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NCI CANCERLIT® Search: Surgery for Breast Cancer - August 2002
National Cancer Institute®
Last Modified: August 1, 2002
- Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers' experience.
- Pathologic tumor size and lymph node status predict for different rates of locoregional recurrence after mastectomy for breast cancer patients
- Breast imaging and the conservative treatment of breast cancer.
- [Indications and limits of breast conserving treatment]
- [Assessment of complications in a randomized controlled study on multimodality therapy for patients following breast-conserving surgery:
- [Is extra local radiation still indicated in breast cancer patients who are older than 60 years after breast conserving surgery?]
- [Complicated antiphospholid antibody syndrome]
- [Follow-up after surgery for breast cancer]
- Is radiotherapy needed after breast conservation for small invasive breast cancers?
- Bilateral angiosarcoma of the breast after conservative treatment of bilateral invasive carcinoma: genetic predisposition?
- The novel technique of delivering targeted intraoperative radiotherapy (Targit) for early breast cancer.
- Juvenile fibroadenoma of the breast.
- Nipple-areola reconstruction: satisfaction and clinical determinants.
- The coincidence of TRAM flaps and prostheses in the setting of breast reconstruction.
- Complete one-stage, immediate breast reconstruction with prosthetic material in patients with large or ptotic breasts.
- Free omental flap for skin-sparing breast reconstruction harvested laparoscopically.
- Principles and guidelines for surgeons--management of symptomatic breast cancer. On behalf of the European Society of Surgical Oncology.
- European guidelines for quality assurance in the surgical management of mammographically detected lesions. European Breast Cancer Working Group.
- What is the impact of guidelines for the surgical treatment of breast cancer?
- Sentinel lymph node micrometastases in DCIS.
- Consequences of axillary recurrence after conservative breast surgery.
- Debilitating lymphedema of the upper extremity after treatment of breast cancer.
- Breast cancer in pregnancy.
- Patient and provider characteristics that affect the use of axillary dissection in older women with stage I-II breast carcinoma.
- Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by
Table of Contents
1
UI - 12095552
AU - Cutuli B; Cohen-Solal-le Nir C; de Lafontan B; Mignotte H; Fichet V; Fay
TI -
R; Servent V; Giard S; Charra-Brunaud C; Lemanski C; Auvray H; Jacquot
S; Charpentier JC
Breast-conserving therapy for ductal carcinoma in situ of the breast:
the French Cancer Centers' experience.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 15;53(4):868-79
AD - Department of Radiation Oncology, Paul Strauss Center Strasbourg and
Polyclinique de Courlancy, Reims, France. b.cutuli@wanadoo.fr
PURPOSE: To assess the long-term outcome for women with ductal carcinoma
in situ of the breast treated in current clinical practice by
conservative surgery with or without definitive breast irradiation.
METHODS AND MATERIALS: We analyzed 705 cases of ductal carcinoma in situ
treated between 1985 and 1995 in nine French regional cancer centers;
515 underwent conservative surgery and radiotherapy (CS+RT) and 190 CS
alone. The median follow-up was 7 years. RESULTS: The 7-year crude local
recurrence (LR) rate was 12.6% (95% confidence interval [CI] 9.4-15.8)
and 32.4% (95% CI 25-39.7) for the CS+RT and CS groups, respectively (p
<0.0001). The respective 10-year results were 18.2% (95% CI 13.3-23) and
43.8% (95% CI 30-57.7). A total of 125 LRs occurred, 66 and 59 in the
CS+RT and CS groups, respectively. Invasive or microinvasive LRs
occurred in 60.6% and 52% of the cases in the same respective groups.
The median time to LR development was 55 and 41 months. Nine (1.7%) and
6 (3.1%) nodal recurrences occurred in the CS+RT and CS groups,
respectively. Distant metastases occurred in 1.4% and 3% of the
respective groups. Patient age and excision quality (final margin
status) were both significantly associated with LR risk in the CS+RT
group: the LR rate was 29%, 13%, and 8% among women aged < or =40,
41-60, and > or =61 years (p <0.001). Even in the case of complete
excision, we observed a 24% rate of LR (6 of 25) in women <40 years.
Patients with negative, positive, or uncertain margins had a 7-year
crude LR rate of 9.7%, 25.2%, and 12.2%, respectively (p = 0.008). RT
reduced the LR rate in all subgroups, especially in those with
comedocarcinoma (17% vs. 59% in the CS+RT and CS groups, respectively, p
<0.0001) and mixed cribriform/papillary tumors (9% vs. 31%, p <0.0001).
In the multivariate Cox regression model, young age and positive margins
remained significant in the CS+RT group (p = 0.00012 and p = 0.016).
Finally, the relative LR risk in the CS+RT group compared with the CS
group was 0.35 (95% CI 0.25-0.51, p = 0.0001). Subsequent contralateral
breast cancer occurred in 7.1% and 7.5% of the patients in the CS+RT and
CS groups, respectively. CONCLUSION: Despite the absence of
randomization, our results are extremely consistent with the updated
National Surgical Adjuvant Breast Project B17 and European Organization
for Research and Treatment of Cancer 10853 trials. We also noted that
the LR risk was very high in women <40 years and/or in the case of
incomplete excision.
