fractions. Radiotherapy was delivered during immediate post-mastectomy reconstruction. Patients were evaluated by both a radiation oncologist and a surgeon 24-36 months after treatment. The median follow-up duration was 37 months. According to Baker's classification, capsular contracture was grade 0, 1, or 2 in 67.5% of cases; it was grade 3 or 4 in 32.5% of cases. In total, 32 breast reconstruction failures required surgery. In univariate analysis, the following factors were associated with Baker grade 3 and 4 capsular contraction: adjuvant hormone therapy (P = 0.02), the surgeon (P = 0.04), and smoking (P = 0.05). Only one factor was significant in multivariate analysis: the surgeon (P = 0.009). Three factors were associated with immediate post-mastectomy breast reconstruction failure in multiple logistic regression analysis: T3 or T4 tumors (P = 0.0005), smoking (P = 0.001), and pN? axillary status (P = 0.004). Patients with none, 1, 2, or all 3 factors have a probability of failure equal to 7, 15.7, 48.3, and 100%, respectively (P = 3.6 9 10 -6 ). The model accurately predicts 80% of failures. Mastectomy, immediate reconstruction (expander followed by implant), and radiotherapy should be considered when conservative surgery is contraindicated. Three factors may be used to select patients likely to benefit from this technique with a low failure rate.

Purpose Small field dosimetry for radiotherapy is one of the major challenges due to the size of most dosimeters, for example, sufficient spatial resolution, accurate dose distribution and energy dependency of the detector. In this context, the purpose of this research is to develop a small size scintillating detector targeting small field dosimetry and compare its performance with other commercial detectors. Method An inorganic scintillator detector (ISD) of about 200 µm outer diameter was developed and tested through different small field dosimetric characterizations under high‐energy photons (6 and 15 MV) delivered by an Elekta Linear Accelerator (LINAC). Percentage depth dose (PDD) and beam profile measurements were compared using dosimeters from PTW namely, microdiamond and PinPoint three‐dimensional (PP3D) detector. A background fiber method has been considered to quantitate and eliminate the minimal Cerenkov effect from the total optical signal magnitude. Measurements were performed inside a water phantom under IAEA Technical Reports Series recommendations (IAEA TRS 381 and TRS 483). Results Small fields ranging from 3 × 3 cm2, down to 0.5 × 0.5 cm2 were sequentially measured using the ISD and commercial dosimeters, and a good agreement was obtained among all measurements. The result also shows that, scintillating detector has good repeatability and reproducibility of the output signal with maximum deviation of 0.26% and 0.5% respectively. The Full Width Half Maximum (FWHM) was measured 0.55 cm for the smallest available square size field of 0.5 × 0.5 cm2, where the discrepancy of 0.05 cm is due to the scattering effects inside the water and convolution effect between field and detector geometries. Percentage depth dose factor dependence variation with water depth exhibits nearly the same behavior for all tested detectors. The ISD allows to perform dose measurements at a very high accuracy from low (50 cGy/min) to high dose rates (800 cGy/min) and was found to be independent of dose rate variation. The detection system also showed an excellent linearity with dose; hence, calibration was easily achieved. Conclusions The developed detector can be used to accurately measure the delivered dose at small fields during the treatment of small volume tumors. The author's measurement shows that despite using a nonwater‐equivalent detector, the detector can be a powerful candidate for beam characterization and quality assurance in, for example, radiosurgery, Intensity‐Modulated Radiotherapy (IMRT), and brachytherapy. Our detector can provide real‐time dose measurement and good spatial resolution with immediate readout, simplicity, flexibility, and robustness.