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NCI CANCERLIT^® Search: Surgery for Breast Cancer - February 2002

National Cancer Institute^®
Last Modified: February 1, 2002

Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial.

Treatment selection in ductal carcinoma in situ.

3D-MR mammography-guided breast conserving surgery after neoadjuvant chemotherapy: clinical results and future perspectives with reference to

[Less operations required due to perioperative frozen section examination of sentinel nodes in 275 breast cancer patients]

En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

A cost-outcome analysis of adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients.

Tamoxifen increases von Willebrand factor in women who underwent breast cancer surgery.

Immediate breast reconstruction with free TRAM flap: a case report with a 10-year follow-up and radiological imaging.

When can the nipple-areola complex safely be spared during mastectomy?

Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery.

EMLA reduces acute and chronic pain after breast surgery for cancer.

Table of Contents

1
UI - 11521809
AU - Veronesi U; Marubini E; Mariani L; Galimberti V; Luini A; Veronesi P;
TI - Salvadori B; Zucali R Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial.
SO - Ann Oncol 2001 Jul;12(7):997-1003
AD - Department of Senology, European Institute of Oncology, Milano, Italy. umberto.veronesi@ieo.it
BACKGROUND: Breast-conserving surgery followed by radiotherapy is a widely accepted form of treatment in patients with breast cancer of limited extent. Many attempts have been made to identify subgroups of patients who might avoid radiotherapy. PATIENTS AND METHODS: Between 1987 and 1989, 579 women with carcinoma of the breast were randomly assigned to quadrantectomy, axillary dissection and radiotherapy (299) and to quadrantectomy with axillary dissection without radiotherapy (280). Eligible patients were women with a breast carcinoma less than 2.5 cm in maximum diameter up to 70 years of age. Primary endpoints were intra-breast tumour reappearance (IBTR) and all-cause mortality. RESULTS: The number of IBTRs was significantly higher in patients treated with surgery alone (59 cases out of 273; 10-year crude cumulative incidence of 23.5%) than in patients treated with surgery plus radiotherapy (16 cases out of 294; 10-year crude cumulative incidence of 5.8%). The difference in IBTR frequency between the two treatments appeared to be particularly high in women up to 45 years of age, tending to decrease with increasing age up to no apparent difference in women older than 65 years. Overall survival curves for the two groups, did not differ significantly (P = 0.326). However, a limited survival advantage was evident after radiotherapy for node-positive women. CONCLUSIONS: After breast-conserving surgery radiotherapy appears indicated in all patients up to 55 years of age, in patients with positive axillary nodes, and in patients with extensive intraductal component at histology. The data suggest that radiotherapy may be avoided in patients older than 65, and may be optional in women aged 56-65 years with negative nodes.

2
UI - 11791117
AU - Morrow M
TI - Treatment selection in ductal carcinoma in situ.
SO - Breast Cancer 2001;8(4):275-82
AD - Lynn Sage Breast Cancer Program and Department of Surgery, Northwestern University, Chicago, IL 60611, USA. mmorrow@nmh.org

3
UI - 11791129
AU - Nakamura S; Kenjo H; Nishio T; Kazama T; Do O; Suzuki K
TI - 3D-MR mammography-guided breast conserving surgery after neoadjuvant chemotherapy: clinical results and future perspectives with reference to FDG-PET.
SO - Breast Cancer 2001;8(4):351-4
AD - Department of Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan. seigonak@po.iijnet.or.jp
BACKGROUNDS: Three dimensional MR Mammography (3D-MRM) can detect tumor extension more accurately than mammography or ultrasound. There are two shrinkage patterns observed by 3D-MRM after neoadjuvant chemotherapy. Concentric shrinkage is a good indication for breast conserving surgery. On the other hand, a dendritic pattern was represent ductal spread. Therefore, we developed MRM guided mapping to aid BCS for tumors showing a dendritic pattern. METHODS: Fifteen patients consisting of 8 stage II (T > 3.5 cm) cases and 7 stage IIIa cases aged 39 to 61 years (mean 47-8 years) were treated with AT neoadjuvant chemotherapy with the aim of performing breast conserving surgery. All patients were examined by 3D-MRM before and after neoadjuvant chemotherapy. Breast conserving surgery indications were determined by tumor volume reduction and shrinkage patterns on 3D-MRM. Supine position mapping using MRM was performed for dendritic type tumors. FDG-PET was simultaneously performed for one case with bilateral breast cancer. RESULTS: Breast conserving surgery was performed for 13 of the 15 cases. One case underwent re-operating and mastectomy because of a positive margin. One case had microscopically positive margin and received boost radiation. Therefore, 11 of 15 cases (73.3%) underwent BCS and achieved negative margins under MRM guidance. PET scanning can detect residual tumor and occult metastasis but it is not suitable for mapping because of its spatial resolution. Conclusions: 3D-MRM is a useful modality to select appropriate cases for breast conserving surgery after neoadjuvant chemotherapy. FDG-PET can also detect residual tumor or occult metastasis but it may not be suitable for mapping. Because both examinations have potential, further evaluation of their clinical efficacy is necessary.

