CHICAGO – Breast augmentation is the most popular cosmetic procedure in the U.S. Millions of women have implants – 347,500 in 2007 alone. But like other women, one in eight will be faced with breast cancer. For these cancer patients, treatment is far more devastating – often resulting in mastectomy rather than lumpectomy, due to treatment complications.
A radiation oncologist reported at the Radiological Society of North America (RSNA; Oak Brook, Illinois) meeting yesterday that he has invented a partial-breast brachytherapy treatment that spares the breast, saves the implant and results in positive cosmetic outcomes.
"There is a big problem developing in that young women with silicone or saline implants are now growing into the age where they develop breast cancer," said Robert Kuske Jr., MD, clinical professor at the University of Arizona Health Sciences Center (Tucson) and radiation oncologist at Arizona Oncology Services (Scottsdale, Arizona). "The number is skyrocketing and is one-third of my practice now."
The most common breast cancer treatment for patients with breast implants is skin-sparing mastectomy and implant exchange. Whole-breast radiation therapy after lumpectomy is an option, but carries a substantial risk during the healing process of scar tissue wrapping around the implant, causing it to become rock hard and extremely painful. This condition, known as capsular contracture, also distorts the appearance of the breast.
So Kuske determined that partial-breast radiation with brachytherapy offers a better outcome for women with implants who want to avoid mastectomy.
Breast brachytherapy is a radiation treatment that can be given in higher doses to a small, targeted area of the breast after lumpectomy. Radioactive seeds are guided into place through small plastic tubes, or catheters, with the aid of imaging and a computer. The seeds emit high doses of radiation in short bursts.
"Brachytherapy delivers pinpoint radiation therapy to the diseased site without exposing implant to comprehensive radiation," Kuske told RSNA attendees. "Thin plastic catheters surround the surgical lumpectomy site. Radioactive seeds are then delivered to the site [and remain for one week, then are removed]. Our hypothesis is that with brachytherapy – which I call radiation from the inside out – the augmentation implant will only get a tiny dose, so hardening of the implant can be avoided."
Kuske invented a Plexiglas template that guides the exact location of those catheters. The template, which is being developed by Nucletron (Veenendaal, the Netherlands), has predrilled holes to guide the catheters and compresses breast tissue away from the implant.
Kuske presented a study of 65 women – with a median age of 50 – who were diagnosed with small, early stage malignant tumors. All were treated with brachytherapy after a lumpectomy. The women received two doses per day, separated by six hours, over a five-day period.
Follow-up was six months to five years. None of the patients experienced tumor recurrence during the follow-up period. Cosmetic outcome was determined to be good to excellent in 100% of patients. Implant hardening was not observed in any of the patients.
"For 91% of the patients, you couldn't tell which breast is treated after healing," he said. "Nine percent had mild asymmetry."
A better mechanism to evaluate autism
Researchers have harnessed the power of magnetoencephalography (MEG), combined it with newly developed software, to create a system to better diagnose and evaluate children with autism.
"We know autism is a devastating and debilitating condition affecting one in 150 children," said Timothy Roberts, PhD, vice chair of research in the department of radiology at Children's Hospital of Philadelphia during the RSNA's scientific sessions. "We know that different children have different manifestations of autism. Language and communication is what we probed with this study. It's about brain connectivity."
There are less than 300 MEG machines in the world, mainly because they're so expensive – up to $3 million. Typically used for epilepsy evaluation, MEG can also be used to identify timing abnormalities in the brains of patients with autism.
What Roberts discovered in a study of 64 patients, age six to 15, is that children with autism have a delay in the way they hear and understand language.
They discovered this after audio stimulation was introduced to the children in the form of beeps, tones in pairs, vowels or sentences. Sounds were presented at different frequencies and tone pairs in rapid succession, including unusual streams of incongruous tones and vowels. The results were analyzed and compared with the results from a control group of age-matched non-autistic children.
"We found that signatures of autism are revealed in the timing of brain activity," Roberts said. "We see a fraction of a second delay in autistic patients."
Autism is a complex developmental disability that affects mostly boys, according to the Autism Society of America (Bethesda, Maryland). Autism inhibits the brain functions that govern the development of social and communication skills.
For a MEG exam, a helmet that houses magnetic detectors and looks similar to an old-fashioned hair dryer is lowered over the patient's head while the patient remains in a seated position. The helmet analyzes electrical currents from the brain.
"This new technology can reveal these timing delays," he said. "The delays can be used to sub-classily along the autism spectrum. Sound simply comes in too fast to cope. That's perhaps what the autistic child is hearing."
He explained that the potential intervention would be a way to slow down the language input.
Roberts is currently working on other, related studies to refine the test, extending it to children whose diagnosis is ambiguous and to neonatal infants and young babies. The latter study of babies is attempting to identify autism at a much earlier age with hopes of future, as yet unknown, interventions.
For the study, Roberts used a MEG machine by VSM MedTech (Vancouver, British Columbia). The software he wrote to facilitate the new autism diagnostic will be free to whoever can use it.
"We're not commercializing it," he told Medical Device Daily. "We prefer to have an open-source approach."
New treatment for painful foot condition
Plantar fasciitis is the most common cause of heel pain. A presenter at RSNA 2008 flipped a graphic on the screen of multiple pushpins about to puncture a soft foot intended to illustrate just how painful the condition can be.
To date, conservative treatments take up to a year to have an effect. The alternative: shockwave therapy, in which sound waves are directed at the foot. It requires multiple treatments, is painful and doesn't always work.
An Italian scientist has developed a 15-minute, ultrasound-guided therapy that eliminated pain in 95% of treated patients within three weeks.
"There is no widely accepted therapy or standard of care for patients when first-line treatments fail to relieve the pain of plantar fasciitis," said Luca Sconfienza, MD, of the University of Genoa. "Our new technique is an effective, one-time outpatient procedure.
"Plantar fasciitis accounts for up to 15% of all foot symptoms and hit people at an average age of 50 years old," he said.
For the study presented at RSNA, Sconfienza and colleagues used a new ultrasound-guided technique, along with steroid injection, on 44 patients with plantar fasciitis that was unresponsive to conservative treatments.
After injection of a small amount of anesthesia, the anesthetic needle is used to repeatedly puncture the site where the patient feels the pain. This technique is known as dry-needling. Dry-needling creates a small amount of local bleeding that helps to heal the fasciitis. Then a steroid is injected around the fascia to eliminate the inflammation and pain.
The technique is performed with ultrasound guidance to improve accuracy and to avoid injecting the steroids directly into the plantar fascia, which could result in rupture.
"Dry needling is done to induce bleeding, which helps tissue to heal spontaneously," Sconfienza said. "We allow nature to work for us. This method could be theoretically used for tennis elbow too."