2
UI - 12095553
AU - Buchholz TA; Katz A; Strom EA; McNeese MD; Perkins GH; Hortobagyi GN;
TI -
Thames HD; Kuerer HM; Singletary SE; Sahin AA; Hunt KK; Buzdar AU;
Valero V; Sneige N; Tucker SL
Pathologic tumor size and lymph node status predict for different rates
of locoregional recurrence after mastectomy for breast cancer patients
treated with neoadjuvant versus adjuvant chemotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 15;53(4):880-8
AD - Department of Radiation Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston, TX 77030, USA. tbuchhol@mdanderson.org
PURPOSE: To compare the pathologic factors associated with
postmastectomy locoregional recurrence (LRR) in breast cancer patients
not receiving radiation who were treated with neoadjuvant chemotherapy
(NEO) vs. adjuvant chemotherapy (ADJ). METHODS AND MATERIALS: We
retrospectively analyzed the rates of LRR of subsets of women treated in
prospective trials who underwent mastectomy and received chemotherapy
but not radiation. These trials were designed to answer chemotherapy
questions. There were 150 patients in the NEO group and 1031 patients in
the ADJ group. In the NEO group, 55% had clinical Stage IIIA or higher
vs. 9% in the ADJ group (p <0.001, chi-square test). RESULTS: Despite
the more advanced clinical stage in the NEO group, the pathologic size
of the primary tumor and the number of positive lymph nodes (+LNs) were
significantly less in the NEO group than in the ADJ group (p <0.001 for
both comparisons). However, the 5-year actuarial LRR rate was 27% for
the NEO group vs. 15% for the ADJ group (p = 0.001, log-rank). The
5-year risk for LRR was higher in the NEO patients for all pathologic
tumor sizes: 0-2 cm (18% vs. 8%, p = 0.011), 2.1-5 cm (36% vs. 15%, p
<0.001), and >5 cm (46% vs. 28%, p = 0.028). The risk of LRR by the
number of +LNs was similar in the NEO and ADJ groups, except for the
subset of patients with > or =4 +LNs (53% vs. 23%, p <0.001). The rates
of LRR in the patients with primary tumors measuring < or =2.0 cm and
1-3 +LNs were similar in both groups. However, for the patients with a
pathologic tumor size of 2.1-5.0 cm and 1-3 +LNs, the LRR was higher in
the NEO group than in the ADJ group (30% vs. 15%, p = 0.016). Most
failures in this NEO subgroup had clinical Stage III disease. In a
subset of NEO and ADJ patients matched for clinical stage, no
significant differences were found in the rates of LRR according to
primary tumor size and number of +LNs when these variables were analyzed
independently. Again, however, differences were found in the subgroup of
patients with tumors pathologically measuring 2.1-5.0 cm with 1-3 +LNs
(32% NEO vs. 8% ADJ, p = 0.030). CONCLUSION: The rates of postmastectomy
LRR for any pathologic tumor size are higher for patients treated with
initial chemotherapy than for patients treated with initial surgery.
Radiotherapy should be offered to all patients with > or =4 +LNs, tumor
size >5 cm, or clinical Stage IIIA or greater disease, regardless of
whether they receive neoadjuvant or postoperative chemotherapy. The
information assessing LRR rates in patients with clinical Stage II
disease who receive neoadjuvant chemotherapy, particularly if 1-3 lymph
nodes remain pathologically involved, is insufficient to determine
whether these patients should receive radiotherapy.
3
UI - 12117189
AU - Dershaw DD
TI -
Breast imaging and the conservative treatment of breast cancer.
SO - Radiol Clin North Am 2002 May;40(3):501-16
AD - Department of Radiology, Memorial Sloan-Kettering Cancer Center, New
York, NY 10021, USA. dershawd@mskcc.org
Breast conservation, where appropriate, offers effective treatment for
breast cancer while preserving the breast. The increased use of
mammographic screening has led to increased detection of small, curable
breast cancers that are amenable to breast-conserving surgery.
Mammography and other imaging modalities, such as sonography and MRI,
assist in the determination of the appropriateness of breast
conservation and in the differentiation of recurrence from benign
sequelae of treatment.
4
UI - 12145991
AU - Takahashi K; Nishimura S; Tada K; Saito M; Makita M; Tada T; Yoshimoto
TI -
M; Kasumi F; Akiyama F; Sakamoto G
[Indications and limits of breast conserving treatment]
SO - Gan To Kagaku Ryoho 2002 Jul;29(7):1125-31
AD - Dept. of Breast Surgery, Cancer Institute Hospital.
In Japan, 41% of surgeries for breast cancer were breast conserving
treatment (BCT) in 2000. The indications for BCT in the guidelines of
the Japanese Breast Cancer Society (1999) are as follows: (1) tumor size
is 3 cm or less, (2) image diagnosis indicates no sign of extensive
intraductal spread, (3) cases with multiple tumor are excluded, (4)
radiation therapy is possible, (5) the patient wants to receive BCT. The
pathological negative margin is favorable in BCT; however, we estimate
based on our study that only about 30% of all breast cancers can be
completely resected by partial mastectomy. To extend the indications for
BCT, the roles of postoperative radiotherapy, endocrine therapy and
preoperative chemotherapy will be important. Patients with ipsilateral
breast tumor recurrence (IBTR) have increased risk of distant
metastases, and the presence of IBTR is an important predictive factor
for distant metastases. When we discuss the indications and limits of
BCT, we have to take the rate of IBTR into careful consideration.
