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Treatment was started 1 week prior to surgery, and continued during follow-up until 5 months after surgery, when it was ended by radiotherapy of the breast. study did not evaluate radiation-induced tumor shrinkage, but it did provide sufficient data showing the relative protection afforded by high-dose group.
The investigators did a prospective observational study of 30 patients who underwent lumpectomy under general anesthesia using standard laparoscopic techniques after receiving a total breast reconstruction for previous cancer. They compared their preoperative radiation dose to the amount that was used in the procedure and noted that mean preoperative radiation dose was 4.7 mSv, whereas the median postoperative radiation dose was 14 mSv, suggesting a possible relationship between the dose and extent of reduction in size. the 30 patients who underwent procedure, 18 had benign tumors that were resected, 11 underwent benign breast adenocarcinoma, and 3 had nonneoplastic metastases.
The median follow-up period was 2.3 years. The mean (±SEM) radiation dose received during and after the procedure was 7.5 (±1.9) and 13.5 (±6.4), respectively. Patients in the high dose group had a mean
2mg clonazepam vs. 2mg alprazolam reduction in the size of benign breast tumor by 4.5±1.3 cm2 (95% CI: 4.3, 5.2 cm2), in the adenocarcinoma by 3.2±1.6 cm2 (95% CI: 2.8, 4.3 cm2), and in the nonneoplastic metastases by 5.6±4.4 cm2 (95% CI: 6.4, 7.5 cm2).
Because radiation was administered intraoperatively, some radiation-induced tumor shrinkage may occur without adjuvant chemotherapy. In a large prospective trial of
precio clonazepam 2mg postoperative radiation therapy invasive breast fibroadenomas, and chemotherapy together were used in 14 percent of the patients, but median chemotherapy dose was 3 mSv, but the mean (±SEM) radiation dose was 13 mSv (range: 0–24 mSv). In addition, the high dose group patients received adjuvant chemotherapy in 30 percent of the patients. authors concluded that adjuvant drugs are necessary in order to obtain clinically significant results and noted that adjuvant chemotherapy is generally used only after a significant reduction in the radiation dose. It is believed that the beneficial effects of adjuvant chemotherapy cannot be achieved without high-dose radiation therapy in postoperative operations.
Another study by the same investigators evaluated 40 patients who underwent radical (NCT02606681) or open (NCT02335789) mastectomy for metastatic breast carcinoma at a single center. All were treated with 5–7 mSv of radiation. All underwent adjuvant chemotherapy. Of the patients enrolled, 23 (80%) were deemed treatment failures due to local recurrence of the tumor.
Postoperative tumor growth in this study was measured by imaging at 4 weeks, 1 month, and 8 months following surgery. No metastatic spread was detectable at 4 weeks (P=0.6), 1 (P=0.4) or 8 months (P=0.04) following surgery. The median follow-up time was 6½ months (range 4–23 months). There were no treatment failures after therapy. In postoperative studies, the median survival time is 6.75 months.
Another large randomized study compared the effect of 2 largest doses radiation — 15 mSv (10 × 10 mSv/kg) to the lowest dose of 7.4 mSv (6 × 10 mSv/kg) — for the reduction of tumor volume in patients with Stage IA or IB breast cancer, according to radiation efficiency. The mean follow-up period was 10 months (range 4 to 27 months), and the median progression-free survival in high-dose group was 11 months (range 5 to 30 months). Three patients were dead at 1 month from all causes. In this study, the authors concluded that a high exposure to radiation can yield a significant improvement in the patients who are need of radiation.
One of the earliest studies radiation, one of the first radiation-guided breast cancer treatments, examined 2 patients who were receiving an aggressive dose of radiation as part a clinical trial sponsored by the National Cancer Institute as an adjunctive treatment for high-grade metastatic breast cancer. The patients received adjuvant radiotherapy and underwent surgery to reconstruct both breasts as close possible to the original tumor site with bilateral lobectomy. They received the highest dose of radiation (13 to 15 mSv/kg of body weight) and the radiation dose was adjusted so that the radiation dose delivered into patient's lymph nodes averaged 1.
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