Objective(s): radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer.Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion.Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction.Conclusion: The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome.

Lichenoid dermatitis is a rare complication after radiation therapy and is often considered as a delayed hypersensitivity reaction. It is different from lichen planus and is characterized by fine white scale (Wickham’ s striae). Here, we report a case of lichenoid dermatitis developed after hypofractionated whole-breast radiation therapy followed by breast-conserving surgery. A 60-year-old female patient underwent hypofractionated whole-breast radiation therapy followed by a boost to the tumor bed. Post-radiation course was uneventful, but violaceous, polyangular, and pruritic papules accompanied by the eruption were noted at the boost site. Clinical findings were consistent with lichenoid dermatitis, so steroid ointment and oral antihistamines were administered. Her lichenoid dermatitis was completely relieved in 2 weeks, and there was no sign of relapse during the 5 years follow-up. There are some reports of lichen planus induced after radiotherapy; however, this is the first report that shows lichenoid dermatitis as a possible complication after hypofractionated radiation therapy for breast cancer.

breast Crawl is initiating breastfeeding and evidence based method. Followed by numerous studies on breast-feeding, and mother and child heath, BC was discussed for which a protocol was presented. There are few studies on BC method. For the first time in Iran, we performed this method in Alzahra hospital of Tabriz where we came across an interesting case. The report is about a term infant who was put on the mother's abdomen to find the mother’ s breast. The infant was stuck to the mother’ s skin due to abundant Vernix and could not move despite her attempts. This lengthens the expected time for BC method, but in the end, the infant managed to reach the mother’ s breast and started sucking on her breast without any help. There are various causes that might prolong BC implementation time or even prevent you from doing it. This case mentions to a problem that never listed in breast crawl guideline and may be selected as a hindering factor for breast crawl in future.