5
UI - 12145995
AU - Hiraoka M; Koyama H; Inoue T; Kono N; Kono M; Kodama H; Inaji H; Sako M;
TI -
Suzuki R; Kansai Breast Cancer Radiotherapy Research Group
[Assessment of complications in a randomized controlled study on
multimodality therapy for patients following breast-conserving surgery:
Kansai Breast Cancer Radiotherapy Research Group (5'-KBR)]
SO - Gan To Kagaku Ryoho 2002 Jul;29(7):1153-60
AD - Dept. of Therapeutic Radiology and Oncology, Kyoto University Graduate
School of Medicine.
PURPOSE: We conducted a randomized controlled study to evaluate the
safety and usefulness of a combined treatment of radiotherapy and
chemotherapy with doxifluridine (5'-DFUR) plus tamoxifen (TAM) as an
adjuvant therapy for breast cancer patients after conservative surgery.
The complications observed in this trial are reported herein. METHODS: A
total of 550 patients were registered and randomized (based on factors
such as T, N, with/without radiotherapy) to groups A and B. Drug
regimens were: group A, 5'-DFUR 600 mg/body/day for 6 months and TAM 20
mg/body/day for 2 years; group B, 5'-DFUR 600 mg/body/day for 2 years
and TAM 20 mg/body/day for 2 years. Radiotherapy (2 Gy x 5 times/week,
for 5 weeks) was administered to 88.6% of evaluable patients (481/543).
Radiation-related acute adverse reactions occurred in 28.5% of the 481
patients and moderate to severe reactions occurred in 1.5% of the
patients. Delayed radiation-related adverse reactions occurred in 23.8%
of the patients but none were severe. Chemo-endocrine therapy-related
adverse reactions occurred in 17.9% of group A patients and 25.6% of
group B patients. Grade 3 reactions occurred in 6 of the group A
patients (2.4%) and in 5 of the group B patients (1.9%); all adverse
reactions subsided after dose reduction or discontinuation. These
findings suggest that the combination therapy of irradiation and 5'-DFUR
with TAM is safe for patients after breast conserving surgery.
6
UI - 12014245
AU - van Tienhoven G
TI -
[Is extra local radiation still indicated in breast cancer patients who
are older than 60 years after breast conserving surgery?]
SO - Ned Tijdschr Geneeskd 2002 Apr 27;146(17):824; discussion 824
7
UI - 12098096
AU - Langer F; Eifrig B; Hegewisch-Becker S; Marx G; Neuber K; Hossfeld DK
TI -
[Complicated antiphospholid antibody syndrome]
SO - Dtsch Med Wochenschr 2002 Jul 5;127(27):1458-62
AD - Zentrum fur Innere Medizin, Medizinische Klinik II, Onkologie und
Hamatologie, Hamburg, Germany. drflanger@aol.com
HISTORY AND CLINICAL FINDINGS: A 51-year-old female patient suffered
from recurrent ischemic strokes and venous thromboembolism although
treated with ASS and phenprocoumon, which mainly occurred after
diagnosis and treatment of an invasive-ductal mamma carcinoma. The
severely ill patient presented with right-sided hemiparesis and
dysarthria, a swollen leg, a painful necrotic-ulcerative lesion at the
left-lateral ankle and a systolic heart murmur. INVESTIGATIONS:
Laboratory data revealed a haemoglobin of 8,4 g/dl, a leucocyte count of
3,1 x 10 (9)/l and a platelet count of 87 x 10 (9)/l. C-reactive
protein, ESR and plasma fibrinogen were markedly increased. Levels of
antinuclear, IgG-anticardiolipin and anti-doublestranded-DNA antibodies
were excessively elevated. A test for lupus anticoagulant was strongly
positive. Sonographic examinations showed deep vein thrombosis and
significant mitral valve regurgitation. Suspected pulmonary embolism was
demonstrated by CT scan. We diagnosed systemic lupus erythematosus with
secondary antiphospholipid antibody syndrome (APAS). TREATMENT AND
COURSE: Phenprocoumon was stopped and full-dose anticoagulation with
low-molecular-weight heparin initiated. Additional immunosuppressive
therapy consisted of cyclophosphamide, azathioprin and prednisone
resulting in prevention of further thromboembolism and significant
improvement of clinical symptoms. The observed severe interference of LA
with the prothrombin time after cessation of phenprocoumon (INR 3,6; FII
activity 81 %) suggested that the effect of oral anticoagulation had
been overestimated in the past. CONCLUSION: APAS may present as an acute
and life-threatening disorder. In this case interdisciplinary
co-operation and a highly individualised treatment strategy are
mandatory.
8
UI - 12082822
AU - Soot ML; Nielsen DL; Kamby C
TI -
[Follow-up after surgery for breast cancer]
SO - Ugeskr Laeger 2002 May 27;164(22):2918-22
AD - Onkologisk afdeling R, Amtssygehuset i Herlev, DK-2730 Herlev.
