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Abramson Cancer CenterNCI CANCERLIT® Search: Surgery for Breast Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11074688
AU - King AG
TI -
Re: Progression of idiopathic thoracolumbar scoliosis after breast
reconstruction with a latissimus dorsi flap: a case report (Spine 2000;
25: 622-5).
SO - Spine 2000 Nov 15;25(22):2968
2
UI - 11148554
AU - Chan KC; Knox WF; Sinha G; Gandhi A; Barr L; Baildam AD; Bundred NJ
TI -
Extent of excision margin width required in breast conserving surgery
for ductal carcinoma in situ.
SO - Cancer 2001 Jan 1;91(1):9-16
AD - Department of Surgery, University Hospital of South Manchester,
Manchester, United Kingdom.
BACKGROUND: Breast conserving surgery (BCS) is common practice for
unifocal ductal carcinoma in situ (DCIS) less than 4 cm in size, but the
extent of tumor free margin width around DCIS necessary to minimize
recurrence is unclear. METHODS: Clinical and pathologic details were
recorded from all patients with pure DCIS < 4 cm in size, treated with
BCS between 1978 and 1997. Histologic margins were measured by using an
ocular micrometer. Patients with clear margins (> 1 mm) were divided up
into 3 groups for analysis based on margin of normal tissue excised:
1.1-5 mm, 5.1-10 mm, and 10.1-40 mm. RESULTS: There were 66 patients
with close margins (< or = 1 mm), of which 25 cases (37.9%) recurred.
The recurrence rates for the 3 clear margin groups ranged from 4.5-7.1%.
Median followup was 47 months (range 12-197 mos). Risk of recurrence in
the group with close margins was greater than the subgroups with clear
margins (P < 0.001); no differences in recurrence was seen between the
individual subgroups with clear margins. Nuclear Grade 3 was predictive
of recurrence (P = 0.03). Following excision alone, the recurrence rate
was 18.6%, compared with 11.1% when radiotherapy was given as adjuvant
therapy. Women with clear margins following excision had a recurrence
rate of only 8.1%. CONCLUSION: After BCS for DCIS, close margins were
associated with a high risk of local recurrence. Radiotherapy did not
compensate for inadequate surgical clearance. Copyright 2001 American
Cancer Society.
3
UI - 11369255
AU - Zurrida S; Galimberti V; Gibelli B; Luini A; Gianoglio S; Sandri MT;
TI -
Passerini R; Maisonneuve P; Zucali P; Jeronesi G; Pigatto F; Veronesi U
Timing of breast cancer surgery in relation to the menstrual cycle: an
update of developments.
SO - Crit Rev Oncol Hematol 2001 Jun;38(3):223-30
AD - Senology Department, European Institute of Oncology, Milan, Italy.
stefano.zurrida@ieo.it
It is well-established that hormones have multiple effects on breast
cancer. Some, but not all studies indicate that the phase of the
menstrual cycle (and hence hormonal status) at the time of breast
surgery may influence survival. In this paper we review the literature
in this area, explore how it is possible that such an association may
occur, and note that randomised studies which unambiguously determined
the phase of the cycle at the time of the operation are lacking. We go
on to describe an ongoing self-randomised trial designed to address this
problem and present preliminary results which show that only about 75%
of the women ovulated during the cycle in which the operation took
place, and that the established prognostic factor Ki-67 varied with the
phase of the cycle in women who ovulated. It is too early to assess the
significance of this finding.
4
UI - 11369256
AU - Petit J; Rietjens M; Garusi C
TI -
Breast reconstructive techniques in cancer patients: which ones, when to
apply, which immediate and long term risks?
SO - Crit Rev Oncol Hematol 2001 Jun;38(3):231-9
AD - European Institute of Oncology-EIO, Plastic and Reconstructive Surgery
Unit, Via Ripamonti, 435, 20.141, Milan, Italy. jean.petit@ieo.it
Breast reconstruction is considered as part of the breast cancer
treatment when a mastectomy is required. The techniques available today,
allow reconstruction of the breast even in almost all the cases even in
poor local conditions. In 60-70% of the cases, the reconstruction can be
performed with an implant inserted behind the pectoralis muscle. Special
implants called expanders, are inflatable progressively in the
postoperative course thanks to a reservoir located subcutaneously. They
provide a progressive distention of the teguments and a more natural
shape after substitution of the expander with a definitive implant. The
symmetry is usually obtained thanks to a contralateral plastic surgery,
which allows at the same time histological check up of the glandular
tissue of the opposite breast. The nipple areolar complex is usually
reconstructed in a second stage under local anesthesia, using local
flaps for the nipple and a tattoo for the colour of the areola. In 30%
of the cases, especially after radiotherapy when a salvage mastectomy is
required, a flap reconstruction is preferred. The autologous tissue
reconstruction with the rectus myocutaneous flap gives excellent
cosmetic results and the most natural shape for the breast. But it is a
more demanding technique requiring a good experience. In some occasions,
the reconstruction with the latissimus flap can also be autologous but
usually requires the addition of prosthesis. In most cases, the
reconstruction can be performed immediately. The delayed reconstruction
is usually preferred when the adjuvant chemotherapy should be delivered
as soon as possible after the mastectomy. Complications of the
reconstruction such as local necrosis or infections, leading to implant
removal or revision of the flap could be detrimental to the patient in
delaying the start of the chemotherapy. It is not recommended to
reconstruct the breast immediately in case of locally advanced breast
cancer. Partial breast reconstruction using plastic surgery procedures
can also be performed in case of quadrantectomy in order to obtain a
better cosmetic result. Local glandular flaps, as well as specific
incisions according to the location of the tumor in the breast allow the
reshaping of the breast even in case of large resection and, therefore,
provide an opportunity to increase the number of conservative treatment
indications, especially in case of in-situ carcinomas.
