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Sample records for breast conserving surgery

  1. Oncoplastic breast conserving surgery

    OpenAIRE

    Mansfield, Lucy; Agrawal, Avi; Cutress, Ramsey I.

    2013-01-01

    Oncoplastic breast conserving surgery is a fundamental component of the repertoire for the management of breast cancer. It facilitates removal of large volumes of breast tissue, and can improve cosmetic outcomes and patient satisfaction whilst maintaining good oncological principles, reducing re-excision and mastectomy rates and assisting in adjuvant radiotherapy planning.

  2. Breast reconstruction in conserving breast cancer surgery

    International Nuclear Information System (INIS)

    Breast conserving treatment (BCT) combined with radiotherapy have provedthe test of time as a sound oncological operation regarding survival andlocal recurrence. Successful BCT is a balance between adequate surgery andmaintaining the breast's appearance. Unsatisfactory outcome reaches 20-30% instandard techniques of BCD. Concepts described to widen the spectrum of BCT,have made an improvement of cosmetic outcome and facilitated a liberal safetymargin. Volume displacement techniques, such as glandular flap, mammoplasty,donut mastopexy and batwing mastopexy proved useful in large breasts andvolume replacement, such as latissimus dorsi flap and local flaps are ofgreat advantage to replace defects in small and medium sized breasts. Some ofthese techniques are simple, but comprehensive knowledge and training arerequired for sophisticated ones. The objectives of this article are to shedlight on different techniques adopted by surgeons to perform BCT inconjunction with various oncoplastic techniques and to discuss the factorsthat influence their applications to achieve best oncological and aestheticoutcome. (author)

  3. Breast Conservation Surgery: State of the Art

    International Nuclear Information System (INIS)

    Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement. Such an approach can also be used in the management of carefully selected cases of multifocal or multi centric breast cancer. The role of novel techniques, such as endoscopic breast surgery and radiofrequency ablation, is yet to be precisely defined.

  4. Oncoplastic options in breast conservative surgery

    OpenAIRE

    Rancati, Alberto; Gonzalez, Eduardo; Angrigiani, Claudio; Gercovich, Gustavo; Deza, Ernesto Gil; Dorr, Julio

    2013-01-01

    Conservative surgery has become the primary alternative in the treatment of breast cancer, and cosmetic outcome fundamental goal, as well as oncologic control. Different options to achieve these goals are presented. Oncoplastic treatment of breast cancer needs planning and knowledge of well-established plastic surgery techniques.

  5. RECURRENCE PATTERN FOLLOWING BREAST - CONSERVING SURGERY FOR EARLY BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Govindaraj

    2015-08-01

    Full Text Available OBJECTIVE: To study the Local Recurrence and metastasis pattern after Breast - Conserving Surgery for early breast cancer. MATERIALS AND METHODS: From 2010 to 2014 in department of surgery in VIMS Bellary, 70 patients with stage I or II invasive breast carcinoma were treated with breast - conserving surgery, radiation and chemotherapy. In this study we investigated the prognostic value of clinical and pathological factors in early breast cancer patients treated with BCS. All of the surgeries were performed by a single surgical team. Recurrence and its risk factors were evaluated.

  6. Irradiation method in the breast conserving surgery

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    Ohkawa, Tomohiko [Tokyo Women' s Medical Coll. (Japan); Akiyama, Futoshi; Ito, Yoshiyuki (and others)

    1998-12-01

    This is the guideline on the irradiation in the breast conserving surgery thought to be applicable now in Japan (May, 1998). The breast conserving surgery should be carried out to patients who sufficiently understood the informed consent. This guideline describes and recommends the application, the surgical method, the irradiation method, the adjuvant therapy, follow-up and the elevation. When the breast irradiation is carried out, it is important to sufficiently understand the breast conserving surgery and to make the radiation therapy planning under the consideration of the pathohistological examination for the postoperative evaluation. And it is also necessary to establish the quality control system for the guarantee of the quality assuarance. (K.H.)

  7. Irradiation method in the breast conserving surgery

    International Nuclear Information System (INIS)

    This is the guideline on the irradiation in the breast conserving surgery thought to be applicable now in Japan (May, 1998). The breast conserving surgery should be carried out to patients who sufficiently understood the informed consent. This guideline describes and recommends the application, the surgical method, the irradiation method, the adjuvant therapy, follow-up and the elevation. When the breast irradiation is carried out, it is important to sufficiently understand the breast conserving surgery and to make the radiation therapy planning under the consideration of the pathohistological examination for the postoperative evaluation. And it is also necessary to establish the quality control system for the guarantee of the quality assuarance. (K.H.)

  8. Depression and conservative surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    Mauriceia C. L. de Medeiros

    2010-01-01

    Full Text Available BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25 or without breast reconstruction (n = 25 at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ2 test. RESULTS: There were no significant differences between groups in age (p = 0.72 or educational level (p = 0.20. A smaller number of patients had undergone the menopause (p = 0.02 in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ2=9.97; p = 0.126. CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

  9. Breast appearance and function after breast conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Between 1978 and 1985, 247 breast cancer patients were treated with breast conserving surgery and radiotherapy. One hundred and twenty of these patients form the basis of this report, having replied to an 11-point structured questionnaire evaluating breast appearance and breast, shoulder and arm function. Good to perfect cosmetic, functional and overall scores are shown to be in the range 61-89%. The extent of primary surgery and axillary irradiation are the major factors affecting the cosmetic appearance. Other problems with cosmetic and functional assessment from subjective and objective view points are also discussed. (orig.)

  10. Breast-conserving surgery and radiotherapy for early breast cancer

    International Nuclear Information System (INIS)

    From March 1987 through September 1989, a total of 31 patients with early breast cancer were treated with breat-conserving surgery and radiotherapy. As of February 1989, all patients are alive without recurrence. Cosmetic results were satisfactory (excellent; 25%, good; 75%) at 1 year after radiotherapy. Mild radiation pneumonitis requiring medication developed in 3 patients. (author)

  11. Oncoplastia surgery breast conservation. First results

    International Nuclear Information System (INIS)

    Oncoplastic surgery is an important tool in the treatment patients with breast cancer stages I and II. A prospective study descriptive period between October 2005 and October 2006, which included 10 patients younger than 60 years in stages I and II, selected from the universe that came to the National Cancer Institute and Havana Radiobiology (INOR), following the inclusion criteria and exclusion. Were assessed before and after surgery from surveys that collected data questioning the patients and data clinical examination performed by the plastic surgeon. The predominant lesion was invasive ductal cancer and most patients were in stage I. There were no loco-regional recurrence in 2 year period. The most common complication was dehiscence surgical wound. Good aesthetic results were obtained in sixty percent of cases. It is confirmed that the surgery is Breast Oncoplastic very effective for the oncological safety and promising in terms of aesthetic results. (Author)

  12. Conservative treatment for breast cancer. Complications requiring reconstructive surgery

    International Nuclear Information System (INIS)

    Women who select conservative treatment for carcinoma of the breast (tumor excision followed by supervoltage radiation therapy) place a premium on breast preservation and aesthetics. When local control fails and they require a mastectomy, or when the aesthetic appearance is unacceptable, they may request breast reconstruction. The goal of this study is to evaluate a series of 10 patients who required reconstructive breast surgery after complications of conservative treatment. Patient classification: I. Breast or chest wall necrosis (3). II. Breast fibrosis and gross asymmetry (3). III. Local recurrence of breast cancer (5). IV. Positive margins after the initial lumpectomy (1). The mean age was 34 years. Radiation dosage average was 5252 rads with two patients receiving iridium-192 implant boosts. The reconstructive management was complex and usually required a major musculocutaneous flap because of the radiation effects

  13. Endoscopy-assisted breast-conserving surgery for breast cancer patients

    OpenAIRE

    Ozaki, Shinji; Ohara, Masahiro

    2014-01-01

    Breast-conserving surgery (BCS) combined with postoperative radiotherapy is a standard therapy for early-stage breast cancer patients. In addition, recent developments in oncoplastic surgery have improved cosmetic outcomes and patient satisfaction. Therefore, a breast surgeon’s current role in BCS is not only to perform a curative resection of cancerous lesions with adequate surgical margins, but also to preserve the shape and appearance of the treated breast. Endoscopy-assisted breast-conser...

  14. Surgery for Breast Cancer

    Science.gov (United States)

    ... Next Topic Breast-conserving surgery (lumpectomy) Surgery for breast cancer Most women with breast cancer have some type ... Relieve symptoms of advanced cancer Surgery to remove breast cancer There are two main types of surgery to ...

  15. Acquired Lymphangiectasia of the Breast After Breast Conserving Surgery.

    Science.gov (United States)

    Kılıç, Murat Özgür; Dener, Cenap

    2015-12-01

    Lymphangiectasia is characterized by vesicular dilation of lymphatic vessels and is generally a complication of radiotherapy or surgery of various malignant tumors such as breast and cervical cancers. Although it is not a precancerous disease, correct diagnosis is important to rule out Stewart-Treves syndrome which is defined as lymphangiosarcoma that develops in long-standing chronic postmastectomy lymphedema. Observation alone or many therapeutic options including cryosurgery, electrocauterization, sclerotherapy, and excision have been widely used in the management. Herein, a case of breast lymphangiectasia was presented as a late and rare complication of breast cancer-related therapies. PMID:27011587

  16. Breast-conserving surgery is contraindicated for recurrent giant multifocal phyllodes tumours of breast

    OpenAIRE

    Weledji, Elroy P; Enow-Orock, George; Ngowe, Marcelin N.; Aminde, Leopold

    2014-01-01

    Background The controversy between breast conserving surgery and simple mastectomy for phyllodes tumours of the breast remains because of the unpredictable nature of the disease. Although some benign tumours may show an unusually aggressive behaviour, modified radical surgery for phyllodes tumours offers no survival advantage, and recently more conservative surgical approaches have been deployed. Case presentation A 30-year-old woman with a giant multifocal tumour of the breast underwent brea...

  17. Conservative surgery of breast cancer in women; psychological benefits

    OpenAIRE

    Răzvan V. Scăunașu; Traean Burcoș; Ștefan Voiculescu; Bogdan Popescu; Șerban V. Berteșteanu; Oana-Denisa Bălălău; Nicolae Bacalbașa; Cristian Bălălău

    2016-01-01

    Breast surgery was one of the most dynamic fields of medicine which benefited from significant progress during the last decades. The transition from aggressive and mutilating amputations to conservative, oncoplastic and reconstructive techniques has been constant, offering improved and rewarding results, viewed from both, oncological and aesthetical perspectives. Conservative techniques, especially those which preserve the nipple areola complex, are followed by improved patient’s perceptio...

  18. Conservative surgery and radiation therapy for early breast cancer

    International Nuclear Information System (INIS)

    A retrospective review of 402 patients with stage I or II invasive breast carcinoma treated with conservative surgery and radiotherapy between 1979 and 1992 w as done. Disease free and actuarial survival rates, local, regional and distant recurrence rates and treatment related acute and chronic complications were evaluated according to stage. The technique and dose of radiotherapy were assessed in relation to stage of the disease, status of margin of lumpectomy and cosmetic results. Treatment related morbidity was minimal and overall cosmetic results were excellent. In stage 0 (in situ), I and II survival at 12 years has been 100%, 90% and 80% respectively. It is concluded that breast conservation treatment is an appropriate method of primary therapy, along with radiation therapy, for women with Stage I and II breast cancer

  19. Oncoplastic breast conserving surgery: Volume replacement vs. volume displacement.

    Science.gov (United States)

    Noguchi, M; Yokoi-Noguchi, M; Ohno, Y; Morioka, E; Nakano, Y; Kosaka, T; Kurita, T

    2016-07-01

    Oncoplastic breast conserving surgery (BCS) has emerged as a third option between conventional BCS and mastectomy. Oncoplastic BCS includes two fundamentally different approaches: volume replacement and volume displacement. The former involves partial mastectomy and immediate reconstruction of the breast with the transposition of autologous tissue from elsewhere, while the latter involves partial mastectomy and using the remaining breast tissue to fill the defect resulting from extirpation of the tumor. There are several benefits associated with oncoplastic BCS. First, it allows partial mastectomy without cosmetic penalties, and can achieve better cosmetic outcomes than total mastectomy with immediate breast reconstruction. Second, it avoids the need for total mastectomy in an increasing number of patients without compromising local control. Third, partial breast reconstruction is less extensive and has fewer complications than conventional procedures. Partial mastectomy and partial breast reconstruction can be carried out either simultaneously as a one-stage procedure, or using a two-stage approach. Although patients prefer a one-stage procedure, it requires intraoperative confirmation of complete tumor excision using frozen-section analysis. Moreover, oncoplastic BCS requires combined skills, knowledge, and understanding of both oncological and plastic surgeries, which may be optimally achieved by an oncoplastic surgeon. PMID:26988623

  20. Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    Liu Qian; Liu Yinhua; Xu Ling; Duan Xuening; Li Ting; Qin Naishan; Kang Hua

    2014-01-01

    Background This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer.Methods The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012.The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group).Enhanced MRI was used to measure breast volume,longest diameter of tumor and tumor volume.The correlations between these measurements and those derived from histopathologic findings were assessed.The relationships between the success rate of breast-conserving surgery and MRI-and pathology-based measurement results were statistically analyzed in the breast-conserving group.Results The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group.Allocation to these groups was based on clinical indications and patient preferences.The cut-off for concurrence between MRI-and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm.In the total mastectomy group,the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%.Correlation coefficients for MRI and histopathology-based measurements of breast volume,tumor volume and tumor volume/breast volume ratio were r=0.861,0.569,and 0.600,respectively (all P <0.001).In the breast-conserving group,with 0.30 cm taken as the cut-off for concurrence,the 95% confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98%-44.01%.The subjective and objective success rates for breast-conserving surgery were 100% and 88.54%,respectively.Conclusions There were significant correlations between dynamic enhanced MRI-and histopathology-based measurements of the longest

  1. Conservative surgery of breast cancer in women; psychological benefits

    Directory of Open Access Journals (Sweden)

    Răzvan V. Scăunașu

    2016-04-01

    Full Text Available Breast surgery was one of the most dynamic fields of medicine which benefited from significant progress during the last decades. The transition from aggressive and mutilating amputations to conservative, oncoplastic and reconstructive techniques has been constant, offering improved and rewarding results, viewed from both, oncological and aesthetical perspectives. Conservative techniques, especially those which preserve the nipple areola complex, are followed by improved patient’s perception of their body image, confidence and sexuality, with the only drawback of increased anxiety linked to recurrence risk.

  2. Surgical resection margins after breast-conserving surgery: Senonetwork recommendations.

    Science.gov (United States)

    Galimberti, Viviana; Taffurelli, Mario; Leonardi, Maria Cristina; Aristei, Cynthia; Trentin, Chiara; Cassano, Enrico; Pietribiasi, Francesca; Corso, Giovanni; Munzone, Elisabetta; Tondini, Carlo; Frigerio, Alfonso; Cataliotti, Luigi; Santini, Donatella

    2016-06-01

    This paper reports findings of the "Focus on Controversial Areas" Working Party of the Italian Senonetwork, which was set up to improve the care of breast cancer patients. After reviewing articles in English on the MEDLINE system on breast conserving surgery for invasive carcinoma, the Working Party presents their recommendations for identifying risk factors for positive margins, suggests how to manage them so as to achieve the highest possible percentage of negative margins, and proposes standards for investigating resection margins and therapeutic approaches according to margin status. When margins are positive, approaches include re-excision, mastectomy, or, as second-line treatment, radiotherapy with a high boost dose. When margins are negative, boost administration and its dose depend on the risk of local recurrence, which is linked to biopathological tumor features and surgical margin width. Although margin status does not affect the choice of systemic therapy, it may delay the start of chemotherapy when further surgery is required. PMID:27103209

  3. A patient with angiosarcoma of the breast after breast-conserving surgery and radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    An 89-year-old woman underwent breast-conserving surgery and axillary lymph node dissection (right AC region, T2N0M0, stage 2A, invasive ductal carcinoma, papillotubular type) for right breast cancer in February 2005. She received postoperative radiotherapy to the residual breast. She then developed marked edema of the right arm and right breast. A mass developed in the right breast in March 2011 and March 2013. This was originally suspected to be an ipsilateral breast recurrence of the cancer, but turned to be angiosarcoma after developing recurrent mass in March 2013, which histopathology was proved to be showed angiosarcoma of the breast. The patient subsequently had repeated intradermal and subcutaneous metastases and recurrence. She is currently receiving chemotherapy with docetaxel (30 mg/m2 biweekly). This interesting case of angiosarcoma of the breast after breast-conserving surgery for breast cancer is reported. (author)

  4. Breast-conserving surgery after neoadjuvant chemotherapy in patients with locally advanced cancer. Preliminary results

    OpenAIRE

    VERGINE, M.; SCIPIONI, P.; GARRITANO, S.; COLANGELO, M.; Di Paolo, A; LIVADOTI, G.; MATURO, A.; Monti, M

    2013-01-01

    Neoadjuvant chemotherapy (NACT) in locally advanced breast tumors may allow an adequate control of the disease impossible with surgery alone. Moreover, NACT increases the chance of breast-conserving surgery. Between 2008 and 2012, we treated with NACT 83 patients with locally advanced breast cancer. We report the preliminary results evaluating the impact of NACT on the type of surgery.

  5. Why do younger women have higher breast cancer recurrence rates after breast-conserving surgery?

    International Nuclear Information System (INIS)

    Preventing breast cancer recurrence after breast-conserving surgery is an important issue. The main factors contributing to such recurrence are positive margins, absence of radiotherapy and young age. To investigate the clinical significance of age in breast-conserving surgery, we examined the relationship between clinicopathological findings or outcome and age, especially young age. The cases were divided into three groups by age; 35 years old or less, 36-50y.o. and 51y.o. or higher. Between April 1989 and March 2003, 743 patients were treated with breast-conserving surgery. There were 49 patients aged 35 years old or less (6.6%). Younger age significantly correlated with positive surgical margin, lymph node metastases, higher proliferative activity, negative estrogen receptor (ER) or progesterone receptor (PgR), larger tumor size, and shorter nipple-tumor distances. Although younger patients had a higher recurrence rate irrespective of radiotherapy, margin status had an impact on recurrence rate. Thus, the reason young age was a significant factor for breast recurrence after breast-conserving surgery was that young patients frequently had numerous risk factors such as positive margin, higher proliferative activity, positive nodes, negative ER/PgR and larger tumor. However, negative surgical margins could reduce recurrence rates even in young women. These results suggest that more suitable criteria and strategies may be needed for young patients with breast cancer. (author)

  6. Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

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    Ho Yong Park

    2013-07-01

    Full Text Available Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer.Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons.Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15, the lower lateral quadrant (n=2, and the central lateral area (n=3. Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes.Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.

  7. Clinical significance of radiation therapy in breast recurrence and prognosis in breast-conserving surgery

    International Nuclear Information System (INIS)

    Significant risk factors for recurrence of breast cancer after breast-conserving therapy, which has become a standard treatment for breast cancer, are positive surgical margins and the failure to perform radiation therapy. In this study, we evaluated the clinical significance of radiation therapy after primary surgery or breast recurrence. In 344 cases of breast-conserving surgery, disease recurred in 43 cases (12.5%), which were classified as follows: 17 cases of breast recurrence, 13 cases of breast and distant metastasis, and 13 cases of distant metastasis. Sixty-two patients (16.7%) received radiation therapy. A positive surgical margin and younger age were significant risk factors for breast recurrence in patients not receiving postoperative radiation therapy but not in patients receiving radiation therapy. Radiation therapy may be beneficial for younger patients with positive surgical margins. Furthermore, radiation therapy after recurrence was effective in the cases not treated with postoperative radiation but not in cases with inflammatory recurrence. Patients with breast recurrence alone had significantly higher survival rates than did patients with distant metastases regardless of breast recurrence. These findings suggest that the adaptation criteria of radiation therapy for local control must be clarified. (author)

  8. Similar Outcomes of Standard Radiotherapy and Hypofractionated Radiotherapy Following Breast-Conserving Surgery

    OpenAIRE

    Hou, Hai-Ling; Song, Yong-Chun; Li, Rui-Ying; Zhu, Li; Zhao, Lu-Jun; Yuan, Zhi-yong; You, Jin-Qiang; Chen, Zhong-Jie; Wang, Ping

    2015-01-01

    Background Adjuvant radiation therapy is commonly administered to breast cancer patients who received breast-conserving surgery. However, lengthy treatment times of standard radiotherapy pose certain challenges. Here, we performed a prospective controlled study comparing standard radiation to hypofractionated radiotherapy in terms of efficacy and outcome. Material/Methods Eighty breast cancer patients (tumor stage pT1-2N0-1M0) who had undergone breast-conservation surgery were randomly divide...

  9. Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer

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    Kim, Jin Hee; Byun, Sang Jun [Dongsan Medical Center, Daegu (Korea, Republic of)

    2009-09-15

    To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10{approx}16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13{approx}179 months, with a median of 92.5 months. The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ({<=}6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

  10. Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer

    International Nuclear Information System (INIS)

    To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10∼16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13∼179 months, with a median of 92.5 months. The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy (≤6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks

  11. Clinical results of intensity modulated radiotherapy for breast cancer after breast-conserving surgery

    International Nuclear Information System (INIS)

    Objective: To analyze the efficacy and cosmetic results of intensity modulate radiation therapy (IMRT) for breast cancer after breast-conserving surgery. Methods: From 2003 to 2006, 117 patients with breast cancer, after breast-conserving surgery followed by 4 - 6 cycles of chemotherapy, received intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3DCRT). The radiation dose was 50 Gy in 25 fractions to the whole breast and 10 Gy boost to the tumor bed. Patients with positive hormone receptors then received endocrine treatment. Results: The follow-up rate was 94.0% until September 2009. 114 and 91 patients were followed up to 3 and 5 years, respectively. The 3-and 5-year overall survival rates were 99.1% and 96%. The 5-year disease free survival and local recurrence rates were 88% and 3.6%. Cosmetic results were satisfied. Severe radiation toxicities, such as radiation pneumonitis, pulmonary fibrosis and heart injury were not found. Conclusions: Patients treated with IMRT after breast-conserving surgery have a satisfied prognosis as well as cosmetic results. (authors)

  12. Does adjuvant systemic therapy contribute to decrease of breast recurrence after breast-conserving surgery?

    International Nuclear Information System (INIS)

    Preventing breast recurrence after breast-conserving surgery is an important issue. The main factors contributing to breast recurrences are positive margins and absence of radiotherapy. In late years a standard adjuvant treatment is widely used in Japan. We examined whether these standard treatments contributed to reduction of a breast recurrence. By March 2003, 845 patients were treated by breast-conserving surgery, and the cases were divided into two groups by operation period; 426 cases until 1998 (the first half group) and 202 patients with follow-up periods more than 2 years (the latter group). There were much positive margins and patients with radiotherapy in a latter group in background factor. An endocrine therapy for estrogen receptor (ER) positive was performed in 68.1% in first half period, and in contrast 94.2% in the latter period, and chemotherapy was performed in 87% (mainly Epirubicin) for ER negative in the latter period, and 77% (mainly oral agent) in the first half period. There was a significant difference of breast recurrence-free survival between 2 groups; an early recurrence was seen in 19 cases (4.5%) in the first half period and 2 cases (1.0%) in the latter group. In particular the difference was significant in patients with absence of radiotherapy or negative ER. Multivariate analysis revealed that the operation time was a significant factor for breast recurrence. In conclusion, an apparent reduction of breast recurrence may be brought by a standard adjuvant therapy. (authors)

  13. Margins in breast conserving surgery: A practice-changing process.

    Science.gov (United States)

    Rubio, I T; Ahmed, M; Kovacs, T; Marco, V

    2016-05-01

    Margins in breast conserving surgery (BCS) have been a long standing subject debate. This largely arises from the absence of a consensus on what constitutes an adequate margin width, resulting in re-excision rates of 25-40% for close or positive margins and its consequent impact upon cosmesis, economic costs, patient dissatisfaction and lack of bearing on survival. Accepting that the increased risk of local recurrences (LR) has its influence on survival, the decrease in LR in BCS in the last decade have been motivated by better surgical techniques for assessing negative margins, use of targeted therapies and in general with the multimodal treatment in the management of breast cancer patients. Since the publication of the consensus guidelines on margins there has evolved a trend of changing attitudes towards re-excision. Surgeons are considering margins in the context of all factors including not only patient and tumor characteristics but also the regional and systemic treatment the patient is receiving. PMID:26880017

  14. The Results of Primary Radiotherapy following Breast-Conserving Surgery for Early Breast Cancer

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    Koh, Kyong Hwan; Kim, Mi Sook; Yoo, Seong Yul [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    1995-06-15

    Purpose : Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy during the past 2 decades. In this country, however, the practice of conservative therapy for early invasive breast cancer has not been generalized yet. The purpose of this report was to evaluate the results and complications of breast conservation therapy in Korean Cancer Center Hospital(KCCH) Materials and Methods : From January 1987 to December 1989, 45 patients with early breast cancer treated with conservative treatment in KCCH were studied retrospectively. Median follow up was 54 months(range, 4 to 82 months). All patients received partial mastectomy (biopsy, tumorectomy, or quadrantectomy) and radiation therapy. Twenty eight patients received axillary dissection. The breast was treated with two opoosing tangential fields (total 50 Gy or 50.4 Gy in 5 weeks with daily target dose of 2 Gy or 1.8 Gy). Thirty patients received chemotherapy before and after radiotherapy. Eleven patients received hormonal therapy. Results : Five-year survival rate, 5-year disease free survival rate and 5-year local control rate were 87.2%, 86.5% and 97.6%, respectively. Administration of systemic Therapy (chemotherapy or hormonal therapy) correlated with good prognosis but statistically not significant (0.05 < p < 0.01). The sever late complication rate was 8.9%. Conclusion : Primary radiation therapy following breast-conserving surgery for early breast cancer is an alternative treatment comparing to radical treatment. Long term follow-up and more patients collection is needed to evaluate the prognostic factor and cosmetic outcome.

