- Cancer Types
Information about risk, prevention, screening, symptoms, diagnosis, treatment, and support for all cancers Cancer A to Z - Cancer Treatment
Cancer Treatment
Information about cancer treatment, including surgery, chemotherapy, radiation therapy, clinical trials, proton therapy, complementary medicine, and cutting edge technologies.
- Risk and Prevention
- Cancer Drugs
- Support
Support
Ways for cancer patients and caregivers to cope with cancer, side effects, nutrition, general cancer support issues, grief/end of life issues, and shared survivor's experiences.
- Healthcare Professionals
- Clinical Trials
My Patient Treatment Binder
OncoLink Blogs
What's My Cancer Risk?
OncoPilot: Navigating Your Cancer Journey
Community Events Calendar
OncoLink eNews
Abramson Cancer CenterNCI CANCERLIT® Search: Surgery for Breast Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- A prospective trial of preoperative chemotherapy in resectable breast cancer: predictors of breast-conservation therapy feasibility.
- Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy.
- Outcome with postmastectomy radiation with transverse rectus abdominis musculocutaneous flap breast reconstruction.
- 12. Timing of surgery for breast cancer.
- Oophorectomy and tamoxifen adjuvant therapy in premenopausal Vietnamese and Chinese women with operable breast cancer.
- The surgical management of breast cancer.
- [Pathological examination of breast biopsy specimens]
- [Combined ROLL and sentinel lymph node: a new strategy in radio-guided surgery]
- Correlation between timing of surgery in relation to the menstrual cycle and prognosis of premenopausal breast cancer patients.
- Preoperative/neoadjuvant medical therapy for early breast cancer.
- [Departmental review of surgical cases in the last 17 years: Breast neoplasms]
- Is mastectomy overused? A call for an expanded research agenda.
- [The use of adjuvant chemotherapy in stage II breast cancer in the last 25 years--a brief review]
- National practice patterns of sentinel lymph node dissection for breast carcinoma.
- Practice patterns in sentinel lymph node biopsy.
- Effects of early discharge following breast surgery.
- Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer.
- Age at diagnosis and outcome for women with ductal carcinoma-in-situ of the breast: a critical review of the literature.
- Endoscopic resection of benign breast tumors: retromammary space approach.
- Breast cancer guidelines.
- Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma.
- Utilization of breast-conserving surgery in breast cancer.
- Sentinel node mapping affects intraoperative pulse oximetric recordings during breast cancer surgery.
- Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report.
- Re: Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report (Spine 2000;
- Radical faith: the right stuff?
- Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction.
- Treatment guidelines and techniques in delivery of postmastectomy radiotherapy in management of operable breast cancer.
- Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel
- A comparison of rates of lymph node metastases between patients undergoing sentinel and axillary lymphadenectomy.
- Phyllodes tumors of the breast.
- Occult breast cancer and axillary mass.
- Operable breast cancer.
- Primary soft tissue sarcoma of the breast.
Table of Contents
1
UI - 11923128
AU - Newman LA; Buzdar AU; Singletary SE; Kuerer HM; Buchholz T; Ames FC;
TI -
Ross MI; Hunt KK
A prospective trial of preoperative chemotherapy in resectable breast
cancer: predictors of breast-conservation therapy feasibility.
SO - Ann Surg Oncol 2002 Apr;9(3):228-34
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston, Texas 77030-4009, USA.
BACKGROUND: The role of preoperative chemotherapy for breast cancer is
evolving. We initiated a prospective trial of sequential preoperative
paclitaxel and doxorubicin-based combination chemotherapy in patients
with stage I (tumor >1 cm), II, or IIIA disease and evaluated its effect
on breast-conservation therapy (BCT) eligibility. METHODS: Pathology
findings for the initial 100 consecutive patients who underwent surgery
were analyzed. RESULTS: The median tumor size at presentation was 2.4
cm, and 39% of patients were deemed eligible for BCT. After
chemotherapy, the median tumor size decreased to 1.0 cm (P <.001), and
59% of patients seemed BCT eligible (BCT conversion rate 34% among
patients initially assessed as BCT ineligible; P <.001). Final pathology
confirmed BCT feasibility in 90% of patients assessed as BCT candidates
before surgery. The pathology from mastectomy specimens revealed BCT
feasibility in 11 (27%) of 41 patients deemed BCT ineligible.
Multivariate analysis revealed lobular histology, multicentricity, and
calcifications, but not age, initial tumor size, or nodal status to
predict final pathology indicating BCT ineligibility. CONCLUSIONS:
Induction chemotherapy improves BCT eligibility for breast cancer
patients. Improved breast imaging methods after chemotherapy are
necessary to improve accuracy in predicting the feasibility of BCT,
especially in patients presenting with diffuse calcifications or
multicentricity.
2
UI - 11923132
AU - Mirza NQ; Vlastos G; Meric F; Buchholz TA; Esnaola N; Singletary SE;
TI -
Kuerer HM; Newman LA; Ames FC; Ross MI; Feig BW; Pollock RE; McNeese M;
Strom E; Hunt KK
Predictors of locoregional recurrence among patients with early-stage
breast cancer treated with breast-conserving therapy.
SO - Ann Surg Oncol 2002 Apr;9(3):256-65
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston, Texas 77030, USA.