5
UI - 11409025
AU - Gupta A
TI -
Current status of sentinel node biopsy in breast cancer.
SO - ANZ J Surg 2001 Jun;71(6):381-2
6
UI - 11450122
AU - Cattelani L; Galimberti A; Piccolo P; Del Rio P; Palli D; Boselli A
TI -
[Biopsy of sentinel lymph nodes in the treatment of breast carcinoma:
experience of the Surgery Department of the Hospital of Parma]
SO - Acta Biomed Ateneo Parmense 2000;71(5):187-92
Radical axillary nodes dissection in breast cancer is a standard for a
correct staging, unfortunately this approach can cause several
unpleasant sequelae and complications. Sentinel node biopsy applied to
breast tumors could be a good option for predicting axillary nodes
status avoiding complete dissection. The aim of this work is to report
our experience with sentinel node biopsy during a period of 18 months.
One hundred and nine patients with an infiltrating breast tumor T1 had
been studied. There wasn't clinical and ultrasonographic evidence of
axillary infiltration. Tumors had been injected on the day before
surgery with a mixture of colloidal human albumin particles marked with
99m Technetium. In 108 out of 109 patients (99%) sentinel node had been
identified using a gamma probe and biopsied during surgical intervention
performed under local anesthesia. Sentinel node has been examined both
with conventional histology and immunohistochemistry. In 26 cases the
node was positive for metastases. Radical axillary dissection in this
subgroup of patients showed that in 85% of them sentinel node was the
only positive. We conclude that sentinel node biopsy can be a good
alternative to traditional axillary dissection but there are still
important questions about the best method of analysis and, before the
technique become a routine procedure in breast cancer management, we
should know the results of prospective clinical trials comparing
survival of patients staged by sentinel node biopsy versus traditional
axillary dissection.
7
UI - 11432635
AU - Zgajnar J; Gatzemeier W; Costa A
TI -
Will the sentinel lymph node (SLN) stand a second time--SLN biopsy in
breast cancer patients with isolated local recurrence following breast
conserving therapy and previous SLN procedure.
SO - Ann Oncol 2001 May;12(5):723
8
UI - 11452833
AU - Procaccini E
TI -
[Radioimmunoguided surgery (RIGS) in breast disease]
SO - Chir Ital 2001 May-Jun;53(3):431
9
UI - 11449180
AU - Tocchi A; Mazzoni G; Bettelli E; Miccini M; Giuliani A; Cassini D
TI -
Impact of axillary level I and II lymphnode dissection on the therapy of
stage I and II breast cancer.
SO - Panminerva Med 2001 Jun;43(2):103-7
AD - 1st Department of Surgery, University of Rome La Sapienza, Rome, Italy.
BACKGROUND: Routine performance of axillary node dissection (AND) in the
treatment of stage I and II breast cancer has become controversial
because of pretended morbidity of this procedure and progressing consent
for sentinel lymphadenectomy. METHODS: Ninety-four consecutive patients
who underwent AND for clinical stage I and II breast cancer were
evaluated for a range of 48.3 months after surgery for movement and
sensory alterations and arm swelling. Arm circumference was measured in
all patients at the same four sites on both the operated and non
operated sides preoperatively and in the immediate and late
postoperative course. Capacity for movement was assessed pre- and
postoperatively as active ranging at the shoulder joint. Postoperative
numbness and paresthesias were assessed by standard questions. RESULTS:
No patient had axillary recurrence. None of the detected differences
between the preoperative and postoperative arm circumferences reached
statistical significance. No persistent motion limitation was observed.
Pain, numbness, paresthesia were detected in almost all patients in the
immediate postoperative period but resolved spontaneously in all cases
within 6 months. The obese body habit was detected on multivariate
analysis as the only significant predictor of edema. CONCLUSIONS: No
significant morbidity and no axillary recurrence were observed in
current experience to follow AND. These findings suggest that axillary
level I and II dissection remains an effective and safe tool for
diagnostic, as well therapeutic, purposes in the treatment of stage I
and II breast cancer. Further studies are necessary before it can safely
be reported that axillary node dissection is an optional part of the
treatment of stage I and II breast cancer.