  15. The Results of Primary Radiotherapy following Breast-Conserving Surgery for Early Breast Cancer

    International Nuclear Information System (INIS)

    Purpose : Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy during the past 2 decades. In this country, however, the practice of conservative therapy for early invasive breast cancer has not been generalized yet. The purpose of this report was to evaluate the results and complications of breast conservation therapy in Korean Cancer Center Hospital(KCCH) Materials and Methods : From January 1987 to December 1989, 45 patients with early breast cancer treated with conservative treatment in KCCH were studied retrospectively. Median follow up was 54 months(range, 4 to 82 months). All patients received partial mastectomy (biopsy, tumorectomy, or quadrantectomy) and radiation therapy. Twenty eight patients received axillary dissection. The breast was treated with two opoosing tangential fields (total 50 Gy or 50.4 Gy in 5 weeks with daily target dose of 2 Gy or 1.8 Gy). Thirty patients received chemotherapy before and after radiotherapy. Eleven patients received hormonal therapy. Results : Five-year survival rate, 5-year disease free survival rate and 5-year local control rate were 87.2%, 86.5% and 97.6%, respectively. Administration of systemic Therapy (chemotherapy or hormonal therapy) correlated with good prognosis but statistically not significant (0.05 < p < 0.01). The sever late complication rate was 8.9%. Conclusion : Primary radiation therapy following breast-conserving surgery for early breast cancer is an alternative treatment comparing to radical treatment. Long term follow-up and more patients collection is needed to evaluate the prognostic factor and cosmetic outcome

  16. Results of Breast Conserving Surgery and Subsequent Postoperative Radiotherapy for Cases of Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chie, Eui Kyu; Kim, Kyu Bo; Choi, Jin Hwa [Seoul National University College of Medicine, Seoul (Korea, Republic of)] (and others)

    2008-09-15

    We analyzed the treatment outcomes and prognostic factors of breast conserving surgery, followed by postoperative radiotherapy. Materials and Methods: A total of 424 breast cancer patients treated with breast conserving surgery and postoperative radiotherapy between February 1992 and January 2001 were retrospectively analyzed. A quadrantectomy and axillary lymph node dissection was performed in 396 patients. A total of 302 patients had T1 disease, and 122 patients had T2 disease. Lymph node involvement was confirmed in 107 patients. Whole breast irradiation was administered at up to 50.4 Gy in 28 fractions, followed by a 10 Gy boost in 5 fractions to the tumor bed. In addition, 57 patients underwent regional lymph node irradiation. Moreover, chemotherapy was administered in 231 patients. A regimen consisting of cyclophosphamide, methotrexate, and 5-fluorouracil was most frequently used with 170 patients. The median follow-up time was 64 months. Results: The 5-year local control rate was 95.6%. During the follow-up period, local tumor recurrence was observed in 15 patients. The 5-year overall and disease-free survival rates were 93.1% and 88.7%, respectively. The 5-year overall survival rates, by stage, were 94.8% for stage I, 95.0% for stage IIA, 91.1% for stage IIB, 75.9% for stage IIIA, and 57.1% for stage IIIC. As for disease-free survival, the corresponding figures, by stage (in the same order), were 93.1%, 89.4%, 82.8%, 62.0%, and 28.6%, respectively. The advanced N stage (p=0.0483) was found to be a significant prognostic factor in predicting poor overall survival, while the N stage (p=0.0284) and age at diagnosis (p=0.0001) were associated with disease-free survival. Conclusion: This study has shown that breast conserving surgery and postoperative radiotherapy for early breast cancer results was excellent for local control and survival.

  17. Aesthetic Evaluation in Oncoplastic and Conservative Breast Surgery: A Comparative Analysis

    OpenAIRE

    Michela Massa, MD; Paolo Meszaros, MD; Ilaria Baldelli, MD; Nadia Bisso, MD; Simonetta Franchelli, MD

    2015-01-01

    Background: In conservative breast surgery, the achievement of a satisfactory cosmetic result could be challenging; oncoplastic techniques may be helpful in many cases. A comparative analysis was performed among 3 groups of patients undergoing oncoplastic techniques plus external radiation therapy or intraoperative radiotherapy (IORT) and breast conservative surgery plus external radiation therapy; long-term oncologic results in terms of disease relapse and aesthetic outcomes were compared. M...

  18. Aesthetic Evaluation in Oncoplastic and Conservative Breast Surgery: A Comparative Analysis

    OpenAIRE

    Michela Massa, MD; Paolo Meszaros, MD; Ilaria Baldelli, MD; Nadia Bisso, MD; Simonetta Franchelli, MD

    2015-01-01

    Background: In conservative breast surgery, the achievement of a satisfactory cosmetic result could be challenging; oncoplastic techniques may be helpful in many cases. A comparative analysis was performed among 3 groups of patients undergoing oncoplastic techniques plus external radiation therapy or intraoperative radiotherapy (IORT) and breast conservative surgery plus external radiation therapy; long-term oncologic results in terms of disease relapse and aesthetic outcomes were compared. ...

  19. Leiomyosarcoma arising in irradiated region after breast-conserving surgery: a case report

    OpenAIRE

    Hayashi, Satoshi; KITADA, MASAHIRO; Matsuda, Yoshinari; Ishibashi, Kei; Takahashi, Nana

    2015-01-01

    Background Radiation therapy (RT) is considered a risk factor for the development of sarcoma in patients with breast cancer. However, there are few reports regarding post-irradiation sarcoma (PIS). Case presentation The patient was a 59-year-old woman who presented with a chief complaint of induration in the lower outer quadrant of the left breast. She underwent breast-conserving surgery (BCS) for breast cancer located in the left upper inner region and received endocrine therapy following RT...

  20. Assessment of cosmetic outcome of oncoplastic breast conservation surgery in women with early breast cancer: A prospective cohort study

    OpenAIRE

    G Adimulam; Challa, V R; Dhar, A.; S Chumber; V Seenu; Srivastava, A.

    2014-01-01

    Background: The aim of this study was to assess the cosmetic outcome of patients undergoing oncoplastic breast conserving surgery in Indian population. Materials and Methods: A prospective cohort of 35 patients who were eligible for breast conservation surgery was included in the study from year 2007 to 2009. Patients with central quadrant tumors were excluded from the study. A double - blind cosmetic assessment was done by a plastic surgeon and a senior nurse not involved in the management o...

  1. Analysis of whole Breast Radiotherapy Methods for Treatment of Early Stage Breast Cancer after Conserving Surgery

    International Nuclear Information System (INIS)

    Introduction. At present moment breast cancer in Latvia is at second place for whole population and at first place among women. In year 2004 there were 1012 new breast cancer cases discovered. There was growth in number of breast cancer patients from 58.6 per 100 000 inhabitants in 1995 to 80.4 per 100 000 inhabitants in 2004. This growth is primarily attributed to breast cancer screening program which is nowadays active in Latvia. Breast cancer is third death cause among cancers in Latvia, - in 1995 there where 27.4 deaths per 100 000 inhabitants and in 2004 - 36.2 deaths per 100 000 inhabitants. Due to screening program there is increasing number of patients with stage I and II breast cancer. In 2004 toe where 9884 women with breast cancer registered in Latvian Cancer Registry and among them 79 percent were presented as stage I or II. Breast conservative surgery with adjuvant radiotherapy as standard part of it plays great role in breast cancer treatment in our Center. In year 2004 there were 103 breast conservative surgeries performed in our Center. Radiotherapy is a standard part of treatment in modem breast saving operations for early stage breast cancer, At present, only whole breast postoperative irradiation is performed in Latvia. For selected group of patients this treatment can be substituted with other radiotherapy methods in order to reduce acute reactions and/or late toxicity, maintaining the same tumor control. Aim of this work is to show that during whole breast irradiation dose maximum and tissue volume which receives doses more than 105% from prescribed dose, is linked with size of treated volume (treated volume - tissue volume receiving > 95% from prescribed dose), which is strictly linked with breast volume. Because of this for large breast volumes there is higher complication probability performing whole breast irradiation, and it seems to be meaningful to use Intensity Modulated Radiotherapy or Accelerated Partial Breast Irradiation for

  2. Bilateral breast cancer treated with breast-conserving surgery and definitive irradiation

    International Nuclear Information System (INIS)

    Objective: To assess whether patients with early stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complication rates, and cosmetic outcomes. Material and Methods: We reviewed 55 cases of patients with synchronous or sequential bilateral breast cancer treated with definitive irradiation following breast-conserving surgery at our institution from 1977 to 1992. Analysis of cases was limited to women who were AJCC clinical Stage 0, I, and II. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, AJCC stage, pathologic axillary lymph nodes status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Analysis regarding matching technique, cosmetic outcome, and complication rate was also performed. The 5- and 10-year overall survival (OS), no evidence of disease (NED) survival, relapse-free survival (RFS), and local control rates were evaluated. Twelve women (22%) presented with synchronous bilateral carcinoma, and 43 women (78%) had sequential bilateral carcinoma. Of the 12 patients with synchronous cancer, 5 received adjuvant chemotherapy, 2 received Tamoxifen, and 1 received both adjuvant therapies. Of the 43 patients with sequential cancer, 6 received chemotherapy, 1 received Tamoxifen, and 1 received both adjuvant therapies for the first cancer treatment; seven received chemotherapy and 6 received Tamoxifen for the second cancer treatment. Results: The median age at the time of treatment of the first cancer was 56 years (range 26-86 years). For the 12 patients with synchronous cancer, the median follow-up was 48 months (range 9-164). For the 43 patients with sequential cancer, the median follow-up was 112 months (range 52-188 months) after the first cancer, and 59 months (range 11-153 months) after the second. The median dose delivered was 64 Gy (range 42-72 Gy) using a combination of

  3. Mammotome-assisted endoscopic breast-conserving surgery: a novel technique for early-stage breast cancer

    OpenAIRE

    Xu, Yan; Ming, Jia; Zhou, Yan; QI, XIAOWEI; Fan, Linjun; Jiang, Jun

    2014-01-01

    Background Because of its minimally invasive and highly accurate nature, the use of Mammotome, a vacuum-assisted breast biopsy device has proven beneficial to the treatment of benign breast lesions. Taking advantage of endoscopic and Mammotome techniques together, we utilized the Mammotome device for therapeutic excision of malignant lesions in breast-conserving surgery (BCS). Methods Between December 2009 and January 2010, two patients with early breast cancer received Mammotome-assisted end...

  4. Pedicled dermoglandular flap reconstruction following breast conserving surgery

    International Nuclear Information System (INIS)

    Breast conserving therapy is the gold standard treatment of early breast cancer. However, a balance between good cosmetic outcome and limiting the risk of locoregional recurrence remains the key of success. The aim of this work was to evaluate the outcome of partial breast reconstruction using pedicled dermoglandular flap from the upper outer quadrant, for central quadrantectomy BCS. Patients and methods: Thirty patients underwent wide excision of carcinoma of retroareolar or periareolar regions of the breast, from July 2008 to August 2011. Excisions included the nipple/areola complex down to the pectoral is fascia with a wide safety margin, and complete axillary dissection. Breast reconstruction was done by means of pedicled dermoglandular flap. Results: Mean age of patients was 51.86 years (range from 30 to 70 years). Tumor size ranged from 1 to 4.2 cm. Postoperative pathological results came out with 21 (70.0%) patients mean (range) of the tumor safety margin 2.01 (0.5-2.8). Seventeen (56.7%) patients had positive axillary lymph nodes. All patients received postoperative radiation therapy to the breast, while 17/30 (56.67%) and 6/30 (20%) received endocrine therapy or adjuvant chemotherapy, respectively, and only 7/ 30 (23.34%) patients received both therapies. During a median follow-up period of 24 months, neither local nor distant metastasis, were detected. The postoperative cosmetic result was excellent in 80% patients, good in 13.3% patients, acceptable in 6.7% with no poor result. Conclusion: Following central quadrantectomy BCS for small centrally located breast cancer, a pedicled dermoglandular flap from the upper outer quadrant is a good reconstructive option.

  5. Management of Early Breast Cancer with Breast Conservative Surgery. An Egyptian Experience

    International Nuclear Information System (INIS)

    Background: Breast conservative surgery (BCS) has been an established method for treatment of early breast cancer. The volume of the procedure varies from a wide local excision to partial mastectomy and ipsilateral axillary lymphadenectomy. The nipple and areola complex sparing, depends on their proximity to the tumour. Radiotherapy, chemotherapy and or hormonal treatment play an integral role in the treatment of early breast cancer. Aim of the Study: In the present study we present our experience at National Cancer Institute, Cairo University with breast conservative surgery in treatment of female patients with early (T1-T2) breast cancer. The aim is to examine the evidence based management of those cases and the outcome of treatment in terms of loco regional recurrence and/or distant metastasis. Patients and Methods: The study includes 200 with early breast cancer patients who presented to the department of surgery, National Cancer Institute between May 2002 and February 2007. The average age was 46±6.5 years and the range was (26-72 years). Bilateral mammography, chest X-ray and full blood count were done routinely in the entire patients' group. The inclusion criteria included all patients presented with a breast tumor up to 4 cm in greatest dimension (T1-2N0). Results: Sixty Eight percent of patients underwent wide local excision, 20% underwent quadrantectomies, and 12% underwent partial mastectomy with or without nipple and areola preservation. All patients who underwent quadrantectomy or partial mastectomy required an augmentation mammoplasty to restore the breast volume. A latissmus dorsi myocutaneous flap was used in the majority of cases (70%), the rest were reconstructed with either a prosthetic implant or transverse rectus abdominis flap. The complications involved a total flap loss in 2 patients, partial flap loss in 2, nipple and areola sloughing in 4, wound infection in 5, haematoma in 4, seroma in 60, and donor site morbidity in 12 patients. Ninety

  6. Cirurgia conservadora no câncer de mama Breast-conserving surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    Daniel Guimarães Tiezzi

    2007-08-01

    Full Text Available O tratamento cirúrgico do câncer de mama sofreu expressivas mudanças nas últimas décadas. A cirurgia conservadora é o tratamento padrão para o câncer de mama em estádio inicial. Com a implementação dos programas de rastreamento e o uso emergente de tratamento sistêmico neoadjuvante, um crescente número de pacientes está sendo considerado elegível para o tratamento conservador. No entanto, uma série de fatores importantes merecem ser considerados no planejamento terapêutico destas pacientes. Esta revisão fornece uma visão geral da metodologia cirúrgica no tratamento conservador do carcinoma da mama.The surgical strategy for breast cancer treatment has changed considerably over the last decade. The breast conserving surgery (BCS is the standard treatment for early stage breast cancer nowadays. With the current population breast cancer screening programs and the emerging use of systemic neoadjuvant therapy, an increasing number of patients have been eligible to BCS. However, several specific factors must be considered for the therapeutic planning for these patients. This review provides a surgical methodology overview for the BCS in breast carcinoma.

  7. Assessment of cosmetic outcome of oncoplastic breast conservation surgery in women with early breast cancer: A prospective cohort study

    Directory of Open Access Journals (Sweden)

    G Adimulam

    2014-01-01

    Full Text Available Background: The aim of this study was to assess the cosmetic outcome of patients undergoing oncoplastic breast conserving surgery in Indian population. Materials and Methods: A prospective cohort of 35 patients who were eligible for breast conservation surgery was included in the study from year 2007 to 2009. Patients with central quadrant tumors were excluded from the study. A double - blind cosmetic assessment was done by a plastic surgeon and a senior nurse not involved in the management of patients. Moreover, self-assessment was carried out by the patient regarding the satisfaction of surgery, comfort with brasserie, social and sexual life after oncoplastic surgery. Results: In this study, 35 patients underwent oncoplastic breast conservation surgery by various techniques. The cosmetic outcome scores of the surgeon and nurse were analyzed for inter rater agreement using inter-class Correlation Coefficients. There was a good association between them. The risk factors for poor cosmetic outcome was studied by univariate analysis and significant correlation was obtained with age, volume of breast tissue excised and estimated percentage of breast volume excised (P < 0.05. Moreover, 96% of patients were moderately to extremely satisfied with the surgery. Patients were offered an option for cosmetic correction of contralateral breast by mastopexy or reduction mammoplasty however, none of them agreed for another procedure. Conclusions: Oncoplastic breast surgery helps to resect larger volume of tissue with wider margins around the tumor. It helps to achieve better cosmesis and extends the indications for breast conservation. Most of the patients were satisfied with mere preservation of the breast mound rather than a symmetrical contralateral breast.

  8. Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence

    International Nuclear Information System (INIS)

    Purpose: To examine the effect of the time interval (interval) between breast-conserving surgery (BCS) and the start of radiation therapy (RT) on the subsequent risk of ipsilateral breast cancer recurrence (IBR). Methods and Materials: We reviewed interval and a number of prognostic and treatment factors among 1,962 women treated with BCS and RT for invasive breast cancer diagnosed between January 1, 1989 and December 31, 1993 in British Columbia, Canada. Subjects were female, less than 90 years old at diagnosis, not treated with chemotherapy, not stage T4 or M1, and had survived more than 30 days from diagnosis. The cumulative incidence of IBR was estimated in four interval groups: 0-5, 6-8, 9-12, and 13+ weeks. Only 23 women had an interval of greater than 20 weeks between BCS and start of RT. To assess whether an imbalance of prognostic and treatment factors could be obscuring real differences between the interval groups, Cox proportional hazards regression analyses were conducted. Results: Median follow-up was 71 months. The crude incidence of IBR for the entire sample was 3.9%. The cumulative incidence of IBR in the 6-8, 9-12, and 13+ week groups was not statistically significantly different from the cumulative incidence of IBR in the 0-5 week group. Multivariate analyses demonstrated that patients not using tamoxifen (p 0.027) and those with grade 3 histology (p = 0.003) were more likely to recur in the breast. Interval between BCS and RT was not a statistically significant predictor of breast recurrence when entered into a model incorporating tamoxifen use and tumor grade (0-5 vs. 6-8 weeks, p = 0.872; 0-5 vs. 9-12 weeks, p = 0.665; 0-5 vs. 13+ weeks, p = 0.573). Conclusions: We found no univariate or multivariate difference in ipsilateral breast cancer recurrence between intervals of 0 to 20 weeks from breast conserving surgery to start of radiation therapy, in a population-based, low risk group of women not receiving adjuvant chemotherapy, after

  9. Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

    International Nuclear Information System (INIS)

    There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance)

  10. Radiation-induced sarcoma of the retained breast after conservative surgery and radiotherapy for early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Choy, A.; Barr, L.C.; Serpell, J.W.; Baum, M. (Royal Marsden Hospital, London (United Kingdom))

    1993-08-01

    The combination of breast conserving surgery and radiotherapy has become established as an alternative to mastectomy in the treatment of primary operable breast cancer. A number of reports of late complications of this approach have appeared in the literature, including radiation-induced brachial plexus neuropathy and myocardial damage. The potential for radiation-induced secondary tumours is also a cause for concern. (author).

  11. Ipsilateral Breast Recurrence After Breast Conserving Surgery in Patients with Small (≤ 2 cm) Breast Cancer Treated with Modern Adjuvant Therapies

    OpenAIRE

    Siponen, E.T.; Vaalavirta, L.; Joensuu, H; Vironen, J.; Heikkilä, P.; Leidenius, M.H.K.

    2010-01-01

    Abstract Background Modern multimodality treatment greatly influences the rate and the predictive factors for ipsilateral cancer recurrence (IBR) after breast conserving surgery. Material and Methods The study is based on 1,297 patients with pT1 breast cancer and treated with breast conserving surgery in February 2001 to August 2005. The median duration of follow-up was 57 months. Results IBR occurred in only 27 (2.1%) patients...

  12. Clinical analysis of intraoperative radiotherapy during breast-conserving surgery of early breast cancer in the Chinese Han population

    OpenAIRE

    Xin WANG; Liu, Jiaqi; Wang, Wenyan; Feng, Qinfu; Wang, Xiang

    2015-01-01

    Purpose While results of intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS) have been reported when used either as a boost at the time of surgery or as the sole radiation treatment, the clinical safety and cosmetic outcome of IORT in the Chinese Han population has not. This report reviews oncologic and cosmetic outcomes for Chinese Han breast cancer patients who received IORT either as a boost or as their sole radiation treatment at our hospital. Method From July 2008 t...

  13. Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.

    LENUS (Irish Health Repository)

    Smith, Myles J

    2012-02-03

    OBJECTIVE: We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer. BACKGROUND: Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase\\/Akt (PI3K\\/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer. METHODS: Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb\\/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period. RESULTS: We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K\\/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15). CONCLUSION: Investigating therapies which target tumour survival pathways such as PI3K\\/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.

  14. A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT

    OpenAIRE

    Zhao, Hongfu; He, Mingyuan; Cheng, Guanghui; Han, Dongmei; Wu, Ning; Shi, Dan; Zhao, Zhipeng; Jin, Jianxue

    2015-01-01

    Background and purposes This study compared VMAT and IMRT plans for intact breast radiotherapy for left sided breast cancer and evaluated the irradiated dose of planning target volume and OARs, especially focusing on heart and coronary artery. Materials and methods Eleven patients with left sided breast cancer whose breast was relatively smaller (the mean volumes is 296 cc) treated with breast-conserving surgery were prescribed radiotherapy of 50 Gy in 25 fractions using two or four-field ste...