Routine follow-up of patients operated for primary breast cancer is a
very expensive service, and it is necessary to clarify what purpose it
serves. There is no evidence that routine follow-up of mastectomised
patients influences morbidity, mortality, or quality of life. Only
patients entering clinical trials or quality programmes should thus be
followed-up. However, there is agreement in the literature that these
patients should be offered follow-up in order to diagnose loco regional
recurrences. Lumpectomised patients may be cured, if recurrence in the
ipsilateral breast is detected at an early stage. Therefore, these
patients should be followed up at regular visits. It is recommended that
patients should be offered clinical examination every six months for the
first five years, and once a year thereafter until ten years have
elapsed since the primary treatment. Except for mammography of residual
mamma at intervals of 12-18 months, there is no indication for any
further paraclinical investigations.
9
UI - 12099645
AU - Athow AC; Gattuso JM; Perry N; Wells C; Dutt N; Bahsir GM; Mair G;
TI -
Carpenter R
Is radiotherapy needed after breast conservation for small invasive
breast cancers?
SO - Eur J Surg Oncol 2002 Jun;28(4):379-82
AD - St Bartholomew's Hospital, West Smithfield, London, UK.
AIMS: The purpose of this study was to determine the rate of local
recurrence in patients with small invasive breast cancers (<1 cm) who
had been treated with breast-conserving surgery either with (group 1) or
without (group 2) adjuvant radiotherapy. METHODS: This is a
retrospective study of 110 patients with an invasive breast cancer less
than 1 cm in size, treated in our centre by breast-conserving surgery.
Parameters examined included age at and mode of presentation,
histopathological features, adjuvant therapy, length of follow-up and
outcome in terms of local recurrence rate and death. RESULTS: In group 1
there were 59 women of median age 57 (38-80) years. The median tumour
size was 9 (1-10) mm and median follow-up was 74 (15-110) months. There
were no local recurrences. In group 2 the median age at presentation was
59 (48-81) years. The median tumour size was 7 (2-10) mm and median
follow-up was 47 (14-93) months. There were three non-breast-cancer
related deaths and three local recurrences (6%). CONCLUSIONS: A local
recurrence rate of 6% at almost 4 years median follow-up suggests that
it may be possible to avoid adjuvant radiotherapy in a subgroup of
largely screen-detected, node-negative patients with invasive tumours
less than 1 cm, in whom adequate local excision is performed. Further
follow-up is required to substantiate this. Copyright 2002 Elsevier
Science Ltd. All rights reserved.
10
UI - 12099648
AU - de Bree E; van Coevorden F; Peterse JL; Russell NS; Rutgers EJ
TI -
Bilateral angiosarcoma of the breast after conservative treatment of
bilateral invasive carcinoma: genetic predisposition?
SO - Eur J Surg Oncol 2002 Jun;28(4):392-5
AD - Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The
Netherlands.
AIMS: In view of the increasing application of breast-conserving therapy
(BCT) for early breast cancer during the last decades, the number of
BCT-associated angiosarcomas is likely to increase. Their aetiology is
not completely clear. The aim of this study was to examine the potential
role of genetic predisposition for development of this rare tumour.
METHODS: The authors report on a case of consecutive bilateral
development of angiosarcoma of the breast 6 and 12 years after BCT for
bilateral invasive breast carcinoma. The literature was reviewed and the
potential role of genetic predisposition was examined. RESULTS: Such a
case of bilateral BCT-induced breast angiosarcoma has not been
previously reported in the international literature. The change on
development of such a tumour bilaterally is 0.25-2.6 per million women
who underwent bilaterally BCT with radiotherapy for invasive carcinoma.
The case history and the literature review suggest that gene mutations
are likely to play a role in development of post-radiation angiosarcoma
of the breast. CONCLUSIONS: It is assumed that genetic predisposition
may play a role in the development of angiosarcoma after BCT. When such
a predisposition is known, one might decide to avoid BCT in favour of
mastectomy.
11
UI - 12099658
AU - Vaidya JS; Baum M; Tobias JS; Morgan S; D'Souza D
TI -
The novel technique of delivering targeted intraoperative radiotherapy
(Targit) for early breast cancer.
SO - Eur J Surg Oncol 2002 Jun;28(4):447-54
AD - Department of Surgery, Royal Free and University College London Medical
School, 67-73 Riding House St, London, W1W 7EJ, UK. j.vaidya@ucl.ac.uk
AIM: We believe that conservative treatment of early breast cancer may
not require radiotherapy that encompasses the whole breast in all
patients. We have developed a novel therapeutic approach that allows
targeted intraoperative radiotherapy (Targit) to be safely and
accurately delivered in a standard operating theatre. We are currently
recruiting for a randomized trial testing whether Targit can replace the
whole 6 weeks of post-operative radiotherapy after breast conserving
surgery. METHODS: This paper describes the operative technique. It
employs a miniature electron-beam-driven X-ray source called INTRABEAM
(PeC) that emits soft X-rays (50 kV) from within the breast. The X-rays
are emitted from the tip of a 10 cm x 3.2 mm diameter probe, that is
enclosed in a spherical applicator (available in 2.5-5 cm diameter
sizes), which in turn is inserted in the tumour bed and intraoperative
radiotherapy is delivered in about 25 min. The prescribed dose is 5 and
20 Gy at 1 cm and 0.2 cm respectively, from the tumour bed. RESULTS: The
biologically effective dose is 7-53 Gy for alpha/beta=10 and 20-120 Gy
for alpha/beta=1.5. The quick attenuation of the radiation reduces the
damage to normal tissues and allows radiotherapy to be delivered in a
standard operating theatre. Tungsten impregnated rubber sheets, cut to
size, are placed on the chest wall to protect the heart/lungs and over
the wound to stop stray radiation. The skin dose is monitored with
thermoluminescent detectors (TLDs). After wide local excision of the
tumour and good haemostasis, a spherical applicator is inserted in the
tumour bed and the target breast tissues are wrapped around it with a
purse-string suture. Thus, true conformation of the target around the
applicator source is achieved in real time. CONCLUSION: As a tumour bed
boost, this technique has the potential to reduce local recurrence by
avoiding geographical misses and achieving excellent dosimetry. In
patients with low risk of local recurrence, it has the potential to
replace the full 6 weeks of post-operative radiotherapy with
considerable implications to patients and hospitals. Copyright 2002
Elsevier Science Ltd. All rights reserved.
