The optimal radiotherapy regimen following mastectomy and immediate breast reconstruction remains under active investigation. In particular, the safety of moderate hypofractionation (HF) compared to conventional fractionation (CF) for postmastectomy radiotherapy (PMRT) has not been clearly established. Given the growing adoption of HF in breast cancer treatment, a thorough synthesis comparing complication outcomes is essential to guide clinical practice. A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL up to January 10, 2025. Studies comparing HF (2.4-2.7 Gy/fraction) and CF (1.8-2.0 Gy/fraction) in patients undergoing immediate breast reconstruction with PMRT were included. Studies involving partial breast irradiation or accelerated fractionation were excluded. Risk of bias was assessed using RoB 2 and ROBINS-I V2; certainty of evidence was evaluated using GRADE. A random-effects meta-analysis was performed, estimating pooled odds ratios (ORs) with 95 % confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023471267). Eleven studies (n = 3611), including three randomized controlled trials, were included. HF and CF demonstrated similar risks of major complications (OR: 0.83; 95 % CI: 0.51-1.35; p = 0.45; n = 5). No significant differences were observed for infection, wound dehiscence, or hematoma among photon-based studies. HF was associated with a lower risk of capsular contracture (OR: 0.38; 95 % CI: 0.15-0.99; p = 0.05; n = 5). Only one study evaluated quality of life, reporting no difference in physical well-being. HF offers a safety profile comparable to CF following breast reconstruction and may be preferred due to its reduced treatment burden and a potentially lower risk of capsular contracture.

Purpose: This study aimed to compare QoL outcomes among patients undergoing active breathing control (ABC), voluntary deep inspiration breath hold (vDIBH), and surface-guided radiation therapy (SGRT). Methods: This was a non-randomized, three-arm clinical trial in which 55 patients were sequentially allocated to ABC (n = 19), SGRT (n = 20), or vDIBH (n = 16). QoL was assessed using the European Organization for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30) at baseline, treatment completion, and 6–8 weeks post-treatment. Linear regression was used to compare changed scales in QoL domains across groups. A p-value of <0.05 was considered statistically significant. Results: Baseline QoL scores were high across all groups, with physical functioning being the highest-rated domain and global health status the lowest. Fatigue, pain, and insomnia were the most highly reported symptoms at all time points. At 6–8 weeks, social functioning improved significantly in SGRT compared to vDIBH (16.67 vs. −12.50, p = 0.0053). Patients in the vDIBH group reported significantly increased pain compared to ABC at 6–8 weeks (p = 0.0240). No other significant differences were observed in QoL changes between the groups. Conclusions: The three breath-hold techniques maintained overall QoL with no differences between the groups, except for pain between vDIBH and ABC and social functioning for vDIBH and SGRT both at 6–8 weeks of follow-up. Despite the limitations of this study, each breath-hold technique has demonstrated comparable impact on QoL in patients with left-sided breast cancer and each could be used as a viable option with respect to QoL.

Medical education plays a crucial role in shaping future healthcare providers' attitudes, skills, and understanding of underserved populations, including those experiencing homelessness. Summarizing the existing literature on medical students’ perception of People Experiencing Homelessness (PEH) can aid medical educators in developing a curriculum to allow medical students to comprehensively care for this population. The databases Web of Science, ERIC, Psychinfo, Embase and Medline were searched from 1946 to June 2023. Published quantitative and qualitative studies reporting on the perceptions or attitudes of medical students towards PEH were included. The studies were analyzed with descriptive statistics and described narratively. The search identified 1667 studies, with 15 ultimately included. Of the included studies, 66.7% were conducted in the United States of America, 26.7% were conducted in Canada, and 6.7% were completed in the United Kingdom. These studies revealed that medical students' perceptions vary, although most studies found medical students possess positive attitudes towards PEH, albeit feeling uncomfortable in their ability to provide care to this population. Additionally, most studies found when medical students were given educational exposures to PEH, they reported improved attitudes, more positive perceptions, and increased confidence in providing care. These results emphasize the benefits of providing structured educational experiences with PEH to medical students for improving patient care. More regionally diverse research in addition to studies examining the long-term effects of exposure to PEH during medical education on subsequent professional attitudes and behaviours is necessary.

PurposeTo evaluate the acute skin toxicity and treatment-related factors in patients undergoing breast re-irradiation in a tertiary cancer centre.MethodsA retrospective review was conducted of patients who received a repeat course of breast or chest wall radiation for ipsilateral breast cancer recurrence between April 20, 2011, and December 31, 2023. Patient characteristics, treatment parameters, and clinician-graded acute toxicity were recorded. Associations between toxicity and treatment factors were analyzed.ResultsSeventy patients met inclusion criteria. Acute skin toxicity was lower during retreatment than initial treatment with 22.9% of patients (n=16) developing moderate/severe reactions during re-irradiation compared with 51.4% (n=36) during the initial course. Severe toxicity at retreatment was not common, including moist desquamation in 10 patients (14.3%). Toxicity during the initial course did not predict toxicity during re-irradiation (p=0.75). Across all fractionation schedules, no significant associations were observed between dose regimen and symptoms such as pruritus, pain, erythema, discoloration, edema, burning, dry desquamation or moist desquamation.ConclusionsBreast re-irradiation was well tolerated in the acute setting, with toxicity patterns influenced primarily by radiation dose and delivery. The findings emphasize the need for ongoing prospective work to assess long-term outcomes.