10
UI - 11456055
AU - Janni W; Rjosk D; Dimpfl TH; Haertl K; Strobl B; Hepp F; Hanke A;
TI -
Bergauer F; Sommer H
Quality of life influenced by primary surgical treatment for stage I-III
breast cancer-long-term follow-up of a matched-pair analysis.
SO - Ann Surg Oncol 2001 Jul;8(6):542-8
AD - Department of Gynecology and Obstetrics, Women's Clinic at
Ludwig-Maximilians-University, Munich, Germany.
janni@fk-i.med.uni-muenchen.de
BACKGROUND: Breast-conserving therapy has been demonstrated to be just
as safe and a less disruptive experience compared with mastectomy for
surgically manageable breast cancer. There is, however, no agreement in
the literature about the impact of these procedures on several important
aspects of quality of life (QOL). The purpose of the present study is to
compare the long-term impact of these two surgical approaches on QOL in
patients with identical tumor stages and to suggest possible
shortcomings of the standard QOL questionnaires. METHOD: Between August
patients at the I. Frauenklinik, Ludwig-Maximilians University Munich,
as part of routine follow-up examinations. The pairs of patients, each
consisting of one patient after mastectomy and one after breast
conservation, were selected according to the highest degree of
equivalence in tumor stage. All patients had been initially treated for
stage I-III breast cancer without evidence of distant metastases. The
QOL was evaluated by using the QLQ-C30 questionnaire version 2.0 of the
EORTC Study Group on Quality of Life. We formulated seven additional
questions about the patients' satisfaction with the primary surgical
treatment modality as viewed from their current perspective. The QOL
questionnaires were answered after a median interval of 46 months
following primary treatment. RESULTS: Tumor stage, prognostic factors,
and adjuvant systemic treatment were well balanced between the two
groups. No differences between the two groups were observed in terms of
all QOL items measured by the QLQ-C30. Our additional questions,
however, revealed that patients in the mastectomy group were less
satisfied with the cosmetic result of their primary operation (P <
.0001), were more likely to feel basic changes in their appearance (P <
.0001), and were more likely to be emotionally stressed by these facts
(P < .0001). From their perspective at the time of completing the
questionnaires, 11 patients in the mastectomy group (15%) would decide
differently about the surgical treatment modality, compared with only 3
patients (4%) in the breast conservation group (P = .025). CONCLUSION:
While the primary surgical treatment modality seems to have no long-term
impact on general QOL, certain body-image-related problems may be caused
by mastectomy. Standard measuring instruments for QOL may fail to detect
differences in satisfaction and adaptation with the primary surgical
treatment modality.
11
UI - 11478545
AU - Deadman JM; Leinster SJ; Owens RG; Dewey ME; Slade PD
TI -
Taking responsibility for cancer treatment.
SO - Soc Sci Med 2001 Sep;53(5):669-77
AD - Department of Clinical Psychology, Sutton General Hospital, Surrey, UK.
One hundred and fourteen consecutive patients with early breast cancer
were entered into a study on the psychological effects of involvement in
treatment choice. All women were offered counselling throughout. One
group of women (n = 34), were advised to undergo mastectomy, due to the
nature or position of the tumour. These women fared less well
psychologically when compared on a battery of measures, before and after
surgery, with women who were involved in choosing their own treatment (n
= 80). The latter group itself was randomly allocated into two groups
for taking explicit responsibility for treatment choice, using a
double-blind procedure. These were a Patient Decision Group (n = 41) and
a Surgeon Decision Group (n = 39). Results support the hypothesis that
over and above the benefits of receiving their preferred treatment,
women can further benefit from taking explicit responsibility for their
treatment choice.
12
UI - 11482066
AU - Stanislawek A; Kurylcio L; Janikiewicz A
TI -
Arm lymphoedema after surgical treatment for the cancer of the breast.
SO - Ann Univ Mariae Curie Sklodowska [Med] 2000;55():155-60
AD - Katedra Onkologii Akademii Medycznej w Lublinie.
13
UI - 11482067
AU - Stanislawek A; Kurylcio L
TI -
Complications of axillary node dissection for breast carcinoma as
perceived by patients.
SO - Ann Univ Mariae Curie Sklodowska [Med] 2000;55():161-7
AD - Katedra Onkologii Akademii Medycznej w Lublinie.
14
UI - 11527290
AU - Dodwell D; Horgan K
TI -
Breast cancer: locoregional control and survival.
SO - Clin Oncol (R Coll Radiol) 2001;13(3):172-3
AD - Breast Unit, Leeds Cancer Centre, Leeds General Infirmary, UK.
15
UI - 11520082
AU - Cense HA; Rutgers EJ; Lopes Cardozo M; Van Lanschot JJ
TI -
Nipple-sparing mastectomy in breast cancer: a viable option?
