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  1. Article ; Online: From the Plexus to the Cord: A Case of Metastatic Breast Cancer.

    Anakwenze Akinfenwa, Chidinma P / Strom, Eric A

    International journal of radiation oncology, biology, physics

    2022  Volume 114, Issue 2, Page(s) 181–182

    MeSH term(s) Brachial Plexus ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Breast Neoplasms/radiotherapy ; Female ; Humans
    Language English
    Publishing date 2022-09-02
    Publishing country United States
    Document type Case Reports ; Editorial
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2021.01.020
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Book ; Online: Breast Cancer 2nd edition

    Hunt, Kelly K. / Robb, Geoffrey L. / Strom, Eric A. / Ueno, Naoto T.

    2008  

    Author's details edited by Kelly K. Hunt, Geoffrey L. Robb, Eric A. Strom, Naoto T. Ueno
    Keywords Oncology
    Language English
    Publisher Springer Science + Business Media, LLC
    Publishing place New York, NY
    Document type Book ; Online
    HBZ-ID TT050386889
    ISBN 978-0-387-34950-3 ; 978-0-387-34952-7 ; 0-387-34950-2 ; 0-387-34952-9
    DOI 10.1007/978-0-387-34952-7
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  3. Article ; Online: Initial clinical experience using protons for accelerated partial-breast irradiation: longer-term results.

    Strom, Eric A / Ovalle, Valentina

    International journal of radiation oncology, biology, physics

    2014  Volume 90, Issue 3, Page(s) 506–508

    MeSH term(s) Breast Neoplasms/radiotherapy ; Carcinoma, Ductal, Breast/radiotherapy ; Female ; Humans ; Photons/therapeutic use ; Proton Therapy/methods ; Radiotherapy, Conformal/methods ; Skin/radiation effects
    Language English
    Publishing date 2014-11-01
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2014.06.039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Association Between Symptom Burden and Early Lymphatic Abnormalities After Regional Nodal Irradiation for Breast Cancer.

    Yoder, Alison K / Xu, Tianlin / Youssef, Peter / DeSnyder, Sarah / Marqueen, Kathryn E / Isales, Lynn / Lin, Ruitao / Smith, Benjamin D / Woodward, Wendy A / Stauder, Michael C / Strom, Eric A / Aldrich, Melissa B / Shaitelman, Simona F

    Practical radiation oncology

    2023  Volume 14, Issue 3, Page(s) e180–e189

    Abstract: Purpose: Dermal backflow visualized on near-infrared fluorescence lymphatic imaging (NIRF-LI) signals preclinical lymphedema that precedes the development of volumetrically defined lymphedema. We sought to evaluate whether dermal backflow correlates ... ...

    Abstract Purpose: Dermal backflow visualized on near-infrared fluorescence lymphatic imaging (NIRF-LI) signals preclinical lymphedema that precedes the development of volumetrically defined lymphedema. We sought to evaluate whether dermal backflow correlates with patient-reported lymphedema outcomes (PRLO) surveys in breast cancer patients treated with regional nodal irradiation (RNI).
    Methods and materials: Patients with breast cancer planned for axillary dissection and RNI prospectively underwent perometry, NIRF-LI, and PRLOs (the Lymphedema Symptom Intensity and Distress Survey [LSIDS] and QuickDASH) at baseline, after surgery, and at 6, 12, and 18 months after radiation. Clinical lymphedema was defined as an arm volume increase ≥5% over baseline. Trends over time were assessed using analysis of variance testing. The association between survey responses and both dermal backflow and lymphedema was assessed using a linear mixed-effects model.
    Results: Sixty participants completed at least 2 sets of measurements and surveys and were eligible for analysis. Fifty-four percent of patients had cT3-T4 disease, 53% cN3 disease, and 75% had a body mass index >25. Dermal backflow and clinical lymphedema increased from 10% to 85% and from 0% to 40%, respectively, from baseline to 18 months. In the adjusted model, soft tissue sensation, neurologic sensation, and functional LSIDS subscale scores were associated with presence of dermal backflow (all P < .05). Both dermal backflow and lymphedema were associated with QuickDASH score (P < .05).
    Conclusions: In this high-risk cohort, we found highly prevalent early signs of lymphedema, with increased symptom burden from baseline. Presence of dermal backflow correlated with PRLO measures, highlighting a potential NIRF-LI use to identify patients for early intervention trials after RNI.
    MeSH term(s) Humans ; Female ; Breast Neoplasms/radiotherapy ; Middle Aged ; Lymphedema/etiology ; Aged ; Prospective Studies ; Adult ; Lymph Nodes/radiation effects ; Lymph Nodes/pathology ; Symptom Burden
    Language English
    Publishing date 2023-10-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2655748-4
    ISSN 1879-8519 ; 1879-8500
    ISSN (online) 1879-8519
    ISSN 1879-8500
    DOI 10.1016/j.prro.2023.10.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Breast IMRT: new tools leading to new vision.