4
UI - 11789162
AU - de Vries J
TI - [Less operations required due to perioperative frozen section examination of sentinel nodes in 275 breast cancer patients]
SO - Ned Tijdschr Geneeskd 2001 Dec 22;145(51):2508-9

5
UI - 11372610
AU - Lifrange E; Dondelinger RF; Fridman V; Colin C
TI - En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?
SO - Eur Radiol 2001;11(5):796-801
AD - Breast Department, Sart Tilman University Hospital, 4000 Liege, Belgium. elifrange@chu.ulg.ac.be
This study was prospectively conducted to evaluate the clinical potential of the advanced breast biopsy instrumentation (ABBI) system as an alternative to needle localization and open surgery in the management of nonpalpable breast lesions (NPBL). One hundred and eighty-six consecutive patients were referred for management of NPBL. Thirty-six underwent an ABBI procedure, offered as a first step before possible surgery for lesions which would in any case have required complete excision. The 18 patients with a malignant ABBI biopsy underwent re-excision of the biopsy site and axillary dissection was carried out in cases of infiltrating carcinoma. The other 150 patients underwent image-guided needle biopsy. Following these procedures, 60/150 (40%) patients underwent needle-guided surgery. Finally, 96/186 (51%) patients required complete excision. A total of 43 benign lesions and 53 carcinomas were confirmed. Thirty-six out of 96 (38%) excisions were obtained with the ABBI system; 17/43 (40%) benign lesions and 11/53 (21%) carcinomas were completely removed with the ABBI system. Out of 9 malignant specimens with a pathological size less than 10 mm, 5/9 (55%) had tumor-free margins and in 8/9 (89%) no residual disease was found at re-excision. The preliminary results of this study suggest that, in selected cases, en bloc excision using the ABBI procedure could be an alternative to conventional surgery.

6
UI - 11072153
AU - Dunscombe P; Samant R; Roberts G
TI - A cost-outcome analysis of adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients.
SO - Int J Radiat Oncol Biol Phys 2000 Nov 1;48(4):977-82
AD - Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada. pdunscombe@neorcc.on.ca
PURPOSE: To calculate cost-effectiveness and cost-utility ratios for adjuvant postmastectomy locoregional radiotherapy in premenopausal node-positive breast cancer patients and to place these ratios in the context of generally accepted medical expenditures. MATERIALS AND METHODS: A spreadsheet-based activity costing model using 1997 Canadian (cdn) capital, operating, and administrative costs has been used to identify, from the institutional perspective, the incremental cost of adding radiotherapy to surgery and chemotherapy for this group of patients. Outcome data were derived from two recently published clinical trials and were converted to discounted incremental life years and quality-adjusted life years gained. Recommended health economics principles were employed in the quantification of both costs and outcomes, and a sensitivity analysis was performed. Three referenced publications provide a context within which to evaluate the calculated cost-effectiveness and cost-utility ratios. RESULTS: The incremental cost of adjuvant radiotherapy for this group of patients is calculated to be approximately $7,000cdn in 1997 Canadian dollars and in the Canadian socialized health-care environment. Based on published work the discounted incremental outcome benefit is calculated to be 0.5 life years or 0.45 quality-adjusted life years at ten years. Thus, cost effectiveness and cost-utility ratios are estimated to be $14,000cdn and $15,600cdn, respectively. CONCLUSION: Within the context of generally accepted medical expenditures, adjuvant postmastectomy locoregional radiotherapy for premenopausal node-positive breast cancer patients would be regarded as a cost-effective treatment strategy.

