Perspectives and Risks of Breast-Conservation Therapy for Breast Cancer (original) (raw)
Related papers
Cancer Radiotherapie - CANCER RADIOTHER, 2001
Background: Breast-conserving therapy (BCT) has been shown to be as effective as mastectomy in the treatment of tumors 2 cm or smaller. However, evidence of its efficacy, over the long term, in patients with tumors larger than 2 cm is limited. From May 1980 to May 1986, the European Organization for Research and Treatment of Cancer carried out a randomized, multicenter trial comparing BCT with modified radical mastectomy for patients with tumors up to 5 cm. In this analysis, we investigated whether the treatments resulted in different overall survival, time to distant metastasis, or time to locoregional recurrence. Methods: Of 868 eligible breast cancer patients randomly assigned to the BCT arm or to the modified radical mastectomy arm, 80% had a tumor of 2.1-5 cm. BCT comprised lumpectomy with an attempted margin of 1 cm of healthy tissue and complete axillary clearance, followed by radiotherapy to the breast and a supplementary dose to the tumor bed. The median follow-up was 13.4 years. All P values are two-sided. Results: At 10 years, there was no difference between the two groups in overall survival (66% for the mastectomy patients and 65% for the BCT patients; P = .11) or in their distant metastasis-free rates (66% for the mastectomy patients and 61% for the BCT patients; P = .24). The rate of locoregional recurrence (occurring before or at the same time as distant metastasis) at 10 years did show a statistically significant difference (12% of the mastectomy and 20% of the BCT patients; P = .01). Conclusions: BCT and mastectomy demonstrate similar survival rates in a trial in which the great majority of the patients had stage II breast cancer. [J Natl Cancer Inst 2000;92:1143-50] Affiliations of authors: J. A. van Dongen *Eleven patients were excluded from the model because of missing information.
New England Journal of Medicine, 1995
Background. Breast-conservation therapy for early-stage breast cancer is now an accepted treatment, but there is still controversy about its comparability with mastectomy. Between 1979 and 1987, the National Cancer Institute conducted a randomized, single-institution trial comparing lumpectomy, axillary dissection, and radiation with mastectomy and axillary dissection for stage I and II breast cancer. We update the results of that trial after a median potential follow-up of 10.1 years.
Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?
Advances in Breast Cancer Research, 2021
Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients' surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS).
European Journal of Cancer, 1995
Breast conservation has become well-established in the treatment of early mammary carcinoma. However, a standardised treatment modality has not emerged. We have analysed the data from 1,973 patients treated in three consecutive randomised trials by four different radiosurgical procedures: Halsted mastectomy, quadrantectomy plus radiotherapy, lumpectomy plus radiotherapy, and quadrantectomy without radiotherapy, to compare the outcomes of these procedures in terms of local recurrence rate and overall survival. Eligibility criteria were similar in the three trials, and comparability between the four subgroups was excellent. Median follow-up for all patients was 82 months. The annual rates of local recurrence varied markedly according to the treatment. Patients treated with Halsted mastectomy and quadrantectomy plus radiotherapy had low annual rates of local recurrence (0.20 and 0.46, respectively) while both lumpectomy plus radiotherapy and quadrantectomy without radiotherapy had significantly higher rates (2.45 and 3.28, respectively). Patients under 45 years of age had a much higher incidence of local recurrences, while in women over 55 years local recurrences were much less frequent. Overall survival curves were identical in the four groups of patients, so that the three breast conserving radiosurgical procedures had the same survival rates as Halsted mastectomy. However, local recurrence rates were markedly influenced by the treatment method, patient age and specific histological features.
Surgical margins in breast-conserving therapy: current trends and future prospects
Annali italiani di chirurgia
Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during ...
Risk factors in breast-conserving therapy
Journal of Clinical Oncology
Purose: To identify clinical and pathologic factors associated with an increased risk of local recurrence following breast-conservation therapy (BCT) to assess the safety of this procedure for all subgroups of patients.
