Preoperative MRI in Patients with Locoregional Recurrent Breast Cancer

Oseledchyk, Anton; Kaiser, Christina; Nemes, Lisa; Döbler, Michael; Abramian, Alina; Keyver-Paik, Mignon-Denise; Leutner, C.; Schild, Hans H.; Kuhn, Walther; Debald, Manuel

doi:10.1016/j.acra.2014.05.012

Cited by 5 publications

(2 citation statements)

References 43 publications

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“…13 As indicated by the study results, magnetic resonance imaging was either unavailable or limited to certain regions and, thus, could not be used to supplement traditional diagnostic procedures in identifying locoregional extensions in younger patients. 14 Although radiotherapy and lumpectomy have equal benefits to total mastectomy in early stages of the disease, the lack of radiation therapy and specialized breast surgeons may translate to an overly aggressive surgery. 15 , 16 Targeted agents, such as trastuzumab, are of no benefit to Syrian patients with human epidermal growth factor receptor 2 amplifications because of limited availability and expense 17 ; only survey participants from East Ghouta, Homs, and Damascus reported having access to trastuzumab.…”

Section: Discussionmentioning

confidence: 99%

Cancer Care at Times of Crisis and War: The Syrian Example

Sahloul

Salem

Alrez

et al. 2017

JGO

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PurposeAs Syria enters its fifth year of conflict, the number of civilians killed and injured continues to rise sharply. Along with this conflict comes the rapid decline of medical care, specifically cancer care. To determine physician and equipment availability, cancer screening and management, and possible solutions relative to various major cities, a survey was distributed to physicians inside Syria through the help of the humanitarian organization Syrian American Medical Society.MethodsOnline surveys were distributed to both certified oncologists who work in cancer clinics and general physicians who work in rural and mobile clinics inside Syria. Variables assessed were physician specialty, location, population, cost, regional situation (besieged versus government controlled), and resource availability and access. Results were stratified by location and physician specialty.ResultsSurvey results revealed a large shortage of specialized physicians and inhibited accessibility to screening and management options in besieged areas compared with government-controlled regions. Physicians within both government-controlled and besieged cities reported limited or no targeted agents, radiation therapy, clinical trials, bone marrow transplantation, positron emission tomography scans, magnetic resonance imaging, and genetic testing.ConclusionThe Syrian civil war has resulted in suboptimal oncology care in the majority of the region. In consideration of specific deficiencies in cancer care, we recommend several solutions that may better the level of care in Syria: patient education on medical documentation and self-examination; online consultation; and cheap, effective screening methods. The implementation of these recommendations may change the course of cancer care in a country that has deteriorated into the worst humanitarian crisis of the century.

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Section: Discussionmentioning

confidence: 99%

Cancer Care at Times of Crisis and War: The Syrian Example

Sahloul

Salem

Alrez

et al. 2017

JGO

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“…In order to accurately characterize local target movement, a more suitable imaging technique is required. Magnetic resonance imaging (MRI) could enable this, since it provides superior soft-tissue contrast and potentially high temporal resolution, thereby allowing fast tumor (bed) visualization relative to the surrounding anatomy, in 2D and 3D, in high spatial resolution (Schmitz et al 2012, Bieri and Scheffler 2013, Oseledchyk et al 2014. In the future, on-line adaptive MRI-guided RT strategies could be facilitated by a hybrid MRI/RT modality, such as the MRI linear accelerator (MRL), currently in development at the university medical center (UMC) in Utrecht, The Netherlands, which is specifically designed for target tracking and dynamic planning (Lagendijk et al 2008, Raaymakers et al 2009.…”

Section: Introductionmentioning

confidence: 99%

Quantification of intra-fraction motion in breast radiotherapy using supine magnetic resonance imaging

et al. 2016

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In early-stage breast-cancer patients, accelerated partial-breast irradiation techniques (APBI) and hypofractionation are increasingly implemented after breast-conserving surgery (BCS). For a safe and effective radiation therapy (RT), the influence of intra-fraction motion during dose delivery becomes more important as associated fraction durations increase and targets become smaller. Current image-guidance techniques are insufficient to characterize local target movement in high temporal and spatial resolution for extended durations. Magnetic resonance imaging (MRI) can provide high soft-tissue contrast, allow fast imaging, and acquire images during longer periods. The goal of this study was to quantify intra-fraction motion using MRI scans from 21 breast-cancer patients, before and after BCS, in supine RT position, on two time scales. High-temporal 2-dimensional (2D) MRI scans (cine-MRI), acquired every 0.3 s during 2 min, and three 3D MRI scans, acquired over 20 min, were performed. The tumor (bed) and whole breast were delineated on 3D scans and delineations were transferred to the cine-MRI series. Consecutive scans were rigidly registered and delineations were transformed accordingly. Motion in sub-second time-scale (derived from cine-MRI) was generally regular and limited to a median of 2 mm. Infrequently, large deviations were observed, induced by deep inspiration, but these were temporary. Movement on multi-minute scale (derived from 3D MRI) varied more, although medians were restricted to 2.2 mm or lower. Large whole-body displacements (up to 14 mm over 19 min) were sparsely observed. The impact of motion on standard RT techniques is likely small. However, in novel hypofractionated APBI techniques, whole-body shifts may affect adequate RT delivery, given the increasing fraction durations and smaller targets. Motion management may thus be required. For this, on-line MRI guidance could be provided by a hybrid MRI/RT modality, such as the University Medical Center Utrecht MRI linear accelerator.

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