SO - Eur J Surg Oncol 2001 Sep;27(6):521-6
AD - Department of Surgery, Isala Clinics location Weezenlanden, Zwolle, The
Netherlands. hacense@knmg.nl
BACKGROUND: In women with breast cancer for whom breast-conserving
therapy (BCT) is not the best option, a nipple and areola complex-(NAC)
sparing mastectomy with immediate reconstruction has been proposed as a
good and safe alternative to conventional, more radical mastectomy.
Surgeons hesitate to perform this operation for fear of recurrence of
tumour in the NAC due to undetected nipple involvement (NI) of the
tumour. In order to determine whether a NAC-sparing mastectomy is a
viable option, the frequency and predictive factors of NI by the tumour
were studied in the literature. METHODS: A literature survey was
performed by searching the Medline database. Other references were
derived from the material perused. RESULTS AND CONCLUSIONS: NI is found
in up to 58% of mastectomy specimens and correlates with tumour size,
tumour-areola or tumour-nipple distance, positive lymph nodes and
clinical suspicion. Best candidates for NAC-sparing mastectomy are
patients with a small tumour (T1) at a large distance (>4-5 cm) from the
nipple. However, in these patients BCT has excellent results with low
complications and recurrence rates. Considering the incidence of NI in
larger tumours (T2 average 33%, T3 average >50%) a NAC-sparing
mastectomy may carry an unacceptable high risk for local relapse and
should therefore not be advocated. Copyright 2001 Harcourt Publishers
Limited.
16
UI - 11520085
AU - Shrotria S
TI -
Breast mass removal made easy by the lump extractor: introducing a new
instrument in breast surgery.
SO - Eur J Surg Oncol 2001 Sep;27(6):539-40
AD - Ashford Breast Unit, Ashford Hospital, Ashford, Middlesex, TW15 3AA, UK.
The difficulty encountered in the removal of breast lumps has been
addressed by the use of a new instrument. The lump extractor described
in this paper allows minimal scar surgery and prevents crushing of the
breast mass. Copyright 2001 Harcourt Publishers Limited.
17
UI - 11520096
AU - Shrotria S
TI -
The peri-areolar incision--gateway to the breast!
SO - Eur J Surg Oncol 2001 Sep;27(6):601-3
AD - Ashford Breast Unit, Ashford Hospital, Ashford, Middlesex, TW15 3AA, UK.
BACKGROUND: In breast surgery the challenge for good cosmesis needs to
be met in the management of benign or malignant disease. With tumours
this must be balanced against good clearance with safe and adequate
margins. For excision of benign lesions obvious deforming scars are
unacceptable while with breast preserving cancer surgery a badly placed
scar reduces reconstructive choices. The peri-areolar incision has a
role in skin sparing mastectomy (SSM) and in breast conserving surgery.
This paper describes the application of this incision in breast surgery.
METHODS: Patients undergoing breast surgery for benign and malignant
disease have undergone operations using a peri-areolar incision.
Examples of use of this incision are shown. CONCLUSION: The peri-areolar
incision provides good cosmesis while allowing for future or immediate
reconstruction and without reducing the range of options. Copyright
Harcourt Publishers Limited.
18
UI - 11520097
AU - Ball S; Arolker M; Purushotham AD
TI -
Breast cancer, Cowden disease and PTEN-MATCHS syndrome.
SO - Eur J Surg Oncol 2001 Sep;27(6):604-6
AD - Cambridge Breast Unit, Addenbrookes Hospital, Hills Road, Cambridge, UK.
19
UI - 11520102
AU - Mostafa A; Carpenter R
TI -
Anaphylaxis to patent blue dye during sentinel lymph node biopsy for
breast cancer.
SO - Eur J Surg Oncol 2001 Sep;27(6):610
20
UI - 11574205
AU - Lampl L
TI -
Chestwall resection: a new and simple method for stabilization of
extended defects.
SO - Eur J Cardiothorac Surg 2001 Oct;20(4):669-73
AD - I. Chirurgische Klinik, Zentralklinikum Augsburg, Stenglinstrasse 2,
86156 Augsburg, Germany. dr_ludwig_lampl@hotmail.com
OBJECTIVE: Postresectional chestwall defects can usually be stabilized
by reconstructions under tension. Only few extended defects require
combined stabilizing methods. The one used mostly is Marlex-Sandwich,
despite some disadvantages. An alternative method using alloplastic
material/metal bar is presented. MATERIAL AND METHODS: Between 1986 and
1999, 189 chestwall resections were performed either for infiltrating
bronchogenic carcinoma (Type I, n=67), tumors originating from chestwall
or bony metastases (Type II, n=88), or local recurrences and
infiltration by breast cancer or sequelae of its treatment (Type III,
n=34).The standard reconstruction is performed with non-absorbable
alloplastic meshes or patches under some degree of tension. For defects
exceeding 250 cm(2), usually Type-II cases, a reconstruction under
tension is no longer appropriate. Therefore we developed a procedure
which we used in six cases. Alloplastic mesh or patch gets sutured in
the same way as is done in smaller defects. Then a metal bar (Grob-Stab,
Ulrich, Herrlingen/Blaustein, Germany) is threaded through the
alloplastic material and is fixed at the adjacent ribs by Parham steel
bands (Ethicon, Sommerville, KY, USA). RESULTS: In all cases we achieved
excellent stability. All of the patients were extubated on the operating
table. There was no morbidity or mortality. In three cases the metal
bars were removed after 3, 6 and 16 months postoperatively
(dynamization). CONCLUSION: The new procedure is safe, simple and
quickly performed. The additional costs are low (160 euro). The
patient's comfort is excellent; borderline problems as described for
Marlex-Sandwich can be avoided, so that this procedure can be considered
as an alternative to Marlex-Sandwich.
