#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Locoregional Recurrences after Conservative Surgery in Early Breast Cancer


Authors: J. Gatěk 1;  J. Kotoč 1;  K. Kotočová 1;  J. Katrušák 2;  P. Vážan 3;  J. Duben 1;  L. Hnátek 1;  B. Dudešek 1
Authors‘ workplace: Chirurgické oddělení nemocnice Atlas, Univerzita Tomáše Bati ve Zlíně 1;  RDO oddělení nemocnice Atlas Zlín 2;  Bioptická a cytologická laboratoř Zlín 3
Published in: Rozhl. Chir., 2010, roč. 89, č. 10, s. 604-611.
Category: Monothematic special - Original

Overview

Introduction:
Conservative surgery is considered as standard and alternative mastectomy in early stage breast cancer but number of local recurrence is higher. Aim of the study was to detect number of local recurrences after conservative surgery and to identify risk factors of local recurrence especially importance of resection margins.

Materials and methods:
Local recurrences were evaluated in patients after conservative surgery in early breast cancer at department of surgery Atlas hospital in Zlin between January 2004 and December 2008. T1-2 (only one T3) breast cancers were included in study. Diagnostic biopsy, lumpectomy and quadrantectomy were performed. In all patients axillary nodes were examined. Study guidelines required microscopic distance between resection line and tumor margin 5mm. Specimen after surgery was marked with black ink and from June 2006 with six colors ink. Radiotherapy and chemotherapy in additions to character of cancer followed surgery.

Results:
Conservative surgery was performed in 330 patients. Mean age was 59 years. Follow-up was 39.6 month. Stage of the tumor: 0 19x, I 101x, IIA 163x, IIB 33x, IIIA 5, IIIB 0, IIIC 9. Lumpectomy was made 111x including 11 diagnostic biopsies and quadrantectomy 219x. Final conservative surgery was 331x and mastectomy 19x. Positive axillary nodes were 98x. In breast local recurrence appeared in 5 (3.6%) patients and one had regional recurrence without in breast recurrence. Distant metastases were 8x (2.4%) and ten patient died on primary disease without locoregional recurrence.

Conclusion:
Local recurrence appeared only 5x. Clear margins after breast conserving surgery are very important factor in prevention local recurrence. We recommend keeping 5 mm resection distance.

Key word:
breast cancer – local recurrence – conservative surgery


Sources

1. Fisher, B., Redmond, C., Poisson, R. et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. A Engl. J. Med., 1989, 320, s. 822–828.

2. Jacobson, J., Danforth, D., Cowan, K., et al. Ten-year results of the National Cancer Institutes randomized trial of breast conservation versus mastectomy for stage I and II breast cancer. N. Engl. J. Med., 1995, 332, s. 907–911.

3. von Dongen, J. A., Bartelink, H., Fentiman, I. S., et al. Randomized clinical trial to asses the value of breast-conserving therapy in stage I and II breast cancer, EORT 10801 trial, In Consensus Development Conference on the Treatment of Early-Stage Breast Cancer Monogr. Natl. Cancer Inst. 1992 11 s. 15–18 (NIH publication No 90-3187).

4. Blichert-Toth, M., Rosen, C., Anderson, A. et al. Danish randomized trial comparing breast conservation with mastectomy: Six years of life table analysis. J. Natl. Cancer Inst. Monogr., 1992, 11, s. 19–26.

5. Arriagada, R., Le, M. G., Rochard, F., et al. For the IGR Breast Cancer Group. Conservative treatment versus mastectomy in early breast cancer: pattern of failure with fifteen years of follow up. J. Clin. Oncol., 1996, 14, s. 1558–1564.

7. Veronesi, U., Salvadori, B., et al. Conservative treatment of early breast cancer. Ann. Surg., 1990, 3, s. 250–259.

8. Kreike, B., Hart, M., Velde, T. Continuing Risk of Ipsilateral breast relapse after breast-conserving therapy at long-term follow-up Int. J. Radiation Biol. Phys., 2008, 71, s. 1014–1021.

9. Schwartz, G., Veronesi, U., Clouhg, K., et al. Proceedings of the Consensus Conference on Breast Conservation, April 28 to May 1 2005 Milan Italy. Cancer, 2006, 107, s. 242–250.

10. Kaufman, M., Morrow, M., Mincgwitz, G., et al. Locoregional Treatment of Primary Breast Cancer. Cancer, 2010, 116, s. 1184–1191.

11. Veronesi, U., Volterani, F., Luini, A., et al. Quadrantectomy versus lumpectomy for small size breast cancer. Eur. J. Cancer, 1990, 26, s. 671–673.