Annals of Surgery, 2003
To confirm evidence that breast-conserving treatment (BCT) does not impair the prognosis in breast cancer patients as compared to mastectomy and to argue that it be regarded as the treatment of choice in stage I and II disease. Summary Background Data Scientifically, survival rates in breast cancer have been shown to be stage-dependent, but independent of the extent of surgical breast tissue removal, as long as the resection margins are free of tumor infiltration. Methods Between 1984 and 1997, six different trials conducted by the Austrian Breast & Colorectal Cancer Study Group accrued a total of 4,259 women with hormone-responsive disease. The authors selected and compared three patient groups (n ϭ 3,316) according to pathologic stage, age, and the surgical procedure applied.
Breast conservation in the treatment of early breast cancer a 20-year follow-up
Cancer, 1984
Two hundred sixty-three patients with unilateral primary breast cancer, treated by local excision of the primary tumor and radical radiation therapy between 1954 and 1969, were followed up for a minimum of 10 years and a maximum of 20 years. The treatment plan delivered 4500 rad in fractions of orthovoltage irradiation to five fields: tangential breast fields, axilla with posterior axillary field, parasternal and supraclavicular, with a subsequent boost of lo00 rad to the primary tumor site, axilla, and supraclavicular fossa. Patients were clinically staged using the TNM zyxwvu (UICC) system; 115 patients had tumors less than 2 cm in diameter and a clinically negative axilla (TlNONla), 96 had tumors 2 to 5 cm in diameter with a clinically negative axilla (TtNONla), and 52 had tumors less than 5 cm in diameter and clinical axillary lymph node metastases (TlT2Nl b). The actuarial relapse-free survival of patients with T1 NONla tumors was 72% at 5 years, 59% at 10 years, and 47% at both 15 and 20 years. The relapse-free survival of patients with T2NONla tumors was not statistically different zyxwv (P > 0.05). A significantly worse survival was observed in patients with clinical axillary lymph node metastases (TlT2Nlb), with a survival of 37% at 5 years, 29% at 10 years, 23% at 15 years, and 22% at 20 years, when compared with patients with clinically negative lymph nodes (P < 0.01). Locoregional relapse occurred in 22%, at 10 years, of those patients with T1 or T2NONla tumors and 52% of the patients with TlT2Nl b tumors. The pattern of locoregional relapses indicated that approximately 50% occur at least 5 years after treatment; this contrasts with the pattern of early locoregional relapse after mastectomy. The commonest sites of relapse were in the breast in 19% and axilla in 6% of patients with TI or T2NONla tumors. There was no attenuation of the radiation dose administered at the site of a subsequent relapse. Surgery for radiation failure produced a 42% crude relapse-free survival at 5 years after salvage mastectomy in those patients originally treated for TI or TlNONla tumors. The results of this study suggest that a significant proportion of patients relapse locally over a prolonged period after breast conservation. The evolution of new radiation techniques may provide better locoregional control and early salvage surgery may result in improved long-term survival.
Breast-conserving therapy for breast carcinoma: Margins, re-excision and recurrence rates
South African Journal of Oncology
Background: Breast-conserving therapy (BCT) is a wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer. There has not been a formal audit to review BCT outcomes in our unit.Objectives: To determine excision margins, re-excision and local recurrence rates.Methods: A histopathological and oncology records’ review of BCT patients from 01 January 2006 to 31 December 2010. The health faculty’s ethics committee granted approval. Data points accrued included age, histological tumour size, nodal status, tumour type, oestrogen receptor status, lymphovascular invasion, volume of specimen, margin status, management of involved or close margins, radiotherapy, ipsilateral breast recurrence rate and duration of follow-up.Results: A total of 192 patients had BCT. The mean age is 53 years. A median of 229.5 cm3 volume of specimen was excised. Infiltrating ductal carcinoma was the...