21
UI - 11587678
AU - Ashkanani F; Sarkar T; Needham G; Coldwells A; Ah-See AK; Gilbert FJ;
TI -
Hutcheon AW; Eremin O; Heys SD
What is achieved by mammographic surveillance after breast conservation
treatment for breast cancer?
SO - Am J Surg 2001 Sep;182(3):207-10
AD - Department of Surgery, University of Aberdeen, Aberdeen, UK.
BACKGROUND: After breast conservation surgery for breast cancer,
patients are followed up by regular clinical examination and
mammography, at intervals which vary according to local practice.
However, the optimum interval remains unclear with current guidelines
suggesting mammography should be carried out every 1 to 2 years. This
study has investigated this aspect and, in particular, whether
mammography or clinical examination or both allowed an early detection
of recurrence of the disease in the conserved breast. METHODS: A total
of 695 patients who had undergone breast conservation surgery were
identified from a database of prospectively recorded data during the
period 1990 to 1995. Clinical examination and annual mammography were
performed in accordance with local protocol. The results of clinical
examination, mammography, and local recurrence rates were evaluated.
RESULTS: A total of 2,181 mammograms were undertaken in the 695 patients
studied. Local recurrence of disease in the conserved breast occurred in
21 patients (3%), at a mean follow-up of 3.5 years. The first
identification of tumor recurrence was by clinical examination in 11
patients with local recurrence, and by the surveillance mammography in
the other 10 patients with local recurrence. Overall, mammography
detected the local recurrence in 13 of 20 (65%) patients who underwent
this examination. In the other patients, the recurrence was detected on
clinical examination only. In addition, in 52 patients, mammography was
falsely positive, giving a false positive rate of 2.3%. Contralateral
cancers in the opposite breast were detected in 2 patients. CONCLUSIONS:
The detection of local disease after breast conservation surgery
requires both clinical examination and mammography. In the context of
our follow-up policy, in 52% of patients with local recurrence, this was
first identified by clinical examination. Disease recurrence was
identified in the other 48% of patients by mammographic surveillance.
Overall, mammography will identify or confirm local recurrence in two
thirds of women. However, in a small number of cases (2.3% in our
series) mammography will give false positive results. New imaging
modalities to assist in the diagnosis of local recurrence of disease
after breast conservation surgery are required.
22
UI - 11596017
AU - Izzo F; Thomas R; Delrio P; Rinaldo M; Vallone P; DeChiara A; Botti G;
TI -
D'Aiuto G; Cortino P; Curley SA
Radiofrequency ablation in patients with primary breast carcinoma: a
pilot study in 26 patients.
SO - Cancer 2001 Oct 15;92(8):2036-44
AD - Division of Surgical Oncology, The G. Pascale National Cancer Institute,
Naples, Italy.
BACKGROUND: The authors performed a pilot trial of ultrasound-guided
percutaneous radiofrequency ablation (RFA) in patients with T1 and T2
breast tumors 1) to confirm complete coagulative necrosis of tumor
tissue and 2) to determine the safety and complications related to this
treatment. METHODS: Twenty-six patients with biopsy-proven, invasive
breast carcinoma underwent RFA of their breast tumors followed by
immediate resection. Treatment was planned to ablate the tumor and a 5
mm margin of surrounding breast tissue. Tumor viability after RFA was
assessed by hematoxylin and eosin and nicotinamide adenine dinucleotide
vital staining. RESULTS: Twenty patients (77%) had T1 tumors, and six
patients (23%) had T2 tumors. The mean greatest dimension of tumors that
were treated with RFA was 1.8 cm (range, 0.7-3.0 cm). The mean treatment
time for two-phase RFA treatment was 15 minutes and 23 seconds (range,
from 6 minutes and 25 seconds to 24 minutes and 54 seconds). Coagulation
necrosis of the tumor was complete in 25 of 26 patients (96%): One
patient had a microscopic focus of viable tissue adjacent to the needle
shaft site. A single patient (1 of 26 patients; 4%) had a complication
related to RFA: a full thickness burn of the skin overlying a tumor that
was immediately beneath the skin. CONCLUSIONS: This pilot experience
with RFA in the treatment of patients with early-stage, primary breast
carcinoma revealed that 1) coagulative necrosis of the entire tumor
occurred in 96% of the patients, and 2) the treatment was safe, with
only a 4% complication rate. The authors have initiated a trial of RFA
alone (no resection) for patients with T1 and T2 breast tumors that will
include sentinel lymph node mapping and postablation irradiation.