12
UI - 12110805
AU - Wechselberger G; Schoeller T; Piza-Katzer H
TI -
Juvenile fibroadenoma of the breast.
SO - Surgery 2002 Jul;132(1):106-7
AD - Department of Plastic and Reconstructive Surgery, Leopold-Franzens
University Innsbruck, Austria.
13
UI - 12142660
AU - Jabor MA; Shayani P; Collins DR Jr; Karas T; Cohen BE
TI -
Nipple-areola reconstruction: satisfaction and clinical determinants.
SO - Plast Reconstr Surg 2002 Aug;110(2):457-63; discussion 464-5
AD - Christus St. Joseph Hospital Plastic Surgery Residency Program, Houston,
Texas 77002, USA.
After performing a chart review, the authors identified 120 patients who
underwent breast cancer-related reconstruction. All charts were
evaluated with regard to breast mound reconstruction type, nipple-areola
reconstruction type, the interval between breast mound and nipple-areola
reconstruction, the number of procedures needed to achieve nipple-areola
reconstruction, patient history of radiation therapy, and complications.
A questionnaire was then developed and mailed to all of the patients who
underwent both breast mound and nipple/areola reconstruction (n = 105)
to evaluate their level of satisfaction. Of the 43 patients who returned
the questionnaire, 41 completed all portions correctly. The
questionnaire evaluated patient satisfaction with breast mound
reconstruction; patient satisfaction with nipple-areola reconstruction;
what the patient disliked most about the nipple-areola reconstruction;
and whether or not the patient would choose to have breast
reconstruction again. Several parameters were then tested statistically
against the reported patient satisfaction.A review of all patients who
underwent breast reconstruction revealed that their breast mound
reconstructions were done using either a TRAM flap (59 percent), a
latissimus dorsi flap and an implant (19 percent), an expander followed
by an implant (9 percent), an implant only (4 percent), or other means
(9 percent). The nipple-areola was reconstructed in these patients with
either a star flap (36 percent), nipple sharing (10 percent), a keyhole
flap (9 percent), a skate flap (9 percent), an S-flap (8 percent), a
full-thickness skin graft (6 percent), or by another means (22 percent).
The number of procedures needed to achieve nipple-areola reconstruction
was either one (in 66 percent of the patients), two (in 32 percent of
the patients), or three or more (2 percent of the patients). Eleven
percent of the patients experienced the complication of nipple
necrosis.Satisfaction with breast mound reconstruction was reported by
81 percent of patients to be excellent/good, by 14 percent of patients
to be fair, and by 5 percent of patients to be poor. Reported
satisfaction with nipple-areola reconstruction was excellent/good for 64
percent of patients, fair for 22 percent of patients, and poor for 14
percent of patients. The factors patients disliked most about their
nipple-areola reconstruction were, in descending order, lack of
projection, color match, shape, size, texture, and position. Statistical
analysis of the data revealed inferior patient satisfaction when there
was a longer interval between breast mound and nipple areola
reconstruction (p = 0.003). No significant difference was observed in
nipple/areola reconstruction satisfaction ratings when compared with
breast mound reconstruction type (p = 0.46), nipple-areola
reconstruction type (p = 0.98), and history of radiation therapy (p =
0.23). There was also no significant difference when breast mound
reconstruction was compared with technique (p = 0.51) and history of
radiation therapy (p = 0.079). Overall, there was a greater satisfaction
with breast mound reconstruction than with nipple-areola reconstruction
(p = 0.0001).
14
UI - 12142664
AU - Spear SL; Wolfe AJ
TI -
The coincidence of TRAM flaps and prostheses in the setting of breast
reconstruction.
