BackgroundLymphopenia is a known significant factor for treatment outcome in cancer patients, with underlying risk factor poorly understood in breast cancer. We hypothesize that the effective dose to the circulating immune cells (EDIC) which was related with lymphopenia in lung cancer will also have significant effect for radiation induced lymphopenia (RIL) in patients with breast cancer.Material and MethodsPatients treated with adjuvant radiotherapy (RT) and with complete blood tests within one week from RT end/start (post/preRT) were eligible in this study. Radiation dosimetric factors were collected retrospectively, and EDIC for each patient was calculated based on the doses to lung, heart and total body according to the model description, as previously reported. RIL was defined by the CTCAE5.0 based on postRT peripheral lymphocyte count (PLC). Linear regression was first used to test the correlation between EDIC with post/preRT PLC ratio and postRT PLC, using all these as continuous variables. Normal tissue complication probability (NTCP) was used to develop models that predict the CTCAE graded RIL from EDIC.ResultsA total of 735 patients were eligible. The mean post/preRT PLC ratio was 0.66 (95% CI: 0.64-0.68) and mean EDIC of breast cancer was 1.70Gy (95% CI: 1.64-1.75). Both post/preRT PLC ratio and postRT PLC were significantly correlated with EDIC (P<0.001), with R2 of 0.246. For patients with normal preRT PLC, the post/preRT PLC ratio was better associated with EDIC, and postRT PLC was expressed as PLCpreRT*(0.89−0.16*EDIC). For patients with preRT lymphopenia, postRT PLC was better associated with EDIC and it was 1.1 – 0.17 * EDIC. Using binned EDIC as the dose variable, the bootstrap validated NTCPs fit the data nicely with R2 of 0.93, 0.96, and 0.94 for grade-1, grade-2, and grade-3 RIL, respectively. The corresponding EDIC to induce 50% of grade-1, grade-2 and grade-3 RIL was 1.2, 2.1 and 3.7 Gy, respectively.ConclusionEDIC is a significant factor for RIL in patients with breast cancer, and may be used to compute the risk of lymphopenia in each individual patient with the use of the conventional NTCP modeling. External validation is needed before the EDIC can be used to guide RT plan.

Purpose/Hypothesis: To determine if agreement exists between microcurrent conductance through the skin over an injury, myoglobin levels in the serum, and diagnostic ultrasound measurements of swelling. Number of Subjects: 140. Materials/Methods: Subject underwent microcurrent conductance, serum myoglobin, diagnostic ultrasound, and strength testing before and after delayed onset muscle soreness (DOMS) was induced. Non-control subjects were also given a therapy wrap, dry heat, moist heat, or cold, either applied immediately or delayed 24 hours. Results: After induction of DOMS, there was agreement between significant 37% decreases in microcurrent conductance, significant 37% serum myoglobin increases, and significant 20% increases in quadriceps size, measured by diagnostic ultrasound. When either dry heat or cold was applied immediately, changes in these measurements were insignificant and less than 10%. Agreement was weaker when treatment was delayed 24 hours. Also, cold packs showed less than a 5% decrease in microcurrent conductance for covered areas compared to a 22% decrease for uncovered areas around the knee with 24 hour delay. Moist heat packs showed an insignificant change overall, but a significant 11% decrease for the covered center of the quadriceps with immediate treatment. Strength decreased 25% after DOMS, and all immediate treatments, along with 24 hour delayed cold and moist heat showed significantly smaller decreases. Conclusions: Changes in microcurrent conductance through the skin over injured tissue appear to be indicative of initial injury and recovery, and also for detecting the specific area of the injury. Clinical Relevance: Microcurrent through the skin over injured tissue appears to be a promising objective measurement of tissue injury as well as recovery from injury.