Copyright 2001 American Cancer Society.
23
UI - 11595118
AU - Sartor CI
TI -
Postmastectomy radiotherapy in women with breast cancer metastatic to
one to three axillary lymph nodes.
SO - Curr Oncol Rep 2001 Nov;3(6):497-505
AD - Department of Radiation Oncology and Lineberger Comprehensive Cancer
Center, University of North Carolina School of Medicine, Chapel Hill, NC
27599, USA. sartor@radonc.unc.edu
The influence of postmastectomy radiotherapy on survival has long been
debated. Early randomized trials established a clear role for adjuvant
postmastectomy chest wall radiotherapy (PMCWRT) in reducing locoregional
recurrence (LRR), and PMCWRT became standard therapy for patients at
high risk of LRR: those with T3 or T4 tumors and four or more involved
lymph nodes. However, without effective systemic therapy, distant
metastases limited any effect of improved local control on overall
outcome, and radiotherapy showed no benefit in survival. In fact, early
meta-analyses showed a negative impact of radiotherapy on survival. As
data and techniques matured, a favorable influence of PMCWRT on breast
cancer-specific mortality emerged but was offset by a
radiotherapy-related increase in vascular mortality. Improvements in
radiotherapy delivery to increase efficacy and reduce toxicity,
restriction of PMCWRT to patients at intermediate or high risk of LRR
after mastectomy, and improved distant control of disease with systemic
therapy are expected to bring the greatest likelihood of a survival
advantage from locoregional control. Three randomized trials with
sufficient follow-up meet these criteria. All demonstrate significant
improvement in overall survival with PMCWRT. However, the trials were
not designed to specifically address the benefit of PMCWRT in patients
at intermediate risk of LRR (those with T1 or T2 tumors and one to three
involved lymph nodes). These findings have been discussed in a host of
publications and conferences in light of historical negative results.
This review focuses on the recent data on PMCWRT in patients with one to
three involved nodes.
24
UI - 11597809
AU - Fowble B; Hanlon A; Freedman G; Nicolaou N; Anderson P
TI -
Second cancers after conservative surgery and radiation for stages I-II
breast cancer: identifying a subset of women at increased risk.
SO - Int J Radiat Oncol Biol Phys 2001 Nov 1;51(3):679-90
AD - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia,
PA 19111, USA.
PURPOSE: To assess the risk and patterns of second malignancy in a group
of women treated with conservative surgery and radiation in a relatively
contemporary manner for early-stage invasive breast cancer, and to
identify a subgroup of these women at increased risk for a second
cancer. METHODS AND MATERIALS: From 1978 to 1994, 1,253 women with
unilateral Stage I-II breast cancer underwent wide excision, axillary
dissection, and radiation. The median follow-up was 8.9 years, with 446
patients followed for >or= 10 years. The median age was 55 years.
Sixty-eight percent had T1 tumors and 74% were axillary-node negative.
Radiation was directed to the breast only in 78%. Adjuvant therapy
consisted of chemotherapy in 19%, tamoxifen in 19%, and both in 8%.
Factors analyzed for their association with the cumulative incidence of
all second malignancies, contralateral breast cancer, and non-breast
cancer malignancy were: age, menopausal status, race, family history,
obesity, smoking, tumor size, location, histology, pathologic nodal
status, region(s) treated with radiation, and the use and type of
adjuvant therapy. RESULTS: One hundred seventy-six women developed a
second malignancy (87 contralateral breast cancers at a median interval
of 5.8 years, and 98 non-breast cancer malignancies at a median interval
of 7.2 years). Nine women had both a contralateral breast cancer and
non-breast cancer second malignancy. The 5- and 10-year cumulative
incidences of a second malignancy were 5% and 16% for all cancers, 3%
and 7% for contralateral breast cancer, 3% and 8%, for all second
non-breast cancer malignancies, and 1% and 5%, respectively, for second
non-breast cancer malignancies, excluding skin cancers. Patient age was
a significant factor for contralateral breast cancer and non-breast
cancer second malignancy. Young age was associated with an increased
risk of contralateral breast cancer, while older age was associated with
an increased the risk of a second non-breast cancer second malignancy. A
positive family history increased the risk of contralateral breast
cancer, but not non-breast cancer malignancies. The risk of a
contralateral breast cancer increased as the number of affected
relatives increased. Tamoxifen resulted in a nonsignificant decrease in
contralateral breast cancer and an increase in non-breast cancer second
malignancies. The 5-and 10-year cumulative incidences for leukemia and
lung cancer were 0.08% and 0.2%, and 0.8% and 1%, respectively. There
was no significant effect of chemotherapy or the regions treated with
radiation on contralateral breast cancer or non-breast cancer second
malignancy. The most common types of second non-breast cancer
malignancies were skin cancers, followed by gynecologic malignancies
(endometrial), and gastrointestinal malignancies (colorectal and
pancreas). CONCLUSION: The 10-years cumulative incidence of a second
cancer in this study was 16%. Young age and family history predicted for
an increased risk of contralateral breast cancer, and older age
predicted for an increased risk of non-breast cancer malignancy. The
majority of patients treated with conservative surgery and radiation
with or without adjuvant systemic therapy will not develop a second
cancer. Long-term follow-up is important to document the risk and
patterns of second cancer, and knowledge of this risk and the patterns
will influence surveillance and prevention strategies.