  15. Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Heung Lae; Kim, Cheo Ljin; Park, Sung Kwang; Oh, Min Kyung; Lee, Jin Yong; Ahn, Ki Jung [Inje University College of Medicine, Busan (Korea, Republic of)

    2008-12-15

    This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. Materials and Methods: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range 43.8-129.4 months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for Tis and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had 1-3 lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close ({<=}2 mm) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy (41.4-60.4 Gy) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. Results: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0

  16. Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer

    International Nuclear Information System (INIS)

    This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. Materials and Methods: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range 43.8-129.4 months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for Tis and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had 1-3 lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (≤2 mm) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy (41.4-60.4 Gy) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. Results: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0

  17. Early-stage bilateral breast cancer treated with breast-conserving surgery and definitive irradiation: the university of Pennsylvania experience

    International Nuclear Information System (INIS)

    Purpose: To determine whether patients with early-stage bilateral breast cancer can be treated with definitive irradiation following breast-conserving surgery with acceptable survival, local control, complications, and cosmesis. Methods and Materials: During the period 1977-1992, 55 women with Stage 0, I, or II concurrent (n = 12) or sequential (n = 43) bilateral breast cancer were treated with definitive irradiation following breast-conserving surgery. The records of these 55 patients with 110 treated breasts were reviewed for tumor size, histology, pathologic axillary lymph node status, first and overall site(s) of failure, and adjuvant chemotherapy or hormonal therapy. Curves for survival, local control, and regional control were determined. Cosmetic outcome, complication rates, and matching technique were analyzed. The median total radiation dose delivered was 64 Gy (range 42-72) using tangential whole-breast irradiation followed by an electron or iridium implant boost. The tangential fields were matched with no overlap in 40 patients (73%); there was overlap on skin of up to 4 cm in 14 patients (25%); and the matching technique was unknown in 1 patient (2%). The median follow-up for the 12 women with concurrent bilateral breast cancer was 4.0 years. The median follow-up for the other 43 women with sequential cancer was 9.3 and 4.9 years, respectively, after the first and second cancers. Results: For the overall group of 55 patients, the 5- and 10-year overall survival rates were 96% and 94%, respectively, after treatment of the first cancer, and 96% and 92%, respectively, after treatment of the second cancer. The 5- and 10-year actuarial relapse-free survival rates were 90% and 75%, respectively, after treatment of the first cancer, and 83% and 72%, respectively, after treatment of the second cancer. For the 110 treated breast cancers, the 5- and 10-year actuarial local failure rates were 5% and 15%, respectively. Complication rates were: 28% breast edema, 8

  18. Methods and clinical utility of intraoperative radiotherapy (IORT) in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Miyauchi, Mitsuru; Yamamoto, Naoto; Fujita, Yoshihiro; Honda, Ichiro; Hatano, Kazuo; Sekiya, Yuichi [Chiba Cancer Center (Japan); Suzuki, Masato; Nakajima, Nobuyuki

    1996-03-01

    We have developed an intraoperative radiotherapy technique in breast-conserving surgery. Following lumpectomy and axillary dissection up to Level II, the subcutaneous fat layer was lifted from the gland over the entire breast. Electron beams of 25 Gy were irradiated within cylinder, avoiding the skin and subcutaneous tissue. The surface of the gland was covered with cotton swabs saturated with normal saline to equalize the energy depth to the chest wall. This technique has so far been applied to 8 patients, all of whom went through a successful postoperative period without serious complications. The cosmetic results were satisfactory from immediately after the operation. Intraoperative radiotherapy combined with breast-conserving surgery may be helpful in improving the QOL of patients by eliminating the adverse effects associated radiation injury to the skin of the breast and long-term postoperative follow-up. (author).

  19. Dosimetric absorption of intensity-modulated radiotherapy compared with conventional radiotherapy in breast-conserving surgery

    OpenAIRE

    Lin, Yang; WANG, BENZHONG

    2014-01-01

    The aim of this study was to investigate the dosimetric benefits between intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CR) among patients receiving breast-conserving surgery. A dosimetric comparison of IMRT and CR was evaluated in 20 patients with early-stage breast cancer using a three-dimensional treatment planning system. The prescribed mammary gland dose was completed in 25 fractions with a total dose of 5,000 cGy. Homogeneity of the planning target volume (PTV), ...

  20. Adjuvant radiotherapy after breast conserving surgery – A comparative effectiveness research study

    International Nuclear Information System (INIS)

    Purpose: The purpose of this retrospective outcome study was to validate the effectiveness of postoperative radiotherapy in breast conserving therapy (BCT) and to evaluate possible causes for omission of radiotherapy after breast conserving surgery (BCS) in a non-trial population. Methods: Data were provided by the population-based Munich Cancer Registry. The study included epidemiological data of 30.811 patients diagnosed with breast cancer from 1998 to 2012. The effect of omitting radiotherapy was analysed using Kaplan–Meier-estimates and Cox proportional hazard regression. Variables predicting omission of radiotherapy were analysed using multivariate logistic regression. Results: Use of postoperative radiotherapy after BCS was associated with significant improvements in local control and survival. 10-year loco-regional recurrence-free-survival was 90.8% with postoperative radiotherapy vs. 77.6% with surgery alone (p < 0.001). 10-year overall survival rates were 55.2% with surgery alone vs. 82.2% following postoperative radiotherapy (p < 0.001). Variables predicting omission of postoperative radiotherapy included advanced age (women ⩾80 years; OR: 0.082; 95% CI: 0.071–0.094, p < 0.001). Conclusions: This study shows a decrease in local control and a survival disadvantage if postoperative radiotherapy after breast conserving surgery is omitted in an unselected cohort of primary breast cancer patients. Due to its epidemiological nature, it cannot answer the question in whom postoperative radiotherapy can be safely omitted

  1. Clinical outcome of adjuvant chemotherapy plus intensity modulated radiotherapy after breast-conserving surgery

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and side effects of adjuvant chemotherapy plus intensity modulated radiotherapy (IMRT) after breast-conserving surgery for stage I and II breast cancer. Methods: After breast-conserving surgery, 108 patients received six cycles of chemotherapy followed by IMRT. The irradiation dose of the whole breast was 50 Gy given by 25 fractions, followed by 10 Gy boost to the tumor bed given by 5 fractions with electron beams. Patients with positive estrone receptor or progesterone receptor were given endocrine treatment, mostly with tamoxifen. Results: The follow-up rate was 100% by December 2007. The number of patients followed-up at 1-, 2- and 3-year was 108,88 and 58. The 1-, 2- and 3-year over survival rates were 100%, 100% and 98%. Three patients had local recurrence. Different degree of dermatitis occurred with good long-term cosmetic results. No severe side effects occurred such as radiation-induced pneumonitis, pulmonary, fibrosis and heart injury. Conclusions: Breast cancer patients treated by adjuvant chemotherapy plus IMRT after breast-conserving surgery have high survival rate and low side-effect rate. The survival quality and local control can be improved. (authors)

  2. The influence of radiotherapy on cosmetic outcome after breast conservative surgery

    International Nuclear Information System (INIS)

    Purpose: The influence of radiotherapy in the cosmetic outcome after conservative surgery for breast cancer was evaluated using an objective method of calculating the asymmetry between the two breasts. Methods and Materials: One hundred and one patients treated with the same conservative surgery were evaluated for cosmetic outcome. Sixty-one of them received external radiotherapy (50 + 10 Gy) to the residual breast; the remaining 40 underwent surgery only. The aspect of the patients' breasts was objectively assessed for symmetry by means of a computerized technique. A subjective assessment of the cosmetic outcome was performed both by physician and patient. These objective and subjective assessments were compared in the two groups treated with or without radiotherapy. Results: The results obtained did not show significant differences in terms of cosmetic outcome in the two groups. Skin telangectasia was noted in two radiotherapy patients, while hypertrophic breast scars were only noted in six nonirradiated patients. Conclusions: We found that standard radiotherapy does not seem to influence the symmetry and the cosmetic results in breast conservative treatment when compared to a similar group of patients with the same quadrantectomy procedure and no radiotherapy

  3. Lactation following conservation surgery and radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    A 38-year-old woman with early stage invasive breast cancer was treated with wide excision of the tumor, axillary lymph node dissection, and breast irradiation. Three years later, she gave birth to a normal baby. She attempted breast feeding and had full lactation from the untreated breast. The irradiated breast underwent only minor changes during pregnancy and postpartum but produced small amounts of colostrum and milk for 2 weeks postpartum. There are only a few reports of lactation after breast irradiation. These cases are reviewed, and possible factors affecting breast function after radiotherapy are discussed. Because of scant information available regarding its safety for the infant, nursing from the irradiated breast is not recommended

  4. Three-dimensional conformal partial breast external-beam irradiation after conservative surgery of the breast

    International Nuclear Information System (INIS)

    reaction was seen in 14 patients and grade l in 3 patients and there was not equal to or more than grade 2 of skin reaction for all the patients. Cosmetic effect were appreciated and satisfaction defined as excellent or good appearance of the irradiated breasts for all the patients. No recurrence of local tumor for all of the patients followed for one year. Therefore, the cosmetic result of 1 yr. follow-up was 100% and no recurrence was found after 1 yr. follow-up. The 1-year tumor-free survival rate were all 100%. Conclusions: For selected patients with early breast cancer after breast-conservative surgery, 3DCPBI assisted by ABC is feasible, however, the selection criteria for the patients, technique pro- tocol and dose fractionation of 3DCPBI and its influence on late cosmetic effect, local tumor control and survival need to be continuously explored and observed in the future. (authors)

  5. Three-dimensional (3D) MRI for indication of breast conserving surgery

    International Nuclear Information System (INIS)

    3D-MRI has the following advantages: To observe the whole breast from any direction. To calculate each volume of the main tumor, whole breast and the planned surgical area. At this time, Gd-enhanced 3D-MRI was performed to 56 patients with 58 lesions to determine indication of breast conserving surgery. Extensive intraductal component (EIC) was evaluated by 3D-MRI preoperatively and it was confirmed by pathological examination postoperatively. The main tumor was detected in 56 of 58 lesions by 3D-MRI (sensitivity, 96.6%). EIC (+) was pointed out in 19 of 27 lesions (sensitivity, 70.4%) EIC (-) was correctly estimated in 19 of 29 lesions (specificity, 65.5%). Next, the volumes of the main lesion, whole breast and the planned surgical area were calculated (23 of 56 patients). The volume ratio of the main tumor/whole breast and the planned surgical area/whole breast were compared to the postoperative cosmetic result respectively. To maintain the volume ratio of the planned surgical area/whole breast under 20% was one of the key factors to obtain good cosmetic result. Therefore, 3-D MRI may become indispensable to indication of breast conserving surgery. (author)

  6. Cosmetic outcome and curative effect of radiotherapy for early breast cancer after conservative surgery

    International Nuclear Information System (INIS)

    Objective: To study the cosmetic outcome and curative effect of 6 MV X-ray tangential field radiotherapy for early stage breast cancer after conservative surgery. Methods: The eligible criteria were single tumor ≤3 cm in diameter, surgical margin negative and lymph node negative. The exclusive criteria were inflammatory carcinoma or male breast cancer. After conservative surgery, 42 patients with stage 0, I or II breast cancer were treated with conventional radiotherapy with a total dose of 50 Gy to the whole breast and 10 Gy boost to the tumor bed. The efficacy and the cosmetic outcome of radiotherapy were evaluated every 3 months for the first 2 years and every 6 months after that and every 12 months after 5 years. Results: The follow up time was 19-90 months (median 56 months). Two patients died of metastasis after 16 months and 36 months, which was diagnosed by CT scan. Excellent or good cosmetic outcome was > 93% at 36 months. The local control rate was 100%. The 1- and 3-year survival rates was 100% and 98%, respectively. Conclusions: Tangential field radiotherapy for early breast cancer after conservative surgery has a satisfied result in both tumor control and cosmetic outcome, which can definitely improve the life quality of the patients. (authors)

  7. The 10-Year Local Recurrence and Partial Breast Radiotherapy for Early Breast Cancer Treated by Conservative Surgery

    Institute of Scientific and Technical Information of China (English)

    Zhizhen Wang; Ruiying Li

    2006-01-01

    OBJECTIVE To study the local recurrence and the role of whole breast radiotherapy for early breast cancer treated by conservative surgery.METHODS From April 1990 to December 2000, 49 patients with early primary breast cancer were treated by conservative surgery in our hospital. The cases were comprised of Stage 0, 1; Stage Ⅰ, 31; and Stage Ⅱa,17. Forty cases underwent quadrantectomy plus axillary lymph node dissection, and the other 9 cases had lumpectomy alone. Irradiation, which was received by 39 patients, was administered by using low tangential half fields with 6 MV X-ray to decrease the pulmonary irradiative volume.The dose to the whole breast was 45 Gy/22~23f/4.5W, then a 15 Gy boost dose was delivered to the tumor bed by an electron beam. The other patients underwent an irradiated regional field according to postoperative pathology.RESULTS All patients were followed-up for 10 years or more. The 10year local recurrence rates, distant metastasis rates and survival rates were 6.1%, 4.1% and 98.0% respectively. All of the 3 patients who had a local recurrence had infiltrative carcinomas and negative lymph nodes.The 10-year local recurrence rate was higher (2.6% vs. 20.0%) with nonpostoperative whole breast radiotherapy, but the statistical difference was not marked because of the low number of cases. All of the recurrent lesions localized within 3 cm of the primary lesion.CONCLUSION Original recurrence of the tumor was the main type of local recurrence. Radiotherapy after conservative surgery is very essential.After conservative surgery it is feasible that irradiation can be delivered alone to the neighboring region of the tumor bed. Partial breast radiotherapy can substitute for whole breast radiotherapy.

  8. Prognostic Impact of Time to Ipsilateral Breast Tumor Recurrence after Breast Conserving Surgery

    Science.gov (United States)

    Gosset, Marie; Hamy, Anne-Sophie; Mallon, Peter; Delomenie, Myriam; Mouttet, Delphine; Pierga, Jean-Yves; Lae, Marick; Fourquet, Alain; Rouzier, Roman; Reyal, Fabien; Feron, Jean-Guillaume

    2016-01-01

    Background The poor prognosis of patients who experience ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) is established. A short time between primary cancer and IBTR is a prognostic factor but no clinically relevant threshold was determined. Classification of IBTR may help tailor treatment strategies. Purpose We determined a specific time frame, which differentiates IBTR into early and late recurrence, and identified prognostic factors for patients with IBTR at time of the recurrence. Methods We analyzed 2209 patients with IBTR after BCS. We applied the optimal cut-points method for survival data to determine the cut-off times to IBTR. A subgroup analysis was performed by hormone receptor (HR) status. Survival analyses were performed using a Cox proportional hazard model to determine clinical features associated with distant-disease-free survival (DDFS) after IBTR. We therefor built decision trees. Results On the 828 metastatic events observed, the majority occurred within the first 3 months after IBTR: 157 in the HR positive group, 98 in the HR negative group. We found different prognostic times to IBTR: 49 months in the HR positive group, 33 in the HR negative group. After multivariate analysis, time to IBTR was the first discriminant prognostic factor in both groups (HR 0.65 CI95% [0.54–0.79] and 0.42 [0.30–0.57] respectively). The other following variables were significantly correlated with the DDFS: the initial number of positive lymph nodes for both groups, the initial tumor size and grade for HR positive tumors. Conclusion A short interval time to IBTR is the strongest factor of poor prognosis and reflects occult distant disease. It would appear that prognosis after IBTR depends more on clinical and histological parameters than on surgical treatment. A prospective trial in a low-risk group of patients to validate the safety of salvage BCS instead of mastectomy in IBTR is needed. PMID:27494111

  9. Combining supine MRI and 3D optical scanning for improved surgical planning of breast conserving surgeries

    Science.gov (United States)

    Pallone, Matthew J.; Poplack, Steven P.; Barth, Richard J., Jr.; Paulsen, Keith D.

    2012-02-01

    Image-guided wire localization is the current standard of care for the excision of non-palpable carcinomas during breast conserving surgeries (BCS). The efficacy of this technique depends upon the accuracy of wire placement, maintenance of the fixed wire position (despite patient movement), and the surgeon's understanding of the spatial relationship between the wire and tumor. Notably, breast shape can vary significantly between the imaging and surgical positions. Despite this method of localization, re-excision is needed in approximately 30% of patients due to the proximity of cancer to the specimen margins. These limitations make wire localization an inefficient and imprecise procedure. Alternatively, we investigate a method of image registration and finite element (FE) deformation which correlates preoperative supine MRIs with 3D optical scans of the breast surface. MRI of the breast can accurately define the extents of very small cancers. Furthermore, supine breast MR reduces the amount of tissue deformation between the imaging and surgical positions. At the time of surgery, the surface contour of the breast may be imaged using a handheld 3D laser scanner. With the MR images segmented by tissue type, the two scans are approximately registered using fiducial markers present in both acquisitions. The segmented MRI breast volume is then deformed to match the optical surface using a FE mechanical model of breast tissue. The resulting images provide the surgeon with 3D views and measurements of the tumor shape, volume, and position within the breast as it appears during surgery which may improve surgical guidance and obviate the need for wire localization.

  10. Presence of extensive intraductal component in patients undergoing breast conservative surgery predicts presence of residual disease in subsequent completion mastectomy

    Institute of Scientific and Technical Information of China (English)

    Christopher C. P. Yiu; Wings T. Y. Loo; C. K. Lam; Louis W. C. Chow

    2009-01-01

    Background Local recurrence remains a serious problem among patients undergoing breast conservative surgery. This study aimed at identifying risk factors for residual disease after breast conservative surgery.Methods This retrospective study was based on patients with invasive breast cancer who have received breast conservative surgery and subsequent completion mastectomy. All patients had a clear resection margin in the initial operation. We analyzed the association between the presence of residual disease during completion mastectomy and the following risk factors: T staging, young age, and presence of extensive intraductal component (EIC), a close margin, lymphovascular permeation (LVP), positivity of estrogen receptor, progesterone receptor, and c-erbB-2.Results Residual disease was encountered in 21 (45.7%) of 46 patients; EIC was present in 28 patients (60.9%), of whom 17 had residual disease. Presence of EIC during breast conservation surgery was associated with a higher risk of residual disease during completion mastectomy (P=0.011). Other variables were not statistically significant risk factors for presence of residual disease. No local recurrence was recorded in our cohort, and the disease-free survival and overall survival after completion mastectomy were similar for patients who had residual disease and those who had not.Conclusions The presence of EIC is a significant risk factor for residual disease in patients after breast conservative surgery. Our findings may suggest the indicated value of completion mastectomy in patients with EIC during initial breast conservative surgery to decrease the risk of subsequent local failure.

  11. Histopathological Features of Invasion of Breast Invasive Ductal Carcinoma and Safety of Breast-conserving Surgery

    Institute of Scientific and Technical Information of China (English)

    Chunping LIU; Huaxiong PAN; Zhi LI; Lan SHI; Tao HUANG

    2009-01-01

    In order to investigate the relationship between the extent of tumor invasion and the tu-mor size,axillary lymph nodes metastasis,Her-2 gene overexpression,and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery,the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed.The correlation analysis on invasive extent,which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre,and the tumor size,axillary lymph nodes metastasis,Her-2 gene overexpression,and his-tologic grading was processed.There was a significant correlation between invasive extent and tumor size (r=0.766,P0.05),and histologic grading (r=0.228,P>0.05).The 100% negative rate of infiltration in patients without nipple discharge with tumor size 3 cm was obtained at 1.5,2.0 and 2.5 cm away from the tumor respectively.It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

  12. Re-resection rates and risk characteristics following breast conserving surgery for breast cancer and carcinoma in situ

    DEFF Research Database (Denmark)

    Kryh, C G; Pietersen, C A; Rahr, Hans;

    2014-01-01

    OBJECTIVES: To examine the frequency of re-resections and describe risk characteristics: invasive carcinoma or carcinoma in situ (CIS), palpability of the lesion, and neoadjuvant chemotherapy. RESULTS: 1703 breast conserving surgeries were performed: 1575 primary breast conserving surgeries (BCS......), and 128 diagnostic excisions (DE). 176 BCS (11.2% [9.6; 12.7]) and 100 DE had inadequate margins indicating re-resection. The overall re-resection rate was 16.2% [14.5; 18.0]. 10.3% of invasive carcinoma BCS patients, and 28.6% CIS patients underwent re-resection (relative risk (RR) 2.8 [1.9; 4.......3%). Ilc had an RR of re-resection of 2.5 compared to idc. Palpability and neoadjuvant chemotherapy did not significantly influence the risk of re-resection....

  13. Conservative Surgery and Primary Radiotherapy for Early Breast Cancer; Yonsei Cancer Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Chang Ok; Lee, Hy De; Lee, Kyung Sik; Jung, Woo Hee; Oh, Ki Keun; Kim, Gwi Eon [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1994-10-15

    Breast conserving surgery and irradiation is now accepted as preferable treatment method for the patients with stage I and II breast cancer. Our institution activated team approach for breast conservation 1991 and treated on hundred and forty patients during the next three years. Purpose: To present our early experience with eligibility criteria, treatment techniques, and the morbidities of primary radiotherapy. Materials and Methods: Sixty four patients with early stage breast cancer who received breast conserving treatment between January 1991 and December 1992 were evaluated. All patients received partial mastectomy(wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Total dose of 4500-5040 cGy in 5-5 1/2 weeks was given to entire involved breast and boost dose of 1000-2000 cGy in 1-2 weeks was given to the primary tumor site. Linac 4 MV X-ray was used for breast irradiation and electron beam was used for boost. Thirty five patients received chemotherapy before or after radiotherapy. Patients characteristics, treatment techniques, and treatment related morbidities were analyzed. Results: Age distribution was ranged from 23 to 59 year old with median age of 40. Twenty-seven patients had T1 lesions and 34 patients had T2 lesions. In three patients, pathologic diagnosis was ductal carcinoma in situ. Thirty-seven patients were N0 and 27 patients were N1. There were three recurrences, one in the breast and two distant metastases during follow-up period(6-30 months, median 14 months). Only one breast recurrence occurred at undetected separate lesion with microcalcifications on initial mammogram. There was no serious side reaction which interrupted treatment courses or severe late complication. Only one symptomatic radiation pneumonitis and one asymptomatic radiation peumonitis were noted. Conclusions: Conservative surgery and primary radiotherapy for early breast cancer in proven to be safe and comfortable treatment method without

  14. Conservative Surgery and Primary Radiotherapy for Early Breast Cancer; Yonsei Cancer Center Experience

    International Nuclear Information System (INIS)

    Breast conserving surgery and irradiation is now accepted as preferable treatment method for the patients with stage I and II breast cancer. Our institution activated team approach for breast conservation 1991 and treated on hundred and forty patients during the next three years. Purpose: To present our early experience with eligibility criteria, treatment techniques, and the morbidities of primary radiotherapy. Materials and Methods: Sixty four patients with early stage breast cancer who received breast conserving treatment between January 1991 and December 1992 were evaluated. All patients received partial mastectomy(wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Total dose of 4500-5040 cGy in 5-5 1/2 weeks was given to entire involved breast and boost dose of 1000-2000 cGy in 1-2 weeks was given to the primary tumor site. Linac 4 MV X-ray was used for breast irradiation and electron beam was used for boost. Thirty five patients received chemotherapy before or after radiotherapy. Patients characteristics, treatment techniques, and treatment related morbidities were analyzed. Results: Age distribution was ranged from 23 to 59 year old with median age of 40. Twenty-seven patients had T1 lesions and 34 patients had T2 lesions. In three patients, pathologic diagnosis was ductal carcinoma in situ. Thirty-seven patients were N0 and 27 patients were N1. There were three recurrences, one in the breast and two distant metastases during follow-up period(6-30 months, median 14 months). Only one breast recurrence occurred at undetected separate lesion with microcalcifications on initial mammogram. There was no serious side reaction which interrupted treatment courses or severe late complication. Only one symptomatic radiation pneumonitis and one asymptomatic radiation peumonitis were noted. Conclusions: Conservative surgery and primary radiotherapy for early breast cancer in proven to be safe and comfortable treatment method without

  15. The use of breast conserving surgery: linking insurance claims with tumor registry data

    International Nuclear Information System (INIS)

    The purpose of this study was to use insurance claims and tumor registry data to examine determinants of breast conserving surgery (BCS) in women with early stage breast cancer. Breast cancer cases registered in the Hawaii Tumor Registry (HTR) from 1995 to 1998 were linked with insurance claims from a local health plan. We identified 722 breast cancer cases with stage I and II disease. Surgical treatment patterns and comorbidities were identified using diagnostic and procedural codes in the claims data. The HTR database provided information on demographics and disease characteristics. We used logistic regression to assess determinants of BCS vs. mastectomy. The linked data set represented 32.8% of all early stage breast cancer cases recorded in the HTR during the study period. Due to the nature of the health plan, 79% of the cases were younger than 65 years. Women with early stage breast cancer living on Oahu were 70% more likely to receive BCS than women living on the outer islands. In the univariate analysis, older age at diagnosis, lower tumor stage, smaller tumor size, and well-differentiated tumor grade were related to receiving BCS. Ethnicity, comorbidity count, menopausal and marital status were not associated with treatment type. In addition to developing solutions that facilitate access to radiation facilities for breast cancer patients residing in remote locations, future qualitative research may help to elucidate how women and oncologists choose between BCS and mastectomy

  16. Oncoplastic breast surgery in Denmark

    DEFF Research Database (Denmark)

    Klit, Anders; Henriksen, Trine Foged; Siersen, Hans Erik;

    2014-01-01

    With improved survival rates after breast cancer treatment, more attention is drawn to improve the cosmetic outcome after surgical treatment of breast cancer. In this process the oncoplastic breast surgery was conceived. It supplements the traditional surgical treatments (mastectomy and breast...... conserving surgery) with increased focus on individualized therapy. The ambition is to obtain the best possible cosmetic outcome without compromising recurrence rates and survival. This article provides an overview of the current oncoplastic breast surgery treatment offered in Denmark....