BACKGROUND: Our aim was to identify predictors of locoregional
recurrence (LRR) in patients with early-stage breast cancer treated with
breast-conserving therapy (BCT) and long-term follow-up. METHODS: From
1970 to 1994, 1153 patients with stage I to II breast cancer underwent
BCT and radiotherapy at our institution. Patients with prior breast
cancer or other primary malignancies were excluded. Clinical and
pathologic characteristics evaluated were age, race, tumor size, stage,
pathologic tumor margins, axillary nodal involvement, estrogen and
progesterone receptor status, Black's nuclear grade, type of surgery,
and use of adjuvant therapy. RESULTS: Of 1083 patients, 54% presented
with stage I disease and 46% with stage II disease. Median age was 50
years, and median follow-up was 9 years. Axillary nodes were positive in
31% of the patients who underwent axillary dissection. LRR developed in
6%, LRR followed by systemic recurrence in 5%, and systemic recurrence
alone in 13%; 76% had no evidence of recurrence at last follow-up. Age,
tumor size, positive lymph nodes, and not receiving chemotherapy or
hormonal therapy were independent predictors of LRR. Disease-specific
survival among patients with LRR was similar to that among patients with
no recurrence. CONCLUSIONS: Multidisciplinary treatment strategies
should be used to accomplish durable locoregional control after BCT.
3
UI - 12013281
AU - Proulx GM; Loree T; Edge S; Hurd T; Stomper P
TI -
Outcome with postmastectomy radiation with transverse rectus abdominis
musculocutaneous flap breast reconstruction.
SO - Am Surg 2002 May;68(5):410-3
AD - Department of Radiation Oncology, Roswell Park Cancer Institute,
Buffalo, New York 14263, USA.
The effects of radiation on the outcome of patients undergoing
transverse rectus abdominis musculocutaneous (TRAM) flap breast
reconstruction have not been extensively studied. Concern still exists
of a possible negative impact secondary to irradiation as related to
control of disease, cosmetic outcome, and flap viability. Thirty-six
patients underwent both a modified radical mastectomy (MRM) with TRAM
flap reconstruction and irradiation to the chest wall to include the
TRAM flap and/or regional nodes either before reconstruction or after
TRAM flap reconstruction. Fifteen patients had all of their treatment
and follow-up at our institution and were retrospectively reviewed to
assess treatment and outcome. During a median follow-up of 36 months
there were no local-regional failures. One patient at Stage IIIA failed
with distant metastases 3 years after treatment. One patient had a flap
loss from a nonhealing wound after reconstruction performed 2 years
after MRM and radiotherapy. Only one patient expressed dissatisfaction
with the cosmetic outcome. Patients undergoing MRM with TRAM flap
reconstruction and irradiation before or after reconstruction can
achieve excellent local-regional control and satisfactory cosmesis. Risk
of flap loss is low. Further follow-up is needed for assessing
longer-term outomes in this patient group. Larger prospective studies
are necessary for more definitive conclusions.
4
UI - 12018824
AU - Fentiman IS
TI -
12. Timing of surgery for breast cancer.
SO - Int J Clin Pract 2002 Apr;56(3):188-90
AD - Hedley Atkins Breast Unit, Guy's Hospital, London, UK.
Several studies have now shown that premenopausal women with early
breast cancer have a significantly better prognosis if their tumours are
excised during the luteal phase of the cycle. The 10-year survival for
node positive cases undergoing follicular phase surgery was 33% compared
with 78% in those having surgery at other times of the menstrual cycle.
Further work has shown that there is an improved survival in those with
plasma progesterone levels >4 ng/ml(-1), associated with the luteal
phase. Luteal phase surgery is also associated with a decreased risk of
vascular invasion, implying that the tumour is more cohesive at that
time. Similarly, in the heaviest quartile of postmenopausal patients,
with the highest endogenous oestrogen levels, there was vascular
invasion around tumours in 45% compared with only 11% of the lightest
quartile. Changing the hormonal milieu at the time of surgery for breast
cancer may have the ability to improve the prognosis for some patients
with early breast cancer.
5
UI - 12011136
AU - Love RR; Duc NB; Allred DC; Binh NC; Dinh NV; Kha NN; Thuan TV; Mohsin
TI -
SK; Roanh le D; Khang HX; Tran TL; Quy TT; Thuy NV; The PN; Cau TT; Tung
ND; Huong DT; Quang le M; Hien NN; Thuong L; Shen TZ; Xin Y; Zhang Q;
Havighurst TC; Yang YF; Hillner BE; DeMets DL
Oophorectomy and tamoxifen adjuvant therapy in premenopausal Vietnamese
and Chinese women with operable breast cancer.
SO - J Clin Oncol 2002 May 15;20(10):2559-66
AD - University of Wisconsin Comprehensive Cancer Center, 610 Walnut Street,
Madison, WI 53705-2397, USA. rrlove@facstaff.wisc.edu
PURPOSE: In 1992, the Early Breast Cancer Trialists' Collaborative Group
reported that a meta-analysis of six randomized trials in European and
North American women begun from 1948 to 1972 demonstrated disease-free
and overall survival benefit from adjuvant ovarian ablation.
Approximately 350,000 new cases of breast cancer are diagnosed annually
in premenopausal Asian women who have lower levels of estrogen than
western women. PATIENTS AND METHODS: From 1993 to 1999, we recruited 709
premenopausal women with operable breast cancer (652 from Vietnam, 47
from China) to a randomized clinical trial of adjuvant oophorectomy and
tamoxifen (20 mg orally every day) for 5 years or observation and this
combined hormonal treatment on recurrence. At later dates estrogen- and
progesterone-receptor protein assays by immunohistochemistry were
performed for 470 of the cases (66%). RESULTS: Treatment arms were well
balanced. With a median follow-up of 3.6 years, there have been 84
events and 69 deaths in the adjuvant treatment group and 127 events and
91 deaths in the observation group, with 5-year disease-free survival
rates of 75% and 58% (P =.0003 unadjusted; P =.0075 adjusted), and
overall survival rates of 78% and 70% (P =.041 unadjusted) for the
adjuvant and observation groups, respectively. Only patients with
hormone receptor-positive tumors benefited from the adjuvant treatment.
In Vietnam, for women unselected for hormone receptor status, a
cost-effectiveness analysis suggests that this intervention costs $350
per year of life saved. CONCLUSION: Vietnamese and Chinese women with
hormone receptor-positive operable breast cancer benefit from adjuvant
treatment with surgical oophorectomy and tamoxifen.