7
UI - 11372695
AU - Blann AD; Baildam AD; Howell A; Miller JP
TI - Tamoxifen increases von Willebrand factor in women who underwent breast cancer surgery.
SO - Thromb Haemost 2001 May;85(5):941-2

8
UI - 11759964
AU - Chowchuen B; Chowchuen P
TI - Immediate breast reconstruction with free TRAM flap: a case report with a 10-year follow-up and radiological imaging.
SO - J Med Assoc Thai 2001 Jul;84(7):1037-45
AD - Department of Surgery, Faculty of Medicine, Khon Kaen University, Thailand.
Immediate breast reconstruction using free microsurgical transverse rectus abdominis flap (free TRAM flap) has been emerging as the recommended treatment for breast cancer patients. Progress of a patient receiving this treatment was documented using a ten-year follow-up study. The results were very satisfactory in both cosmetic appearance and therapeutic result. The surgical techniques of breast mound reconstruction and subsequent nipple and alreolar reconstruction with contralateral mastopexy were described. Mammographic findings of the post-reconstruction breast, recommendation for follow-up and the use of mammography were presented. With this successful long-term follow-up, the authors recommend immediate breast reconstruction using free TRAM flap as another option for breast cancer treatment.

9
UI - 11818873
AU - Jensen JA
TI - When can the nipple-areola complex safely be spared during mastectomy?
SO - Plast Reconstr Surg 2002 Feb;109(2):805-7

10
UI - 11091258
AU - Cserni G
TI - Intraoperative sentinel lymph node examination by imprint cytology and frozen sectioning during breast surgery.
SO - Br J Surg 2000 Nov;87(11):1596

11
UI - 10925929
AU - Fassoulaki A; Sarantopoulos C; Melemeni A; Hogan Q
TI - EMLA reduces acute and chronic pain after breast surgery for cancer.
SO - Reg Anesth Pain Med 2000 Jul-Aug;25(4):350-5
AD - Department of Anesthesiology, St Savas Hospital, Athens, Greece.
BACKGROUND AND OBJECTIVES: A significant percentage of women undergoing breast surgery for cancer may develop neuropathic pain in the chest, and/or ipsilateral axilla and/or upper medial arm, with impairment in performing daily occupational activities. We designed this study to determine if the perioperative application of EMLA (eutectic mixture of local anesthetics; AstraZeneca) cream in the breast and axilla area reduces analgesic requirements, as well as the acute and chronic pain after breast surgery. METHODS: Forty-six female patients scheduled for breast surgery received randomly 5 g of EMLA or placebo on the sternal area 5 minutes before surgery, and 15 g on the supraclavicular area and axilla at the end of the operation. Treatment with EMLA cream (20 g) or placebo was also applied daily on the 4 days after surgery. In the postanesthesia care unit (PACU), 3, 6, 9, and 24 hours after surgery, and on the second to sixth day postoperatively, pain was assessed by visual analogue scale (VAS) at rest and after movement, and postoperative analgesic requirements were recorded. Three months later, patients were asked if they had pain in the chest wall, axilla and/or medial upper arm, decreased sensation, if they required analgesics at home, and for the intensity of pain. RESULTS: Acute pain at rest and with movement did not differ between the EMLA and control groups, and the analgesics consumed during the first 24 hours were the same for the EMLA and control groups. However, time to the first analgesia requirement was longer (P = .04), and codeine and paracetamol consumption during the second to fifth days was less (P = .001, and P = .004, respectively) in the EMLA versus the control group. Three months postoperatively, pain in the chest wall, axilla, and the total incidence and the intensity of chronic pain were significantly less in the EMLA versus the control group (P = .004, P = .025, P = .002 and P = .003, respectively). The use of analgesics at home and abnormal sensations did not differ between the 2 groups. CONCLUSIONS: The application of EMLA to patients undergoing breast surgery for cancer reduced the postoperative analgesic requirements and the incidence and intensity of chronic pain.

The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.

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