  17. Radiation therapy and chemotherapy after breast conserving surgery for invasive breast cancer: an intermediate result

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seok Ho; Lee, Kyu Chan; Choi, Jin Ho; Lee, Young Don; Park, Heoung Kyu; Kim, Hyun Young; Park, Se Hoon [Gachon Medical School, Incheon (Korea, Republic of)

    2007-03-15

    Breast conserving surgery (BCS) followed by chemotherapy (CT{sub x}.) and radiation therapy (RT) is widely performed for the treatment of early breast cancer. This retrospective study was undertaken to evaluate our interim results in terms of failure patterns, survival and relative risk factors. From January 1999 through December 2003, 129 patients diagnosed with invasive breast cancer and treated with BCS followed by RT were subject to retrospective review. The median age of the patients was 45 years (age distribution, 27 {approx} 76 years). The proportions of patients according to their tumor, nodes, and metastases (TNM) stage were 65 (50.4%) in stage I, 41 (31.7%) in stage IIa, 13 (10.1%) in stage IIb, 9 (7.0%) in stage III, and 1 patient (0.8%) in stage IIIc. For 32 patients (24.8%), axillary node metastasis was found after dissection, BCS consisted of quadrantectomy in 115 patients (89.1%) and lumpectomy in 14 patients (10.6%). Axillary node dissection at axillary level I and II was performed for 120 patients (93%). For 7 patients (5.4%), only sentinel node dissection was performed with BCS. For 2 patients (1.6%) axillary dissection of any type was not performed. Postoperative RT was given with 6 MV X-rays. A tumor dose of 50.4 Gy was delivered to the entire breast area using a tangential field with a wedge compensator. An additional dose of 9 {approx} 16 Gy was given to the primary tumor bed areas with electron beams. In 30 patients (23.3%), RT was delivered to the supraclavicular node. Most patients had adjuvant CT{sub x}. with 4 {approx} 6 cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens. The median follow-up period was 50 months (range: 17 {approx} 93 months). The actuarial 5 year survival rate (5Y-OSR) was 96.9%, and the 5 year disease free survival rate (5Y-DFSR) was 93.7%. Local recurrences were noted in 2 patients (true: 2, regional node: 1) as the first sign of recurrence at a mean time of 29.3 months after surgery. Five

  18. Positive margins prediction in breast cancer conservative surgery: Assessment of a preoperative web-based nomogram.

    Science.gov (United States)

    Alves-Ribeiro, Lídia; Osório, Fernando; Amendoeira, Isabel; Fougo, José Luís

    2016-08-01

    Margin status of the surgical specimen has been shown to be a prognostic and risk factor for local recurrence in breast cancer surgery. It has been studied as a topic of intervention to diminish reoperation rates and reduce the probability of local recurrence in breast conservative surgery (BCS). This study aims to validate the Dutch BreastConservation! nomogram, created by Pleijhus et al., which predicts preoperative probability of positive margins in BCS. Patients with diagnosis of breast cancer stages cT1-2, who underwent BCS at the Breast Center of São João University Hospital (BC-CHSJ) in 2013-2014, were included. Association and correlation were evaluated for clinical, radiological, pathological and surgical variables. Multivariable logistic regression and ROC curves were used to assess nomogram parameters and discrimination. In our series of 253 patients, no associations were found between margin status and other studied variables (such as age or family history of breast cancer), except for weight (p-value = 0.045) and volume (p-value = 0.012) of the surgical specimen. Regarding the nomogram, a statistically significant association was shown between cN1 status and positive margins (p-value = 0.014). No differences were registered between the scores of patients with positive versus negative margins. Discrimination analysis showed an AUC of 0.474 for the basic and 0.508 for the expanded models. We cannot assume its external validation or its applicability to our cohort. Further studies are needed to determine the validity of this nomogram and achieve a broader view of currently available tools. PMID:27326978

  19. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer

    NARCIS (Netherlands)

    A.C. Voogd (Adri); F.J. van Oost (F.); E.J. Rutgers; S. Elkhuizen (Sylvia); A.N. van Geel (Albert); L.J.E.E. Scheijmans (L. J E E); M.J.C. van der Sangen (Maurice); G. Botke (G.); C.J.M. Hoekstra (C. J M); J.J. Jobsen (Jan); C.J.H. van de Velde (Cornelis); M.F. von Meyenfeldt (Maarten); J.M. Tabak (J.); J.L. Peterse (J.); M.J. Vijver (Marc ); J.W.W. Coebergh (Jan Willem); G. van Tienhoven (Geertjan)

    2005-01-01

    textabstractWe have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years. At

  20. Recurrent and second breast cancer detected on follow-up mammography and breast ultrasound after breast-conserving surgery: Findings and clinicopathologic factors

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Ga Young; Cha, Joo Hee; Kim, Hak Hee; Shin, Hee Jung; Chae, Eun Young; Choi, Woo Jung [Dept. of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul (Korea, Republic of)

    2016-01-15

    To assess the imaging and clinicopathologic outcomes of recurrent and second breast cancer after breast-conserving surgery for invasive ductal carcinomas detected on follow-up mammography and breast ultrasound (US). Seventy-six women with an ipsilateral breast tumor recurrence (IBTR) or regional lymph node recurrence and/or contralateral breast cancer (RLNR and CBC) after breast-conserving surgery were included in this study. The mammography and US images were analyzed and the clinicopathologic parameters were compared between the groups. Thirty had an IBTR, and 46 had a RLNR and CBC. The IBTR group's mammography and US images frequently revealed calcification and masses on the breast, respectively. The most frequent site of RLNR detected during follow-up mammography and breast US was the axilla. In univariate analysis, the tumors in the IBTR group were predominantly estrogen receptor (ER)-negative, HER-2 overexpression, and p53-positive. ER and HER-2 were shown by the multivariate analysis to be independent parameters associated for both types of recurrences. A mass or calcification is frequently present in IBTR and the axillary lymph node is the most frequent site of RLNR. ER and HER-2 status are major independent factors associated with recurrent and second breast cancer.

  1. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang1

    2012-09-01

    Full Text Available Background In Korean women, many of whom have small to moderate-sized breasts, it isdifficult to cover a partial breast defect using oncoplastic volume displacement techniquesafter removal of an adequate volume of tissue during oncologic surgery. In such cases,oncoplastic volume replacement techniques are more useful.Methods From January 2007 to December 2011, 104 women underwent a total of 107 breastconservingsurgeries with various kinds of oncoplastic volume replacement techniques. Weused latissimus dorsi (LD myocutaneous flap for cases in which the resection mass was greaterthan 150 g. In case with a resection mass less than 150 g, we used regional flaps such as alateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostalartery perforator (ICAP flap or a thoracodorsal artery perforator (TDAP flap.Results The mean age was 46.1 years, and the average follow-up interval was 10.3 months. Thepatients underwent oncoplastic volume replacement techniques with a lateral thoracodorsalflap (n=9, thoracoepigastric flap (n=7, ICAP flap (n=25, TDAP flap (n=12, and LD flap(n=54. There was one case of congestion in an LD flap, and two cases of fat necrosis in anICAP flap. Most of the patients were satisfied with the cosmetic results.Conclusions Oncoplastic volume replacement techniques can be reliable and useful for thecorrection of breast deformity after breast-conserving surgery, especially in patients withsmall to moderate-sized breasts.

  2. Correlation of breast recurrence (inflammatory type or not) after breast conserving surgery with radiation therapy and clinicopathological factors in breast cancer

    International Nuclear Information System (INIS)

    To clarify risk factors for breast recurrence of inflammatory type after breast conserving therapy, we examined clinicopathological findings and therapies given after initial surgery. Nine cases of inflammatory breast recurrence out of 133 recurrent cases collected from a collaborative group supported by a grant-in-aid for Cancer Research by Japanese Ministry of Health and Welfare (7-24, Chairman: H. Koyama) were analyzed by a case control study. And forty-three recurrent cases in Kumamoto City Hospital were also analyzed similarly. Inflammatory breast recurrence after breast conserving surgery is characterized as follows: Most cases have negative surgical margin and may be unresponsive to radiation therapy, unlike non-inflammatory breast recurrence. Lymph node metastasis is involved in recurrence, but the difference in patients with only distant metastasis was positive lymphatic invasion. Distant metastasis coexisted at the time of recurrence, and secondary surgery was impossible in most cases. The prognosis after recurrence was unfavorable. These findings suggest that inflammatory recurrence is manifestation of so-called ''occult'' inflammatory breast cancer. (author)

  3. Clinical outcome of three dimensional conformal radiation therapy for early breast cancer after conservative surgery

    International Nuclear Information System (INIS)

    Objective: To compare the efficacy, complications, cosmetic results between conventional radiotherapy (CR) and three dimensional conformal radiation therapy (3DCRT) after conservative surgery for early breast cancer. Methods: Totally 106 patients underwent postoperative radiotherapy after breast-conserving surgery, including 62 patients who received CR and 46 received 3DCRT. The radiation dose was determined by the tumor size, tumor location and axillary node involvement. Tangential fields were used to deliver 6 MV X-ray beams to a total dose of 50 Gy in 5 weeks. An additional 10-15 Gy was given to the tumor bed with 6-9 MeV electron beams in 1.0-1.5 weeks. The median follow-up time was 32 months. Results: The local recurrence, metastasis or death were observed in 3, 5 and 2 patients in the CR group, while 1, 4 and 2 in the 3DCRT group. No statistical significant difference was found between these two groups (P>0.05). Radiation induced pneumonia was observed in 11 patients in CR group versus none in the 3DCRT group. Six months and one year after radiotherapy, 90% and 93% of these patients were assessed as excellent or in fine cosmetic state in the CR group, versus 91.5% and 93.8% in the 3DCRT group. There was no significant difference in the cosmetic results between these two groups (P > 0.05). Conclusions: Three dimensional conformal radiation therapy possesses similar treatment and cosmetic results to conventional radiotherapy after conservative surgery for early breast cancer. But the former, one can markedly reduce the likely hood of radiation complications. (authors)

  4. Analysis of dosimetry and clinical outcome using intensity modulated radiation therapy for early breast cancer patients after breast conservative surgery

    International Nuclear Information System (INIS)

    Objective: To analyze the dosimetric benefits, clinical effect and side-respond of whole breast using intensity modulated radiotherapy for early breast cancer after conservative surgery. Methods: From Oct. 2004 to Aug. 2005, 103 patients received the whole breast intensity modulated radiation therapy (IMRT). A dosimetric comparison of IMRT with conventional radiotherapy (CR) was performed on each patient. The cosmetic results, clinical effect and side-respond were observed. Results: The average volume proportion of 95% and 107% prescribed dose was 95.8% ± 4.90% and 84.0% ± 20.7% (t=9.60, P20 (lung volume of accepted > 20 Gy/all lung volume x 100%) of the ipsilateral lung were 15.70% ± 4.64% and 23.11% ± 7.88% (t=-13.3, P30 of the heart were 4.44% ± 3.93% and 15.55% ± 10.89% (t=-11.3, P<0.01) with IMRT and CR respectively for sixty-three left side breast cancer patients. The 1- and 2-year excellent rate of good cosmetic outcome was both 100%. The 1-, 2- and 3-year local control rate was 99%, 99% and 98 %, respectively. The 1-, 2- and 3-year disease-free survival rate was 99%, 99% and 96%, respectively. The Grade 1 and 2 acute radiation skin reaction rate was 95.1% and 4.9%, respectively. Conclusion: Compared with conventional radiotherapy, IMRT improves dose distribution of CTV and reduce the dose of normal tissue around CTV; but with better clinical effects and lower side-respond for early breast cancer patients after' breast conservative surgery. (authors)

  5. Does ultrasound provide any added value in breast contouring for radiotherapy after conserving surgery for cancer?

    International Nuclear Information System (INIS)

    Whole breast irradiation after conserving surgery for breast cancer requires precise definition of the target volume. The standard approach uses computed tomography (CT) images. However, since fatty breast and non-breast tissues have similar electronic densities, difficulties in differentiating between them hamper breast volume delineation. To overcome this limitation the breast contour is defined by palpation and then radio-opaque wire is put around it before the CT scan. To optimize assessment of breast margins in the cranial, caudal, medial, lateral and posterior directions, the present study evaluated palpation and CT and determined whether ultrasound (US) provided any added value. Twenty consecutive patients were enrolled after they had provided informed consent to participating in this prospective study which was approved by the Regional Public Health Ethics Committee. Palpation and US defined breast margins and each contour was marked and outlined with a fine plastic wire. Breasts were then contoured on axial CT images using the breast window width (WW) and window level (WL) (401 and 750 Hounsfield Units –HU- respectively), at which setting the plastic wires were invisible. Then, the lung window function (WW 1601 HU; WL −300 HU) was inserted to visualize the plastic wires which were used as guidelines to contour the palpable and US breast volumes. As each wire had a different diameter, both volumes were easily defined on CT slices. Results were analyzed using descriptive statistics, percentage overlap and reproducibility measures (agreement and reliability). Volumes: US gave the largest and palpation the smallest. Agreement was best between palpation and CT. Reliability was almost perfect in all correlations. Extensions: Cranial and posterior were highest with US and smallest with palpation. Agreement was best between palpation and CT in all extensions except the cranial. Since strong to almost perfect agreement emerged for all comparisons, reliability

  6. Dosimetric Evaluation of Different Intensity-Modulated Radiotherapy Techniques for Breast Cancer After Conservative Surgery.

    Science.gov (United States)

    Zhang, Fuli; Wang, Yadi; Xu, Weidong; Jiang, Huayong; Liu, Qingzhi; Gao, Junmao; Yao, Bo; Hou, Jun; He, Heliang

    2015-10-01

    Intensity-modulated radiotherapy (IMRT) potentially leads to a more favorite dose distribution compared to 3-dimensional or conventional tangential radiotherapy (RT) for breast cancer after conservative surgery or mastectomy. The aim of this study was to compare dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) among helical tomotherapy (HT), inverse-planned IMRT (IP-IMRT), and forward-planned field in field (FP-FIF) IMRT techniques after breast-conserving surgery. Computed tomography scans from 20 patients (12 left sided and 8 right sided) previously treated with T1N0 carcinoma were selected for this dosimetric planning study. We designed HT, IP-IMRT, and FP-FIF plans for each patient. Plans were compared according to dose-volume histogram analysis in terms of PTV homogeneity and conformity indices (HI and CI) as well as OARs dose and volume parameters. Both HI and CI of the PTV showed statistically significant difference among IP-IMRT, FP-FIF, and HT with those of HT were best (P IMRT showed smaller exposed volumes of ipsilateral lung, heart, contralateral lung, and breast, while HT indicated smaller exposed volumes of ipsilateral lung but larger exposed volumes of contralateral lung and breast as well as heart. In addition, HT demonstrated an increase in exposed volume of ipsilateral lung (except for fraction of lung volume receiving >30 Gy and 20 Gy), heart, contralateral lung, and breast compared with IP-IMRT. For breast cancer radiotherapy (RT) after conservative surgery, HT provides better dose homogeneity and conformity of PTV compared to IP-IMRT and FP-FIF techniques, especially for patients with supraclavicular lymph nodes involved. Meanwhile, HT decreases the OAR volumes receiving higher doses with an increase in the volumes receiving low doses, which is known to lead to an increased rate of radiation-induced secondary malignancies. Hence, composite factors including dosimetric advantage, clinical effect, and economic

  7. Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema. The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation. Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema. Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings

  8. Subareolar breast cancer: long-term results with conservative surgery and radiation therapy

    International Nuclear Information System (INIS)

    Purpose: It has been suggested that patients presenting with breast cancers within 2 cm of the nipple areolar complex represent a relative contraindication to conservative management due to either a compromised cosmetic result associated with sacrifice of the nipple areolar complex, reluctance to include the entire nipple areolar complex in the conedown field, or increased risk of multicentricity. We have reviewed our experience of conservatively treated patients with specific reference to the subset of patients presenting with tumors within 2 cm of the nipple areolar complex. Methods and Materials: Between January 1970 and December 1989, 1014 patients with early stage breast cancer were treated at Yale-New Haven Hospital by excisional biopsy with or without axillary lymph node dissection. Of the 1014 charts reviewed, a total of 98 patients fulfilled the criteria of having a central/subareolar breast cancer. Reexcision was performed on only 16 patients. Following conservative surgery, patients were treated with radiation therapy to the intact breast to a total median dose of 48 Gy with conedown to a total of 64 Gy. Adjuvant systemic therapy and regional nodal irradiation were administered as clinically indicated. Results: As of December 1993, the median follow-up for the 98 patients in this study was 9.03 years. The majority of patients had presented with either a palpable mass or a mammographically detected lesion. Three patients presented with Paget's disease, five with nipple discharge, and seven with nipple inversion. Ten of the 98 patients had the nipple areolar complex sacrificed at the time of surgery, while the remaining 88 patients had the entire nipple areolar complex included in the conedown field. Four of these 88 patients had the nipple partially blocked during the electron conedown. There were no significant complications associated with including the entire nipple areolar complex within the conedown field to a median dose of 64 Gy. Six of the 98

  9. Oncoplastic breast surgery: current strategies

    OpenAIRE

    Piper, Merisa; Peled, Anne Warren; Sbitany, Hani

    2015-01-01

    The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction an...

  10. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

    International Nuclear Information System (INIS)

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  11. Clinical outcome and cosmetics in breast cancer patients treated with conservative surgery and radiotherapy

    International Nuclear Information System (INIS)

    Objective: To evaluate the effectiveness and the cosmetics result of radiotherapy after conservative surgery for early breast cancer. Methods: Altogether 109 patients were treated by post-operative whole-breast irradiation and a tumor bed boost from May, 1995 to December, 2002. Among them 79 cases received a brachytherapy boost (192Ir HDR implant Nucletron ) of 10-12 Gy(DB) by single plan of implantation with 1.5 cm between the needles for T1 and double plan for T2-4 tumors, and 30 cases received an electron beam boost with 15 Gy. External beam irradiation was applied to the whole breast with 45-52 Gy(mean 48.6 Gy) in 25 fractions over 5 weeks followed or concurrently with chemotherapy (CMF or CEF) and hormonotherapy. The cosmetic result was scored by a doctor and patients via questionnaire. Results: The median follow-up time was 52 months. The actuarial 5-year overall survival rate was 93.8% using Kaplan-Meier method and the within breast recurrence rate was 6.5%. No radiation- induced ulcer in the breast occurred except acute inflammation of skin around the pinholes in 5 patients. Cosmetic results were scored to be good by patients and the doctor (81% and 87%, respectively) for 75 followed-up cases, and good cosmetic rate was reported by the doctor for 82% (39/48) of the cases treated with brachytherapy boost and 85.2%(23/27) for those treated with external beam boost. There was no difference in cosmetic results between these two groups(P>0.05). Conclusion: In patients at high risk for local recurrence, tumor-bed boost with brachytherapy or electron beam carried out after limited surgery and external radiotherapy can provide satisfactory local control without morbidity. Cosmetic result may not be influenced by the boost technique. (authors)

  12. A case of organizing pneumonia which recurred 51 months after radiotherapy following breast-conserving surgery

    International Nuclear Information System (INIS)

    A 54-year-old woman who had undergone breast-conserving surgery followed by irradiation presented to a local physician after developing a cough and low-grade fever 9 months after radiation therapy. She was given a diagnosis of pneumonia and antibiotics were administered, but since she did not improve, she was transferred to our hospital. We performed lung biopsy via thoracoscopy and diagnosed organizing pneumonia based on pathological findings. Steroid administration based on her chest X-ray findings, improved her condition. After discharge, her steroid dose was tapered on an outpatient basis, but she suffered relapse of her organizing pneumonia three times. The prednisolone dose at relapse was 10 mg/day at 20 months, 7.5 mg/day at 36 months, and 7 mg/day at 51 months after radiation therapy, respectively. Organizing pneumonia that develops after irradiation following breast-conserving surgery has been known to occasionally relapse, and to the best of our knowledge the final relapse reported here, 51 months after radiation therapy is the longest relapse reported. (author)

  13. Sequence of Radiotherapy and Chemotherapy in Breast Cancer After Breast-Conserving Surgery

    International Nuclear Information System (INIS)

    Purpose: The optimal sequence of radiotherapy and chemotherapy in breast-conserving therapy is unknown. Methods and Materials: From 1983 through 2007, a total of 641 patients with 653 instances of breast-conserving therapy (BCT), received both chemotherapy and radiotherapy and are the basis of this analysis. Patients were divided into three groups. Groups A and B comprised patients treated before 2005, Group A radiotherapy first and Group B chemotherapy first. Group C consisted of patients treated from 2005 onward, when we had a fixed sequence of radiotherapy first, followed by chemotherapy. Results: Local control did not show any differences among the three groups. For distant metastasis, no difference was shown between Groups A and B. Group C, when compared with Group A, showed, on univariate and multivariate analyses, a significantly better distant metastasis–free survival. The same was noted for disease-free survival. With respect to disease-specific survival, no differences were shown on multivariate analysis among the three groups. Conclusion: Radiotherapy, as an integral part of the primary treatment of BCT, should be administered first, followed by adjuvant chemotherapy.

  14. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Senthi, Sashendra, E-mail: sashasenthi@msn.com [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne (Australia); Link, Emma [Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne (Australia); Chua, Boon H. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne (Australia); University of Melbourne, Melbourne (Australia)

    2012-10-01

    Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

  15. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To evaluate cosmetic outcome and its association with breast wound seroma after breast-conserving surgery (BCS) with targeted intraoperative radiation therapy (tIORT) boost for early breast cancer. Methods and Materials: An analysis of a single-arm prospective study of 55 patients with early breast cancer treated with BCS and tIORT boost followed by conventional whole breast radiation therapy (WBRT) between August 2003 and January 2006 was performed. A seroma was defined as a fluid collection at the primary tumor resection site identified clinically or radiologically. Cosmetic assessments using the European Organization for Research and Treatment of Cancer rating system were performed at baseline before BCS and 30 months after WBRT was completed. Results: Twenty-eight patients (51%) developed a seroma, with 18 patients (33%) requiring at least 1 aspiration. Tumor location was significantly associated with seroma formation (P=.001). Ten of 11 patients with an upper inner quadrant tumor developed a seroma. Excellent or good overall cosmetic outcome at 30 months was observed in 34 patients (62%, 95% confidence interval 53%-80%). Seroma formation was not associated with the overall cosmetic result (P=.54). Conclusion: BCS with tIORT boost followed by WBRT was associated with an acceptable cosmetic outcome. Seroma formation was not significantly associated with an adverse cosmetic outcome.

  16. Dosimetric impact of post-operative seroma reduction during radiotherapy after breast-conserving surgery

    International Nuclear Information System (INIS)

    Purpose: Three boost radiotherapy (RT) techniques were compared to evaluate the dosimetric effect of seroma reduction during RT after breast-conserving surgery (BCS). Materials and methods: Twenty-one patients who developed seroma after BCS were included. Each patient underwent three CT scans: one week before RT (CT-1), in the third (CT3) and fifth (CT5) week of RT. For each patient, three plans were generated. (1) SEQ: whole breast irradiation planned on CT-1, sequential boost planned on CT5, (2) SIB: simultaneous integrated boost planned on CT-1, (3) SIB adaptive radiation therapy (SIB-ART): planned on CT-1 and re-planned on CT3. Irradiated volumes, mean lung (MLD) and maximum heart dose (HDmax) were projected and compared on CT5. Results: On average 62% seroma reduction during RT was observed. Volumes receiving ≥107% of prescribed whole breast dose were significantly smaller with SIB-ART compared to SEQ and SIB. The undesired volume receiving ≥95% of prescribed total dose was also significantly smaller with SIB-ART. For SEQ, SIB-ART and SIB, respectively, small but significant differences were found in MLD (4.2 vs. 4.6 vs. 4.7 Gy) and in HDmax for patients with left-sided breast cancer (39.9 vs. 35.8 vs. 36.9 Gy). Conclusions: This study demonstrates a dosimetric advantage for patients with seroma when simultaneous integrated boost is used with re-planning halfway through treatment.