    Strom, Eric A

    International journal of radiation oncology, biology, physics

    2002  Volume 54, Issue 5, Page(s) 1297–1298

    MeSH term(s) Breast Neoplasms/radiotherapy ; Female ; Humans ; Radiometry ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal/instrumentation ; Radiotherapy, Conformal/methods
    Language English
    Publishing date 2002-12-01
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/s0360-3016(02)03744-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Prediction of breast cancer-related lymphedema by dermal backflow detected with near-infrared fluorescence lymphatic imaging.

    Aldrich, Melissa B / Rasmussen, John C / DeSnyder, Sarah M / Woodward, Wendy A / Chan, Wenyaw / Sevick-Muraca, Eva M / Mittendorf, Elizabeth A / Smith, Benjamin D / Stauder, Michael C / Strom, Eric A / Perkins, George H / Hoffman, Karen E / Mitchell, Melissa P / Barcenas, Carlos H / Isales, Lynn E / Shaitelman, Simona F

    Breast cancer research and treatment

    2022  Volume 195, Issue 1, Page(s) 33–41

    Abstract: Purpose: Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet ... ...

    Abstract Purpose: Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL.
    Methods: In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and regional nodal radiotherapy (RT) were followed serially, between 2016 and 2021, before surgery, 4-8 weeks after surgery, and 6, 12, and 18 months after RT. Arm volume was measured by perometry, and lymphatic (dys) function was assessed by NIRF-LI.
    Results: By 18 months after RT, 30 of 42 study subjects (71%) developed mild-moderate BCRL (i.e., ≥ 5% arm swelling relative to baseline), all manifested by "dermal backflow" of lymph into lymphatic capillaries or interstitial spaces. Dermal backflow had an 83% positive predictive value and 86% negative predictive value for BCRL, with a sensitivity of 97%, specificity of 50%, accuracy of 83%, positive likelihood ratio of 1.93, negative likelihood ratio of 0.07, and odds ratio of 29.00. Dermal backflow appeared on average 8.3 months, but up to 23 months, before the onset of mild BCRL.
    Conclusion: BCRL can be predicted by dermal backflow, which often appears months before arm swelling, enabling early treatment before the onset of edema and irreversible tissue changes.
    MeSH term(s) Breast Cancer Lymphedema/diagnostic imaging ; Breast Cancer Lymphedema/etiology ; Breast Neoplasms/complications ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/radiotherapy ; Female ; Humans ; Lymph Node Excision/adverse effects ; Lymphatic Vessels/diagnostic imaging ; Lymphedema/diagnostic imaging ; Lymphedema/etiology ; Prospective Studies
    Language English
    Publishing date 2022-07-10
    Publishing country Netherlands
    Document type Journal Article ; Observational Study
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-022-06667-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Workup and staging of locally advanced breast cancer.

    Whitman, Gary J / Strom, Eric A

    Seminars in radiation oncology

    2009  Volume 19, Issue 4, Page(s) 211–221

    Abstract: This article reviews current approaches for workup and staging in patients with locally advanced breast cancer (LABC). Careful clinical examination and detailed imaging are discussed to accurately classify the extent of local, regional, and distant ... ...

    Abstract This article reviews current approaches for workup and staging in patients with locally advanced breast cancer (LABC). Careful clinical examination and detailed imaging are discussed to accurately classify the extent of local, regional, and distant disease. Most patients with LABC receive neoadjuvant chemotherapy as initial treatment, and, in such patients, it is critical to accurately delineate the initial extent of disease because the initial clinical stage affects subsequent local-regional treatment decisions. Emphasis is placed on sonography, which is used extensively at the University of Texas M. D. Anderson Cancer Center for regional lymph node staging. Other modalities discussed in this article include mammography, magnetic resonance imaging, positron emission tomography (PET), and PET/computed tomography (CT). Conventional imaging (chest radiography, bone scan, and abdominal CT scans) techniques used in the evaluation of possible metastatic disease are discussed. In addition, the role of sentinel lymph node mapping in LABC patients is reviewed.
    MeSH term(s) Breast Neoplasms/diagnosis ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Female ; Humans ; Lymph Nodes/diagnostic imaging ; Magnetic Resonance Imaging ; Mammography ; Neoplasm Staging ; Positron-Emission Tomography ; Sentinel Lymph Node Biopsy ; Ultrasonography, Mammary
    Language English
    Publishing date 2009-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1146999-7
    ISSN 1532-9461 ; 1053-4296
    ISSN (online) 1532-9461
    ISSN 1053-4296
    DOI 10.1016/j.semradonc.2009.05.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Prospective, early longitudinal assessment of lymphedema-related quality of life among patients with locally advanced breast cancer: The foundation for building a patient-centered screening program.

