A streamlined failure mode and effects analysis.

Purpose: Explore the feasibility and impact of a streamlined failure mode and effects analysis (FMEA) using a structured process that is designed to minimize staff effort.

Methods: FMEA for the external beam process was conducted at an affiliate radiation oncology center that treats approximately 60 patients per day. A structured FMEA process was developed which included clearly defined roles and goals for each phase.

Local recurrence after mastectomy in patients with T3pN0 breast carcinoma treated without postoperative radiation therapy.

Objective: The need for comprehensive adjuvant radiotherapy in patients with T3pN0 breast cancer is controversial. This retrospective analysis was performed to assess the frequency of local and distant recurrence in patients treated with mastectomy without postoperative radiation.

Materials And Methods: A single institution database of 2362 patients with breast carcinoma treated from 1974 to 1994 yielded 101 patients who had T3pN0 disease and did not receive chest wall or nodal irradiation.

Sentinel lymph node positivity of patients with ductal carcinoma in situ or microinvasive breast cancer.

Purpose: The purpose of this study was to determine the rates of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal carcinoma in situ (DCIS) or microinvasive breast cancer (MIC).

Methods: One hundred thirty patients underwent SLN mapping from 1998 to 2003 for DCIS or MIC.

Results: One hundred nine patients with DCIS and 21 with MIC underwent SLN mapping.

Can axillary dissection be avoided in patients with sentinel lymph node metastasis?

Background: Who should undergo a completion dissection following identification of a +sentinel lymph node (SLN) is controversial.

Methods: The records of 1,133 patients who underwent SLN mapping were reviewed. The association between patient, tumor, and treatment characteristics and the presence of +SLNs and +nonSLNs was analyzed using two-way tables of frequency counts and Pearson chi2 test.

Factors associated with involvement of four or more axillary nodes for sentinel lymph node-positive patients.

Purpose: Sentinel lymph node-positive (SLN+) patients who are unlikely to have 4 or more involved axillary nodes might be treated with less extensive regional nodal radiation. The purpose of this study was to define possible predictors of having 4 or more involved axillary nodes.

Methods And Materials: The records of 224 patients with breast cancer and 1 to 3 involved SLNs, who underwent completion axillary dissection without neoadjuvant chemotherapy or hormonal therapy were reviewed.

Radiation therapy in management of breast cancer.

Randomized trials have demonstrated the efficacy of radiation therapy in the treatment of breast cancer. A reduction in the risk of recurrence has been shown in breast conservation for ductal carcinoma in situ and in invasive cancers after breast conservation and mastectomy. The importance of local control in breast cancer is becoming more apparent.

Significance of axillary lymph node extranodal soft tissue extension and indications for postmastectomy irradiation.

Background: Extranodal soft tissue extension of axillary lymph node metastases (ETE) has been considered an indication for postmastectomy radiotherapy, including the axilla. However, it is unclear whether patients with ETE are at an increased risk of axillary recurrence.

Methods: From a single institutional database of 2362 patients with breast carcinoma treated between 1974-1994, a total of 487 patients who underwent mastectomy for lymph node positive, infiltrating (T1-T3) breast carcinoma was found.

Radiation therapy and breast cancer.

The role of radiation therapy in the management of breast cancer is well established. Questions remain, however, regarding: 1) which patients derive the most benefit from the addition of radiation in breast conservation for ductal carcinoma in situ (DCIS) and after mastectomy for node-positive invasive cancer; 2) what is the role of brachytherapy in the management of invasive disease, either as primary therapy or as a boost after external beam therapy; and 3) whether radiation fields can be modified given the low rates of local-regional recurrence reported after breast conserving therapy in patients receiving systemic therapy.

Predictors of breast recurrence after conservative surgery and radiation therapy for invasive breast cancer.

The majority of women with breast cancer are adequately treated with breast-conserving surgery and radiation therapy. Although most women need very limited surgery, some require a larger volume of resection to attain a high level of local control, and some might even require a mastectomy. This article summarizes the current state of knowledge concerning the assessment of the adequacy of excision.

Skin recurrences after breast-conserving therapy for early-stage breast cancer.

Purpose: To assess the frequency and prognosis of skin recurrences after breast-conserving therapy (BCT) compared with other breast recurrences.

Materials And Methods: From 1968 to 1986, 1,624 patients with unilateral stage I or II breast cancer treated with BCT at the Joint Center for Radiation Therapy (Boston, MA) underwent gross tumor excision and received a dose of > or = 60 Gy to the tumor bed. Skin recurrences (SR) were defined as breast recurrences without associated parenchymal disease.