  17. Patients with Invasive Lobular Breast Cancer Are Less Likely to Undergo Breast-Conserving Surgery: A Population Based Study in The Netherlands

    NARCIS (Netherlands)

    Truin, W.; Roumen, R.M.; Siesling, S.; Heiden-van der Loo, van der M.; Duijm, E.M.; Tjan-Heijnen, V.C.G.; Voogd, A.C.

    2015-01-01

    Purpose The aim of this study was to compare the frequency of breast-conserving surgery (BCS) between early-stage invasive ductal (IDC) and invasive lobular breast cancer (ILC). Methods Women with primary non-metastatic pT1 and pT2 IDC or ILC diagnosed between 1990 and 2010 were selected from th

  18. Survival and breast relapse in 3834 patients with T1-T2 breast cancer after conserving surgery and adjuvant treatment

    International Nuclear Information System (INIS)

    Purpose: The aim of the present analysis is to determine the long-term results in terms of breast relapse and specific survival in patients treated with conserving surgery and adjuvant treatment for early breast cancer. Methods: From January 1980 to December 2001, 3834 patients with pT1-T2 breast cancer were treated consecutively at the University of Florence. The median age of the patient population was 55 years (range 30-80). All patients were followed for a median of 7.4 years (range 0.6 year to 22.5 years). The crude probability of survival (or local recurrence) was estimated by using Kaplan-Meier method, and survival (or local recurrence) comparisons were carried out using Cox proportional hazard regression models. Results: The Cox regression model by stepwise selection showed some parameters, such as chemotherapy (HR 1.53; CI 1.19-1.95), pT status (HR 1.62, CI 1.31-2.01), positive axillary lymph nodes (HR 1.92, CI 1.66-2.22), and local recurrence (HR 4.58; CI 3.66-5.73), as independent prognostic factors for breast cancer death. Moreover, we found lower rate survival among patients treated before 1991 in comparison to women treated after 1991 (p = 0.0001) probably due to inadequate treatment. For local disease free survival, age at presentation (HR 0.47; CI 0.35-0.63), use of tamoxifen (HR 0.42; CI 0.25-0.71), surgical margins (HR 2.00; CI 1.21-3.30), and chemotherapy (HR 0.53; CI 0.31-0.91) emerged by multivariate analyses as significant breast relapse predictors. Conclusion: In our experience breast conserving surgery followed by adjuvant radiotherapy treatment gives high rates of local control in women with early breast cancer. The use of routinely adjuvant chemotherapy and hormone therapy lowered the local recurrence and probably the modification of therapeutic approach in the last decades also improved the specific survival

  19. Feasibility, efficacy and cosmetic effect of three-dimensional conformal external bean partial breast irradiation for the selected early stage breast cancer patients after breast-conserving surgery

    International Nuclear Information System (INIS)

    Objective: To explore the feasibility, efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients. Methods: From June 2003 to December 2010, Forty-four early stage breast cancer patients underwent underwent EB-PBI after breast-conserving surgery. Twenty patients had CT simulation scan in moderate deep inspiration breathing hold, and twenty-four patients in free breathing. EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT) with four non-coplanar beams. The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients, twice per day at an interval of at least six hours, in five consecutive days. Results: The number of patients with follow up time of 2, 3 and 5 years were 39, 31 and 16, Grade 1 acute radiation-induced dermatitis was observed in 17 patients (39%) at three months. Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95% cases at two years after radiotherapy. The 2-, 3- and 5- year local control rates were 100%, 99% and 94%, respectively. The 2-, 3-, and 5-year survival rates were all 100% and no metastases occurred. Conclusions: EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery. The cosmetic effect, local control rate and long-term survival rate are satisfactory, and acute radiation toxicity is very low. (authors)

  20. Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery

    OpenAIRE

    Karanlik, Hasan; Ozgur, Ilker; Sahin, Dilek; Fayda, Merdan; Onder, Semen; Ekrem YAVUZ

    2015-01-01

    Background The purpose of this study was to evaluate ultrasound-guided surgery for palpable breast cancer by comparing the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumor-free margins, and cosmetic outcomes. Methods This was a prospective, observational cohort study conducted from January 2009 to July 2011. Breast cancer patients, diagnosed via biopsy, were operated in guidance with either ultrasound or palpation. Patient de...

  1. Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery

    OpenAIRE

    Bellavance, Emily Catherine; Kesmodel, Susan Beth

    2016-01-01

    One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this ...

  2. Decision making in the surgical treatment of breast cancer: factors influencing women’s choices for mastectomy and breast conserving surgery

    OpenAIRE

    Emily Catherine Bellavance; Susan Beth Kesmodel

    2016-01-01

    One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery (BCS) or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to healthcare, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through...

  3. Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

    International Nuclear Information System (INIS)

    Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distant disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone

  4. Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.ca [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Cherian, Anil [Station Health Centre, Royal Air Force Lossiemouth, Moray (United Kingdom); Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, Ontario (Canada); Perera, Francisco [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

    2015-02-01

    Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distant disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone.

  5. From Radical Mastectomy to Breast-Conserving Therapy and Oncoplastic Breast Surgery: A Narrative Review Comparing Oncological Result, Cosmetic Outcome, Quality of Life, and Health Economy

    OpenAIRE

    Kaviani, Ahmad; Sodagari, Nassim; Sheikhbahaei, Sara; Eslami, Vahid; Hafezi-Nejad, Nima; Safavi, Amin; Noparast, Maryam; Fitoussi, Alfred

    2013-01-01

    Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From...

  6. Using surface markers for MRI guided breast conserving surgery: a feasibility survey

    Science.gov (United States)

    Ebrahimi, Mehran; Siegler, Peter; Modhafar, Amen; Holloway, Claire M. B.; Plewes, Donald B.; Martel, Anne L.

    2014-04-01

    Breast MRI is frequently performed prior to breast conserving surgery in order to assess the location and extent of the lesion. Ideally, the surgeon should also be able to use the image information during surgery to guide the excision and this requires that the MR image is co-registered to conform to the patient’s position on the operating table. Recent progress in MR imaging techniques has made it possible to obtain high quality images of the patient in the supine position which significantly reduces the complexity of the registration task. Surface markers placed on the breast during imaging can be located during surgery using an external tracking device and this information can be used to co-register the images to the patient. There remains the problem that in most clinical MR scanners the arm of the patient has to be placed parallel to the body whereas the arm is placed perpendicular to the patient during surgery. The aim of this study is to determine the accuracy of co-registration based on a surface marker approach and, in particular, to determine what effect the difference in a patient’s arm position makes on the accuracy of tumour localization. Obtaining a second MRI of the patient where the patient’s arm is perpendicular to body axes (operating room position) is not possible. Instead we obtain a secondary MRI scan where the patient’s arm is above the patient’s head to validate the registration. Five patients with enhancing lesions ranging from 1.5 to 80 cm3 in size were imaged using contrast enhanced MRI with their arms in two positions. A thin-plate spline registration scheme was used to match these two configurations. The registration algorithm uses the surface markers only and does not employ the image intensities. Tumour outlines were segmented and centre of mass (COM) displacement and Dice measures of lesion overlap were calculated. The relationship between the number of markers used and the COM-displacement was also studied. The lesion COM

  7. Cosmetic results in early stage breast cancer patients with high-dose brachytherapy after conservative surgery

    International Nuclear Information System (INIS)

    Purpose: to reveal cosmetic results in patients at early stages of low risk breast cancer treated with partial accelerated radiotherapy using high dose rate brachytherapy. Methods and materials: from March 2001 to July 2003,14 stages l and ll breast cancer patients were treated at the Colombian national cancer institute in Bogota with conservative surgery and radiotherapy upon the tumor bed (partial accelerated radiotherapy), using interstitial implants with iridium 192 (high dose rate brachytherapy) with a dose of 32 Gys, over 4 days, at 8 fractions twice a day. Results: with an average follow up of 17.7 months, good cosmetic results were found among 71.4 % of patients and excellent results among 14.3% of patients, furthermore none of the patients neither local nor regional or distant relapses. Conclusion: among patients who suffer from breast cancer at early stages, it showed is possible to apply partial accelerated radiotherapy upon the tumor bed with high doses over 4 days with good to excellent cosmetic results

  8. Dermatofibrosarcoma protuberans of breast treated with conservative surgery and radiation therapy - a case report

    International Nuclear Information System (INIS)

    Dermatofibrosarcoma protuberans (DFSP) is an uncommon low grade cutaneous malignancy originating from deep dermis and subcutaneous tissue. Dermatofibrosarcoma protuberans is characterized clinically by locally aggressive growth and high propensity for local recurrence. Dermatofibrosarcoma protuberans occurring in the breast is very unusual. A retrospective evaluation of outcome was performed, who received radiation as an adjuvant to surgical resection. A 62- year old woman presented with progressively enlarging right breast lump since three months. Lumpectomy revealed 6 x 5 cm pale white to tan well defined homogenous mass with tiny cystic spaces. Histological examination showed intersecting fascicles of spindle to oval fibroblasts, infiltrating adjacent mammary tissue. Lack of necrosis and low mitotic rate was observed. The tumor cells showed strong immunoreactivity for CD34 and negativity for calponin, S-100 and BcI-2. Hence, the final diagnosis Dermatofibrosarcoma protuberans was given. Patient received median dose of 60 Gy. At a median follow up of 3 years, patient did not develop recurrence. Dermatofibrosarcoma protuberans of the breast though uncommon, does exist. Dermatofibrosarcoma protuberans is a radioresponsive tumor with excellent local control after conservative surgery and radiation therapy. (author)

  9. Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

    International Nuclear Information System (INIS)

    A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series. Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected. Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85%) patients treated with hypofractionation and in 67/70 (96%) patients treated with conventional fractionation (p = 0.01). Late toxicity was observed in 8 patients (10%) in the hypofractionation group and in 10 patients (15%) in the conventional fractionation group, respectively (p = 0.4). The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice

  10. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

    International Nuclear Information System (INIS)

    A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS) – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of 'propensity' is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA) data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients

  11. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    FAN Lin-jun; JIANG Jun; YANG Xin-hua; ZHANG Yi; LI Xing-gang; CHEN Xian-chun; ZHONG Ling

    2009-01-01

    Background Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting.Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P>0.05).The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P>0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence-one of these patients died of multiple organ metastasis.Conclusions After considering the wide Indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants-the new surgery of choice for breast cancer-warrants serious consideration as the prospective next standard surgical procedure.

  12. Criteria for radiation therapy following breast-conserving surgery based EIC, TW, ly, and n factor

    International Nuclear Information System (INIS)

    The usefulness of postoperative radiation therapy following breast-conserving surgery has been accepted, but reports have been published which identify cases in which postoperative radiation therapy is not necessary. We therefore compared the postoperative disease-free rate in 65 cases by classifying them into a radiation therapy group and a non-radiation therapy group based on the level of extensive intraductal component (EIC) and lymphatic invasion (ly) and the presence or absence of n factor. The results of this comparison showed that in cases with the absence or minimal presence of EIC and the absence of ly, postoperative radiation therapy should no significant effect. Of these cases, those with negative TW and negative or unknown lymph node metastasis showed satisfactory postoperative results, even without radiation therapy. Furthermore, salvage operation was possible, even following recurrence. It is therefore thought that postoperative radiation therapy is not necessarily indicated in these cases. (author)

  13. Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?

    Science.gov (United States)

    Houvenaeghel, Gilles; Tallet, Agnès; Jalaguier-Coudray, Aurélie; Cohen, Monique; Bannier, Marie; Jauffret-Fara, Camille; Lambaudie, Eric

    2016-01-01

    The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. Therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCT) of MC/MF tumors. It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A meta-analysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists. PMID:27081646

  14. Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery

    Directory of Open Access Journals (Sweden)

    Zorzi Manuel

    2007-10-01

    Full Text Available Abstract Background Several previous studies conducted on cancer registry data and hospital discharge records (HDR have found an association between hospital volume and the recourse to breast conserving surgery (BCS for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. Methods Admissions of breast cancer patients for BCS or mastectomy in the period 2000–2004 were identified from the discharge database of the Veneto Region (Italy. The role of procedural volume (low 100 breast cancer surgeries/year, and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. Results Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07–1.18 and high-volume (1.09, 1.03–1.14 compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67% was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. Conclusion The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers.

  15. Local control with conventional and hypofractionated adjuvant radiotherapy after breast-conserving surgery for ductal carcinoma in-situ

    International Nuclear Information System (INIS)

    Purpose: Adjuvant whole breast radiotherapy (WBRT) for ductal carcinoma in situ (DCIS) improves local control, however an optimal dose fractionation remains undefined. WBRT following breast-conserving surgery for invasive breast cancer demonstrates equivalent efficacy and morbidity for conventional and hypofractionated treatment. Our group policy allowed for the use of both schedules, therefore we compared local control in women with DCIS following breast-conserving surgery. Patients and methods: Two hundred and sixty-six patients treated between January 1999 and December 2004 with conventional (50 Gy in 25 fractions) or hypofractionated (42.4 Gy in 16 fractions or 40 Gy/16 + 12.5 Gy boost) WBRT after breast-conserving surgery for DCIS were retrospectively reviewed. Median follow-up was 3.76 years (range 0.1-8.9 years). Results: One hundred and four patients (39%) were treated with conventional and 162 (61%) with hypofractionated WBRT. The median age was 56.7 years (range 32.2-83.8 years), and prognostic features were well matched in both groups, apart from a small increase in tumour size in the conventional arm (1.75 vs. 2.12 cm, p = 0.05). Actuarial risk of recurrence at 4 years was 7% with hypofractionated WBRT and 6% with the conventional schedule (p = 0.9). Univariate analysis showed an increased risk of recurrence with high nuclear grade tumours (11% at 4 years for grade 3 vs. 4% for grade 1/2, p = 0.029). Conclusions: Hypofractionated adjuvant WBRT following breast-conserving surgery for DCIS has comparable local control to a conventional radiation schedule. Hypofractionated WBRT is more convenient for patients, has equivalent morbidity and should be considered in this patient group.

  16. An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

    International Nuclear Information System (INIS)

    Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

  17. Cosmetic Evaluation of long term results following intraoperative radiotherapy (IORT) of conservative surgery for breast carcinoma

    International Nuclear Information System (INIS)

    Introduction In breast conserving therapy (BCT) of breast cancer, cosmetic results have become next to tumor-related outcome parameters a criterion of increasing awareness. The aim of this study is the evaluation of long term cosmetic results after conservative surgery and intraoperative radiotherapy with 10 Gy electrons (IOERT), followed by whole breast radiotherapy (WBRT) with 50-54 Gy. Patients and Methods From October 1998 to October 2005, 818 patients (median age 57.89 years) were treated by IOERT during breast conserving surgery, 12 of them for bilateral cancer. 32 patients were referred to mastectomy within primary treatment, 50 were reported as dead at the beginning of the study, 4 patients had developed an in-breast-recurrence and had been salvaged by secondary mastectomy, and in 41 cases an intercurrent dissemination was noted. All 679 remaining patients were invited in written form to participate in the cosmesis study. 403 of them (59.4%) have answered and were object of the evaluation (August 2006 to April 2007). To provide reproducible examination conditions, a standardized photo-documentation in four positions (frontal, loose-hanging and elevated arms; left and right lateral, elevated arms) was accomplished. Patients and treating physicians evaluated the cosmetic results separately within a 5-point-score (Excellent, Good, Moderate, Bad, Complications). Patient-, tumor- and treatment-related factors were investigated with regard to possible impact on the cosmetic outcome in all patients (group 1). A separate subgroup analysis was carried out for 261 patients with a follow-up of at least three years after completion of local treatment (group 2). For computation of the statistic correlation between the variables and the cosmetic evaluation the rank correlation coefficients Kendall's τ Spearman's ρ were used. A correlation is significant below a p-value of 0.05. Results The self-assessment of the patients in group 1 yielded around 69% excellent, 25

  18. Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity

    Directory of Open Access Journals (Sweden)

    Tunesi Sara

    2010-11-01

    Full Text Available Abstract Background A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series. Methods Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected. Results Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85% patients treated with hypofractionation and in 67/70 (96% patients treated with conventional fractionation (p = 0.01. Late toxicity was observed in 8 patients (10% in the hypofractionation group and in 10 patients (15% in the conventional fractionation group, respectively (p = 0.4. Conclusions The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.

  19. Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

    International Nuclear Information System (INIS)

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10–122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  20. Prognosis after local recurrence after conservative surgery and radiation for early-stage breast cancer

    International Nuclear Information System (INIS)

    Purpose: To determine the long-term prognosis of patients who develop a local recurrence (LR) after conservative surgery (CS) and radiation therapy (RT) for early-stage invasive breast cancer. Methods and materials: Between 1970 and 1987, 2102 patients with clinical Stage I-II breast cancer were treated with CS+RT. LR was defined as any recurrence within the ipsilateral breast with or without simultaneous regional nodal or distant metastasis. Patients were at risk for a LR until the first of distant metastases, second nonbreast malignancy, or death (DF/S/D). The final study population comprised 341 patients with LR. The median time to LR was 72 months. The median follow-up time after LR was 85 months. A proportional hazards model of time from LR to DF/S/D was done to investigate the influence of factors at initial diagnosis and at LR on subsequent outcome. Results: The actuarial freedom from DF/S/D 5 years after LR was 65% and the survival was 81%. Variables significantly associated with time to DF/S/D were: LR histology (invasive vs. ductal carcinoma in situ, hazard ratio [HR] = 4.1, p 5 years, HR = 2.6, p 5 years, HR = 1.8, p = 0.006); and age at initial diagnosis (≥60 vs. < 60, HR = 1.6, p = 0.01). Conclusions: Many patients with LR after CS+RT have prolonged distant disease-free survival, particularly those able to be treated with mastectomy. Patients with a noninvasive LR, longer interval to LR, or age <60 had a longer time to distant failure, second malignancy, or death than other patients

  1. Local relapse after breast-conserving surgery and radiotherapy. Effects on survival parameters

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    Hammer, Josef; Spiegl, Kurt J.; Feichtinger, Johannes; Braeutigam, Elisabeth [Dept. of Radiation Oncology, Barmherzige Schwesten Hospital, Linz (Austria); Track, Christine [Dept. of Radiation Oncology, Barmherzige Schwesten Hospital, Linz (Austria); Comprehensive Breast Health Center, Barmherzige Schwesten Hospital, Linz (Austria); Seewald, Dietmar H. [Dept. of Radiation Oncology, General Hospital, Voecklabruck (Austria); Petzer, Andreas L. [Dept. of Internal Medicine I - Hematology and Oncology, Barmherzige Schwesten Hospital, Linz (Austria); Langsteger, Werner [Dept. of Nuclear Medicine and PET Center, Barmherzige Schwesten Hospital, Linz (Austria); Poestlberger, Sabine [Comprehensive Breast Health Center, Barmherzige Schwesten Hospital, Linz (Austria); Dept. of Surgery, Barmherzige Schwesten Hospital, Linz (Austria)

    2009-07-15

    Purpose: This retrospective analysis of 1,610 women treated for breast cancer and 88 patients with local relapse aims to show the poor survival parameters after local failure and to evaluate risk factors and compare them with other studies and analyses published. Patients and methods: Between 1984 and 1997, 1,610 patients presenting with a total of 1,635 pT1-2 invasive and noninvasive carcinomas of the breast were treated at the authors' institution. The mean age was 57.1 years (range 25-85 years). Treatment protocols involved breast-conserving surgery with or without systemic therapy and whole-breast radiotherapy in all women, followed by a boost dose to the tumor bed according to risk factors for local recurrence. All axillary node-positive patients underwent systemic therapy (six cycles of classic CMF or tamoxifen 20 mg/day for 2-5 years). The time of diagnosis of local relapse was defined as time 0 for the survival curves after local failure. The association of clinicopathologic factors was studied using uni- and multivariate analyses. Survival and local control were calculated by the Kaplan-Meier actuarial method and significance by the log-rank test. Results: After a mean follow-up of 104 months, 88 local failures were recorded (5.4%). Calculated from the time of diagnosis of local relapse, 5-year overall survival (OS) was 62.8%, metastasis-free survival 60.6%, and disease-specific survival 64.2%. In patients with failure during the first 5 years after treatment, the survival parameters were worse (OS 50.6%) compared to those who relapsed after 5 years (OS 78.8%; p < 0.028). Significances were also found for initial T- and N-stage and type of failure (solid tumor vs. diffuse spread). Conclusion: This analysis again shows that the survival parameters are worsening after local relapse, especially in case of early occurrence. In breast cancer treatment, therefore, the goal remains to avoid local failure. (orig.)

  2. Local relapse after breast-conserving surgery and radiotherapy. Effects on survival parameters

    International Nuclear Information System (INIS)

    Purpose: This retrospective analysis of 1,610 women treated for breast cancer and 88 patients with local relapse aims to show the poor survival parameters after local failure and to evaluate risk factors and compare them with other studies and analyses published. Patients and methods: Between 1984 and 1997, 1,610 patients presenting with a total of 1,635 pT1-2 invasive and noninvasive carcinomas of the breast were treated at the authors' institution. The mean age was 57.1 years (range 25-85 years). Treatment protocols involved breast-conserving surgery with or without systemic therapy and whole-breast radiotherapy in all women, followed by a boost dose to the tumor bed according to risk factors for local recurrence. All axillary node-positive patients underwent systemic therapy (six cycles of classic CMF or tamoxifen 20 mg/day for 2-5 years). The time of diagnosis of local relapse was defined as time 0 for the survival curves after local failure. The association of clinicopathologic factors was studied using uni- and multivariate analyses. Survival and local control were calculated by the Kaplan-Meier actuarial method and significance by the log-rank test. Results: After a mean follow-up of 104 months, 88 local failures were recorded (5.4%). Calculated from the time of diagnosis of local relapse, 5-year overall survival (OS) was 62.8%, metastasis-free survival 60.6%, and disease-specific survival 64.2%. In patients with failure during the first 5 years after treatment, the survival parameters were worse (OS 50.6%) compared to those who relapsed after 5 years (OS 78.8%; p < 0.028). Significances were also found for initial T- and N-stage and type of failure (solid tumor vs. diffuse spread). Conclusion: This analysis again shows that the survival parameters are worsening after local relapse, especially in case of early occurrence. In breast cancer treatment, therefore, the goal remains to avoid local failure. (orig.)

  3. High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

    International Nuclear Information System (INIS)

    In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each pathology type from the other four using a multivariate

  4. Breast conserving surgery with preservation of the nipple-areola complex as a feasible and safe approach in male breast cancer: a case report

    Science.gov (United States)

    Lanitis, Sophocles; Filippakis, George; Al Mufti, Ragheed; Hadjiminas, Dimitri J

    2008-01-01

    Introduction Breast cancer in men is rare. The evidence about treatment has been derived from data on the management of the disease in women. The usual treatment is for male patients to undergo modified radical mastectomy. There is insufficient experience of breast conserving surgery with preservation of the nipple. The management of patients who demand such an approach for personal reasons remains a challenge for both the surgeon and oncologist. Case presentation A 50-year-old man with a breast cancer was successfully managed with breast conserving surgery with nipple preservation combined with axillary clearance and postoperative radiotherapy, chemotherapy and hormone treatment. Since there are no similar cases in the literature, we discuss the feasibility, safety and possible indications of such an approach. Conclusion Despite the limited indications and evidence about the safety and efficacy of breast conserving surgery with nipple preservation in men with breast cancer, it is a feasible approach if other options are declined by the patient. More studies are necessary to reach firm conclusions about the safety of such an approach. PMID:18442386

  5. Breast conserving surgery with preservation of the nipple-areola complex as a feasible and safe approach in male breast cancer: a case report

    Directory of Open Access Journals (Sweden)

    Lanitis Sophocles

    2008-04-01

    Full Text Available Abstract Introduction Breast cancer in men is rare. The evidence about treatment has been derived from data on the management of the disease in women. The usual treatment is for male patients to undergo modified radical mastectomy. There is insufficient experience of breast conserving surgery with preservation of the nipple. The management of patients who demand such an approach for personal reasons remains a challenge for both the surgeon and oncologist. Case presentation A 50-year-old man with a breast cancer was successfully managed with breast conserving surgery with nipple preservation combined with axillary clearance and postoperative radiotherapy, chemotherapy and hormone treatment. Since there are no similar cases in the literature, we discuss the feasibility, safety and possible indications of such an approach. Conclusion Despite the limited indications and evidence about the safety and efficacy of breast conserving surgery with nipple preservation in men with breast cancer, it is a feasible approach if other options are declined by the patient. More studies are necessary to reach firm conclusions about the safety of such an approach.

