Breast conserving surgery for early breast cancer: Single institutional experience (original) (raw)
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World journal of surgery, 2018
In India and other developing countries, breast conservation surgery (BCS) rates in breast cancer patients are low due to advanced disease at presentation and misconceptions about BCS outcomes. Many patients presenting with large or locally advanced breast cancers (LABC) can be offered post-neoadjuvant chemotherapy (NACT) BCS, safety of which is not as well established as that of primary BCS. This retrospective study compared pathological and surgical outcome parameters in patients undergoing primary and post-NACT BCS. All non-metastatic breast cancer patients undergoing BCS during 2011-2015 with 1-year follow-up were included. Outcome parameters in form of margin infiltration, ipsilateral breast tumor recurrence (IBTR) rates and IBTR-free survival were compared between primary and post-NACT BCS patients groups. One hundred and twenty-nine patients underwent BCS; 95 underwent primary and 34 post-NACT BCS. Patients in both groups underwent similar multimodality treatment as per insti...
Breast Conservation Surgery in Early Breast Carcinoma: Personal Experience with Preliminary Results
Journal of King Abdulaziz University-Medical Sciences, 2000
More than one-third of recorded malignancies of women in the Arab countries are those of the breast. In the U.S.A., breast cancer is second to lung cancer as a cause of death from malignancy among women. Breast Conservation Therapy (BCT) provides survival equivalent to total mastectomy and preserves the breast. It is suitable for patients having a single clinical and mammographic lesion 4 cm or less (stages I and II) without signs of local advancement or extensive axillary nodal involvement. Patients with small breasts and those having central carcinoma are not suitable. In BCT the mass is excised with a safety margin and the axillary glands are removed. The entire breast tissue is irradiated using 4-6 MV linear accelerator of Co-60 units. The total dose is 50 Gy along five weeks. A total of 288 female patients have been subjected to BCT in the present study during the last four years. The lump was present in the right breast in 59% and in the left in 41%, respectively. In 78.6%, the lump was present in the lateral quadrants. Lump size was less than 4 cm in 95.5% of the cases. All patients passed a smooth postoperative course and all of them received postoperative radiotherapy and chemotherapy. Follow-up to 48 months was done to 106 patients and the results were tabulated and recorded. Two patients died of disseminated disease and 1 patient showed evidence of local recurrence.
2021
Background: It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibility of infrastructure and surgeon’s choice. We aimed to elucidate the Indian surgeons’ perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods: We conducted a survey-based cross-sectional study over 3 weeks between January-February 2021. Indian surgeons with general surgical or specialised onco-surgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS to an eligible patient.Results: A total of 347 responses were included. The mean age of the participants was 43...
Breast Conservation in Breast Cancer: A Bangladesh Experience
Journal of Surgical Sciences
Background: Breast cancer is one of the most common cancers in Bangladeshi women. Breast sacrificing treatment is still now the common practice in our country. Now a day’s breast conservative treatment is the standard treatment of breast cancer without compromising the survival. Objective: To observe local recurrence and distant metastasis free survival and overall survival of patients with breast cancer. Methods: Between January 1996 and December 2010, breast conserving treatment was carried out in 237 female patients with breast cancer in different Institutions of Bangladesh. Clinical staging was recorded by physical examination, relevant investigations as well as surgical records. Revised breast conserving surgery was carried out in those who had positive surgical margins or palpable disease. The patients with large but operable cancer or locally advanced cancer were treated by neoadjuvant chemotherapy followed by breast conserving surgery. Systemic adjuvant therapy (chemotherapy...
