Introduction. Breast conserving surgery (BCS) followed by radiation therapy (RT) has become the preferred alternative to mastectomy for patients with early stage breast cancer (BC). Randomized trials have confirmed equivalent locoregional control and overall survival for BCS and mastectomy. Extreme Oncoplasty (EO) extends the indications of BCS for patients who would otherwise require mastectomy, ensuring better aesthetic outcomes and oncological safety. Methods. BC patients with multifocal/multicentric (MF/MC) tumors, extensive DCIS, or large tumor >50mm underwent EO at our breast unit. Therapeutic reduction mammaplasty (TRM) with wise pattern preoperative markings and dual pedicle technique involving parenchymal rearrangement was used for oncoplastic reconstructions in majority of the cases followed by RT. Patient reported outcome measures (PROMs) were assessed using the validated Breast-Q questionnaire. Results. Of the 39 patients in the study, 36 had unilateral and 3 had bilateral BC. Mean age was 47.2 years. Median tumor size was 75mm. 17 (43.6%) patients received NACT; none achieved a complete clinical response. 28 (71.8%) patients were administered to adjuvant chemotherapy. 33(84.6%) patients received RT to the breast with a median dose of 50Gy in 28 fractions and a boost dose of 10Gy in 5 fractions to the tumor bed. No major complications or local recurrences were observed. Excellent Breast-Q scores were observed in patients undergoing EO after 12 months of follow-up. Conclusion. EO followed by RT results in acceptable local-regional control, low rate of complications, and high patient satisfaction. In selected patients, EO could provide a safe alternative for breast conservation surgery instead of mastectomy.

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The Coronavirus disease 2019 (COVID-19) caused by an RNA virus SARS-CoV-2 is an emerging global health pandemic. With currently no approved treatment or prophylaxis, the SARS-CoV-2 is rapidly transmitted via touch, droplets, and fomites. In most affected patients, the disease will have mild flu-like symptoms (fever, dry cough, and difficulty in breathing) and in selected patients may cause severe complications such as progressive pneumonia, acute respiratory distress syndrome, and organ failure due to hyper-inflammation and cytokine storm syndrome. Understanding the pathogenesis of the disease is essential for identification and rational design of effective drug targets. The plant metabolites can provide as a prospective approach for SARS-CoV-2, due to lowest possible side effect and antiviral properties. In this report, we provide an overview of the disease pathogenesis and highlight the potential therapeutic interventions.

Purpose Breast cancer is the most common cancer in India, affecting all socio-economic strata. Despite its growing global acceptance, Breast Oncoplasty Surgery (BOS) remains nascent in India, necessitating local context-specific innovative delivery models for clinicians and the general public. Here, we present experiences from Orchids Breast Health Clinic (OBHC; Pune, India) with the implementation of BOS clinical services, training, and research and community outreach. Methods OBHC, a dedicated breast unit, has established the first dedicated BOS clinic in India, conducted hands-on training workshops for trainee surgeons, developed an MCh degree program in breast oncoplasty with the University of East Anglia (Norwich, United Kingdom), undertaken BOS research in Indian patients, and created outreach programs to popularize BOS. Results A cost-effective one surgeon–dual role concept wherein the same surgeon performs onco- and plastic surgery and one-stage implant-based breast reconstruction has been adopted. Since 2013, BOS cases included BCS (n = 440), breast reconstruction (n = 210), and therapeutic mammoplasty (n = 135). The unavailability of acellular dermal matrices has prompted the innovation of a surgical technique, termed Advanced Autologous Dermal Sling, which uses vascularized local tissue as implant cover. Significant improvement in postsurgery outcomes and protection against radiation complications has been observed. BOS hospitalization costs have been reduced by 50% thereby, which has led to high rates of acceptance (80%) of BOS in patients at OBHC. Young breast surgeons from across India and South Asian Association for Regional Cooperation countries have enrolled in the MCh degree program, which involves an embedded curriculum with online didactic modules and hands-on training workshops in Pune, India. Longitudinal follow-up after 1, 3, and 5 years postsurgery in the study cohorts is undertaken for post-BOS outcomes using clinical assessment (Bakers scale) and patient-reported outcomes measures (BREAST-Q questionnaire). Multiple research projects are undergoing peer-review before publication. To increase awareness of BOS among Indian women, community awareness campaigns with the theme of Losing Is Not an Option are underway via public talks, symposia, marathon, and op-eds in electronic and print media. Conclusion The OBHC model of Affordable Excellence in BOS, developed in the Indian context, can be extrapolated to benefit patients with breast cancer from other low- and middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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