  6. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    International Nuclear Information System (INIS)

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  7. Fat necrosis after conserving surgery and interstitial brachytherapy and/or external-beam irradiation in women with breast cancer

    International Nuclear Information System (INIS)

    Purpose: to investigate the incidence of fat necrosis, breast tissue fibrosis and breast pain after conserving surgery and accelerated partial-breast irradiation (APBI, group A), whole-breast external-beam irradiation (EBRT, group B), or EBRT combined with an interstitial boost (EBIB, group C) in women with breast cancer. Patients and methods: 85 patients who received breast-conserving therapy from 02/2000 to 03/2002 were analyzed. 30 patients received EBRT, 33 patients APBI, and 22 patients EBIB. Median follow-up was 35.5, 35.0, and 37.5 months, respectively. Fat necrosis was detected and rated by mammograms, fibrosis and pain were clinically rated with the LENT-SOMA scores. Results: the incidence of fat necrosis was 15.3% for all patients; and 15.2%, 20.0%, and 9.0% for groups A, B, and C, respectively. The 3-year fat necrosis-free survival probability was 83%, 76%, and 95% (difference not significant). The mean time to first diagnosis of fat necrosis was 25.6, 26.2, and 26.0 months. No patient needed surgical intervention because of fat necrosis-related pain. Fibrosis was present in 27.3%, 63.3%, and 77.3% (p<0.001), breast pain in 9.0%, 33.4%, and 18.1% (p<0.05). Conclusion: asymptomatic fat necrosis is a common finding after both percutaneous and interstitial irradiation after breast-conserving surgery. This analysis did not support the hypothesis that APBI with multicatheter implants leads to higher rates of fat necrosis, fibrosis, or pain. (orig.)

  8. Local tumor control and cosmetic outcome following breast-conserving surgery and radiation up to a total dose of 56 Gy without boost in breast cancer patients

    International Nuclear Information System (INIS)

    Purpose: To evaluate overall survival, local tumor control and cosmetic outcome after breast-conserving surgery followed by radiotherapy without boost irradiation. Patients and Methods: In a retrospective study 270 breast cancer patients were treated with breast conserving surgery combined with a homogenous radiation of the tumor bearing breast up to a total dose of 56 Gy without local boost irradiation. Mean follow-up was 48 months. Local tumor control, side effects, cosmetic results and contentment with treatment were assessed using physical examinations and interviews based on a standardized questionnaire. Results: Cause-specific survival at 5 years after treatment was 88.3%, actuarial disease-free survival at 5 years was 76.1%. Within 23 to 78 months after treatment 12 patients suffered from ipsilateral breast recurrence. The actuarial freedom from local recurrence (single tumor manifestation) was 96.8% at 5 years after treatment, 89% at 10 years. The occurrence of local failures was not significantly correlated to tumor size, margins, grading, nodal status, age or lymphangiosis. 15.6% of the patients developed distant metastases. In all patients treatment was performed without interruption. Side effects were predominantly of mild degree, no severe side effects were detected. 73% of physicians and 81% of patients scored their cosmetic outcome as excellent or good. 93% of patients would again decide in favor of this procedure. Whereas, use of adjuvant chemotherapy as well as subcutaneous reconstruction of breast tissue did not significantly affect breast cosmesis, analysis demonstrated impaired cosmetic results related to a larger breast size. Conclusion: The data of this study show that tumor control achieved by breast conserving surgery in combination with a radiation technique up to a total dose of 56 Gy which omits boost irradiation is within the range of literature data. Side effects of the therapy were tolerable. The treatment displayed a good

  9. Timing of radiotherapy following breast-conserving surgery: outcome of 1393 patients at a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Corradini, S.; Niemoeller, O.M.; Niyazi, M.; Manapov, F.; Belka, C. [University of Munich, Department of Radiation Oncology, Munich (Germany); Haerting, M.; Kahlert, S. [University of Munich, Breast Center, Department of Obstetrics and Gynecology, Munich (Germany); Harbeck, N. [University of Munich, Breast Center, Department of Obstetrics and Gynecology, Munich (Germany); University of Munich, Comprehensive Cancer Center (CCC-LMU), Munich (Germany)

    2014-04-15

    The role of postoperative radiotherapy in breast-conserving therapy is undisputed. However, optimal timing of adjuvant radiotherapy is an issue of ongoing debate. This retrospective clinical cohort study was performed to investigate the impact of a delay in surgery-radiotherapy intervals on local control and overall survival. Data from an unselected cohort of 1393 patients treated at a single institution over a 17-year period (1990-2006) were analyzed. Patients were assigned to two groups (CT+/CT-) according to chemotherapy status. A delay in the initiation of radiotherapy was defined as >7 weeks (CT- group) and >24 weeks (CT+ group). The 10-year regional recurrence-free survival for the CT- and CT+ groups were 95.6 and 86.0%, respectively. A significant increase in the median surgery-radiotherapy interval was observed over time (CT- patients: median of 5 weeks in 1990-1992 to a median of 6 weeks in 2005-2006; CT+ patients: median of 5 weeks in 1990-1992 to a median of 21 weeks in 2005-2006). There was no association between a delay in radiotherapy and an increased local recurrence rate (CT- group: p=0.990 for intervals 0-6 weeks vs. ≥7 weeks; CT+ group: p=0.644 for intervals 0-15 weeks vs. ≥24 weeks) or decreased overall survival (CT- group: p=0.386 for intervals 0-6 weeks vs. ≥7 weeks; CT+ group: p=0.305 for intervals 0-15 weeks vs. ≥24 weeks). In the present cohort, a delay of radiotherapy was not associated with decreased local control or overall survival in the two groups (CT-/CT+). However, in the absence of randomized evidence, delays in the initiation of radiotherapy should be avoided. (orig.)

  10. Cosmetic breast surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000273.htm Cosmetic breast surgery - discharge To use the sharing features on this page, please enable JavaScript. You had cosmetic breast surgery to change the size or shape ...

  11. Treatment outcome and analysis of the prognostic factors of ductal carcinoma in situ treated with breast conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    To evaluate the survival rate, local failure rate and patterns of failure, and analyze the prognostic factors affecting local relapse of ductal carcinoma in situ treated with breast conserving surgery and radiotherapy. From June 1995 to December 2001, 96 patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were retrospectively analyzed. The operations were either local or wide excision in all patients, with an axillary lymph node dissection performed in some patients. Radiation dose to the whole breast was 50.4 Gy, over 5 weeks, with 1.8 Gy daily fractions, with additional doses (10 ∼ 14 Gy) administered to the primary tumor bed in some patients with close (≤ 2 mm) or positive resection margin. The median follow-up period was 43 months (range 12 ∼ 102 months). The 5-year local relapse free survival and overall survival rates were 91 and 100% respectively. Local relapse occurred in 6 patients (6.3%). Of the 6 recurrences, one was invasive ductal cell carcinoma. With the exception of one, all patients recurred 2 years after surgery. There was no regional recurrence or distant metastasis. Five patients with local recurrence were salvaged with total mastectomy, and are alive with no evidence of disease. One patient with recurrent invasive ductal cell carcinoma will receive salvage treatment. On analysis of the prognostic factors affecting local relapse, none of the factors among the age, status of resection margin, comedo type and nuclear grade affected local relapse. Operation extent also did not affect local control (ρ = 0.30). In the patients with close resection margin, boost irradiation to the primary tumor bed did not affect local control (ρ = 1.0). The survival rate and local control of the patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were excellent. Close resection margin and boost irradiation to the primary tumor bed did not affect local relapse, but further

  12. Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast

    International Nuclear Information System (INIS)

    Purpose: Although the clinical outcome after treatment of ductal carcinoma in situ (DCIS) using breast-conservation surgery and radiation therapy has been well documented, little data has been reported on cosmetic outcome or treatment complications. Therefore, the present study was performed to evaluate cosmesis and complications after breast-conservation treatment for DCIS and to analyze various factors that might affect cosmesis and predispose to complications. Methods and Materials: The records of 90 patients who were alive without evidence of disease with a 3-year minimum follow-up were evaluated for cosmetic results and treatment complications following breast-conservation surgery and radiation therapy for DCIS. Complete gross excision of the primary tumor had been performed in all patients. Additionally, 24 patients had undergone an axillary lymph node dissection in the earlier years of the study. The majority of the patients had received 50-50.4 Gy to the whole breast followed by an electron boost for a total dose of 60-66 Gy. Results: The cosmetic results of 90 evaluable patients at 3 years were: excellent in 69 (77%), good in 19 (21%), and fair in 2 (2%). The cosmetic results of 64 evaluable patients at 5 years were: excellent in 46 (72%), good in 16 (25%), and fair in 2 (3%). Factors associated with worse cosmetic results were an increased volume of tissue excised (>70 cm3) and a negative ipsilateral breast biopsy after radiotherapy. Complications in the 24 patients with an axillary dissection were: arm edema (n = 6), cellulitis of the arm (n = 5), and axillary vein thrombosis (n = 1). Complications in the 66 patients without an axillary dissection were: cellulitis of the arm (n = 1) and cellulitis of the breast (n = 1). Discussion: Breast-conservation surgery followed by radiation therapy achieved excellent or good cosmetic results in 98 and 97% of patients at 3 years and 5 years, respectively. Complications were associated primarily with axillary

  13. Combined breast conserving surgery, chemotherapy, and irradiation in breast cancer treatment. Role of the interval between surgery and onset of radiotherapy

    International Nuclear Information System (INIS)

    Background: The timing of breast conserving surgery, chemotherapy, and radiotherapy in breast cancer treatment has become the subject of increasing interest over the last years. Results: Five years after start of treatment overall survival, disease-free survival, and local recurrence rates were 86% (95%-confidence limits, 76 to 93%), 73% (61 to 83%), and 8% (3 to 16%), respectively (totally 72 patients). For disease-free survival, the only significant prognostic factor was the number of involved lymph nodes: 0 to 3=86%, ≥4=40% (p20 weeks) had no significant influence on disease-free survival or local tumor control. In contrast, there was a trend of increased regional and distant failure with shortening of the interval due to the delivery of less than 6 cycles chemotherapy before the onset of radiotherapy. Conclusions: In our experience, there was no negative impact of a delay of radiotherapy in order to deliver full course chemotherapy before initiation of radiotherapy. However, the low statistical power of this analysis due to the small number of patients must be considered. It appears possible that a less intense chemotherapy before starting radiation treatment correlates with enhanced distant failure and subsequently decreased disease-free survival rates. Therefore, for patients at increased risk for distant metastasis, we prefer to give 6 cycles polychemotherapy before irradiation. (orig./VHE)

  14. Conservative surgery and radiotherapy in the treatment of breast cancer. Preliminary results of 148 patients

    International Nuclear Information System (INIS)

    The combination of tumoral resection and radiotherapy with preservation of the breast is called conservative treatment of breast cancer. The literature considers this treatment a good option if used by an experient team and with appropriate equipment. This paper shows the results of 148 cases of breast cancer treated by this conservative approach at Centro de Oncologia Campinas. Follow-up varied from 3 to 87 months (mean 28) considered by the histological diagnosis. Overall actuarial survival of 5 years was 77% disease-free survival 55%. Twelve patients (8%) presented local relapse and 13 (9%) had distant metastases as the first therapeutic failure. Cosmetic results were considered good and fair in 89% of patients. These results are similar to others published in the literature (Author)

  15. Conservative surgery followed by radical radiotherapy in the management of stage I carcinoma of the breast

    International Nuclear Information System (INIS)

    Since October 1976, the treatment policy in our Radiotheapy Center for Stage I carcinoma of the breast has been excision of the tumor mass, when it was cosmetically suitable, followed by irradiation to the breast and periphereal lymphatics. Eighty-three patients were admitted between October 1976 and March 1980. They underwent local excision of the tumor and then received 5000 rad in 5 weeks to the breast, supraclavicular, axillary and internal mammary chain lymph nodes. Each field was treated every day. A boost was then given to the scar, bringing the dose up to 6500 rad, calculated at maximum tumor depth, depending upon the size of the tumor prior to surgery. Cosmetic results were quite good, and the local control rate at 54 months is 98%. The survival with no evidence of disease (NED) at 54 months (actuarial) is 83%. Twenty-one out of 83 patients have had complications (25.3%); of these, 28.8% were surgical and the remainder results from radiotherapy after surgery, either from radiotherapy alone or from combination of treatments. Of the total of 21 complications, 18 were mild and 3 were serious.These results compare favorably with the results achieved in the same Hospital with radical surgery as far as local tumor control and survival with no evidence of disease (NED) is concerned. The results also compared with the great majority of surgical series reported in the literature, allowing us to conclude that patients treated with radiation have nothing to lose and much to gain by preserving the breast

  16. Trans-axillary retro-mammary gland route approach of video-assisted breast surgery can perform breast conserving surgery for cancers even in inner side of the breast

    Institute of Scientific and Technical Information of China (English)

    Koji Yamashita; Kazuo Shimizu

    2008-01-01

    Background The endoscopic surgery for inner-side cancer of the breast is usually performed by periareolar approach,but it often makes deformation or malposition of nipple and areola. The trans-axillary approach is favorable without making any injuries on breast skin. Furthermore, we devised a new approach of retro-mammary route without subcutaneous exfoliation, from axillary skin incision, to preserve skin touch sensation.Methods We have performed video-assisted breast surgery (VABS) on 200 patients since December 2001. The newly devised trans-axillary retromammary-route approach (TARM) was performed on 12 patients of early breast cancer. After endoscopic sentinel lymph node biopsy, we lengthened the axillary skin incision to 2.5 cm, and dissected retromammary tissue from superficial pectoral fascia onto major pectoral muscle below the tumor. The working space was made by lifting traction sutures through the gland. We cut the gland vertically at free margin 2 cm apart from the tumor edge, and dissect skin flap over the tumor. The breast reconstruction was done by filling absorbable fiber cotton.Results Traction sutures made it easier to cut the mammary gland vertically. We did not experience any skin damages like bum. All surgical margins were negative. The operation time was needed longer but the blood loss was not different.The postoperative esthetic results were good. The sensory disturbance was minimal. All patients were satisfied with this operation.Conclusion This newly devised TARM approach need no injury on whole breast, and can become a single standard method for breast conserving surgery wherever the cancer situated.

  17. Radiation therapy after breast-conserving surgery for Stage I and II mammary carcinoma

    International Nuclear Information System (INIS)

    This report describes the results of a program of limited surgery, usually tumor excision, followed by curative radiation therapy in a series of 794 evaluable Stage I and II breast cancer patients treated prior to December, 1976. Clinical cure rates at 5, 10 and 15 years were 85%, 74% and 58% respectively. At 10 years, 86% of the apparently cured patients had the affected breast preserved, 79% of them with a good cosmetic result. In 10-year local/regional recurrence rate was 14%, but 84% of local failures were operable. Salvage surgery provided ultimate local control for 94% of the operable local failures, 61.5% of whom lived for at least 5 years after their secondary operations. It is concluded that a combination of primary tumor excision, limited axillary dissection and curative radiation therapy provides end results which are equivalent to those of primary radical mastectomy and affords the considerable advantage of successful breast preservation in a large majority of cases. (orig.)

  18. Evaluation of anxiety and salivary chromogranin a secretion in women receiving breast conserving surgery followed by radiation therapy

    International Nuclear Information System (INIS)

    We conducted a prospective study to assess the anxiety and salivary Chromogranin A (CgA), which is considered to be a biomarker of the stress response, in outpatients receiving breast conserving surgery followed by radiation therapy (RT) to the whole breast. Fifty consecutive patients who received whole-breast RT were enrolled in this study. The anxiety levels were measured by the State-Trait Anxiety Inventory (STAI) at the beginning of RT (baseline), 30 Gy, completion of RT, and 1 and 3 months after RT. Salivary CgA levels were also measured at the same time. The mean state anxiety score for all patients was 46.16 with a standard error (SE) of 1.57 at the beginning of RT (baseline) which continued to decline during and after RT. It reached its lowest score with 36.34±1.56 at 3 months after RT (p<0.0001). The mean trait anxiety score for all patients was 43.10±1.54 at baseline and remained constant during RT but began to decline after completion of RT and reached a low level at 3 months after RT (p=0.0021). The mean salivary CgA concentration for all patients demonstrated no consistent trends over time, but at 30 Gy the concentration showed a significant decreasing pattern (p=0.0473). Salivary CgA concentrations and state anxiety and trait anxiety scores at all time points showed no correlation. The mean anxiety scores measured by State Trait Anxiety Inventory (STAI) showed no positive correlation with salivary CgA concentration for breast cancer patients undergoing radiation therapy following breast conserving surgery. (author)

  19. Clinical outcome and cosmetic results of conservative surgery plus radiation therapy in early stage breast cancer patients

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical outcome and cosmetic results in early stage breast cancer patients treated with conservative surgery plus radiation therapy. Methods: From May 1995 to December 2002, 109 such patients were so treated. The post-operative radiotherapy consisted of whole-breast 6 MV linear accelerator irradiation with two tangential half-fields to a total dose of 45-52 Gy (mean 48.6 Gy), followed by a boost irradiation to the tumor bed. Among them, 79 patients received 10-12 Gy (DB) boost by interstitial implantation brachytherapy (192Ir HDR, Nucletron), with single plane implantation for T1 and double plane implantation for T2 tumor. Thirty patients received 15 Gy boost by electron beam. Adjuvant/concurrent chemotherapy (CMF or CEF) and hormonotherapy were also used according to the patients' clinical characteristics. The cosmetic results were scored by both the doctor and the patients. Results: The overall actuarial 5-year survival was 93.8%, with local recurrence of 6.5%. No radiation-induced ulcer was observed in the breast except for acute inflammation at skin pinholes in 5 patients treated by interstitial implant brachytherapy. Among the 75 patients who had had breast examination, cosmetic result scored as good by patient and doctor were 81% and 87%, respectively. The good rate assessed by doctor in brachytherapy boost group and electron beam boost group were 81.2% (39/48) and 85.2% (23/27), There was no significant difference between these two boost techniques (P>0.05). Conclusions: Tumor bed boost irradiation by either brachytherapy or electron beam technique can provide satisfactory local control in early breast cancer treated with conservative surgery plus radiotherapy without increasing the side effects. There is no significant difference in cosmetic result between these two boost techniques. (authors)

  20. Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT)

    OpenAIRE

    Haloua, Max H; Volders, José H.; Krekel, Nicole M. A.; Lopes Cardozo, Alexander M. F.; de Roos, Wifred K.; de Widt-Levert, Louise M.; van der Veen, Henk; Rijna, Herman; Bergers, Elisabeth; Jóźwiak, Katarzyna; Meijer, Sybren; van den Tol, M. Petrousjka

    2015-01-01

    Background Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). Objective The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). Methods A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either US...

  1. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Carl [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Bai, Harrison [Yale University School of Medicine, New Haven, Connecticut (United States); Neboori, Hanmanth [Drexel Medical College, Philadelphia, Pennsylvania (United States); Takita, Cristiane [University of Miami, Miami, Florida (United States); Motwani, Sabin [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Wright, Jean L.; Hobeika, Georges [University of Miami, Miami, Florida (United States); Haffty, Bruce G. [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Jones, Tiffanie [Yale University School of Medicine, New Haven, Connecticut (United States); Goyal, Sharad [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Moran, Meena S., E-mail: meena.moran@yale.edu [Yale University School of Medicine, New Haven, Connecticut (United States)

    2012-11-01

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  2. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    International Nuclear Information System (INIS)

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  3. Real-time 3-dimensional virtual reality navigation system with open MRI for breast-conserving surgery

    International Nuclear Information System (INIS)

    We report here the early experiences using a real-time three-dimensional (3D) virtual reality navigation system with open magnetic resonance imaging (MRI) for breast-conserving surgery (BCS). Two patients with a non-palpable MRI-detected breast tumor underwent BCS under the guidance of the navigation system. An initial MRI for the breast tumor using skin-affixed markers was performed immediately prior to excision. A percutaneous intramammary dye marker was applied to delineate an excision line, and the computer software '3D Slicer' generated a real-time 3D virtual reality model of the tumor and the puncture needle in the breast. Under guidance by the navigation system, marking procedures were performed without any difficulties. Fiducial registration errors were 3.00 mm for patient no.1, and 4.07 mm for patient no.2. The real-time 3D virtual reality navigation system with open MRI is feasible for safe and accurate excision of non-palpable MRI-detected breast tumors. (author)

  4. Cosmetic breast surgery - discharge

    Science.gov (United States)

    ... Higdon KK. Reduction mammoplasty. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 8. ... Gabriel A. Breast augmentation. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 2.

  5. Dosimetric comparison of the simultaneous integrated boost in whole-breast irradiation after breast-conserving surgery: IMRT, IMRT plus an electron boost and VMAT.

    Directory of Open Access Journals (Sweden)

    Sangang Wu

    Full Text Available To compare the target volume coverage and doses to organs at risks (OARs using three techniques that simultaneous integrated boost (SIB in whole-breast irradiation (WBI after breast-conserving surgery, including intensity-modulated radiation therapy (IMRT, IMRT plus an electron boost (IMRT-EB, and volumetric-modulated arc therapy (VMAT.A total of 10 patients with early-stage left-sided breast cancer after breast-conserving surgery were included in this study. IMRT, IMRT-EB and VMAT plans were generated for each patient.The conformity index (CI of the planning target volumes evaluation (PTV-Eval of VMAT was significantly superior to those of IMRT and IMRT-EB (P 0.05.Considered the target volume coverage and radiation dose delivered to the OARs (especially the heart and lung, IMRT may be more suitable for the SIB in WBI than IMRT-EB and VMAT. Additional clinical studies with a larger sample size will be needed to assess the long-term feasibility and efficacy of SIB using different radiotherapy techniques.

  6. Evaluation the consistency of location of moist desquamation and skin high dose area for breast cancer patients receiving adjuvant radiotherapy after breast conservative surgery

    International Nuclear Information System (INIS)

    To evaluate whether the location of moist desquamation matches high dose area for breast cancer patients receiving adjuvant radiotherapy (RT) after breast conservative surgery. One hundred and nine breast cancer patients were enrolled to this study. Their highest skin dose area (the hot spot) was estimated from the treatment planning. We divided the irradiated field into breast; sternal/parasternal; axillary; and inframammary fold areas. The location for moist desquamation was recorded to see if it matches the hot spot. We also analyzed other possible risk factors which may be related to the moist desquamation. Forty-eight patients with 65 locations developed moist desquamation during the RT course. Patients with larger breast sizes and easy to sweat are two independent risk factors for moist desquamation. The distribution of moist desquamation occurred most in the axillary area. All nine patients with the hot spots located at the axillary area developed moist desquamation at the axillary area, and six out of seven patients with the hot spots located at the inframammary fold developed moist desquamation there. The majority of patients with moist desquamation over the breast or sternal/parasternal areas had the hot spots located at these areas. For a patient with moist desquamation, if a hot spot is located at the axillary or inframammary fold areas, it is very likely to have moist desquamation occur there. On the other hand, if moist desquamation occurs over the breast or sternal/parasternal areas, we can highly expect these two areas are also the hot spot locations

  7. Is Short-Interval Mammography Necessary After Breast Conservation Surgery and Radiation Treatment in Breast Cancer Patients?

