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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_429"
                     title="Low-Dose Radiation in Breast Cancer Gets Support (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/18339?impressionId=1265818130439"
                     
      &lt;p&gt;About 40% of women in two large breast cancer radiotherapy trials reported being concerned about some aspect of body image over the five years following therapy, researchers said.&lt;/p&gt;
&lt;p&gt;But there was little difference between those in the standard therapy arms and those getting so-called hypofractionated regimens, according to Penelope Hopwood, MD, of the Institute of Cancer Research in Sutton, England, and colleagues.&lt;/p&gt;
&lt;p&gt;The finding is evidence that a lower overall radiation dose given in fewer but larger fractions does not increase adverse effects or worsen body image for most women, Hopwood and colleagues said online in &lt;em&gt;The Lancet Oncology&lt;/em&gt;&lt;em&gt;&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The researchers used data from quality-of-life substudies from the two randomized Standardisation of Breast Radiotherapy (START) trials, conducted concurrently in the U.K.&lt;/p&gt;
&lt;p&gt;The Start A trial compared a standard regimen  --  50 gray (Gy) delivered in five 2.0-Gy fractions weekly over five weeks  --  with two hypofractionated regimens.&lt;/p&gt;
&lt;p&gt;In the first test regimen, women were treated with 41.6 Gy in 13 fractions of 3.2 each over five weeks, with three fractions in one week and two the next. The other regimen followed the same schedule, but delivered 39 Gy in 13 fractions of 3.0 each.&lt;/p&gt;
&lt;p&gt;The Start B study was a noninferiority trial comparing the standard regimen with one that delivered 40 Gy in 15 fractions of 2.67 each over three weeks. In contrast to Start A, both regimens had five fractions per week.&lt;/p&gt;
&lt;p&gt;As part of the studies, the researchers enrolled 2,208 participants in a quality-of-life analysis that looked at adverse events and changes in body image over a five-year follow-up period.&lt;/p&gt;
&lt;p&gt;They found: &lt;ul&gt; &lt;li&gt;The most frequently reported adverse effects in women with breast-conserving surgery were breast hardness and overall change in breast appearance after radiotherapy  --  about 41% and 39%, respectively, at five years. &lt;/li&gt; &lt;li&gt;In all radiotherapy regimens, breast symptoms fell significantly (at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001) from baseline to 60 months, but there was no significant difference between regimens in either trial.&lt;/li&gt; &lt;li&gt;Compared with the standard regimen, adverse effects of radiotherapy tended to be lower for the 39 Gy regimen in trial A and the 40 Gy regimen in trial B, but rates were similar between the control regimen and the 41.6-Gy regimen in trial A. &lt;/li&gt; &lt;li&gt;The only significant difference from the 50-Gy regimen, however, was adverse change in skin appearance, which was lower for patients who received 39 Gy or 40 Gy. The hazard ratios were 0.63 and 0.76, respectively.&lt;/li&gt; &lt;li&gt;There was no significant difference in change in skin appearance between patients who got 41.6 Gy or 50 Gy in trial A. (The hazard ratio was 0.83, but the 95% confidence interval crossed unity.)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Overall, the findings &quot;strengthen evidence in favor of hypofractionated regimens, with a potential for fewer adverse effects on the normal breast tissues,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;The study&apos;s findings &quot;provide a strong foundation&quot; for more research into how patients experience radiotherapy, according to Julie Schnur, PhD, of Mount Sinai School of Medicine in New York City.&lt;/p&gt;
&lt;p&gt;Among areas that might be examined, she wrote in an accompanying editorial, are: &lt;ul&gt; &lt;li&gt;The acute treatment period, which &quot;presents unique challenges to women&quot;&lt;/li&gt; &lt;li&gt;How women view the treated breast specifically, rather than the body overall&lt;/li&gt; &lt;li&gt;The use of behavioral medicine approaches to enhance body image&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Schnur said the researchers showed &quot;a consideration of the patient&apos;s point of view that is too often absent.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from Cancer Research UK, the U.K. Medical Research Council, and the U.K. Department of Health.&lt;/p&gt;&lt;p&gt;The authors declared no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1777"
                     title="ASCO: Action Needed in Early Breast CA with Isolated Cells in Lymph Nodes"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCO/tb/14550?impressionId=1265818130439"
                     
       ORLANDO, June 4 -- The presence of micrometastases in sentinel lymph nodes mandates additional treatment for patients with early-stage breast cancer to reduce the risk of axillary recurrence, data from a Dutch study suggest. 
              &lt;p&gt;
              &lt;p&gt;Micrometastases increased the five-year risk of axillary recurrence more than four-fold compared with no evidence of disease in sentinel nodes, Vivianne Tjan-Heijnen, M.D., Ph.D., of Maastricht University Medical Center in the Netherlands, reported at the American Society of Clinical Oncology meeting. 