SO - Plast Reconstr Surg 2002 Aug;110(2):478-86
AD - Division of Plastic Surgery, Georgetown University Medical Center,
Washington, DC 20007, USA. spears@gunet.georgetown.edu
It is well known that transverse rectus abdominis myocutaneous (TRAM)
flaps can be used to replace unsatisfactory prosthetic breast
reconstructions; however, little has been written about the scope of
breast implant use in TRAM flap patients. In this study, to ascertain
the range of such therapeutic options, their frequency, and their
clinical outcomes, the authors retrospectively reviewed the senior
author's breast reconstruction experience from 1989 to 2000 with
patients in whom both a TRAM flap and an implant were used for breast
reconstruction. The authors examined the surgical indications, body
habitus, bra size, chest wall irradiation history, flap type, implant
type, complications, and outcomes for those patients with TRAM flap and
breast implant combinations.Thirty-two women who had 50 (various)
combinations of a TRAM flap and a breast implant were identified. There
were more clinical scenarios than patients because many of the women had
multiple scenarios. The 50 combination scenarios were then divided into
six groups. Group I consisted of 14 patients who had elective prostheses
placed beneath simultaneous TRAM flaps; group II consisted of 10
patients who had TRAM flaps with contralateral prosthetic reconstruction
(in which two implants were received before the TRAM flaps, five
implants were received simultaneously with the TRAM flaps, and three
implants were received after the TRAM flaps); group III consisted of
eight patients who had contralateral augmentation in addition to their
TRAM flaps; group IV consisted of 11 patients who had TRAM flaps that
were used to cover or replace previous prosthetic reconstructions; group
V consisted of four patients in whom prostheses were used to augment or
improve previous TRAM flap reconstructions; and group VI consisted of
three patients who required prostheses to either reconstruct or salvage
total or near-total TRAM flap failures. A broad range of implant types
was used, although anatomic saline implants predominated. Forty-one
percent of the patients in the review had undergone irradiation during
the course of their treatment for breast cancer. Eight of the 32
patients experienced a total of twelve complications, four of which were
related to the implants and eight of which involved the TRAM flaps and
abdominal donor sites.Although complex, the wide variety of potential
TRAM flap/breast implant combinations can be useful for patients with
challenging reconstructive scenarios, particularly those that involve
radiation therapy. In the group of patients reviewed by the authors,
TRAM flaps were most often used in successful partnership either on the
same side as or opposite to an implant reconstruction. A TRAM flap was
used to salvage or replace an unsatisfactory implant reconstruction in
less than a third of the patients. From a risk point of view, implants
used opposite a TRAM flap reconstruction had a lower incidence of
complication than did implants used beneath TRAM flaps.
15
UI - 12142665
AU - Hudson DA; Skoll PJ
TI -
Complete one-stage, immediate breast reconstruction with prosthetic
material in patients with large or ptotic breasts.
SO - Plast Reconstr Surg 2002 Aug;110(2):487-93; discussion 494-6
AD - Department of Plastic and Reconstructive Surgery, Groote Schuur
Hospital, Cape Town, South Africa. hudsond@uctgsh1.uct.ac.za
Immediate prosthetic breast reconstruction is a relatively simple, quick
procedure with no donor site morbidity. This report discusses immediate
one-stage breast reconstruction using prostheses in 18 patients (19
breasts) who also required a contralateral reduction or mastopexy. In
all cases, an inverted-T pattern was applied to both breasts. The mean
age of the patients was 49 years (range, 32 to 62 years), and the mean
size of the gel implant used was 330 ml (range, 120 to 550 ml); the
implant was inserted in a total submuscular pocket in seven patients and
subcutaneously in 11 patients. In two patients with multiple risk
factors, the prosthesis extruded, and one patient required removal for a
periprosthetic infection. In 10 patients with early stage disease (T1 or
T2) with tumors more than 5 cm from the nipple-areola complex, the
original areola (n = 3) or nipple-areola complex (n = 7) was retained as
a full-thickness skin graft.The breast shape after submuscular
prosthesis insertion is different than that of the contralateral breast
after a mastopexy or reduction, and nipple-areola complex symmetry was
difficult to obtain; thus, this technique was abandoned in favor of the
subcutaneous position (using a modified Wise keyhole pattern with a
de-epithelialized portion, which still allows two-layer closure).In the
subgroup of patients with large breasts or marked ptosis, a single-stage
breast reconstruction procedure can be performed with symmetrical
incisions. The subcutaneous position allows for symmetrical shape and
nipple-areola complex symmetry to be obtained. When the tumors are small
and situated in the periphery of the breast, the nipple-areola complex
may be retained as a full-thickness graft.
16
UI - 12142675
AU - Jimenez AG; St Germain P; Sirois M; Hatheway M; Lethbridge R
TI -
Free omental flap for skin-sparing breast reconstruction harvested
laparoscopically.
SO - Plast Reconstr Surg 2002 Aug;110(2):545-51
AD - Division of Plastic and General Surgery, Chaleur Regional Hospital,
Bathurst, Canada. drgomezj@yahoo.ca
17
UI - 9598248
AU - Blichert-Toft M; Smola MG; Cataliotti L; O'Higgins N
TI -
Principles and guidelines for surgeons--management of symptomatic breast
cancer. On behalf of the European Society of Surgical Oncology.
SO - Ann Chir Gynaecol 1998;87(1):101-9
AD - Department of Surgery, Rigshospitalet, Copenhagen, Denmark.
The European Society of Surgical Oncology is actively involved in the
promotion of a high standard of surgical oncology throughout Europe.