25
UI - 11603561
AU - Answini GA; Woodard WL; Norton HJ; White RL Jr
TI -
Breast conservation: trends in a major southern metropolitan area
compared with surrounding rural counties.
SO - Am Surg 2001 Oct;67(10):994-8
AD - Department of General Surgery and Blumenthal Cancer Center, Carolinas
Medical Center, Charlotte, North Carolina 28203, USA.
Despite randomized prospective studies and National Institutes of Health
recommendations, surgeons especially in the southern United States have
been slow to adopt breast conservation surgery (BCS). Data were analyzed
regarding 3,349 cases of stage 0, I, and II breast cancer (1991-1998)
from Charlotte-Mecklenburg County, NC; 1057 cases from six surrounding
rural counties (1995-1997); and 90,398 cases (1995) from the National
Cancer Data Base. During 1995 through 1997 Charlotte-Mecklenburg County
had statistically significantly higher rates of BCS compared with six
surrounding rural counties for stage I (59% and 42% respectively, P =
0.001) and stage II (37% and 19%, respectively, P = 0.001) breast
cancer. The BCS rates in Charlotte-Mecklenburg County (1991-1998) showed
the following: Stage 0 rate increased from 17 per cent in 1991 to 78 per
cent in 1998 (P = 0.001), stage I rate increased from 31 per cent in
1991 to 65 per cent in 1998 (P = 0.001), and stage II rate increased
from 18 per cent in 1991 to 42 per cent in 1998 (P = 0.001). BCS rates
for early-stage breast cancer in Charlotte-Mecklenburg County have
increased over the last 8 years and now equal national rates; however,
patients in surrounding rural counties are not receiving BCS as
frequently. There is a need for more widespread education of surgeons,
other health care providers, and the general public to increase the use
of BCS.
26
UI - 11606868
AU - Kathleen Adams E
TI -
Going beyond costs when evaluating surgical options for women newly
diagnosed with breast cancer.
SO - Med Care 2001 Nov;39(11):1143-5
27
UI - 11606869
AU - Given C; Bradley C; Luca A; Given B; Osuch JR
TI -
Observation interval for evaluating the costs of surgical interventions
for older women with a new diagnosis of breast cancer.
SO - Med Care 2001 Nov;39(11):1146-57
AD - Department of Family Practice, Michigan State University, East Lansing
48824, USA. givenc@msu.edu
OBJECTIVE: To estimate the episodic costs of surgical treatments for
breast cancer. METHODS: The surgical treatment period as the 6 weeks
following diagnosis is defined. Using a sample of 205 women aged 65 and
older and their Medicare claim files, the cost of treatment is estimated
and the progression from first to subsequent surgical procedures during
the 6-week interval is demonstrated with a decision tree. Two equations
are then estimated: the probability of mastectomy versus breast
conserving surgery (BCS) as first surgery using Probit regression and
the log of total charges using a generalized linear regression model.
RESULTS: It was found that only stage predicts the probability of
mastectomy versus BCS and that 54% of women receiving BCS undergo a
second surgery. Once all treatments in the initial surgical period are
accounted, the difference between the adjusted cost of mastectomy alone
and BCS followed by a second surgery was not statistically significant.
Only a successful first BCS is statistically significantly (P <0.05)
less costly than a mastectomy alone ($4,955 vs. $9,049). CONCLUSIONS: By
defining a 6-week surgical treatment episode it is shown that BCS
followed by subsequent surgeries is the more costly option for initial
treatment. Given the high prevalence of second surgeries, previous work
may have underestimated the costs of surgical interventions for breast
cancer.
28
UI - 11641092
AU - Bourez RL; Rutgers EJ
TI -
The European Organization for Research and Treatment of Cancer (EORTC)
Breast Cancer Group: quality control of surgical trials.
SO - Surg Oncol Clin N Am 2001 Oct;10(4):807-19, ix
AD - Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The
Netherlands.
This article discusses the impact of surgery-related factors on the
outcome of breast cancer patients and the experience of the EORTC in
assessing the quality of breast cancer surgery. Furthermore an overview
is given of the surgical quality control in the EORTC-AMAROS trial NR
10981.
29
UI - 11669588
AU - Cutress RI; Gupta R; Parakh A; Rutter D; Spencer L; Royle GT
TI -
Might patients benefit from oral iron therapy following operative
treatment of breast carcinoma?