6
UI - 11965994
AU - Harmer V
TI -
The surgical management of breast cancer.
SO - Nurs Times 2000 Nov 30-Dec 6;96(48):34-5
AD - St Mary's Hospital, London.
7
UI - 11930535
AU - Obrist P; Brunhuber T; Ensinger C; Zelger BG; Dunser M; Buchberger W
TI -
[Pathological examination of breast biopsy specimens]
SO - Radiologe 2002 Jan;42(1):1-5
AD - Institut fur Pathologische Anatomie, Mullerstrasse 44, 6020
Innsbruck/Osterreich.
No differences for long-term disease free survival could be found
between breast conserving surgery and mastectomy. Most importantly is
the fact that this therapy presents a significantly higher risk for
local recurrence. The characterisation of this risk is one of the most
important things to do. These findings result in a widespread change in
treatment of breast cancer patients. Consequently an increase in
interdisciplinary working between radiologists, surgeons and
pathologists could be found. Histological examinations are necessary for
diagnosis and exactly evaluation of the tumor extension. Microscopic
evaluation of the resection margin is of most important interest,
because there is a direct connection between local recurrence and tumor
infiltration of the resection margin. We performed our investigations by
the use of a standardized complete embedding method with the possibility
of three-dimensional reconstruction, on a cohort of 280 patients.
Additionally this method allowed the detection of all relevant findings
on one hand and on the other hand an evaluation of all resection
margins. Our results showed a breast conserving therapy including tumor
free margins was performed in 67% of the patients. But there was a
second resection necessary in 57% of the cases. An extensive tumor
distribution as the detection of multifocal tumor spread was the reason
for mastectomy in 33%. Our findings point out the necessarily of the
histological examination in the line of the complete embedding method of
the breast biopsy material in order to analyse the tumor including
resection margin evaluation.
8
UI - 12038112
AU - Burelli P; Marinelli P; Borsato N; Bedin N
TI -
[Combined ROLL and sentinel lymph node: a new strategy in radio-guided
surgery]
SO - Chir Ital 2002 Mar-Apr;54(2):209-12
AD - U.O. di Chirurgia Generale, O.C. di Conegliano Veneto, TV.
Radioguided surgery for the treatment of breast cancer is becoming the
gold standard for both diagnosis and therapy. The main rule in using
ROLL is perfect localization of non-palpable lesions and minimal
invasiveness of excision. The same criteria apply to the sentinel lymph
node technique. Clinically occult breast lesions, which require an exact
histological diagnosis, are most frequently detected as the result of
mammographic screening. The authors show that the ROLL technique for
histological diagnosis may alter the subdermal lymphatic drainage so
that the sentinel node cannot be found at later surgery. The aim of this
study was to report the authors' experience with a combined ROLL and
sentinel lymph node biopsy technique for the diagnosis and treatment of
occult cancer of the breast.
9
UI - 11774860
AU - Takeda Y; Nonaka Y; Yanagie H; Yoshizaki I; Eriguchi M
TI -
Correlation between timing of surgery in relation to the menstrual cycle
and prognosis of premenopausal breast cancer patients.
SO - Biomed Pharmacother 2001;55 Suppl 1():133s-137s
AD - Department of Surgery, Institute of Medical Science, University of
Tokyo, Japan. ytake@ims.u-tokyo.ac.jp
The timing of surgery in relation to menstrual phase might affect the
progress of disease in premenopausal women with operable breast cancer.
In the present study, the records were examined of 28 such cases treated
between 1990 and 1999, and compared for recurrence-free survival with
reference to the phases of the menstrual cycle defined by Hrushesky and
Senie. During the follow-up period, breast cancer relapse occurred in
five patients, and one patient died of another disease unconnected with
recurrent breast cancer. The recurrence rate was not significantly
different between two phases classified by either Hrushesky or Senie.
However, patients with early-stage breast cancer operated during the
perimenstrual phase and those with advanced breast cancer which was
resected during the peri-ovulatory phase appeared to have a better
prognosis than patients operated on during the other phases. Since the
prognosis for breast cancer patients is dependent not only on the
menstrual cycle but also on many other factors, it is concluded that the
menstrual cycle cannot constitute an absolute prognostic factor.
10
UI - 11905711
AU - Smith IE; Lipton L
TI -
Preoperative/neoadjuvant medical therapy for early breast cancer.
SO - Lancet Oncol 2001 Sep;2(9):561-70
AD - Breast Unit, Royal Marsden NHS Trust, London, UK.
ian.smith@rmh.nthames.nhs.uk
Preoperative (neoadjuvant) medical therapy has emerged over the past
decade as a new approach for the treatment of early breast cancer.
Results show it has high activity, but survival is no better than with
conventional adjuvant treatment. The need for mastectomy is reduced but
not abolished; in some studies this effect is associated with a small
increase in risk of local recurrence, but without any detriment to
survival. Predictive factors for improved outcome include clinical
response, and especially pathological complete remissions. However,
persisting pathological axillary node involvement is associated with
poor outcome. Biological changes in apoptosis or proliferation pathways
may prove to be more sensitive surrogate markers than clinical or
pathological responses for assessing treatment outcome. The main
long-term aim of preoperative medical treatment must be to establish
such surrogate predictive markers. This would lead to individualised
treatment for each patient, and would allow much more rapid assessment
of new drugs than is currently possible with adjuvant therapy trials.
11
UI - 11989238
AU - Kitamura K; Ishida M; Tokunaga E; Ono S; Kuwano H
TI -
[Departmental review of surgical cases in the last 17 years: Breast
neoplasms]
SO - Fukuoka Igaku Zasshi 2002 Mar;93(3 Suppl):28-33
12
UI - 12036001
AU - Lantz PV; Zemencuk JK; Katz SJ
TI -
Is mastectomy overused? A call for an expanded research agenda.