PurposeApplication of hypofractionated radiotherapy (HFRT) is growing in patients with breast cancer (BC). This study aimed to explore a real-world practice of HFRT in early and locally advanced BC.MethodsPatients with invasive BC between 2015 and 2019 were retrospectively reviewed. Radiotherapy (RT) was delivered by HFRT and conventionally fractionated radiotherapy (CFRT). Locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS) were calculated by Kaplan–Meier curve and compared by Log-rank test. The effect of treatment modality on DFS was estimated by univariate and multivariable analyses.ResultsA total of 1,010 patients were included in this study, and 903 (89.4%) were treated with HFRT. At a median follow-up of 49.5 months, there was no significant difference in a 4-year cumulative incidence of LRRFS in HFRT group (1.5%) and in CFRT group (3.8%) (p = 0.23), neither in different nodal stages nor in N2–3 patients with different molecular subtypes. The 4-year DFS was 93.5% in HFRT group compared with 89.9% in CFRT group with no significant difference either (p = 0.17). Univariate and multivariable analyses also showed no significant difference in DFS between HFRT and CFRT group. However, DFS of HFRT group tended to be lower in N2–3 patients with triple negative BC compared with that of CFRT group (76.2% versus 100%).ConclusionHFRT can achieve similar cumulative incidence of LRRFS and DFS in patients with BC after lumpectomy or mastectomy, and also in different nodal stage, and in locally advanced stage with different molecular subtypes.

Background: A home exercise program is an important part of recovery from musculoskeletal injuries and can improve pain, quality of life, and self-efficacy.  However, there are often challenges with patient adherence and measuring compliance. Mood and pain can have a positive and negative affect on a patient’s adherence and performance. Digital health, such as Recupe, provides an opportunity to examine the relationship between pain, mood, and exercise adherence outside the clinic. Methods: A total of 864 subjects were retrospectively analyzed to assess mood and reps completed per session, mood and time spent exercising per session, and mood and pain level. Mood was measured using three categories: “Happy,” “Neutral,” and “Sad.” Pain was measured using the Numerical Pain Rating Scale (NPRS) of 0-10. Results: The subject population included 331 males, 359 females, and 174 not stated. The average reps completed per session was 218.2 (130.0) for the “Happy” group, 163.3 (101.4) for the “Neutral” group, and 140.0 (95.7) for the “Sad” group with p-values <0.0001 between all groups.  The average time spent exercising per session were 29.54 minutes (24.63) for the “Happy” group, 21.80 minutes (18.30) for the “Neutral” group, and 22.31 minutes (21.23) for the “Sad” group with p-values <0.0001 between all groups. Lastly, the average pain level for each mood was 1.93 (1.69) for the “Happy” group, 4.4 (1.82) for the “Neutral” group, and 6.1 (2.00) for the “Sad” group with p-values <0.0001 between all groups. Conclusion: There is a significant correlation between mood, reported pain levels, and adherence to the patients’ exercise programs. Patients who report higher pain levels, simultaneously report more depressed moods and demonstrate decreased exercise times and repetition counts. Yet, while this correlation is clear, the causation factor is not known and requires more research.  Clinicians should look to observe this pattern in patients to possibly improve recovery.

Background Home exercise plans are key to recovery from surgeries, but poor compliance limits the benefit. Though non-compliance can be up to 70% from previous research, digital health shows promise in improving compliance. This retrospective study compared pain, range of motion (ROM), and manipulation under anesthesia (MUA) complications after a total knee arthroplasty (TKA) from a clinic where one group used digital health and another did not. There is little previous research on this topic, so this study could show the benefits of digital health on joint replacement rehabilitation. Methods Patients were retrospectively selected from Summit Orthopedics TKA patients from 9/1/21 to 4/30/22. 41 patients used Recupe, a digital app that instructs and monitors home exercises along with live coaching with their TKA rehabillitation. 95 patients did not. Age, sex, and BMI between both groups were very similar. Results ROM improved significantly with the use of Recupe, improving to 120 degrees after 1 month - a key ROM level for functional use as indicated by studies. The non-recupe group improved to 112 degrees in the same timeframe. The need for MUA was significantly better for the Recupe group, where 2% required MUA versus 5% for the other group, indicating a lower risk of major complications. Pain averaged 2.34/10 for the Recupe group after 1 month versus 2.86/10 for the non-recupe group, though the decrease did not reach statistical significance. The Recupe group performed their exercises an average of 5.1 times per week. Conclusions The Recupe group and the Non-Recupe group both attended medical and physical therapy visits, so the significant differences in results are likely due to non-adherence of HEP by the Non-Recupe group. These results suggest that lengthened musculoskeletal recovery amongst workers may be due to non-adherence to their prescribed care plan, and that digital health may be an excellent way to improve their compliance. Clinical Significance Use of Recupe during rehabilitation after a Total Knee Arthroplasty results in significantly faster ROM improvement and significantly decreased risk of Manipulation Under Anesthesia. Pain was also decreased though not to statistical significance.