SO - Eur J Surg Oncol 2001 Nov;27(7):621-5
AD - Southampton Breast Unit, Royal South Hants Hospital, Brintons Terrace,
Southampton SO14 0YG, UK.
AIMS: To assess the changes in blood haemoglobin concentration and serum
iron indices as a consequence of breast operations for cancer in our
unit. METHODS: Haematological parameters were measured in 109 patients
undergoing definitive operative treatment for breast carcinoma. RESULTS:
A mean fall in haemoglobin of 2.1 g (P=0.001) occurred in patients
undergoing mastectomy and axillary clearance and of 1.3 g (P<0.001) in
patients undergoing wide local excision and axillary clearance. The
transferrin saturation (serum iron/total iron binding capacity) in both
sets of patients after surgery fell on average to levels that would be
expected to impair subsequent red cell production. CONCLUSION: The
changes in iron indices that occurred were unrelated to the degree of
blood loss consistent with a possible inflammatory effect of the
operation. Oral iron therapy is unlikely to be of benefit to operative
breast patients if they have normal pre-operative iron stores. Copyright
2001 Harcourt Publishers Limited.
30
UI - 11680071
AU - van der Loo EM; Sastrowijoto SH; Bril H; van Krimpen C; de Graaf PW;
TI -
Eulderink F
[Less operations required due to perioperative frozen section
examination of sentinel nodes in 275 breast cancer patients]
SO - Ned Tijdschr Geneeskd 2001 Oct 13;145(41):1986-91
AD - mw.dr.E.M.van der Loo
OBJECTIVE: To determine the reliability of a peroperative frozen section
examinations of sentinel lymph nodes in mammary carcinoma. DESIGN:
Retrospective. METHOD: In the Reinier de Graaf Hospital and Diagnostic
Centre SSDZ Delft, the Netherlands, the results of frozen section from
sentinel lymph node investigations of mammary carcinomas from 1997-2000
were compared with the final pathological results. If axillary
dissection had been performed on these patients, the histopathological
findings of the dissected lymph nodes were also studied. RESULTS: Frozen
sections were made of 287 sentinel lymph nodes from 275 patients. A
tumour was found in the sentinel lymph nodes of 64 patients and these
patients immediately underwent a complete axillary lymph node
dissection. For 31 of these patients a tumour was also found in the
other lymph nodes. In 29 of these 31 patients, histological examination
had shown extranodal extension. The frozen sections from the sentinel
nodes of the remaining 211 patients were considered negative. However,
in 13 of these patients, the paraffin sections of the sentinel node
nevertheless showed a tumour and the remaining axillary lymph nodes were
removed in a second operation. In the last 89 patients studied, the
sentinel lymph nodes were cut at four levels and stained
immunohistochemically at one level for cytokeratins. Accordingly
micrometastases were found in the sentinel lymph nodes of 4 of the 13
patients with (false-)negative frozen sections. False-positive results
did not occur. CONCLUSION: The major advantage of the sentinel node
method in breast cancer is that for women without metastasis present in
the sentinel node, axillary dissection is avoided. By means of a
peroperative examination of frozen sections, 83% of the patients with a
metastasis in the sentinel lymph node (or about one quarter of all
patients) were spared from having a second operation for axillary
dissection at a later stage.
31
UI - 11680022
AU - Sack H
TI -
[Risk factors for local recurrence and distant metastases after breast
conserving therapy of ductal carcinoma in situ]
SO - Strahlenther Onkol 2001 Oct;177(10):557
32
UI - 11693834
AU - Scuderi N; Ribuffo D; Onesti MG; Cigna E
TI -
Reconstructive options: implants versus autologous tissue.
SO - Tumori 2001 Jul-Aug;87(4):S8-9
AD - Department of Plastic Surgery, Policlinico Umberto I, University of Rome
La Sapienza, Italy.
33
UI - 11699375
AU - Lundgren S; Jorgensen S; Karesen R
TI -
[Breast cancer surgery in Norway 1990-95 illustrated by data from SINTEF
United]
SO - Tidsskr Nor Laegeforen 2001 Sep 30;121(23):2688-93
AD - SINTEF Unimed NIS 7465 Trondheim. steinar.lundgren@unimed.sintef.no
BACKGROUND: Breast-conserving therapy has been shown to be as effective
as mastectomy in many cases; hence in many countries more breast cancer
patients are offered this type of treatment. This study focuses on the
amount and type of surgery used in Norway for breast cancer patients and
the possible use of hospital discharge data to evaluate the diffusion of
this surgical practice. MATERIAL AND METHODS: Data from the nationwide
Register of Hospital Discharges in Norway at SINTEF Unimed for patients
operated for breast cancer from 1990 to 1995 were used. RESULTS: 11,041
patients were registered with 11,727 hospital admissions for breast
cancer operations from a total of 64 hospitals. The discrepancy in the
number of breast cancer patients with the National Cancer Registry was
7%. Breast-conserving surgery was performed in 19.7%. An increase from
17% in 1990 to 21% in 1995 was f
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