SO - Health Serv Res 2002 Apr;37(2):417-31
AD - Department of Health Management and Policy, School of Public Health,
University of Michigan SPH, Ann Arbor 48109, USA.
13
UI - 12017895
AU - Sulkes A
TI -
[The use of adjuvant chemotherapy in stage II breast cancer in the last
25 years--a brief review]
SO - Harefuah 2002 Apr;141(4):374-8, 408
AD - Institute of Oncology, Rabin Medical Center Beilinson Campus, Israel.
This review summarizes more than 25 years of experience with the use of
systemic chemotherapy in the adjuvant setting in patients suffering from
stage II breast cancer. The use of the CMF combination in the early 70's
marks the onset of the modern era of this modality. Adjuvant
chemotherapy must be given at optimal doses and schedule, usually for a
period lasting about six months, beginning shortly after the resection
of the primary tumor. The incorporation of the anthracyclines,
adriamycin and epirubicin represent an important milestone in the
developmental history of the adjuvant chemotherapy of breast cancer. The
sequential administration of adriamycin followed by CMF in patients with
4 or more involved axillary lymph nodes deserves particular emphasis.
Meta-analysis of multiple clinical trials including several tens of
thousands of patients with stage II breast cancer indicate that adjuvant
chemotherapy results in a significant increase in both recurrence-free
and overall survival as compared to locoregional treatment only. This
holds true with long-term follow-up of 20 years and more as illustrated
by the CMF experience, showing about a 35% decrease in the relative risk
of recurrence. Efforts in recent years are investigating the role of
newer cytotoxic agents such as the taxanes in the adjuvant setting.
Furthermore, clinical trials are now ongoing with the use of the
monoclonal antibody herceptin in patients with stage II breast cancer
whose tumor over-expresses the oncogene Her2neu. The administration of
adjuvant chemotherapy has the potential for undesirable side effects
such as an increased risk of osteoporosis and ischemic heart disease in
younger patients in whom amenorrhea develops, or cardiotoxicity from
anthracyclines. Most clinical trials to date have not shown an increase
in the occurrence of second primary tumors among patients receiving
adjuvant chemotherapy for breast cancer. Adjuvant chemotherapy has
become an integral part of the treatment of stage II breast cancer.
14
UI - 11294401
AU - Lucci A Jr; Kelemen PR; Miller C 3rd; Chardkoff L; Wilson L
TI -
National practice patterns of sentinel lymph node dissection for breast
carcinoma.
SO - J Am Coll Surg 2001 Apr;192(4):453-8
AD - Michael E DeBakey Department of Surgery, Baylor College of Medicine,
Houston, TX 77030, USA.
BACKGROUND: The sentinel node is the first regional lymph node to
receive tumor cells that metastasize through the lymphatic channel from
a primary tumor. The tumor status of the sentinel node should reflect
the tumor status of the entire regional node basin. Sentinel lymph node
dissection (SLND) has recently been investigated for use in patients
with early breast carcinoma to avoid the sequelae of complete axillary
lymph node dissection (ALND). Published studies of SLND in breast cancer
patients identify marked variations in technique, and there are few
guidelines for credentialing surgeons to perform SLND. STUDY DESIGN: The
purpose of this study was to assess the current practice of SLND for
breast cancer in the United States. A 27-item questionnaire was mailed
to 1,000 randomly selected Fellows of the American College of Surgeons.
Responses were anonymous. Statistical analysis was performed using SAS
software (SAS Institute, Cary, NC). RESULTS: Response rate was 41% (n =
410), and 77% of those who responded performed SLND for breast cancer.
The majority (60%) of surgeons responding routinely ordered preoperative
lymphoscintigraphy. Of those who did lymphoscintigraphy, 28% removed
internal mammary lymph nodes when lymphoscintigraphy showed drainage to
these nodes. Ninety percent of surgeons used both blue dye and
radiocolloid. Eighty percent of centers responding performed routine
immunohistochemistry on sentinel lymph nodes, and 15% performed reverse
transcription polymerase chain reaction. Ninety-six percent of surgeons
performed SLND for primary tumors 5 cm or smaller, and 95% performed
SLND for an excisional cavity 6 cm and smaller. Twenty-eight percent
performed SLND for high-grade ductal carcinoma in situ, and 28% of
respondents performed 10 or fewer SLND procedures with subsequent ALND
before performing SLND alone. Surgeons learned SLND through courses
(35%), oncology fellowships (26%), observation of other surgeons (31%),
or were self-taught (26%). CONCLUSIONS: The majority of surgeons in the
United States use similar technique for SLND breast cancer. But, there
was marked variation in the number of SLND cases validated by an ALND
before performing SLND only.
15
UI - 11584980
AU - Bold RJ; Fahy BN
TI -
Practice patterns in sentinel lymph node biopsy.
SO - J Am Coll Surg 2001 Oct;193(4):466-7
16
UI - 12029907
AU - Murphy A; Holcombe C
TI -
Effects of early discharge following breast surgery.
SO - Prof Nurse 2001 Feb;16(5):1087-90
AD - Royal Liverpool University Hospital.
A small group of breast cancer surgery patients were discharged early
with axillary drains in situ. The group was examined for wound
infection, seroma formation and depression, and compared to a group who
stayed in hospital. There was no indication that early discharge
increased seroma formation or infection. Anxiety and depression appeared
to be less in the early discharge group.
17
UI - 12035037
AU - Medina-Franco H; Vasconez LO; Fix RJ; Heslin MJ; Beenken SW; Bland KI;
TI -
Urist MM
Factors associated with local recurrence after skin-sparing mastectomy
and immediate breast reconstruction for invasive breast cancer.
SO - Ann Surg 2002 Jun;235(6):814-9
AD - Department of Surgery, Section of Surgical Oncology, University of
Alabama at Birmingham, USA.