Scientific Reports, 2020
The present analysis reports the clinical, pathological, treatment profile and overall survival (OS) and disease-free survival (DFS) outcomes of consecutive breast cancer patients from three Indian centres, who underwent curative surgery as their first treatment. Among the 3453 patients, stage I, II, and III cases were 11.75%, 66.79%, and 21.64%, respectively while hormone receptor positive/HER2 negative, triple negative (TNBC) and hormone receptor any/HER2 positive cases were 55.2%, 24.2% and 20.6%, respectively. The five-year OS in the entire cohort, node-negative and node-positive patients were 94.1% (93.25–94.98), 96.17% (95.2–97.15) and 91.83% (90.36–93.31), respectively, and the corresponding DFS were 88.1% (86.96–89.31), 92.0% (90.64–93.39) and 83.93% (82.03–85.89), respectively. The five-year OS in hormone receptor positive/HER2 negative, TNBC and HER2 subgroups were 96.11% (95.12–97.1), 92.74% (90.73–94.8) and 90.62% (88.17–93.15), respectively, and the corresponding DFS were 91.59% (90.19–93.02), 85.46% (82.79–88.22) and 81.29% (78.11–84.61), respectively. This is the largest dataset of early breast cancer patients from India with survival outcome analysis and can therefore serve as a benchmark for future studies.
[Breast-conserving surgery in breast cancer]
Il Giornale di chirurgia
Breast-conserving surgery is the treatment of choice for the breast cancer T < 3 cm. The local recurrence is a problem of diagnosis and consequent treatment. We enrolled, from 1987 to 2004, 1504 breast cancer. In 803 (53.4%) tumor with T < 3 cm we performed conserving surgery. The sentinel lymph node (SN) technique induce to limit the axillary dissection in patients T1a-b to the SN only if non metastatic and located to the first level, the dissection of the 1st level of the axilla in patients T1c-T2 < 3 cm and SN negative, complete axillary dissection in patients with metastatic SN or located to the 2nd level. Our percentage of local recurrence in the follow-up was 3.5% at 5 years and 6% at 10 years.
World Journal of Surgical Oncology, 2007
Background: Breast cancer incidence in India is on rise. We report epidemiological, clinical and survival patterns of breast cancer patients from community perspective. Methods: All breast cancer patients treated at this hospital from July 2000 to July 2005 were included. All had cytological or histological confirmation of breast cancer. TNM guidelines for staging and Immunohistochemistry to assess the receptor status were used. Either lumpectomy with axillary lymph node dissection or Modified radical mastectomy (MRM) was done for operable breast cancer, followed by 6 cycles of adjuvant chemotherapy with FAC or CMF regimens to patients with pT >1 cm or lymph node positive or estrogen receptor negative and radiotherapy to patients after breast conservation surgery, pT size > 5 cm, 4 or more positive nodes and stage IIIB disease. Patients with positive Estrogen receptor or Progesterone receptor were advised Tamoxifene 20 mg per day for 3 years. Descriptive analysis was performed. Independent T test and Chi-square test were used. Overall survival time was computed by Kaplan-Meier method. Results: Of 1488 cancer patients, 122 (8.2%) had breast cancer. Of 122 patients, 96.7% had invasive breast carcinoma and 3.3% had sarcoma. 94% came from the rural and semi urban areas. Premenopausal women were 27%. The median age was 50 years. Stage I-6.8%, II-45.8%, III-22%, IV-6.8%, Bilateral breast cancer-2.5%. The mean pT size was 3.9 cm. ER and PR were positive in 31.6% and 28.1% respectively. MRM was done in 93.8%, while 6.3% patients underwent breast conservation surgery. The mean of the lymph nodes dissected were 3. CMF and FAC regimens were used in 48.8% and 51.2% of patients respectively. FAC group were younger than the CMF group (43.6 yr vs. 54 yrs, P = 0.000). Toxicities were more in FAC than CMF group, alopecia (100% vs. 26.2%), grade2 or more emesis (31.8% vs. 9.2%), grade2 or more fatigue (40.9% vs.19%), anemia (43.1% vs. 16.6%). Median Survival for the cohort was 50.8 months. ER positive patients had better median survival (P = 0.05). Conclusion: MRM was the most frequent surgical option. CMF and FAC showed equivalent survival. FAC chemotherapy was more toxic than CMF. ER positive tumors have superior survival. Overall 3 year survival was 70 percent
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).