    Gandhi, Anusha / Xu, Tianlin / DeSnyder, Sarah M / Smith, Grace L / Lin, Ruitao / Barcenas, Carlos H / Stauder, Michael C / Hoffman, Karen E / Strom, Eric A / Ferguson, Susan / Smith, Benjamin D / Woodward, Wendy A / Perkins, George H / Mitchell, Melissa P / Garner, Desmond / Goodman, Chelain R / Aldrich, Melissa / Travis, Marigold / Lilly, Susan /
    Bedrosian, Isabelle / Shaitelman, Simona F

    Breast (Edinburgh, Scotland)

    2023  Volume 68, Page(s) 205–215

    Abstract: Background: We examined how breast cancer-related lymphedema (BCRL) affects health-related quality of life (HRQOL), productivity, and compliance with therapeutic interventions to guide structuring BCRL screening programs.: Methods: We prospectively ... ...

    Abstract Background: We examined how breast cancer-related lymphedema (BCRL) affects health-related quality of life (HRQOL), productivity, and compliance with therapeutic interventions to guide structuring BCRL screening programs.
    Methods: We prospectively followed consecutive breast cancer patients who underwent axillary lymph node dissection (ALND) with arm volume screening and measures assessing patient-reported health-related quality of life (HRQOL) and perceptions of BCRL care. Comparisons by BCRL status were made with Mann-Whitney U, Chi-square, Fisher's exact, or t tests. Trends over time from ALND were assessed with linear mixed-effects models.
    Results: With a median follow-up of 8 months in 247 patients, 46% self-reported ever having BCRL, a proportion that increased over time. About 73% reported fear of BCRL, which was stable over time. Further in time from ALND, patients were more likely to report that BCRL screening reduced fear. Patient-reported BCRL was associated with higher soft tissue sensation intensity, biobehavioral, and resource concerns, absenteeism, and work/activity impairment. Objectively measured BCRL had fewer associations with outcomes. Most patients reported performing prevention exercises, but compliance decreased over time; patient-reported BCRL was not associated with exercise frequency. Fear of BCRL was positively associated with performing prevention exercises and using compressive garments.
    Conclusions: Both incidence and fear of BCRL were high after ALND for breast cancer. Fear was associated with improved therapeutic compliance, but compliance decreased over time. Patient-reported BCRL was more strongly associated with worse HRQOL and productivity than was objective BCRL. Screening programs must support patients' psychological needs and aim to sustain long-term compliance with recommended interventions.
    MeSH term(s) Humans ; Female ; Breast Neoplasms/pathology ; Prospective Studies ; Quality of Life ; Early Detection of Cancer ; Lymphedema/etiology ; Breast Cancer Lymphedema/etiology ; Lymph Node Excision/adverse effects ; Patient-Centered Care
    Language English
    Publishing date 2023-02-24
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1143210-x
    ISSN 1532-3080 ; 0960-9776
    ISSN (online) 1532-3080
    ISSN 0960-9776
    DOI 10.1016/j.breast.2023.02.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Proton Accelerated Partial Breast Irradiation: Clinical Outcomes at a Planned Interim Analysis of a Prospective Phase 2 Trial.

    Pasalic, Dario / Strom, Eric A / Allen, Pamela K / Williamson, Tyler D / Poenisch, Falk / Amos, Richard A / Woodward, Wendy A / Stauder, Michael C / Shaitelman, Simona F / Smith, Benjamin D / Perkins, George H / Tereffe, Welela / Hoffman, Karen E

    International journal of radiation oncology, biology, physics

    2020  Volume 109, Issue 2, Page(s) 441–448

    Abstract: Purpose: To perform a planned interim analysis of acute (within 12 months) and late (after 12 months) toxicities and cosmetic outcomes after proton accelerated partial breast irradiation (APBI).: Methods and materials: A total of 100 patients with ... ...