              &lt;p&gt;
              &lt;p&gt;The study also showed that about 10% of physicians do not treat micrometastases, presumably because of concern about overtreatment, she added. 
              &lt;p&gt;
              &lt;p&gt;&quot;For patients with completely negative nodes, omission of axillary therapy is safe and standard policy,&quot; Dr. Tjan-Heijnen concluded. &quot;For patients with isolated tumor cells, omission of axillary therapy may only be safe in the presence of otherwise favorable tumor characteristics.&quot; 
              &lt;p&gt;
              &lt;p&gt;Dr. Tjan-Heijnen said she and her colleagues recommend complete axillary treatment in patients with micrometastases to reduce the risk of axillary recurrence. 
              &lt;p&gt;
              &lt;p&gt;Studies conducted before the sentinel node era yielded conflicting results about the prognostic implications of small nodal metastases, said Dr. Tjan-Heijnen. 
              &lt;p&gt;
              &lt;p&gt;The Dutch investigators recently extended the examination of prognostic significance to sentinel node biopsies in the MIRROR study (Micrometastases and Isolated Tumor Cells: Relevant and Robust Or Rubbish?). 
              &lt;p&gt;
              &lt;p&gt;As reported last year, MIRROR showed that both isolated tumor cells and micrometastases significantly increased the hazard for disease-free survival. Moreover, the patients benefited from adjuvant systemic therapy. (See &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/SABCS/12195&quot; target=&quot;blank&quot;&gt; SABCS: Nodal Micrometastases Raise Breast Recurrence Risk&lt;/a&gt;) 
              &lt;p&gt;
              &lt;p&gt;The first analysis of MIRROR data showed that almost half of 795 patients with isolated tumor cells and 15% of 1,028 with micrometastases did not receive additional therapy targeted to the axilla. Another 8% of patients received only axillary radiotherapy, said Dr. Tjan-Heijnen. 
              &lt;p&gt;
              &lt;p&gt;The current analysis focused on the clinical implications of not treating microscopic residual tumor or treating only with axillary radiation. 
              &lt;p&gt;
              &lt;p&gt;MIRROR included 2,680 patients who had sentinel node biopsies from 1997 to 2005 and a final nodal status of pN0, pN0(i+) [isolated cells], or pN1mi (micrometastases). 
              &lt;p&gt;
              &lt;p&gt;All patients had favorable characteristics by 2002 Dutch guidelines, defined as tumor size d1 cm irrespective of grade or tumor size 1 to 3 cm and grades 1 to 2. 
              &lt;p&gt;
              &lt;p&gt;Dr. Tjan-Heijnen reported that 1,218 patients had only sentinel node procedures, 1,314 had complete axillary node dissection, and 148 received axillary radiation therapy. 
              &lt;p&gt;
              &lt;p&gt;Only 13% of the sentinel-node group received adjuvant systemic therapy, compared with a majority of patients in the other two categories (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001). 
              &lt;p&gt;
              &lt;p&gt;The entire study population had a five-year axillary recurrence rate of 1.7%. 
              &lt;p&gt;
              &lt;p&gt;For patients with negative sentinel nodes (pN0), the recurrence rate did not differ significantly between patients who had complete axillary dissection and those who had sentinel node evaluation only (1.6% versus 2.3%). 
              &lt;p&gt;
              &lt;p&gt;The presence of isolated tumor cells (pN0[i+]) increased the hazard ratio for recurrence in patients who had only a sentinel node biopsy and those who had complete axillary dissection. However, the difference was not statistically significant (2.0% versus 0.9%, HR 2.39, 95% CI 0.67 to 8.48). 
              &lt;p&gt;
              &lt;p&gt;Patients with micrometastases (pN1mi) did have a significantly greater risk of recurrence compared with patients who had complete axillary dissection or irradiation of the axilla (5% versus 1%, HR 4.39, 95% CI 1.46 to 13.24). 
              &lt;p&gt;
              &lt;p&gt;None of the patients who had axillary radiotherapy after a positive sentinel node procedure had an axillary recurrence, regardless of whether the sentinel node contained isolated tumor cells or micrometastases. 
              &lt;p&gt;
              &lt;p&gt;The number of patients was too small (148) for meaningful comparisons with the other groups, but the findings are &quot;provocative, challenging the current recommendation of complete axillary node dissection,&quot; said Dr. Tjan-Heijnen. 
              &lt;p&gt;
              &lt;p&gt;In multivariate analysis, other factors that influenced the risk of axillary recurrence in patients with micrometastases included tumor size (HR 8.62, &lt;em&gt;P&lt;/em&gt;=0.021), histologic grade (HR 25.05, &lt;em&gt;P&lt;/em&gt;=0.035), and negative hormone-receptor status (HR 4.96, &lt;em&gt;P&lt;/em&gt;=0.010). 