12. Voogd, A., Nielsen, M., Peterse, J., et al. Differences in Risk Factor for Local and Distant Recurrence After Breast-Conserving Therapy or Mastectomy for Two Large European Randomized Trials. J. Clin. Oncol., 2001, 19, s. 1688–1697.

13. Kuerer, H., Arthur, D., Haffy, A. Repeat Breast-Conserving Surgery for In-Breast Local Breast Carcinoma Recurrence. Cancer, 2004, 100, s. 2269–2280.

14. Gatěk, J., Dudešek, B., Hnátek, L. et al. Lokální recidivy po konzervativních výkonech u karcinomu prsu. Klin. Onkol., 2008, 21, s. 169–173.

15. Veronesi, U., Marubini, E., Del Vecchio, et al. Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J. Natl. Cancer Inst., 1995, 87, s. 19–27.

16. Huang, E., Bucholz, T., Meric, F., et al. Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences. Cancer, 2002, 95, s. 2059–2067.

17. Kuerer, H., Julian, B., Strom, A., et al. Accelerated partial breast irradiation after conservative surgery for breast cancer. Ann. Surg., 2004, 239, 3, s. 338–351.

18. Vicini, F., Kestin, L., Huang, R., et al. Does local Recurrence affect the rate of distant metastases and survival in patients with early-stage breast carcinoma treated with breast conserving therapy? Cancer, 2003, 97, s. 910–919.

19. Hellman, S. Natural History of Small Breast Cancers. J. Clin. Oncol., 1994, 12, s. 2229–2234.

20. Tubiana, M., Koscielny, S. Natural history of human breast cancer: Recent data and clinical implications. Breast Cancer Research and Treatment, 1991, 18, s. 125–140.

21. Koscielny, S., Tubiana, M. The link between local recurrence and distant metastases in human breast cancer I. J. Radiation Oncology Biol. Phys., 1999, 43, s. 11–24.

22. Komoike, Y., Akiyama, F., Iino, Y., et al. Ipsilateral breast tumor recurrence (IBTR) after breast conserving treatment for early breast cancer: risk factors and impact on distant metastases. Cancer, 2006, 106, s. 35–41.

23. Overgaard, M., Hansen, P., Overgaard, J., et al. Postoperative radiotherapy in high-risk premenopausal woman with breast cancer who receive adjuvant chemotherapy. N. Engl. J. Med., 1997, 337, s. 949–955.

24. Ragaz, J., Jackson, S., Le, S., et al. Adjuvant radiotherapy and chemotherapy in node – positive premenopausal women with breast cancer. N. Engl. J. Med., 1997, 337, s. 956–962.

25. Fowble, B. Ipsilateral breast tumor recurrence following breast-conserving surgery for early-stage invasive cancer. Acta Oncol., 1999, 38 (Suppl), 13, s. 9–17.

26. Veronesi, U., Cascinelli, N., Mariani, L., et al. Twenty year of follow up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N. Engl. J. Med., 2002, 347, s. 1227–1232.

27. Fisher, B., Anderson, S., Bryant, J. et al. Twenty year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N. Engl. J. Med., 2002, 347, s. 1233–1241.

28. Singletary, S. E. Surgical margins in patients with early-stage breast cancer treated conservation therapy. Am. J. Surg., 2002, 184, s. 383–393.

29. Waljee, J., Hu, E., Newman, L., et al. Predictors of Re-excision among Woman Indergoing Breast-Conserving Surgery for Cancer. Ann. Surg. Oncol., 15, s. 1297–1303.

30. Veronesi, U., Volterani, F., Luini, A., et al. Quadrantectomy versus lumpectomy for small Size breast cancer. Eur. J. Cancer, 1990, 26, s. 671–673.

31. Mechera, R., Viehl, C., Oertli, D. Factors predicting in-breast tumor recurrence after breast – conserving surgery. Breast Cancer Treat., 2009, 116, s. 171–177.

32. Chen, Ch., Orel, S., Harris, E. Relation between the Method of Detection of Initial Breast Carcinoma and the Method of Detection of Subsequent Ipsilateral Local Recurrence and Contralateral Breast Carcinoma. Cancer, 2003, 98, s. 596–602.

33. Daneš, J. Základy ultrasonografie prsu. Maxdorf, 1996, str. 11, ISBN 80-85800-34-9.

34. Macmilian, R., Purushotham, A., George, W. Local recurrence after breast-conserving surgery for breast cancer. Br. J. Surg., 1996, s. 149–155.

35. Salvadori, B., Marubini, E., Miceli,. et al. Reoperation for locally recurrent breast cancer in patient previously treated with conservative surgery. Br. J. Surg., 1999, 86, s. 84–97.

Labels
Surgery Orthopaedics Trauma surgery
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#