OBJECTIVE: To examine the incidence of local recurrence (LR) and factors
associated with it in a population of patients who underwent
skin-sparing mastectomy (SSM) and immediate reconstruction for invasive
carcinoma. SUMMARY BACKGROUND DATA: The efficacy of SSM has been
challenged by concerns about increased risks of LR. METHODS: A
consecutive series of 173 patients (176 cancers) with invasive carcinoma
1997). Data were analyzed by the Kaplan-Meier method, the log-rank
statistic test, and the Cox proportional hazards model. RESULTS: Mean
patient age was 47 +/- 9 years (27% were 40 or younger). The AJCC stages
were 1 = 43%, 2 = 52%, and 3 = 5%. Thirty percent of tumors were poorly
differentiated. With a median follow-up of 73 months, the LR rate was
4.5%. The mean local relapse-free interval was 26 months. Seventy-five
percent of patients who presented with LR developed distant metastases
and died of disease within a mean of 21 months. On univariate analysis,
factors associated with higher LR rate were tumor stage 2 or 3, tumor
size larger than 2 cm, node-positive disease, and poor tumor
differentiation. Actuarial 1-, 3-, and 5-year overall survival rates
were 98%, 94%, and 88%, respectively. On multivariate analysis, factors
associated with decreased survival were advanced stage, presence of LR,
and absence of hormone therapy. LR was a highly significant predictor of
tumor-related death. CONCLUSIONS: There is a low incidence of LR after
SSM, and it is associated with advanced disease at presentation. LR is
an independent risk factor for tumor-related death.
18
UI - 12039936
AU - Vicini FA; Recht A
TI -
Age at diagnosis and outcome for women with ductal carcinoma-in-situ of
the breast: a critical review of the literature.
SO - J Clin Oncol 2002 Jun 1;20(11):2736-44
AD - Department of Radiation Oncology, William Beaumont Hospital, Royal Oak,
MI 48073, USA. fvicini@beaumont.edu
PURPOSE: Patients younger than 35 to 45 years old at the time of
diagnosis of invasive breast cancer have been found to have a worse
prognosis than older patients in many studies. However, the impact of
patient age at diagnosis on the outcome of treatment with either
lumpectomy and radiation therapy (RT) or mastectomy for patients with
ductal carcinoma-in-situ (DCIS) of the breast has not been extensively
analyzed. MATERIALS AND METHODS: Articles addressing the effect of
patient age at diagnosis on the outcome of treatment of DCIS with
lumpectomy and RT or mastectomy were identified through the MEDLINE and
CancerLit databases and reference lists of relevant articles. Studies
were reviewed to determine the impact of patient age at diagnosis on
clinical and pathologic features of DCIS, the influence of age on
outcome after lumpectomy and RT, and the impact of age on outcome after
mastectomy. RESULTS: DCIS in younger patients more frequently contains
adverse prognostic pathologic factors and extends over a greater
distance in the breast than in older patients. In series with adequate
follow-up, younger patients treated with lumpectomy and RT had a
significantly higher rate of local recurrence than older patients,
especially for invasive local recurrences. Some studies have suggested
that careful attention to margin status and excising larger volumes of
tissue can reduce this difference substantially. No available data show
that younger patients have better long-term cancer-free survival rates
if treated by mastectomy rather than lumpectomy and RT. CONCLUSION:
Successful treatment of younger patients with DCIS with lumpectomy and
RT requires careful attention to patient evaluation, selection, and
surgical technique. When this is done, age at diagnosis should not be a
contraindication to breast-conserving therapy.
19
UI - 11948295
AU - Osanai T; Nihei Z; Ichikawa W; Sugihara K
TI -
Endoscopic resection of benign breast tumors: retromammary space
approach.
SO - Surg Laparosc Endosc Percutan Tech 2002 Apr;12(2):100-3
AD - Second Department of Surgery, Tokyo Medical and Dental University,
Japan. t-osanai.srg2@tmd.ac.jp
Endoscopic surgery is characterized by the creation of a working space.
At our department, we have obtained good results with a retromammary
space approach in which the tumor is resected after creation of a
working space in the retromammary space. The special instruments used
for this purpose comprise an endoscopic vein harvesting system to
dissect the retromammary space, a dissecting balloon to compress the
space to achieve hemostasis, and laparosonic coagulating shears to
incise the tumor. This surgical technique provides a superior cosmetic
result, and the level of patient satisfaction has been high.
20
UI - 12041840
AU - Meterissian S
TI -
Breast cancer guidelines.
SO - CMAJ 2002 May 14;166(10):1254
21
UI - 11304779
AU - Morrow M; White J; Moughan J; Owen J; Pajack T; Sylvester J; Wilson JF;
TI -
Winchester D
Factors predicting the use of breast-conserving therapy in stage I and
II breast carcinoma.
SO - J Clin Oncol 2001 Apr 15;19(8):2254-62
AD - American College of Surgeons Commission on Cancer, Chicago, IL, USA.
PURPOSE: To define patterns of care for the local therapy of stage I and
II breast cancer and to identify factors used to select patients for
breast-conserving therapy (BCT). PATIENTS AND METHODS: A convenience
sample of 16,643 patients with stage I and II breast cancer treated in
1994 was obtained from hospital-based tumor registries. Histologic
variables were determined from original pathology reports. RESULTS: BCT
was performed in 42.6% of patients. Multivariate analysis demonstrated
that living in the Northeast United States (odds ratio [OR], 2.48; 95%
confidence interval [CI], 2.16 to 2.84), having a clinical T1 tumor (OR,
2.51; 95% CI, 2.27 to 2.78), and having a tumor without an extensive
intraductal component (OR, 2.07; 95% CI, 1.81 to 2.37) were the
strongest predictors of breast-conserving surgery. Radiation therapy was
given to 86% of patients who had breast-conserving surgery. Age less
than 70 years was the most significant predictor of receiving radiation
(OR, 2.11; 95% CI, 1.77 to 2.25). Tumor variables did not correlate with
the use of radiation, but favorable tumor characteristics were
associated with the use of breast-conserving surgery. CONCLUSION:
Despite strong evidence supporting the use of BCT, the majority of women
continue to be treated with mastectomy. Predictors of the use of BCT do
not correspond to those suggested in guidelines.