    International Nuclear Information System (INIS)

    Purpose: The optimum timing and frequency of mammography in breast cancer patients after breast-conserving therapy (BCT) are controversial. The American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis but no earlier than 6 months after completion of radiotherapy. The National Comprehensive Cancer Network recommends annual mammography. Intermountain Healthcare currently follows a more frequent mammography schedule during the first 2 years in BCT patients. This retrospective study was undertaken to determine the cancer yield mammography during the first 2 years after BCT. Methods and Materials: 1,435 patients received BCT at Intermountain Healthcare between 2003 and 2007, inclusive. Twenty-three patients had bilateral breast cancer (1,458 total breasts). Patients were followed up for 24 months after diagnosis. The 1- and 2-year mammography yields were determined and compared with those of the general screening population. Results: 1,079 breasts had mammography at less than 1 year, and two ipsilateral recurrences (both noninvasive) were identified; 1,219 breasts had mammography during the second year, and nine recurrences (three invasive, six noninvasive) were identified. Of the 11 ipsilateral recurrences during the study, three presented with symptoms and eight were identified by mammography alone. The mammography yield was 1.9 cancers per 1,000 breasts the first year and 4.9 per 1,000 the second year. Conclusions: These data demonstrate that the mammography yield during the first 2 years after BCT is not greater than that in the general population, and they support the policy for initiating followup mammography at 1 year after BCT.

  8. Is Short-Interval Mammography Necessary After Breast Conservation Surgery and Radiation Treatment in Breast Cancer Patients?

    Energy Technology Data Exchange (ETDEWEB)

    Hymas, Richard V.; Gaffney, David K. [Department of Radiation Oncology, University of Utah, Salt Lake City, UT (United States); Parkinson, Brett T.; Belnap, Thomas W. [Intermountain Medical Center, Salt Lake City, UT (United States); Sause, William T., E-mail: william.sause@imail.org [Intermountain Medical Center, Salt Lake City, UT (United States)

    2012-06-01

    Purpose: The optimum timing and frequency of mammography in breast cancer patients after breast-conserving therapy (BCT) are controversial. The American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis but no earlier than 6 months after completion of radiotherapy. The National Comprehensive Cancer Network recommends annual mammography. Intermountain Healthcare currently follows a more frequent mammography schedule during the first 2 years in BCT patients. This retrospective study was undertaken to determine the cancer yield mammography during the first 2 years after BCT. Methods and Materials: 1,435 patients received BCT at Intermountain Healthcare between 2003 and 2007, inclusive. Twenty-three patients had bilateral breast cancer (1,458 total breasts). Patients were followed up for 24 months after diagnosis. The 1- and 2-year mammography yields were determined and compared with those of the general screening population. Results: 1,079 breasts had mammography at less than 1 year, and two ipsilateral recurrences (both noninvasive) were identified; 1,219 breasts had mammography during the second year, and nine recurrences (three invasive, six noninvasive) were identified. Of the 11 ipsilateral recurrences during the study, three presented with symptoms and eight were identified by mammography alone. The mammography yield was 1.9 cancers per 1,000 breasts the first year and 4.9 per 1,000 the second year. Conclusions: These data demonstrate that the mammography yield during the first 2 years after BCT is not greater than that in the general population, and they support the policy for initiating followup mammography at 1 year after BCT.

  9. A multicenter investigation of late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated whole-breast radiation therapy

    International Nuclear Information System (INIS)

    The objective of this study was to investigate late adverse events in Japanese women treated with breast-conserving surgery plus conventional fractionated radiation therapy in 24 hospitals. This is a prospective investigation into patients who have been followed for 3 years or more after the completion of radiation therapy. The women visited hospitals for routine medical follow-up between 1 March and 31 May 2008. All patients underwent interviews and visual/palpating examinations. Their clinical chart, past chest X-rays and laboratory findings were reviewed. Evaluation criteria for late adverse events and breast cosmetic outcome were based on the Common Terminology Criteria for Adverse Events v.3 and the European Organization for Research and Treatment of Cancer Global Cosmetic Rating System. Seven hundred and three women, including 448 treated with whole-breast irradiation and 255 treated with whole-breast and boost irradiation, were examined by radiation oncologists in 24 hospitals. The frequent adverse events were breast pain (Grade 1, 115; Grade 2, 2), breast fibrosis (Grade 1, 72; Grade 2, 8), chest wall pain (Grade 1, 67; Grade 2, 3), telangiectasia (Grade 1, 29; Grade 2, 5) and pneumonitis (Grade 1, 20; Grade 2, 6; Grade 3, 3). Adverse events of Grade 2 or 3 were found in 27 patients (3.8%); 3 presented with radiation pneumonitis of Grade 3. The percentage of patients with an excellent or good cosmetic outcome was 69.1%. In the first multicenter investigation for Japanese women after breast-conserving therapy, the evaluation of late adverse events and breast cosmetic outcome was similar to several other reports from clinical trials in North America and Europe. (author)

  10. Comparing the effects of conventional and hypofractionated radiotherapies on early skin toxicity and cosmetic outcomes after breast cancer conserving surgery

    Directory of Open Access Journals (Sweden)

    P Haddad

    2012-12-01

    Full Text Available Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0 who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy by either receiving conventional treatment (dose: 50 Gy in 25 fractions with subsequent electron boost or a short-course hypofractionated radiotherapy (dose: 42.5 Gy in 16 fractions and a subsequent electron boost.Results: There were no skin changes during the first or the second week of treatment in the two groups. Cutaneous complications began after the third week as grade 1 skin toxicity after termination of the short-course radiotherapy but there were no difference in complication rate after four weeks of treatment. Six months and one year after treatment, there were no differences in terms of skin complications or cosmetic outcomes between the two groups.Conclusion: Although the use of a whole-breast irradiation with a hypofractionated schedule was associated with desirable outcomes, in term of skin toxicity and cosmetics, but longer follow-up periods with larger sample sizes are needed to confirm these results.

  11. Evaluation of long-term cosmetic results and complications following breast conserving surgery and radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fujishiro, Satsuki; Mitsumori, Michihide; Kokubo, Masaki; Nagata, Yasushi; Sasai, Keisuke; Hiraoka, Masahiro [Kyoto Univ. (Japan). Hospital; Kodama, Hiroshi

    1999-12-01

    Long-term cosmetic outcomes and complications were evaluated in 109 patients with breast cancer who had been treated by breast conservation therapy. Patients received radiation therapy at Kyoto University Hospital following quadrantectomy and level II or III axillary node dissection. Factors that might influence long-term cosmetic results were also analyzed. Irradiation to the breast was administered in 2 Gy fractions, 5 times a week for a total of 50 Gy in all patients. Cobalt-60 {gamma}-rays were used in 108 patients with the exception of 1 patient who received 6 Mev X-ray. Some patients with positive or close margins received boost irradiation of 10 Gy using electron beams to the primary tumor bed. Cosmetic outcome was assessed by both a scoring method and breast retraction assessment (BRA). Forty-seven percent of patients were assessed as excellent to good before radiation therapy. The percent of excellent to good decreased shortly after termination of radiation therapy, but gradually improved and stabilized by 3 years. Seventy percent of patients showed a score of excellent to good 5 years after treatment. The average BRA of the 109 patients was 3.0 cm. This did not change between 3 and 5 years after treatment. A significant correlation between cosmetic score and BRA was shown at all follow-up times. Factors such as age over 50 years (p=0.008), tumor location in the outer quadrant (p=0.02) and boost irradiation (p=0.03) significantly affected the cosmetic score. Arm edema and restriction of shoulder movement were observed in 22% and 49% at the start of radiation therapy, these improved within approximately 3 years and 1 year after treatment, respectively. Mild skin change was observed in 60% of patients even 5 years after treatment. The results indicate that cosmetic outcome after breast conservation therapy is clinically acceptable, and the complication rate is low. (author)

  12. Evaluation of long-term cosmetic results and complications following breast conserving surgery and radiation therapy for breast cancer

    International Nuclear Information System (INIS)

    Long-term cosmetic outcomes and complications were evaluated in 109 patients with breast cancer who had been treated by breast conservation therapy. Patients received radiation therapy at Kyoto University Hospital following quadrantectomy and level II or III axillary node dissection. Factors that might influence long-term cosmetic results were also analyzed. Irradiation to the breast was administered in 2 Gy fractions, 5 times a week for a total of 50 Gy in all patients. Cobalt-60 γ-rays were used in 108 patients with the exception of 1 patient who received 6 Mev X-ray. Some patients with positive or close margins received boost irradiation of 10 Gy using electron beams to the primary tumor bed. Cosmetic outcome was assessed by both a scoring method and breast retraction assessment (BRA). Forty-seven percent of patients were assessed as excellent to good before radiation therapy. The percent of excellent to good decreased shortly after termination of radiation therapy, but gradually improved and stabilized by 3 years. Seventy percent of patients showed a score of excellent to good 5 years after treatment. The average BRA of the 109 patients was 3.0 cm. This did not change between 3 and 5 years after treatment. A significant correlation between cosmetic score and BRA was shown at all follow-up times. Factors such as age over 50 years (p=0.008), tumor location in the outer quadrant (p=0.02) and boost irradiation (p=0.03) significantly affected the cosmetic score. Arm edema and restriction of shoulder movement were observed in 22% and 49% at the start of radiation therapy, these improved within approximately 3 years and 1 year after treatment, respectively. Mild skin change was observed in 60% of patients even 5 years after treatment. The results indicate that cosmetic outcome after breast conservation therapy is clinically acceptable, and the complication rate is low. (author)

  13. One life saved by four prevented recurrencies? Update of the early breast cancer trialists confirms. Postoperative radiotherapy improves survival after breast conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sautter-Bihl, M.L. [Staedtisches Klinikum Karlsruhe (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Sedlmayer, F. [Landeskrankenhaus Salzburg (Austria); Budach, W. [University Hospital Duesseldorf (DE)] (and others)

    2012-06-15

    The debate about the impact of local control on survival in early breast cancer patients is still going on, in spite of the continuously growing evidence that avoidance of locoregional disease reduces the risk of tumor-specific death. Recently, B. Fisher, one of the pioneers of breast conserving therapy claimed that during the last two decades, as a result of the use of systemic therapy in conjunction with breast conserving surgery and radiation, the incidence of locoregional recurrence has been reduced to a level where further reduction is likely to have little impact on survival. The penultimate meta-analysis of the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) reported the effect of radiotherapy in early breast cancer on recurrence and survival in 2005 and provided the essential message that four prevented local recurrences at 5 years would avoid one breast cancer death in 15 years. The scientific community has eagerly awaited the quinquennial update of the EBCTCG which has now been published. A total of 17 randomized studies comparing postoperative radiotherapy vs. none were analyzed and comprised 7 new studies in addition to follow-up data of from 9 previously reported trials. A total of 10,801 patients with pT1-2 tumors were included, the majority of whom (n=7,287) were node negative, while 1,050 were node positive (2,464 unknown). In contrast to the previous meta-analysis, all patients received breast conserving surgery, consisting of lumpectomy (n=8,422) or more extensive techniques like quadrantectomy or sectoral resection (n= 2,399). The effect of radiotherapy on 10-year recurrences of any type and their relation to the 15-year breast cancer death rate were studied in correlation to various prognostic parameters and treatment characteristics (e.g., surgery, tamoxifen use). Moreover, a subgroup analysis was performed according to low, intermediate, and high initial risk of recurrence, from which the expected absolute benefit was derived

  14. Application analysis of breast magnetic resonance imaging in occult breast cancer and breast-conserving surgery%乳腺 MRI 在隐匿性乳腺癌和保乳手术中的应用分析

    Institute of Scientific and Technical Information of China (English)

    王芹; 马行天; 石岚

    2014-01-01

    目的::探讨乳腺核磁共振成像(MRI)在隐匿性乳腺癌和保乳手术中的应用价值。方法:对120例隐匿性乳腺癌及早期患者进行 MRI 检查,对检查结果进行分析和归纳。结果:入组的58例隐匿性乳腺癌患者 MRI 检查,发现乳腺病灶32例,其中19例经病理证实为原发灶,确诊率为32.7%;入组的62例拟行保乳手术的乳腺癌患者 MRI 检查,有25例发现多中心病灶,其中23例放弃保乳手术。结论:MRI 检查对检出隐匿性乳腺癌原发灶有着有较高的分辨率,对多中心乳腺癌的显示以及明确乳腺癌的保乳适应症,有着重要的临床价值。%Objective: To discuss application values of breast magnetic resonance imaging (MRI) in occult breast cancer and breast-conserving surgery. Methods: Breast MRI was performed in 120 grouped patients. The examination results were analyzed and summarized. Results: In the 58 cases of occult breast cancer patients with breast MRI, 32 cases were found with breast lesions, in which 19 cases were confirmed by pathology as the original site; the diagnosis rate was 32. 7% . In the 62 cases of breast cancer being performed breast-conserving surgery with breast MRI, multiple lesions was found in 25 cases, in which 23 cases gave up breast-con-serving surgery. Conclusions: Breast MRI has a higher resolution in finding the primary lesion of occult breast cancer, and has impor-tant value in the display of breast cancers with multicentric lesions and the indication of breast-conserving surgery.

  15. Identification of Patients at Very Low Risk of Local Recurrence After Breast-Conserving Surgery

    International Nuclear Information System (INIS)

    Purpose: To identify clinical and pathological factors that identify groups of women with stage I breast cancer with a 5-year risk of local recurrence (LR) ≤1.5% after breast-conserving therapy (BCS) plus whole-breast radiation therapy (RT). Methods and Materials: Study subjects were 5974 patients ≥50 years of age whose cancer was diagnosed between 1989 and 2006, and were referred with pT1 pN0 invasive breast cancer treated with BCS and RT. Cases of 5- and 10-year LR were examined using Kaplan-Meier methods. Recursive partitioning analysis was performed in patients treated with and without endocrine therapy to identify combinations of factors associated with a 5-year LR risk ≤1.5%. Results: The median follow-up was 8.61 years. Median age was 63 years of age (range, 50 to 91). Overall 5-year LR was 1.5% (95% confidence interval [CI], 1.2%-1.9%) and 10-year LR was 3.4% (95% CI, 2.8%-4.0%). Of 2830 patients treated with endocrine therapy, patient subsets identified with 5-year LR ≤1.5% included patients with grade 1 histology (n=1038; LR, 0.2%; 95% CI, 0%-0.5%) or grade 2 histology plus ≥60 years of age (n=843; LR, 0.5%; 95% CI, 0%-1.0%). Ten-year LR for these groups were 0.8% (95% CI, 0.1%-1.6%) and 0.9% (95% CI, 0.2%-1.6%), respectively. Of 3144 patients treated without endocrine therapy, patients with grade 1 histology plus clear margins had 5-year LR ≤1.5% (n=821; LR, 0.6%; 95% CI, 0.1%-1.2%). Ten-year LR for this group was 2.2% (95% CI, 1.0%-3.4%). Conclusions: Histologic grade, age, margin status, and use of endocrine therapy identified 45% of a population-based cohort of female patients over age 50 with stage I breast cancer with a 5-year LR risk ≤1.5% after BCS plus RT. Prospective study is needed to evaluate the safety of omitting RT in patients with such a low risk of LR

  16. Identification of Patients at Very Low Risk of Local Recurrence After Breast-Conserving Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Sally L., E-mail: ssmith11@bccancer.bc.ca [Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia (Canada); Truong, Pauline T. [Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia (Canada); Lu, Linghong; Lesperance, Mary [Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia (Canada); Olivotto, Ivo A. [Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)

    2014-07-01

    Purpose: To identify clinical and pathological factors that identify groups of women with stage I breast cancer with a 5-year risk of local recurrence (LR) ≤1.5% after breast-conserving therapy (BCS) plus whole-breast radiation therapy (RT). Methods and Materials: Study subjects were 5974 patients ≥50 years of age whose cancer was diagnosed between 1989 and 2006, and were referred with pT1 pN0 invasive breast cancer treated with BCS and RT. Cases of 5- and 10-year LR were examined using Kaplan-Meier methods. Recursive partitioning analysis was performed in patients treated with and without endocrine therapy to identify combinations of factors associated with a 5-year LR risk ≤1.5%. Results: The median follow-up was 8.61 years. Median age was 63 years of age (range, 50 to 91). Overall 5-year LR was 1.5% (95% confidence interval [CI], 1.2%-1.9%) and 10-year LR was 3.4% (95% CI, 2.8%-4.0%). Of 2830 patients treated with endocrine therapy, patient subsets identified with 5-year LR ≤1.5% included patients with grade 1 histology (n=1038; LR, 0.2%; 95% CI, 0%-0.5%) or grade 2 histology plus ≥60 years of age (n=843; LR, 0.5%; 95% CI, 0%-1.0%). Ten-year LR for these groups were 0.8% (95% CI, 0.1%-1.6%) and 0.9% (95% CI, 0.2%-1.6%), respectively. Of 3144 patients treated without endocrine therapy, patients with grade 1 histology plus clear margins had 5-year LR ≤1.5% (n=821; LR, 0.6%; 95% CI, 0.1%-1.2%). Ten-year LR for this group was 2.2% (95% CI, 1.0%-3.4%). Conclusions: Histologic grade, age, margin status, and use of endocrine therapy identified 45% of a population-based cohort of female patients over age 50 with stage I breast cancer with a 5-year LR risk ≤1.5% after BCS plus RT. Prospective study is needed to evaluate the safety of omitting RT in patients with such a low risk of LR.

  17. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

    International Nuclear Information System (INIS)

    The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation. A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median Dmax) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %). After a median follow-up of 97 months (range 4-170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03). Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3. (orig.)

  18. Comparison of Breast-Conserving Surgery and Modified Radical Surgery in Early Breast Cancer%早期乳腺癌保乳手术与改良根治手术的临床效果比较

    Institute of Scientific and Technical Information of China (English)

    赵怡; 章骏; 杨志刚; 曹伟; 周成亮

    2011-01-01

    目的:比较早期乳腺癌保乳手术与改良根治手术的临床效果,探讨治疗早期乳腺癌的最佳手术方案.方法:选择早期乳腺癌患者138例,根据自愿的原则,分为保乳组(BCS)和根治组(MRS),保乳组采取保乳手术方案,根治组采用改良根治手术方案,比较两组患者手术时间、术中出血量、切口长度、住院时间、术后并发症、美容效果满意率及患者预后情况.结果:两组患者手术时间、术中出血量、切口长度、住院时间、术后并发症、美容效果满意率比较,差异具有(高度)统计学意义(P0.05).结论:早期乳腺癌患者外科手术治疗时,应首选保乳手术方式治疗.%Objective: To compare the clinical effects of breast-conserving surgery and modified radical surgery treating in the early breast cancer and research the best surgery program in the early breast cancer.Method: Collect 138 early breast cancer patients,according to the principle of voluntary,76 patients were divided into BCS group with the breast-conserving surgery; 62 patients were divided into MRS group with the modified radical surgery,then compare the operation time,the blood loss, the incision length, the length of hospital stay, the postoperative complications, the satisfaction rate of cosmetic effect and the patients' prognosis.Result: There was a significant (P <0.01 ,P <0.05) in the operation time, the blood loss,the incision length,the length of hospital stay, the postoperative complications, the satisfaction rate of cosmetic effect; there was no significant (P>0.05) in the number of relapse or death patients after 12 months, 18 months and 24 months.Conclusion: When we treat early breast cancer patients by the surgery, we should choose the breast-conserving surgery first.

  19. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status

    International Nuclear Information System (INIS)

    Purpose: This study was performed to determine the long-term outcome for women with mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. Methods and Materials: An analysis was performed of 422 mammographically detected intraductal breast carcinomas in 418 women from 11 institutions in North America and Europe. All patients were treated with breast-conserving surgery followed by definitive breast irradiation. The median follow-up time was 9.4 years (mean, 9.4 years; range, 0.1-19.8 years). Results: The 15-year overall survival rate was 92%, and the 15-year cause-specific survival rate was 98%. The 15-year rate of freedom from distant metastases was 94%. There were 48 local failures in the treated breast, and the 15-year rate of any local failure was 16%. The median time to local failure was 5.0 years (mean, 5.7 years; range, 1.0-15.2 years). Patient age at the time of treatment and final pathology margin status from the primary tumor excision were both significantly associated with local failure. The 10-year rate of local failure was 31% for patient age ≤ 39 years, 13% for age 40-49 years, 8% for age 50-59 years, and 6% for age ≥ 60 years (p=0.0001). The 10-year rate of local failure was 24% when the margins of resection were positive, 9% when the margins of resection were negative, 7% when the margins of resection were close, and 12% when the margins of resection were unknown (p=0.030). Patient age ≤ 39 years and positive margins of resection were both independently associated with an increased risk of local failure (p=0.0006 and p=0.023, respectively) in the multivariable Cox regression model. Conclusions: The 15-year results from the present study demonstrated high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of mammographically detected ductal carcinoma in situ of the

  20. Breast-Conservative Surgery With Close or Positive Margins: Can the Breast Be Preserved With High-Dose-Rate Brachytherapy Boost?

    International Nuclear Information System (INIS)

    Purpose: To evaluate the likelihood of preserving the breast in women who show close or positive margins after conservative surgery for early breast carcinoma. Methods and Materials: Since 1996, 125 women with less than 5 mm or positive margins and positive separate cavity margin sampling were entered in a prospective trial with high-dose radiotherapy. A standard dose of 50 Gy to the whole breast was followed by a high-dose-rate brachytherapy application delivering 3 fractions of 4.4 Gy in 24 hours. The median follow-up was 84 months. Results: There were only seven local recurrences, with an actuarial local control rate of 95.8% at 5 years and 91.1% at 9 years. Actuarial overall and cause-specific survival rates were 92.6% and 95% at 5 years and 86.7% and 90.4% at 9 years, respectively. Late fibrosis was the most common complication, in 30% of patients, with good or excellent cosmetic results in 77%. The final result was that 95.2% of breasts were preserved. Conclusions: Close or positive-margin breast cancer can be well managed with a high-dose boost in a wide tumor bed by means of high-dose-rate brachytherapy. This technique can avoid mastectomy or poor cosmetic resection, with minimal risk of local or general failure

  1. Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival

    International Nuclear Information System (INIS)

    Purpose: Delays in the diagnosis of breast cancer are associated with advanced stage and poor survival, but the importance of the time interval between lumpectomy and initiation of radiation therapy (RT) has not been well studied. We investigated factors that influence the time interval between lumpectomy and RT, and the association between that interval and survival. Patients and Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database on women aged 65 years and older, diagnosed with Stages I-II breast cancer, between 1991 and 1999. Among patients who did not receive chemotherapy, we studied factors associated with the time interval between lumpectomy and the initiation of RT, and the association of delay with survival, using linear regression and Cox proportional hazards modeling. Results: Among 24,833 women with who underwent lumpectomy, 13,907 (56%) underwent RT. Among those receiving RT, 97% started treatment within 3 months; older age, black race, advanced stage, more comorbidities, and being unmarried were associated with longer time intervals between surgery and RT. There was no benefit to earlier initiation of RT; however, delays >3 months were associated with higher overall mortality (hazard ratio, 1.92; 95% confidence interval, 1.64-2.24) and cancer-specific mortality (hazard ratio, 3.84; 95% confidence interval 3.01-4.91). Conclusions: Reassuringly, early initiation of RT was not associated with survival. Although delays of >3 months are uncommon, they are associated with poor survival. Whether this association is causal or due to confounding factors, such as poor health behaviors, is unknown; until it is better understood, efforts should be made to initiate RT in a timely fashion

  2. Cosmetic Evaluation Methods Adapted to Asian Patients after Breast-Conserving Surgery and Examination of the Necessarily Elements for Cosmetic Evaluation

    OpenAIRE

    Nohara, Yuki; Hanamura, Noriko; Zaha, Hisamitsu; Kimura, Hiroko; Kashikura, Yumi; Nakamura, Takashi; Noro, Aya; Imai, Nao; Shibusawa, Mai; Ogawa, Tomoko

    2015-01-01

    Purpose Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS. Methods Frontal photographs of 190 Japan...