              &lt;p&gt;
              &lt;p&gt;Omission of systemic therapy or breast radiotherapy did not increase the risk of axillary recurrence, the researchers noted.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Tjan-Heijnen reported no disclosures. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_118"
                     title="Physiotherapy Lowers Risk of Lymphedema (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/17930?impressionId=1265818130439"
                     
      &lt;p&gt;Physiotherapy may prevent lymphedema after breast cancer surgery that involves dissection of axillary lymph nodes, researchers say.&lt;/p&gt;
&lt;p&gt;Significantly fewer women developed the condition when they were given physiotherapy, compared with women who only received education on preventing the condition, Maria Torres Lacomba, MD, of Alcala de Henares University in Madrid, and colleagues reported online in &lt;em&gt;BMJ&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Lymphedema results from surgery or radiotherapy for breast cancer and is the most important chronic complication after dissection of the axillary lymph nodes, the researchers said. It impairs lymph drainage from the arm, resulting from an imbalance between filtration and resorption.&lt;/p&gt;
&lt;p&gt;To determine the effectiveness of early physiotherapy in reducing the risk of lymphedema, the researchers assessed 120 women who&apos;d had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007 at Asturias Hospital in Madrid.&lt;/p&gt;
&lt;p&gt;The early physiotherapy group was treated by a physiotherapist with a program that included manual lymph drainage, massage of scar tissue, and shoulder exercises, as well as an educational component.&lt;/p&gt;
&lt;p&gt;The control group received only the educational material, which discussed the condition and how to prevent it through shoulder exercises.&lt;/p&gt;
&lt;p&gt;All patients were followed for a year.&lt;/p&gt;
&lt;p&gt;A total of 16% of the women developed secondary lymphedema: 25% of those in the control group versus 7% in the intervention group (&lt;em&gt;P&lt;/em&gt;=0.01).&lt;/p&gt;
&lt;p&gt;That translated to a 72% decreased risk of lymphedema (HR 0.28, 95% CI 0.10 to 0.79).&lt;/p&gt;
&lt;p&gt;By the 12-month follow-up visit, the volume ratio between arms had increased in both groups.&lt;/p&gt;
&lt;p&gt;In the control group, the affected arm was on average 5.1% greater in volume&lt;strong&gt; &lt;/strong&gt;than the unaffected arm, whereas in the intervention group the affected arm was on average 1.6% greater than the unaffected arm (&lt;em&gt;P&lt;/em&gt;=0.0065).&lt;/p&gt;
&lt;p&gt;In a survival analysis, secondary lymphedema was diagnosed four times earlier in the control group than in the intervention group (HR 0.26, 95% CI 0.09 to 0.79, &lt;em&gt;P&lt;/em&gt;=0.01).&lt;/p&gt;
&lt;p&gt;The manual lymph drainage in this study involved gently massaging the area to improve lymph circulation, which improves the removal of interstitial fluid.&lt;/p&gt;
&lt;p&gt;&quot;We think that the implementation of manual lymph drainage after surgery for breast cancer in the early physiotherapy group could have contributed to the better results in that group,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;They noted that the study was limited by a short duration of follow-up, by the fact that it was limited to one hospital, and by a definition of lymphedema in which measurement errors could have been significant.&lt;/p&gt;
&lt;p&gt;The study also was not powered to examine subgroups of patients. Patients who developed lymphedema were more likely to be overweight, to have had more lymph nodes removed, and to have developed postoperative complications regardless of assignment to physiotherapy or control.&lt;/p&gt;
&lt;p&gt;Even so, the researchers concluded that early physiotherapy &quot;could help prevent and reduce secondary lymphedema in patients after breast cancer surgery involving dissection of axillary lymph nodes, at least for one year after surgery.&quot;&lt;/p&gt;
&lt;p&gt;Further studies are needed, they wrote, &quot;to clarify whether early physiotherapy after breast cancer surgery can remain effective in preventing secondary lymphedema in the longer term.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Andrea Cheville, MD, of the Mayo Clinic in Rochester, Minn., wrote that &quot;several factors should be considered when generalizing the results to clinical practice.&quot;&lt;/p&gt;
&lt;p&gt;Cheville noted that physiotherapy can vary depending on therapists&apos; training, and the study couldn&apos;t determine which component of the intervention  --  manual lymph drainage, massage of the scar, shoulder exercises, and education  --  had the most significant effect on outcomes.&lt;/p&gt;
&lt;p&gt;She also noted that the study was limited to one year, so &quot;we do not know if the intervention prevented or simply delayed lymphedema.&quot;&lt;/p&gt;
&lt;p&gt;Still, Cheville wrote that the &quot;limited but compelling evidence supports the usefulness of physiotherapy after surgical clearance of the axillary lymph nodes to control pain, enhance shoulder functionality and range of motion, and reduce a woman&apos;s risk of developing lymphedema.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Health Institute Carlos III of the Spanish Health Ministry.&lt;/p&gt;&lt;p&gt;The researchers reported no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_280"
                     title="The Year in Cancer"
                     score="-0.006"
                     href="