Such an ambition involves recognition of Centres of Excellence in the
management of cancer patients throughout Europe. These centres have a
multi-disciplinary system involved in the total care of patients with
cancer and are concerned with the delivery of care to the highest
available standards. It is accepted that not all patients with cancer
can, nor should, necessarily be treated in such highly specialized
centres. Yet all cancer patients should be guaranteed a high standard of
care. High surgical standards can be ensured if surgeons treating cancer
are trained in specialist centres and, when in independent practice,
follow established guidelines or protocols of treatment. In common with
many national surgical oncology societies, the European Society of
Surgical Oncology is in the process of establishing good practice
guidelines in the treatment of solid tumours. This document on the
management of symptomatic breast cancer is the first of a series of
guidelines to be proposed by ESSO. It draws heavily on excellent
documents already in existence from the British Association of Surgical
Oncology and from the Danish Breast Cancer Co-Operative Group. It is
hoped that this document will be sufficiently clear and purposeful to be
of help to the individual surgeon and yet sufficiently flexible to allow
it to be adopted in the different medical systems throughout Europe.
18
UI - 9598249
AU - O'Higgins N; Linos DA; Blichert-Toft M; Cataliotti L; de Wolf C; Rochard
TI -
F; Rutgers EJ; Roberts PJ; Mattheiem W; da Silva MA; Holmberg L; Schulz
KD; Smola MG; Mansel RE
European guidelines for quality assurance in the surgical management of
mammographically detected lesions. European Breast Cancer Working Group.
SO - Ann Chir Gynaecol 1998;87(1):110-2
The European Guidelines developed for mammography screening have
contributed to the general discussion on quality assurance and the
important tasks of the health professionals dealing with breast cancer
screening. The cooperation of each medical discipline is of utmost
importance in order to achieve optimal results and eventually a
mortality reduction. The following guidelines are based on the British
NHS quality assurance guidelines for surgeons in breast cancer screening
and modified to meet the different needs in the European Countries. The
term "surgeon" denotes a medical doctor trained and involved in the
surgical treatment of breast diseases. The members of the working group
who participated in order to adapt these guidelines are listed above. We
hope that this document will contribute towards a more comprehensive
approach of breast cancer screening-detected lesions throughout Europe.
19
UI - 9598222
AU - von Smitten K
TI -
What is the impact of guidelines for the surgical treatment of breast
cancer?
SO - Ann Chir Gynaecol 1998;87(1):6-7
20
UI - 11352314
AU - Koduri PR
TI -
Sentinel lymph node micrometastases in DCIS.
SO - Ann Surg Oncol 2001 May;8(4):380
21
UI - 12081741
AU - Fredriksson I; Liljegren G; Arnesson LG; Emdin SO; Palm-Sjovall M;
TI -
Fornander T; Holmqvist M; Holmberg L; Frisell J
Consequences of axillary recurrence after conservative breast surgery.
SO - Br J Surg 2002 Jul;89(7):902-8
AD - Karolinska Institute, Department of Surgery, Stockholm Soder Hospital,
Stockholm, Sweden. irma.fredriksson@kirurg.sos.sll.se
BACKGROUND: The aim was to study the incidence, time course and
prognosis of patients who developed axillary recurrence after
breast-conserving surgery, and to evaluate possible risk factors for
axillary recurrence and prognostic factors after axillary recurrence.
METHODS: In a population-based cohort of 6613 women with invasive breast
cancer who had breast-conserving surgery between 1981 and 1990, 92
recurrences in the ipsilateral axilla were identified. Risk factors for
axillary recurrence were studied in a case-control study nested in the
cohort, and late survival was documented in the women with axillary
recurrence. RESULTS: The overall risk of axillary recurrence was 1.0 per
cent at 5 years and 1.7 per cent at 10 years. The risk of axillary
recurrence increased with tumour size (P = 0.033) and was highest in
younger women (odds ratio (OR) 3.9 for women aged less than 40 years
compared with those aged 50-59 years). Radiotherapy to the breast
reduced the risk of axillary recurrence (OR 0.1 (95 per cent confidence
interval 0.1 to 0.4)). The breast cancer-specific survival rate after
axillary recurrence, as measured from primary treatment, was 78.0 per
cent at 5 years and 52.3 per cent at 10 years. Tumour size and node
status had a statistically significant effect on death from breast
cancer. CONCLUSION: Axillary recurrence is rare, although more common in
younger women with large tumours. Radiotherapy to the breast was
protective. Tumour size and node status were the most important
prognostic factors in women with axillary recurrence.
22
UI - 12151966
AU - Bumpers HL; Best IM; Norman D; Weaver WL
TI -
Debilitating lymphedema of the upper extremity after treatment of breast
cancer.
SO - Am J Clin Oncol 2002 Aug;25(4):365-7
AD - Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia
30310, U.S.A.
Lymphedema after mastectomy occurs with a frequency as high as 30%. The
incidence increases with more radical surgical dissection, as was often
seen with radical mastectomies in the late 1800s. This is one aspect of
breast surgery that has been greatly neglected. Surgery has often been
deemed a success if the malignancy is eradicated. Patients may complain
of symptoms as minor as arm heaviness to major ones such as massive
chronic swelling, as was the case with our patient. The patient
presented here had increasing lymphedema during a 14-year period after
modified radical mastectomy and radiation therapy for advanced breast
cancer. This condition had progressed to incapacitation of the extremity
and a patient who as a result had become an invalid. The massively
edematous extremity revealed no signs of recurrent disease or malignant
degeneration. She underwent surgical intervention and physical therapy
as procedures of choice to restore function.