    Abstract Purpose: To perform a planned interim analysis of acute (within 12 months) and late (after 12 months) toxicities and cosmetic outcomes after proton accelerated partial breast irradiation (APBI).
    Methods and materials: A total of 100 patients with pTis or pT1-2 N0 (≤3cm) breast cancer status after segmental mastectomy were enrolled in a single-arm phase 2 study from 2010 to 2019. The clinically determined postlumpectomy target volume, including tumor bed surgical clips and operative-cavity soft-tissue changes seen on imaging plus a radial clinical expansion, was irradiated with passively scattered proton APBI (34 Gy in 10 fractions delivered twice daily with a minimum 6-hour interfraction interval). Patients were evaluated at protocol-specific time intervals for recurrence, physician reports of cosmetic outcomes and toxicities, and patient reports of cosmetic outcomes and satisfaction with the treatment or experience.
    Results: Median follow-up was 24 months (interquartile range [IQR], 12-43 months). Local control and overall survival were 100% at 12 and 24 months. There were no acute or late toxicities of grade 3 or higher; no patients experienced fat necrosis, fibrosis, infection, or breast shrinkage. Excellent or good cosmesis at 12 months was reported by 91% of patients and 94% of physicians; at the most recent follow-up, these were 94% and 87%, respectively. The most commonly reported late cosmetic effect was telangiectasis (17%). The total patient satisfaction rate for treatment and results at 12 and 24 months was 96% and 100%, respectively. Patients' mean time away from work was 5 days (IQR, 2-5 days), and the median out-of-pocket cost was $700 (IQR, $100-$1600). The mean left-sided heart dose was 2 cGy (range, 0.2-75 cGy), and the mean ipsilateral lung dose was 19 cGy (range, 0.2-164 cGy).
    Conclusions: Proton APBI is a maturing treatment option with high local control, favorable intermediate-term cosmesis, high treatment satisfaction, low treatment burden, and exceptional heart and lung sparing.
    MeSH term(s) Aged ; Breast Neoplasms/pathology ; Breast Neoplasms/radiotherapy ; Breast Neoplasms/surgery ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; Middle Aged ; Patient Satisfaction ; Prospective Studies ; Proton Therapy ; Treatment Outcome
    Language English
    Publishing date 2020-09-16
    Publishing country United States
    Document type Clinical Trial, Phase II ; Journal Article
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2020.09.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer.

    Corrigan, Kelsey L / Lei, Xiudong / Ahmad, Neelofur / Arzu, Isidora / Bloom, Elizabeth / Chun, Stephen G / Goodman, Chelain / Hoffman, Karen E / Joyner, Melissa / Mayo, Lauren / Mitchell, Melissa / Nead, Kevin T / Perkins, George H / Reed, Valerie / Reddy, Jay P / Schlembach, Pamela / Shaitelman, Simona F / Stauder, Michael C / Strom, Eric A /
    Tereffe, Welela / Wiederhold, Lee / Woodward, Wendy A / Smith, Benjamin D

    Advances in radiation oncology

    2021  Volume 7, Issue 2, Page(s) 100877

    Abstract: Introduction: The first high-quality clinical trial to support ultrahypofractionated whole-breast irradiation (ultra-HF-WBI) for invasive early-stage breast cancer (ESBC) was published in April 2020, coinciding with the beginning of the COVID-19 ... ...

    Abstract Introduction: The first high-quality clinical trial to support ultrahypofractionated whole-breast irradiation (ultra-HF-WBI) for invasive early-stage breast cancer (ESBC) was published in April 2020, coinciding with the beginning of the COVID-19 pandemic. We analyzed adoption of ultra-HF-WBI for ductal carcinoma in situ (DCIS) and ESBC at our institution after primary trial publication.
    Methods and materials: We evaluated radiation fractionation prescriptions for all patients with DCIS or ESBC treated with WBI from March 2020 to May 2021 at our main campus and regional campuses. Demographic and clinical characteristics were extracted from the electronic medical record. Treating physician characteristics were collected from licensure data. Hierarchical logistic regression models identified factors correlated with adoption of ultra-HF-WBI (26 Gy in 5 daily factions [UK-FAST-FORWARD] or 28.5 Gy in 5 weekly fractions [UK-FAST]).
    Results: Of 665 included patients, the median age was 61.5 years, and 478 patients (71.9%) had invasive, hormone-receptor-positive breast cancer. Twenty-one physicians treated the included patients. In total, 249 patients (37.4%) received ultra-HF-WBI, increasing from 4.3% (2 of 46) in March-April 2020 to a high of 45.5% (45 of 99) in July-August 2020 (
    Conclusions: Adoption of ultra-HF-WBI at our institution increased substantially after the publication of randomized evidence supporting its use. Ultra-HF-WBI was preferentially used in patients with lower risk disease, suggesting careful selection for this new approach while long-term data are maturing. Substantial physician-level variation may reflect a lack of consensus on the evidentiary standards required to change practice.
    Language English
    Publishing date 2021-12-24
    Publishing country United States
    Document type Journal Article
    ISSN 2452-1094
    ISSN 2452-1094
    DOI 10.1016/j.adro.2021.100877
    Database MEDical Literature Analysis and Retrieval System OnLINE

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