Radiation therapy and breast cancer.

Although the role of radiation therapy in the management of ductal carcinoma in situ is somewhat controversial, the benefit of radiation therapy in breast-conserving treatment of early stage invasive breast cancer is well established. Patients undergoing tumor excision with clear margins have low rates of recurrence with radiation therapy whether there is an extensive intraductal component or not. In all patients, there is a significantly higher risk of recurrence without radiation therapy.

Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.

Purposes/objectives: To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidenced by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate.

Design: Experimental, two-group pretest, post-test.

Setting: Two university teaching hospital outpatient radiation therapy departments.

Is machine energy (4-8 MV) associated with outcome for stage I-II breast cancer patients?

Purpose: To assess the relationship between machine energy (4-8 MV) and treatment outcome in patients treated with conservative surgery and radiation therapy.

Methods And Materials: Between 1968 and 1985, 1624 patients were treated for clinical Stage I or II invasive breast cancer. The study population was limited to 1380 patients who underwent complete gross excision and received greater than or equal to 60 Gy to the tumor bed.

Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy.

Background: The relationship between the microscopic margins of resection and ipsilateral breast recurrence (IBR) after breast-conserving therapy for carcinomas with or without an extensive intraductal component (EIC) has not been adequately defined.

Methods: Of 1,790 women with unilateral clinical Stage I or II breast carcinoma treated with radiation therapy as part of breast-conserving therapy, 343 had invasive ductal histology evaluable for an extensive intraductal component (EIC), had inked margins that were evaluable for an review of their pathology slides, and received > or = 60 Gray to the tumor bed; these 343 women constitute the study population. The median follow-up was 109 months.

Age-related differences in patients with nonpalpable breast carcinomas.

Background: The survival benefit of screening mammography may be influenced by the age of the screened population. The current series examines the influence of age on the clinical, histopathologic, and prognostic features of nonpalpable breast carcinoma.

Methods: Needle localization and biopsy of suspicious mammographic lesions identified 173 breast carcinomas that were occult by physical examination.

Relationship of tumor grade to other pathologic features and to treatment outcome of patients with early stage breast carcinoma treated with breast-conserving therapy.

Background: Although histologic grade has previously been described as a predictor of distant failure, it is uncertain whether histologic grade should be used to decide which patients should undergo axillary lymph node dissection and whether grade should be considered as a selection factor for breast-conserving therapy.

Methods: The authors retrospectively analyzed data from 1081 patients with American Joint Committee on Cancer Stage I or II infiltrating ductal carcinoma treated with breast-conserving therapy at the Joint Center for Radiation Therapy between 1970 and 1986. All patients had pathology slides reviewed by one of two study pathologists.

Long-term outcome following breast-conserving surgery and radiation therapy.

Purpose: To examine the long-term pattern and frequency of recurrences after breast-conserving therapy and whether the outcome was influenced by the era of treatment.

Methods And Materials: From 1968 to 1986, 1870 patients with unilateral Stage I or II breast cancer were treated at the Joint Center for Radiation Therapy. Of these, 1628 underwent gross tumor excision and received a dose of > 60 Gy to the tumor bed and constituted the study population.

Who is being screened for melanoma/skin cancer? Characteristics of persons screened in Massachusetts.

We conducted a survey of persons who voluntarily attended melanoma/skin cancer screenings in Massachusetts in 1987. Of 1219 persons asked to fill out a questionnaire, 1116 (92%) completed it. Our study demonstrates that persons attending the melanoma/skin cancer screening program were, for the most part, at risk for the disease and appropriately selected themselves to be screened.

Evaluation of melanoma/skin cancer screening in Massachusetts. Preliminary results.

Although screening for melanoma/skin cancer is theoretically of value, few data are available to evaluate its effectiveness or the value of a visual exam by a dermatologist as a cancer screening tool. From the 2560 persons screened for melanoma/skin cancer in Massachusetts in 1986 and 1987, the authors followed the positive screenees to determine their final diagnosis. The authors obtained information on 85% of these persons, and found nine malignant melanomas, 91 non-melanoma skin cancers, 39 dysplastic nevi, and three congenital nevi.

Prophage-mediated production of a bacteriocinlike substance by SP beta lysogens of Bacillus subtilis.

Cultures of Bacillus subtilis lysogenic for the temperature bacteriophage SP beta release "betacin", a bacteriocinlike substance that inhibits B. subtilis strains which do not carry this phage. Production of betacin is blocked by mutations in the bet gene on the prophage and a second phage gene, tol, is apparently involved in making the lysogen itself tolerant to betacin.