22
UI - 11731521
AU - Dillman RO; Chico S; Finestone S
TI -
Utilization of breast-conserving surgery in breast cancer.
SO - J Clin Oncol 2001 Dec 1;19(23):4350-1
23
UI - 11952442
AU - Koivusalo AM; Von Smitten K; Lindgren L
TI -
Sentinel node mapping affects intraoperative pulse oximetric recordings
during breast cancer surgery.
SO - Acta Anaesthesiol Scand 2002 Apr;46(4):411-4
AD - Department of Anesthesia, The Fourth Department of Surgery, Helsinki
University Hospital, Finland. anna-maria.koivusalo@hus.fi
BACKGROUND: In invasive breast cancer lymphatic mapping with patent blue
vital dye (PBV) is used intraoperatively to identify the sentinel lymph
nodes: the first axillary node draining the mammary lymphatic basin and
first involved by the metastatic growth in breast cancer. Patent blue
vital dye spreads to tissues giving a bluish tinge to patients. We have
noted the possibility that intraoperative peripheral pulse oximetric
(SpO2) values are artificially low when intradermal PBV is used.
METHODS: Twenty patients with normal pulmonary function undergoing
breast cancer surgery in standardized anesthesia either did or did not
receive intradermal PBV sentinel node marking. The radial artery was
cannulated for blood-gas-analysis; arterial oxygen tension (PaO2); and
arterial oxygen saturation (SaO2). Peripheral oxygen saturation was
measured using the light absorption technique. Red and infrared light
(660 and 900 nm), used by pulseoxymetry, is partially absorbed when
passing through the tissue. The amount of light absorbed is sensed and
saturation calculated. The color of the skin was evaluated. RESULTS:
Peripheral oxygen saturation decreased only immediately after the
injection of PBV, and remained at a significantly lower level (P<0.001)
throughout the operation and up to 90 min postoperatively. Arterial
oxygen tension and SaO2 values did not decrease after intradermal PBV.
Patent blue vital dye made patients' skin more bluish (P<0.001). No
changes in SpO2, PaO2 and SaO2 were found in control patients.
CONCLUSION: The spectrum of PBV has a peak absorption at 640 nm, thus
making the SpO2 values incorrect. Peripheral oxygen saturation values
are falsely low and true arterial oxygenation is not impaired when PBV
is used during sentinel node mapping.
24
UI - 10749640
AU - Kim DH; Glazer PA
TI -
Progression of idiopathic thoracolumbar scoliosis after breast
reconstruction with a latissimus dorsi flap: a case report.
SO - Spine 2000 Mar 1;25(5):622-5
AD - Harvard Combined Orthopaedics Residency Program, and the Boston
Orthopaedics Group, Boston, Massachusetts 02446, USA.
STUDY DESIGN: A report of a patient in whom progressive symptomatic
thoracolumbar scoliosis developed after breast reconstruction with a
latissimus dorsi myocutaneous flap. OBJECTIVES: To present the first
reported case of progressive symptomatic scoliosis after breast
reconstruction with a latissimus dorsi myocutaneous flap and to suggest
that latissimus flap harvest may be contraindicated in patients with
preexisting scoliosis. SUMMARY OF BACKGROUND DATA: Latissimus dorsi
myocutaneous flap harvest incorporated into several surgical operations
including breast reconstruction has been presented as a relatively
benign procedure without significant biomechanical consequence.
Nevertheless, various anatomic and animal studies have suggested an
important role for balanced latissimus function in terms of proper
spinal alignment. Long-term follow-up evaluation of patients after
latissimus flap harvest is insufficient and fails to address the
specific issue of spinal deformity. METHODS: Postoperative radiographs
demonstrated significant progression of the patient's thoracolumbar
scoliosis as compared with radiographs taken before her latissimus
harvest. Curve progression accompanied by development of severe and
disabling back pain were considered indications for surgical curve
correction and stabilization. RESULTS: At the time of 1-year follow-up
assessment after posterolateral spinal fusion and instrumentation, the
patient had experienced complete relief from her back pain and
satisfactory spinal fusion. CONCLUSIONS: Although a cause and effect
relation cannot be established, this case study suggests that latissimus
harvest may have a destabilizing effect on the thoracolumbar spine in
the long term, especially in patients with preexisting scoliosis.
Alternative procedures should be considered in these patients.
25
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
26
UI - 6900346
AU - Annas GJ
TI -
Radical faith: the right stuff?
SO - Nurs Law Ethics 1980 Apr;1(4):3, 7
27
UI - 11004327
AU - Palit TK; Miltenburg DM; Brunicardi FC
TI -
Cost analysis of breast conservation surgery compared with modified
radical mastectomy with and without reconstruction.
SO - Am J Surg 2000 Jun;179(6):441-5
AD - Michael E. DeBakey Department of Surgery, Baylor College of Medicine,
Houston, Texas, USA.
