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Background: Radiotherapy can cause adverse skin reactions over the course of their treatment. Currently, management is based on several tropical products although there is no gold-standard approach to prevention and management of radiation toxicity. Method: We report our experience of vitamin E acetate in the treatment of radiation dermatitis in breast cancer patients who experienced grade 4 side effects (according to Radiation Therapy Oncology Group criteria). Results: Clinical management consisted of oral antibiotics and local application of vitamin E acetate and local escarectomy. All of the patients achieved complete re-epithelialization within 40 days. Conclusion: Skin ulceration and necrosis post-radiation may interrupt oncological treatment in breast cancer patients. In acute radiodermatitis with skin necrosis, we propose the use of oral antibiotics together with escarectomy and the application of vitamin E acetate to facilitate the healing process in order to minimize the interruption to the oncological treatment. [ABSTRACT FROM AUTHOR]

Background: Previous studies showed that after breast-conserving surgery for breast cancer, radiotherapy may be applied to the portion of the breast where the primary tumour was removed (partial breast irradiation (PBI), avoiding the irradiation of the whole breast. We developed a procedure of PBI consisting of a single high dose of radiotherapy of 21 Gy with electrons equivalent to 58-60 Gy in fractionated doses, delivered during the surgical session by a mobile linear accelerator, positioned close to the operating table. Patients and methods: From July 1999 to December 2006, 1246 patients with primary carcinoma of less than 2.5-cm maximum diameter, mostly over 48 years, were treated with electron intra-operative radiotherapy (ELIOT) at a single dose of 21 Gy. Results: After a follow-up from 0.3 to 94.7 months (median 26), 24 (1.9%) patients showed a local recurrence and 22 developed distant metastases. Sixteen patients died, seven from breast carcinoma and nine from others causes. The five-year crude survival was 96.5%. Six (0.5%) developed severe breast fibrosis, which resolved in 2-3 years. An additional 40 patients suffered for mild fibrosis. Cosmetic results were good. Conclusions: Electron intra-operative radiotherapy is a safe method for treating conservatively operated breasts and avoids the long period of post-operative radiotherapy, greatly improving the quality of life and reduces the cost of radiotherapy. ELIOT markedly reduces the radiation to normal surrounding tissues and deep organs. Results on short- and medium-term toxicity are good. Data on local control are encouraging. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prognostic relevance of Ki-67 labeling index (LI) in patients with Ductal Intraepithelial Neoplasia (DIN) of the breast. Patients and Methods: From January 1997 to December 2007, histological samples and clinical data of 1,171 consecutive patients operated for DIN in a single institution were collected. The study was performed in accordance with the REMARK criteria. The independent prognostic role of Ki-67 LI was evaluated with a multivariable Cox regression model. A restricted cubic splines model was used to evaluate the prognostic role of Ki-67 LI as a continuous variable. Results: Overall, median age was 52 years (range 23-88), median Ki-67 LI 15% (range 1-80) and median follow-up 86 months (range 1-192). Overall, 549 (46.9%) women were premenopausal at the time of diagnosis. A total of 872 (74.5%) patients underwent breast conservative surgery (BCS). Whole breast radiotherapy (RT) was administered to 356 patients, and 506 patients received low dose tamoxifen (HT) (20mg/week or 5 mg/day). Histologically, most of the cases had a prevalent solid or cribriform pattern (75%), were DIN1c and DIN2 (80%), ER+ (80%), and showed a high (≥ 14%) Ki-67 LI (54%). The prevalence of the immunohistochemically defined subtypes was 39.5% for Luminal (Lum) A, 22.8% for LumB/Her-2-, 18.2% for LumB/Her2+, 15.8% for Her-2+, and 3.7% for Triple Negative. Overall, the rate of invasive and in situ recurrences (5-year cumulative incidence) was 10.7%. Firstly, we analyzed the role of RT according to Ki-67 LI as a continuous variable in DIN2/DIN3 patients after BCS. The curve and interaction model was adjusted for menopause, BMI, Her-2 and ER status, histological grade, presence of necrosis and microcalcifications, and HT. RT was protective in subjects with DIN with Ki-67 LI ≥ 14%, while no evidence of effect was seen for Ki-67 LI <14%. Notably, the higher the Ki-67 LI, the stronger the effect of RT (P-value for the interaction between RT and Ki-67 LI <0.01). Accordingly, RT was effective in all DIN subtypes with the exception of LumA. The adjusted HRRT vs No RT for LumB/Her2-, LumB/Her2+, and Her2 subtypes was 0.20 (95 % CI, 0.08-0.48), 0.44 (95 % CI, 0.16-1.20), and 0.15 (95 % CI, 0.04-0.50), respectively. The HRRT vs No RT for Triple Negative subtype was 0.40 (95 % CI, 0.07-2.41) and was not adjusted because of the sparse number of events. Finally, we focused the analysis on DIN2 patients stratified by Ki-67 LI. Again, after adjustment for menopause, surgical margins, presence of necrosis, microcalcifications, and HT, RT was not effective in DIN2 patients with Ki-67 LI <14% [HRRT vs No RT: 1.15 (95 % CI 0.47-2.80)]. On the contrary, DIN2 patients with a Ki-67 LI ≥ 14% mostly benefit of RT in terms of ipsilateral recurrence[HRRT vs No RT: 0.18 (95% CI 0.07-0.46)]. Low dose tamoxifen was effective in either LumA [adjusted HRHT vs No HT: 0.56 (95 % CI 0.33-0.97)] and LumB/HER2- DIN [HRHT vs No HT: 0.51 (95 % CI 0.27-0.95)], but not in LumB/Her2+ [HRHT vs No HT: 1.06 (95 % CI 0.56-2.05). Conclusion: Our data suggest that Ki-67 LI may be a useful prognostic and predictive adjunct in DIN patients. [ABSTRACT FROM AUTHOR]