Senses and Sciences

Radiation induced lymphedema in patients received hypofractionation schedules in adjuvant radiotherapy settings for non-metastatic breast cancer

Amr Ameen — 2025-11-23

Background

Hypofractionation was introduced in early breast cancer based on multiple clinical trials. The rationale behind hypofractionation is to deliver high dose per fraction over short duration without compromising the local control. The short fractionation was limited to early breast cancer with BCS. However, there are few data regarding the short course after mastectomy. In node positive disease, the role of hypofractionation schedules is limited due to afraid of late toxicity specially lymphedema. We conducted this study to assess the lymphedema in patient with high-risk early disease who received either moderate or ultra hypofractionation schedules.

Materials and methods

One hundred patients received adjuvant radiotherapy using moderate or ultra hypofractionation schedules with either pT1-3 or pN0-1 were subjected for pretreatment lymphedema assessment using International Society of Lymphology staging of lymphoedema and then after radiotherapy every 3 months for 4 years.

Aim of the work

The primary end point: To assess the radiation induced lymphedema incidence and to assess factors affecting lymphedema before and after radiotherapy.

Results

Patients with modified radical mastectomy were associated with high incidence of lymphedema with significant difference compared to BCS. Nighty seven percent of patients with lymphedema had axillary dissection with significant difference compared to sentinel Lymph node biopsy. After radiotherapy, the ratio of positive node to total node dissected was associated with high incidence of lymphedema.

In multivariate analysis. It was found that only axillary dissection was the most significant factor affecting lymphedema after 4 years with 4.9 odds ratio. Using either moderate hypofractionation or ultrahypofractionation had no effect on lymphedema incidence.

Conclusion

Axillary dissection is the most important risk factor for the development of lymphedema specially after radiotherapy. A higher dose per fraction did not increase the incidence of lymphedema even in patients with high-risk node positive early breast cancer.

Histopathological Study of Thrombi Retrieved from Cerebral Arteries following Mechanical Thrombectomy and Correlation with Radiographic, Clinical Outcomes and Origin of the Thrombus

Abdulrahman Mostafa Ibrahim — 2025-11-23

Background: Advancements in endovascular methods for addressing strokes resulting from major cerebral artery occlusions have facilitated the examination of recovered thrombus material, offering a significant avenue to improve the determination of stroke causes. This study aimed to investigate the immuno-histopathological features of clots retrieved through mechanical thrombectomy in individuals with acute ischemic stroke (AIS).

Methods: A total of 22 consecutive patients, aged 18 years or older, were included in this study. All had experienced an acute ischemic stroke caused by large vessel occlusion (LVO) and underwent endovascular thrombectomy at our facility between September 2021 and June 2023. The thrombi extracted during the procedure were subsequently subjected to detailed histopathological analysis.

Results: There were significant differences found between clot composition (WBC, fibrin, and RBC groups) and several factors including ischemic heart disease (IHD), stroke cause, ASPECT score, collateral score, NIHSS immediately post-procedure, mRS at discharge, procedure duration, eTICI, number of passes, and brain edema (P<0.05). The ASPECT and collateral scores were higher in the WBC group compared to the fibrin and RBC groups (P<0.05). Additionally, clot composition influenced immediate post-procedural NIHSS, mRS at discharge, brain edema, and hemorrhage (P<0.05). The fibrin group had a significantly longer procedure duration, and more passes compared to the RBC and WBC groups (P<0.05).

Conclusions: Clot composition was linked to hemorrhage, mRS, and discharge outcomes. Higher CD3 and CD31 levels were associated with better outcomes and higher ASPECT scores. Post-intervention NIHSS and procedure parameters (duration, eTICI) were also associated with CD3.

Retrospective Analysis of the Effect of Radiation Boost versus No Boost Using Hypofractionation Schedule on Breast Cancer Loco-Regional Recurrence

Ahmed Shama — 2025-11-23

Background: Radiation treatment to the preserved breast following breast-conserving surgery lowers the mortality risk from breast cancer and cuts the disease's recurrence rate in half. The aim of this work was to define the effectiveness and feasibility of two different hypo fractionation schedules in the adjuvant settings of non-metastatic breast cancer.

Methods: This study included 100 patients, aged ≥50 years old, who had breast conservative surgery or mastectomy, invasive breast cancer with p T1-3, p N0-2 and non-metastatic breast cancer verified by clinical evaluations and imaging (X-ray chest and ultrasound or CT scan chest and abdomen). Patients were randomized into two equal groups: Control arm: received standard 40.05 gray (2.67 Gy/ fx) over 15 fractions over 3 weeks with or without boost and experimental arm: received 26 Gray (5.2) over 5 fractions over 1.5 weeks using one of the offered regimens.

Results: Lymph vascular invasion (LVI), Adjuvant treatment, clinical target volume (CTV, level1, level 2 and level 3 were significantly lower in boost group than non-boost group (P<0.05). Supraclavicular nodes (SCV), ipsilateral lung v5, mean lung, mean heart, pigmentation and erythema were significantly lower in boost group than non-boost group (P<0.05). Skin toxicity, recurrence and distant recurrence were not significantly different between both groups. Overall survival (OS) was statistically lower in boost group than non-boost group (P<0.05).

Conclusions: Boost group have statically significant lower LVI, Adjuvant treatment, CTV, level1, level2 and level3, SCV nodes, ipsilateral lung V5, mean lung, and mean heart than non-boost group and complication of radiation after mastectomy of breast cancer are less pigmentation, erythema and OS while, recurrence and distant recurrence are indifferent to conventional surgery without post radiation.

Breast cancer molecular subtypes based on MRI diagnosis

Bustan Mohamed Anwer, Dr. — 2025-12-15

Background: Breast cancer (BC) is the most common cancer affecting women worldwide. In 2022, about 2.3 million new cases and 670,000 deaths were reported globally according to World Health Organization, making it a major public health problem. BC is divided into four molecular subtypes according to the way certain genes express themselves, including hormone receptors (estrogen and progesterone receptors), HER2 expression and proliferation index. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has shown crucial role in identifying the characteristic morphological pattern of the different molecular subtypes. Aim of the study was to assess the impact of MRI on the choice of optimal surgical plan for different molecular subtypes of breast cancer. Methods: This prospective study included forty patients diagnosed with breast cancer who underwent immunohistochemistry followed by contrast enhanced MRI. They were all candidates for upfront surgery. Results: The study was done at time interval between June 2022-October 2023. The mean age of selected patients was 51.6 ± 9.8 years. The most dominant molecular subtype was luminal (26/40) followed by HER2 (10/40) and triple negative (4/10). Luminal subtype was strongly associated with spiculated margins, while HER2/neu tumors and TNBC showed circumscribed and irregular margins respectively (p=0.0077). Heterogeneous enhancement was dominant in luminal and HER2/neu cancers, while TNBC showed rim enhancement (p=0.0059). Regarding management, luminal subtypes were mostly managed by breast conservative surgery, while HER2/neu and triple negative were managed by mastectomy. A significant association was found between the molecular subtype and the surgical plan (p < 0.013). Conclusion: MRI morphological pattern of different molecular subtypes can be an acceptable predictor for the optimal surgical plan for each type.