23
UI - 11892870
AU - Falkenberry SS
TI -
Breast cancer in pregnancy.
SO - Obstet Gynecol Clin North Am 2002 Mar;29(1):225-32, ix
AD - Department of Obstetrics and Gynecology, Brown University, Providence,
Rhode Island 02905, USA.
Breast cancer in pregnancy is likely to become more common because more
women have been waiting to bear children until they are in their 40s.
This article presents an overview of pregnancy-associated breast cancer
and a review of surgical, chemotherapeutical, and radiation principles
as they pertain to pregnancy.
24
UI - 12173318
AU - Edge SB; Gold K; Berg CD; Meropol NJ; Tsangaris TN; Gray L; Petersen BM
TI -
Jr; Hwang YT; Mandelblatt JS; Outcomes and Preferences for Treatment in
Older Women Nationwide Study Research Team
Patient and provider characteristics that affect the use of axillary
dissection in older women with stage I-II breast carcinoma.
SO - Cancer 2002 May 15;94(10):2534-41
AD - Department of Surgery, Roswell Park Cancer Institute, Buffalo, New York,
USA.
BACKGROUND: Axillary dissection for the evaluation and treatment of
patients with breast carcinoma often is not performed in older women.
The objective of this study was to examine patient, clinical, and
surgeon characteristics associated with the use of axillary dissection
after breast-conserving surgery (BCS). METHODS: A cohort of 464 women
age > or = 67 years who were newly diagnosed with Stage I-II breast
carcinoma and who underwent BCS were surveyed along with their 158
surgeons, and their medical records were reviewed. Patient, tumor, and
provider characteristics were examined for association with the omission
of axillary dissection. RESULTS: The majority of women (63.4%) underwent
axillary lymph node dissection after BCS. Increasing age was associated
strongly with decreasing odds of undergoing axillary lymph node
dissection, even after considering patient health and preferences,
clinical factors, and provider factors (odds ratio [OR], 0.11; 95%
confidence interval [95%CI], 0.05-0.27). Independent of age and other
factors, women in the lowest quartile of physical functioning were 37%
less likely to undergo axillary lymph node dissection compared with
women in the highest quartile (OR, 0.63; 95%CI, 0.62-0.64). Patients who
were cared for by surgeons with subspecialty training in oncology were
60% less likely to undergo axillary lymph node dissection compared with
patients who were cared for by other surgeons, even after considering
other factors (OR, 0.41; 95%CI, 0.25-0.68). CONCLUSIONS: The results of
this study demonstrated a correlation between lower use of axillary
dissection and advancing age, lower functional status, and greater
surgeon training. These findings suggest that simple, age-based
considerations are important but are not the sole determinants of
variations in treatment.
25
UI - 12192016
AU - Fisher B; Jeong JH; Anderson S; Bryant J; Fisher ER; Wolmark N
TI -
Twenty-five-year follow-up of a randomized trial comparing radical
mastectomy, total mastectomy, and total mastectomy followed by
irradiation.
SO - N Engl J Med 2002 Aug 22;347(8):567-75
AD - National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
15212-5234, USA. bernard.fisher@nsabp.org
BACKGROUND: In women with breast cancer, the role of radical mastectomy,
as compared with less extensive surgery, has been a matter of debate. We
report 25-year findings of a randomized trial initiated in 1971 to
determine whether less extensive surgery with or without radiation
therapy was as effective as the Halsted radical mastectomy. METHODS: A
total of 1079 women with clinically negative axillary nodes underwent
radical mastectomy, total mastectomy without axillary dissection but
with postoperative irradiation, or total mastectomy plus axillary
dissection only if their nodes became positive. A total of 586 women
with clinically positive axillary nodes either underwent radical
mastectomy or underwent total mastectomy without axillary dissection but
with postoperative irradiation. Kaplan-Meier and cumulative-incidence
estimates of outcome were obtained. RESULTS: No significant differences
were observed among the three groups of women with negative nodes or
between the two groups of women with positive nodes with respect to
disease-free survival, relapse-free survival, distant-disease-free
survival, or overall survival. Among women with negative nodes, the
hazard ratio for death among those who were treated with total
mastectomy and radiation as compared with those who underwent radical
mastectomy was 1.08 (95 percent confidence interval, 0.91 to 1.28;
P=0.38), and the hazard ratio for death among those who had total
mastectomy without radiation as compared with those who underwent
radical mastectomy was 1.03 (95 percent confidence interval, 0.87 to
1.23; P=0.72). Among women with positive nodes, the hazard ratio for
death among those who underwent total mastectomy and radiation as
compared with those who underwent radical mastectomy was 1.06 (95
percent confidence interval, 0.89 to 1.27; P=0.49). CONCLUSIONS: The
findings validate earlier results showing no advantage from radical
mastectomy. Although differences of a few percentage points cannot be
excluded, the findings fail to show a significant survival advantage
from removing occult positive nodes at the time of initial surgery or
from radiation therapy. Copyright 2002 Massachusetts Medical Society
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