BACKGROUND: Breast conservation surgery (BCS), consisting of lumpectomy,
axillary lymph node dissection, and radiation therapy, is as effective
as modified radical mastectomy (MRM) for the treatment of early stage
breast cancer. The costs of these treatment options have not been
adequately addressed in the current era of increasing utilization of BCS
and breast reconstruction. The purpose of this study is to determine
differences in treatment costs among BCS, MRM alone, and MRM with
reconstruction. METHODS: Patients with stage I and II breast cancer
receiving inpatient treatment at a private university-affiliated
Charges were determined as follows: inpatient and radiotherapy charges
from the hospital billing department, surgeon fees from group practice
billing codes, and radiotherapy physician fees from the radiation
oncology group practice. Inpatient length of stay was obtained from
hospital medical records. RESULTS: Average hospital inpatient charge for
BCS was $4,748 (n = 74), $6,280 for MRM alone (P <0.001, n = 132), and
$11,946 for MRM with reconstruction (P <0.001, n = 24). Surgeons' fees
for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with
reconstruction. The average radiotherapy charge was $18,742. Average
length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P
<0.001), and 3.71 days for MRM with reconstruction (P <0. 001). Average
total cost of BCS ($26,330) was significantly greater than the average
total cost of either MRM alone ($9,780, P <0.001) or MRM with
reconstruction ($22,720, P <0.001). CONCLUSIONS: BCS is more expensive
than MRM with or without reconstruction. It is the addition of
radiotherapy that results in the higher total cost of CS.
28
UI - 11773304
AU - Pierce LJ
TI -
Treatment guidelines and techniques in delivery of postmastectomy
radiotherapy in management of operable breast cancer.
SO - J Natl Cancer Inst Monogr 2001;(30):117-24
AD - Department of Radiation Oncology, University of Michigan School of
Medicine UHB2C490, Box 0010, 1500 E. Medical Center Dr., Ann Arbor, MI
48109, USA. ljpierce@umich.edu
Radiation therapy has been shown to statistically significantly reduce
the risk of locoregional recurrence in high-risk patients with operable
breast cancer following mastectomy and systemic therapy. Recent trials
have also demonstrated a significant survival benefit following
radiotherapy in high-risk patients. Therefore, it is important to
identify the patients who could potentially derive that survival benefit
and to not offer treatment to those patients who are not at increased
risk for failure. Established risk factors that predict for increased
rates of locoregional recurrence include axillary lymph node involvement
and T3 (or T4) disease. While treatment-related factors, such as the
extent of the axillary dissection and extent of lymph nodal positivity,
also undoubtedly affect locoregional recurrence, additional studies are
needed to define the magnitude of their risk. Locoregional patterns of
failure have identified the chest wall and
supraclavicular/infraclavicular regions to be the most common sites of
locoregional failure following mastectomy, which justifies treatment to
these regions. While long-term complications are uncommon following
locoregional radiotherapy, careful treatment planning is critical to
minimize cardiac (and pulmonary) toxicity.
29
UI - 11773300
AU - Wolmark N; Wang J; Mamounas E; Bryant J; Fisher B
TI -
Preoperative chemotherapy in patients with operable breast cancer:
nine-year results from National Surgical Adjuvant Breast and Bowel
Project B-18.
SO - J Natl Cancer Inst Monogr 2001;(30):96-102
AD - National Surgical Adjuvant Breast and Bowel Project (NSABP), 320 E.
North Ave., Pittsburgh, PA 15212, USA. nwolmark@wpahs.org
National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol
B-18 was initiated in 1988 to determine whether four cycles of
doxorubicin/cyclophosphamide given preoperatively improve survival and
disease-free survival (DFS) when compared with the same chemotherapy
given postoperatively. Secondary aims included the evaluation of
preoperative chemotherapy in downstaging the primary breast tumor and
involved axillary lymph nodes, the comparison of lumpectomy rates and
rates of ipsilateral breast tumor recurrence (IBTR) in the two treatment
groups, and the assessment of the correlation between primary tumor
response and outcome. Initially published findings were based on a
follow-up of 5 years; this report updates results through 9 years of
follow-up. There continue to be no statistically significant overall
differences in survival or DFS between the two treatment groups.
Survival at 9 years is 70% in the postoperative group and 69% in the
preoperative group (P =.80). DFS is 53% in postoperative patients and
55% in preoperative patients (P =.50). A statistically significant
correlation persists between primary tumor response and outcome, and
this correlation has become statistically stronger with longer
follow-up. Patients assigned to preoperative chemotherapy received
notably more lumpectomies than postoperative patients, especially among
patients with tumors greater than 5 cm at study entry. Although the rate
of IBTR was slightly higher in the preoperative group (10.7% versus
7.6%), this difference was not statistically significant. Marginally
statistically significant treatment-by-age interactions appear to be
emerging for survival and DFS, suggesting that younger patients may
benefit from preoperative therapy, whereas the reverse may be true for
older patients.
30
UI - 12034393
AU - Moonka R; Hunter JA; Cray WK Jr; Duncan M; Wechter DG
TI -
A comparison of rates of lymph node metastases between patients
undergoing sentinel and axillary lymphadenectomy.
SO - Am J Surg 2002 May;183(5):558-61
AD - Department of Surgery, Virginia Mason Medical Center, C6-GSUR, 1100
Ninth Ave., P.O. Box 900, Seattle, WA 98111, USA.
BACKGROUND: Recommendations regarding credentialing for sentinel
lymphadenectomy in the staging of breast cancer emphasize the need for a
trial period during which novice surgeons remove both the sentinel lymph
node and the axillary packet, to demonstrate acceptably low rates of
both operative failure and inaccuracy. METHODS: We initiated sentinel
lymph node mapping in our institution without planned axillary
dissection. To establish our ability to accurately stage patients using
sentinel lymphadenectomy, we compared 225 patients who underwent that
procedure and 343 patients previously staged with axillary lymph node
dissection. RESULTS: No differences in node positivity were found
between the two groups. Among sentinel lymphadenectomy patients, no
differences were found between patients in the first and second half of
the institutional experience. CONCLUSIONS: We question the need for a
trial period of planned axillary node dissection with sentinel lymph
node mapping, and review the evidence from other investigators regarding
its necessity.
31
UI - 12057132
AU - Khan SA; Badve S
TI -
Phyllodes tumors of the breast.
SO - Curr Treat Options Oncol 2001 Apr;2(2):139-47
AD - Division of Surgical Oncology, Northwestern Medical School, 675 N. St.
Clair Street, Galter-10, Chicago IL 60611, USA.
Phyllodes tumor is a rare fibroepithelial neoplasm of the breast with a
very variable, but usually benign, course. Formerly known as
cystosarcoma phyllodes, the designation "phyllodes tumor" with
appropriate qualification regarding malignant potential based on
pathologic features is now the agreed-upon term. The most important
diagnostic distinction is from fibroadenoma--phyllodes tumors require
complete excision with free margins even when pathologic features
suggest benignity because of a proclivity to local recurrence. The most
important component of therapy is wide surgical excision, and mastectomy
is necessary only when free margins cannot be achieved without it.
Involvement of axillary nodes is rare, and axillary dissection is not
indicated. The role of radiation therapy and chemotherapy is not
established and has not been studied in randomized trials due to the
rarity of the tumor. At present, there is no consensus that patients
with high-grade phyllodes tumors of the breast will benefit from either
of these modalities.
32
UI - 12057133
AU - Brill KL; Brenin DR
TI -
Occult breast cancer and axillary mass.
SO - Curr Treat Options Oncol 2001 Apr;2(2):149-55
AD - Comprehensive Breast Center, Columbia-Presbyterian Medical Center,
Atchley Pavilion 10, 161 Fort Washington Avenue, New York, NY
10032-3784, USA.
Occult breast cancer presenting with axillary metastases is an unusual
presentation and can be a diagnostic and therapeutic challenge. A
comprehensive work-up, including mammogram, sonogram, magnetic resonance
imaging, and even pathologic examination of the mastectomy specimen may
not disclose the primary tumor in up to one third of patients.
Traditionally, occult breast cancer is treated with total mastectomy and
axillary dissection, but accumulating data suggest that primary breast
irradiation following axillary dissection may provide an equivalent
survival with the advantage of breast conservation. Occult breast cancer
patients are eligible for adjuvant chemotherapy and radiation as stage
II/ III node-positive patients would be treated. Overall, the prognosis
for occult breast cancer is equivalent to or slightly better than staged
counterparts with detectable primary breast tumors.
33
UI - 12057134
AU - Cianfrocca M; Goldstein LJ
TI -
Operable breast cancer.
SO - Curr Treat Options Oncol 2001 Apr;2(2):157-67
AD - Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111,
USA.
Breast cancer is the most common malignancy among American women. As a
result of widespread screening, most patients present with operable
breast cancer that is treated with curative intent. It is well
established that the appropriate use of adjuvant therapy improves the
disease-free and overall survival of patients with breast cancer.
Adjuvant systemic therapy options include tamoxifen for hormone
receptor-positive patients, and systemic polychemotherapy. It is
standard clinical practice to administer adjuvant systemic therapy to
patients with node-positive and high-risk, node-negative breast cancer.
34
UI - 12057135
AU - Trent II JC 2nd; Benjamin RS; Valero V
TI -
Primary soft tissue sarcoma of the breast.
SO - Curr Treat Options Oncol 2001 Apr;2(2):169-76
AD - The University of Texas MD Anderson Cancer Center, Division of Cancer
Medicine, Box 10, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Primary soft tissue sarcoma (STS) of the breast is a rare and
heterogeneous disease. The rarity of this tumor limits most studies to
small retrospective case reviews and case reports. The optimal treatment
of primary STS of the breast can best be determined through
multidisciplinary discussions prior to the initiation of therapy.
Whether chemotherapy is indicated is primarily determined by tumor size.
There is evidence that tumors larger than 5 cm are associated with an
elevated risk of systemic failure and a poor prognosis. Negative
surgical margins are more important for local recurrence and overall
survival than is the extent of surgical resection. Thus, neoadjuvant
chemotherapy should be considered in order to shrink the tumor and help
obtain negative surgical margins. After surgical resection, patients
with chemosensitive tumors should undergo additional adjuvant
chemotherapy to treat micrometastatic disease. Patients with tumors less
than 5 cm that are easily resectable should undergo complete resection
to the extent required to provide negative surgical margins. Radiation
therapy should be used to improve local control in cases in which the
tumor is larger than 5 cm and in cases with positive surgical margins.
The appropriate treatment of primary STS of the breast requires a
multidisciplinary approach necessitating experienced surgeons,
pathologists, radiotherapists, and medical oncologists.
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.
Cancer Types
Bone Cancer
Brain Tumors
Breast Cancer
Carcinoid Tumors
Endocrine System Cancers
Gastrointestinal Cancers
Gynecologic Cancers
Head and Neck Cancers
Leukemia
Lung Cancers
Lymphomas
Myelomas
Pediatric Cancers
Penile Cancer
Prostate Cancer
Sarcomas
Skin Cancers
Testicular Cancer
Thyroid Cancer
Urinary Tract Cancers
OncoLink Vet
Cancer Treatment
Biologic Therapy
Bone Marrow Transplants
Chemotherapy
Clinical Trials
Complementary Medicine
Gene Therapy
General Treatment Concerns
Hormone Therapy
PDT Center
Proton Therapy
Radiation Oncology
Surgical Oncology
Targeted Therapies
Vaccine Therapies
Cancer Support
Caregivers
Hospice Care and Bereavement
Nutrition and Cancer
Sexuality & Fertility
Side Effects
Support
Survivorship
Exercise and Cancer
Cancer Resources
Cancer News
OncoLink University
Nurses' Notes
Conferences
Newly Diagnosed Patients
Causes and Prevention
Legal and Financial Information for Patients
LGBT Resources
NCI Resources
Global Resources
Cancer Resource List
Resources for Young Adults
OncoLink Media Library
OncoLink TV
Book, Music and Video Reviews
Ask the Experts
Brown Bag Chat
Tracy's Corner
About OncoLink
About OncoLink
Giving to OncoLink
Contact Information
Usage Policy
Editorial Board
How to Partner with OncoLink
Link to OncoLink
Mission Statement