  3. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy

    International Nuclear Information System (INIS)

    Purpose: Although breast-conserving surgery followed by radiotherapy (RT) has become a standard treatment option for patients with ductal carcinoma in situ of the breast, risk factors for ipsilateral breast tumor recurrence (IBTR) in these patients remain an active area of investigation. The purpose of this study was to evaluate the impact of clinical and pathologic features on long-term outcome in a cohort of DCIS patients treated with breast-conserving surgery plus RT. Methods and Materials: Between 1973 and 1998, 230 patients with DCIS were treated with breast-conserving surgery plus RT at our institution. All patients were treated by local excision followed by RT to the breast to a total median tumor bed dose of 64 Gy. Adjuvant hormonal therapy was used in only 20 patients (9%). All available clinical, pathologic, and outcome data, including ipsilateral and contralateral events, were entered into a computerized database. The clinical and pathologic variables evaluated included detection method, mammographic appearance, age, family history, histologic subtype, presence of necrosis, nuclear grade, final margin status, and use of adjuvant hormonal therapy. Results: As of December 15, 2000, with a median follow-up of 8.2 years, 17 patients had developed a recurrence in the ipsilateral breast, resulting in a 5- and 10-year IBTR rate of 5% and 13%, respectively. Contralateral breast cancer developed in 8 patients, resulting in a 10-year contralateral recurrence rate of 5%. Patient age, family history, histologic subtype, margin status, and tumor grade were not significantly associated with recurrence on univariate analysis. A significantly higher rate of local relapse was observed in patients with the presence of necrosis. The 10-year relapse rate was 22% in 88 patients with necrosis compared with 7% in 142 patients without necrosis (p <0.01). In multivariate analysis, the presence of necrosis remained a significant predictor of local relapse. No breast relapses

  4. Dosimetric study comparing volumetric arc modulation with RapidArc and fixed dynamic intensity-modulated radiation therapy for breast cancer radiotherapy after breast-conserving surgery

    International Nuclear Information System (INIS)

    Objective: To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery. Methods: Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery. After target definition, treatment planning was performed by RapidArc and two fixed fields dynamic IMRT respectively on the same CT scan. The target dose distribution, homogeneity of the breast, and the irradiation dose and volume for the lungs, heart, and contralateral breast were read in the dose-volume histogram (DVH) and compared between RapidArc and IMRT. The treatment delivery time and monitor units were also compared. Results: In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV), the volume proportion of 95% prescribed dose (V95%) was significantly higher by 0.65% in RapidArc (t=5.16, P=0.001), and the V105% and V110% were lower by 10.96% and 1.48 % respectively, however, without statistical significance (t=-2.05, P=0.055 and t=-1.33, P=0.197). The conformal index of planning target volume (PTV) by the RapidArc planning was (0.88±0.02), significantly higher than that by the IMRT planning [(0.74±0.03), t=18.54, P<0.001]. The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01, significantly lower than that by the IMRT planning (1.12±0.02, t=-2.44, P=0.02). There were no significant differences in the maximum dose (Dmax) and V20 for the ipsilateral lung between the RapidArc and IMRT planning, but the values of V10, V5, Dmin and Dmean by RapidArc planning were all significantly higher than those by the IMRT planning (all P<0.01). The values of max dose and V30 for the heart were similar by both techniques, but the values of V10 and V5 by the RapidArc planning were significantly higher (by 18% and 50%, respectively). The V5 of the contralateral breast and lung by the RapidArc planning were increased by 9

  5. Hypofractionated and Accelerated Radiotherapy With Subcutaneous Amifostine Cytoprotection as Short Adjuvant Regimen After Breast-Conserving Surgery: Interim Report

    International Nuclear Information System (INIS)

    Purpose: Short radiotherapy schedules might be more convenient for patients and overloaded radiotherapy departments, provided late toxicity is not increased. We evaluated the efficacy and toxicity of a hypofractionated and highly accelerated radiotherapy regimen supported with cytoprotection provided by amifostine in breast cancer patients treated with breast-conserving surgery. Methods and Materials: A total of 92 patients received 12 consecutive fractions of radiotherapy (3.5 Gy/fraction for 10 fractions) to the breast and/or axillary/supraclavicular area and 4 Gy/fraction for 2 fractions to the tumor bed). Amifostine at a dose of 1,000 mg/d was administered subcutaneously. The follow-up of patients was 30-60 months (median, 39). Results: Using a dose individualization algorithm, 77.1% of patients received 1,000 mg and 16.3% received 750 mg of amifostine daily. Of the 92 patients, 13% interrupted amifostine because of fever/rash symptoms. Acute Grade 2 breast toxicity developed in 6.5% of patients receiving 1,000 mg of amifostine compared with 46.6% of the rest of the patients (p < .0001). The incidence of Grade 2 late sequelae was less frequent in the high amifostine dose group (3.2% vs. 6.6%; p = NS). Grade 1 lung fibrosis was infrequent (3.3%). The in-field relapse rate was 3.3%, and an additional 2.2% of patients developed a relapse in the nonirradiated supraclavicular area. c-erbB-2 overexpression was linked to local control failure (p = .01). Distant metastasis appeared in 13% of patients, and this was marginally related to more advanced T/N stage (p = .06). Conclusion: Within a minimal follow-up of 2.5 years after therapy, hypofractionated and accelerated radiotherapy with subcutaneous amifostine cytoprotection has proved a well-tolerated and effective regimen. Longer follow-up is required to assess the long-term late sequelae.

  6. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Risk-modifying factors

    International Nuclear Information System (INIS)

    The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis. LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5). Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters. (orig.)

  7. Recommendations from GEC ESTRO Breast Cancer Working Group (I): Target definition and target delineation for accelerated or boost Partial Breast Irradiation using multicatheter interstitial brachytherapy after breast conserving closed cavity surgery

    International Nuclear Information System (INIS)

    Objective: The aim was to develop a delineation guideline for target definition for APBI or boost by consensus of the Breast Working Group of GEC-ESTRO. Proposed recommendations: Appropriate delineation of CTV (PTV) with low inter- and intra-observer variability in clinical practice is complex and needs various steps as: (1) Detailed knowledge of primary surgical procedure, of all details of pathology, as well as of preoperative imaging. (2) Definition of tumour localization before breast conserving surgery inside the breast and translation of this information in the postoperative CT imaging data set. (3) Calculation of the size of total safety margins. The size should be at least 2 cm. (4) Definition of the target. (5) Delineation of the target according to defined rules. Conclusion: Providing guidelines based on the consensus of a group of experts should make it possible to achieve a reproducible and consistent definition of CTV (PTV) for Accelerated Partial Breast Irradiation (APBI) or boost irradiation after breast conserving closed cavity surgery, and helps to define it after selected cases of oncoplastic surgery

  8. Features of nursing care provided for breast cancer patients treated with radiotherapy following breast-conserving surgery. Comparison of nursing practices between certified nurses in breast cancer nursing and non-specialist nurses working with breast cancer patients

    International Nuclear Information System (INIS)

    This study aimed to identifying features of nursing care provided for breast cancer patients during the course of radiotherapy following breast-conserving surgery and improve the quality of nursing care. Subjects were certified nurses in breast cancer nursing (CN) and non-specialist nurses working with breast cancer patients (NS). An anonymous survey questionnaire on nursing care and other practices provided before, during, and after radiotherapy was conducted by postal mail and the results were compared between CN and NS. Valid responses were obtained from 40 CN (41.2%) and 102 NS (56.7%). Significant differences between CN and NS were observed for 15 of 27 (55.6%) care items before radiotherapy, 18 of 18 (100%) items during radiotherapy, and 9 of 20 (45.0%) items after radiotherapy. Among the items with significant differences, significantly more NS than CN performed all nursing care items during the course of radiotherapy, except for one item provided before radiotherapy. These results demonstrate that it is necessary to facilitate enhanced collaboration and coordination between CN and NS providing nursing care for breast cancer patients in order to improve the quality of nursing care delivered to patients. (author)

  9. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast cancer: 20-year follow-up of the Danish randomized DBCG-82TM protocol

    DEFF Research Database (Denmark)

    Blichert-Toft, M.; Nielsen, M.; During, M.;

    2008-01-01

    The main objective of the present study aims at comparing the long-term efficacy of breast conserving surgery (BCS) vs. mastectomy (M) based on a randomized design. The Danish Breast Cancer Cooperative Group (DBCG) conducted the trial (DBCG-82TM) from January 1983 to March 1989 recruiting 1154...... patients with invasive breast carcinoma. Follow-up time ended 1(st) May 2006 with a median follow-up time of 19.6 years (time span 17.1-23.3 years). Eligibility criteria included a one-sided, unifocal, primary operable breast carcinoma, patient age below 70 years, probability of satisfactory cosmetic...... complete series. 10-year recurrence free survival (RFS) and 20-year overall survival (OS) based on intent to treat did not reveal significant differences in outcome between breast conserving surgery vs. mastectomy, p=0.95 and p=0.10, respectively. Including the complete series comprising 1133 eligible...

  10. Does Concurrent Radiochemotherapy Affect Cosmetic Results in the Adjuvant Setting After Breast-Conserving Surgery? Results of the ARCOSEIN Multicenter, Phase III Study: Patients' and Doctors' Views

    International Nuclear Information System (INIS)

    Purpose: To evaluate the cosmetic results of sequential vs. concurrent adjuvant chemotherapy with radiotherapy after breast-conserving surgery for breast cancer, and to compare ratings by patients and physicians. Methods and Materials: From 1996 to 2000, 716 patients with Stage I-II breast cancers were included in a multicenter, Phase III trial (the ARCOSEIN study) comparing, after breast-conserving surgery with axillary dissection, sequential treatment with chemotherapy first followed by radiotherapy vs. chemotherapy administered concurrently with radiotherapy. Cosmetic results with regard to both the overall aspect of the breast and specific changes (color, scar) were evaluated in a total of 214 patients (107 in each arm) by means of questionnaires to both the patient and a physician whose rating was blinded to treatment allocation. Results: Patients' overall satisfaction with cosmesis was not statistically different between the two arms, with approximately 92% with at least satisfactory results (p = 0.72), although differences between the treated and untreated breasts were greater after the concurrent regimen (29% vs. 14% with more than moderate differences; p 0.0015). Physician assessment of overall cosmesis was less favorable, with lower rates of at least satisfactory results in the concurrent arm (60% vs. 85%; p = 0.001). Consequently, the concordance for overall satisfaction with cosmesis between patients and doctors was only fair (κ = 0.62). Conclusion: After breast-conserving surgery, the concurrent use of chemotherapy with radiotherapy is significantly associated with greater differences between the breasts. These differences do not translate into patients' lessened satisfaction with cosmesis

  11. Radiation Therapy After Breast-Conserving Surgery: Does Hospital Surgical Volume Matter? A Population-Based Study in Taiwan

    International Nuclear Information System (INIS)

    Purpose: To examine the association between hospital surgical volume and the use of radiation therapy (RT) after breast-conserving surgery (BCS) in Taiwan. Methods and Materials: We used claims data from the National Health Insurance program in Taiwan (1997–2005) in this retrospective population-based study. We identified patients with breast cancer, receipt of BCS, use of radiation, and the factors that could potentially associated with the use of RT from enrollment records, and the ICD-9 and billing codes in claims. We conducted logistic regression to examine factors associated with RT use after BCS, and performed subgroup analyses to examine whether the association differs by medical center status or hospital volumes. Results: Among 5,094 patients with newly diagnosed invasive breast cancer who underwent BCS, the rate of RT was significantly lower in low-volume hospitals (74% vs. 82%, p < 0.01). Patients treated in low-volume hospitals were less likely to receive RT after BCS (odds ratio = 0.72, 95% confidence interval = 0.62–0.83). In addition, patients treated after the implementation of the voluntary pay-for-performance policy in 2001 were more likely to receive RT (odds ratio = 1.23; 95% confidence interval = 1.05–1.45). Subgroup analyses indicated that the high-volume effect was limited to hospitals accredited as non–medical centers, and that the effect of the pay-for-performance policy was most pronounced among low-volume hospitals. Conclusions: Using population-based data from Taiwan, our study concluded that hospital surgical volume and pay-for-performance policy are positively associated with RT use after BCS.

  12. Method of localization and implantation of the lumpectomy site for high dose rate brachytherapy after conservative surgery for T1 and T2 breast cancer

    International Nuclear Information System (INIS)

    Purpose: This article describes our technique of localization and implantation of the lumpectomy site of patients with T1 and T2 breast cancer. Our method was developed as part of our Phase I/II pilot study of high dose rate (HDR) brachytherapy alone after conservative surgery for early breast cancer. Methods and Materials: In March 1992, we started a pilot study of HDR brachytherapy to the lumpectomy site as the sole radiotherapy after conservative surgery for clinical T1 or T2 invasive breast cancer. Initially, the protocol required intraoperative placement of the interstitial needles at the time of definitive surgery to the breast. The protocol was then generalized to allow the implantation of the lumpectomy site after definitive surgery to the breast, either at the time of subsequent axillary nodal dissection or postoperatively. To date, five patients have been implanted intraoperatively at the time of definitive breast surgery. Twelve patients were implanted after definitive breast surgery, with 7 patients being done at the time of axillary nodal dissection and 5 patients postoperatively. We devised a method of accurately localizing and implanting the lumpectomy site after definitive breast surgery. The method relies on the previous placement of surgical clips by the referring surgeon to mark the lumpectomy site. For each patient, a breast mold is made with radio-opaque angiocatheters taped onto the mold in the supero-inferior direction. A planning CT scan is then obtained through the lumpectomy site. The volume of the lumpectomy site, the number of implant planes necessary, and the orientation of the implants are then determined from the CT scan. The angiocatheters provide a reference grid on the CT films to locate the entry and exit points of the interstitial needles on the plastic mold. The entry and exit points for reference needles are then transferred onto the patient's skin enabling implantation of the lumpectomy site. Needle positions with respect to

  13. The rate of breast-conserving surgery in early breast cancer: an audit of surgical practice at St Vincent's campus, NSW in 1990 and 1994

    International Nuclear Information System (INIS)

    An audit was undertaken to document the use of breast-conserving surgery (BCS) as pereferred local therapy in the management of early breast cancer (EBC) at St Vincent's campus during two time periods, the calendar years 1990 and 1994. The medical records of all women diagnosed with a new primary breast cancer at St Vincent's Public and Private Hospitals initially treated during 1990 and 1994 were reviewed to document patient, tumour and treatment characteristics. Comparisons were made with data on BCS in EBC from the Australian medical literature. A total of 228 patients was managed with a definitive surgical procedure in the years 1990 and 1994. There were no major differences in the manner of presentation, the tumour subtypes or the treatment techniques between the two years. There was an apparent increase in the number of tumours < 2 cm managed in 1994 but no major difference in the use of BCS. The BCS rates for the two years were 33 and 36%, respectively. There were wide variations in the rate of BCS between surgeons, and for the same surgeon, between the two calendar years. These data from a major teaching hospital serving a largely non-mammographically screened population would suggest that BCS rates for EBC are lower than expected. The data on BCS rates for EBC in Australia are limited and the optimal rate of BCS in current practice is unknown. Copyright (1999) Blackwell Science Pty Ltd

  14. PDR brachytherapy with flexible implants for interstitial boost after breast-conserving surgery and external beam radiation therapy

    International Nuclear Information System (INIS)

    Background and purpose: For radiobiological reasons the new concept of pulsed dose rate (PDR) brachytherapy seems to be suitable to replace traditional CLDR brachytherapy with line sources. PDR brachytherapy using a stepping source seems to be particularly suitable for the interstitial boost of breast carcinoma after breast-conserving surgery and external beam irradiation since in these cases the exact adjustment of the active lengths is essential in order to prevent unwanted skin dose and consequential unfavorable cosmetic results. The purpose of this study was to assess the feasibility and morbidity of a PDR boost with flexible breast implants. Materials and methods: Sixty-five high risk patients were treated with an interstitial PDR boost. The criteria for an interstitial boost were positive margin or close margin, extensive intraductal component (EIC), intralymphatic extension, lobular carcinoma, T2 tumors and high nuclear grade (GIII). Dose calculation and specification were performed following the rules of the Paris system. The dose per pulse was 1 Gy. The pulse pauses were kept constant at 1 h. A geometrically optimized dose distribution was used for all patients. The treatment schedule was 50 Gy external beam to the whole breast and 20 Gy boost. PDR irradiations were carried out with a nominal 37 GBq 192-Ir source. Results: The median follow-up was 30 months (minimum 12 months, maximum 54 months). Sixty percent of the patients judged their cosmetic result as excellent, 27% judged it as good, 11% judged it as fair and 2% judged it as poor. Eighty-six percent of the patients had no radiogenous skin changes in the boost area. In 11% of patients minimal punctiform telangiectasia appeared at single puncture sites. In 3% ((2(65))) of patients planar telangiectasia appeared on the medial side of the implant. The rate of isolated local recurrences was 1.5%. In most cases geometrical volume optimization (GVO) yields improved dose distributions with respect to

  15. Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions

    OpenAIRE

    Allen Laura J; Pham Jane T; Gomez Scarlett L

    2009-01-01

    Abstract Background US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM) than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT). Methods We surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147) physicians complet...

  16. Dose-Volume Analysis of Lung and Heart according to Respiration in Breast Cancer Patients Treated with Breast Conserving Surgery

    OpenAIRE

    Shim, Jae-Goo; Kim, Jeong-Koo; Park, Won; Seo, Jeong-Min; Hong, Chae-Sun; Song, Ki-Won; Lim, Cheong-Hwan; Jung, Hong-Ryang; Kim, Chan-Hyeong

    2012-01-01

    Purpose Adjuvant radiotherapy of breast cancer using a photon tangential field incurs a risk of late heart and lung toxicity. The use of free breathing (FB), expiration breath hold (EBH), and deep inspiration breath hold (DIBH) during tangential breast radiotherapy as a means of reducing irradiated lung and heart volume was evaluated. Methods In 10 women with left-sided breast cancer (mean age, 44 years) post-operative computed tomography (CT) scanning was done under different respiratory con...

  17. 2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography after breast conserving surgery: Correlation with molecular markers of breast cancer

    Science.gov (United States)

    Ozguven, Salih; Inanir, Sabahat; Turoglu, Halil Turgut; Erdil, Tanju Yusuf; Ugurlu, Mustafa Umit; Gulluoglu, Bahadir

    2016-01-01

    Aim: To investigate the role of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) early after breast-conserving surgery (BCS) in patients with breast cancer (BC) and whether we can determine which molecular biomarkers of breast carcinoma put the patients at risk. Materials and Methods: This retrospective study involved 88 patients with histologically proven T1 or T2 BC, who were treated with BCS and underwent 18F-FDG PET/CT study. The correlation between biological markers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2], and Ki-67) of the primary tumor and 18F-FDG PET/CT findings was analyzed. Results: 18F-FDG PET/CT demonstrated the presence of BC disease (locoregional disease [LRD], distant metastases, or contralateral BC) in 26 of 88 patients (29.5%). Regarding immunohistochemical profiles, BC expressing high levels of Ki-67 were associated with an increased percentage of LRD, which was the major recurrence pattern on 18F-FDG PET/CT. Although the BC disease was observed more commonly in patients with HER2 positivity compared to those of HER2 negative, the difference did not reach statistical significance. The patients with T2 tumor or a higher histopathological grade had a higher percentage of BC disease. Conclusions: This study demonstrated that patients with early stage BC treated with BCS have a remarkable risk of the presence of BC even early after surgery, and there was a clinically important relationship between 18F-FDG PET/CT findings and biological markers of BC. These findings suggest that high-risk molecular biomarkers (Ki-67, HER2) can be taken into account in the decision-making the process for both preoperative imaging and planning of the surgical approach. PMID:27385883

  18. Oncoplastic Approaches to Breast Conservation

    Directory of Open Access Journals (Sweden)

    Dennis R. Holmes

    2011-01-01

    Full Text Available When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemibatwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, inframammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate.

  19. Oncoplastic Approaches to Breast Conservation

    International Nuclear Information System (INIS)

    When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic teams in determining which approach is most suitable for their patient's tumor size, tumor location, body habitus, and desired cosmetic outcome we present a review of several oncoplastic surgical approaches. For resections located anywhere in the breast, the radial ellipse segmentectomy incision and circumareolar approach for segmental resection are discussed. For resections in the upper or central breast, crescent mastopexy, the batwing incision, the hemi batwing incision, donut mastopexy, B-flap resection, and the central quadrantectomy are reviewed. For lesions of the lower breast, the triangle incision, infra mammary incision, and reduction mastopexy are discussed. Surgeons who are interested in adding oncoplastic breast conserving therapies to their skill sets are encouraged to implement these surgical techniques where applicable and to seek out breast fellowships or enhanced training when appropriate

  20. Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer

    International Nuclear Information System (INIS)

    Purpose: To identify predicting factors for local failure and increased risk of distant metastases by statistical analysis of the data after breast-conserving treatment for early breast cancer. Methods and Materials: Between January 1976 and December 1993, 528 patients with nonmetastatic T1 (tumors ≤ 1 cm [n = 197], >1 cm [n = 220]) or T2 (tumors ≤ 3 cm [n 111]) carcinoma of the breast underwent wide excision (n = 435) or quadrantectomy (n = 93) with axillary dissection (negative nodal status [n-]: 396; 1-3 involved nodes: 100; >3 involved nodes: 32). Radiotherapy consisted of 45 Gy to the entire breast via tangential fields. Patients with positive axillary lymph nodes received 45 Gy to the axillary and supraclavicular area. Patients with positive axillary nodes and/or inner or central tumor locations received 50 Gy to the internal mammary lymph node area. A boost dose was delivered to the primary site by iridium 192 implant in 298 patients (mean total dose: 15.2 ± 0.07 Gy, range: 15-25 Gy) or by electrons in 225 patients (mean total dose: 14.8 ± 0.09 Gy, range: 5-20 Gy). The mean age was 52.5 ± 0.5 years (range: 26-86 years) and 267 patients were postmenopausal. Histologic types were as follows: 463 infiltrating ductal carcinomas, 39 infiltrating lobular carcinomas, and 26 other histotypes. Grade distribution according to the Scarff, Bloom, and Richardson (SBR) classification was as follows: 149 grade 1, 271 grade 2, 73 grade 3, and 35 nonclassified. The mean tumor size was 1.6 ± 0.3 cm (range: 0.3-3 cm). The intraductal component of the primary tumor was extensive (EIC = IC ≥ 25%) in 39 patients. Tumors were microscopically bifocal in 33 cases. Margins were assessed in the majority of cases by inking of the resection margins and were classified as positive in 13 cases, close (≤2 mm) in 21, negative (>2 mm tumor-free margin) in 417, and indeterminate in 77. Peritumoral vascular invasion was observed in 40 patients. Tamoxifen was administered for at

  1. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Five-year Results of 100 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Formenti, Silvia C., E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Hsu, Howard; Fenton-Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Roses, Daniel; Guth, Amber [Department of Surgery, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Jozsef, Gabor [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States); Goldberg, Judith D. [Division of Biostastistics, Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York (United States); DeWyngaert, J. Keith [Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York (United States)

    2012-11-01

    Purpose: To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position. Methods and Materials: Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded. Results: One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36

  2. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log–rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence–free survival (IBRFS), distant metastasis–free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their

  3. Estrogen-Dependent Prognostic Significance of Cyclooxygenase-2 Expression in Early-Stage Invasive Breast Cancers Treated With Breast-Conserving Surgery and Radiation

    International Nuclear Information System (INIS)

    Purpose: To evaluate the prognostic significance of cyclooxygenase-2 (COX-2) in breast cancer patients treated with conservative surgery and radiation therapy (CS+RT). Methods and Materials: Between 1975 and 2003, we retrieved specimens from 504 breast cancer patients treated with CS+RT. The specimens were constructed into tissue microarrays processed and stained for estrogen receptor (ER), progesterone receptor, Her2/neu, and COX-2. Each core was scored as positive or negative. All data including demographics, clinical, pathologic, staging, and outcome variables were entered into a computerized database. Results: Expression of COX-2 was positive in 58% of cases and correlated with younger age (p = 0.01) and larger tumor size (p 0.001). Expression of COX-2 was predictive of local relapse (relative risk[RR], 3.248; 95% confidence interval [CI], 1.340-7.871; p = 0.0091), distant metastasis (RR, 2.21; 95% CI, 1.259-3.896; p = 0.0058), and decreased survival (RR, 2.321; 95% CI, 1.324-4.071; p = 0.0033). Among ER-positive patients, COX-2 expression was predictive of worse local control (85% vs. 93%, p = 0.04), distant metastasis (75% vs. 95%, p = 0.002) and worse survival (65% vs. 94%, p = 0.002). Among ER-negative tumors COX-2 expression was not significantly correlated with local control (87 vs. 95%, p = 0.12), distant metastasis (73% vs. 78%, p = 0.39), or survival (77% vs. 87%, p 0.15). Conclusions: In breast cancer patients treated with CS+RT, COX-2 expression is associated with younger age, larger tumor size, worse local control, distant metastasis, and worse overall survival. The significance is limited to hormone receptor-positive tumors, consistent with the known effect of COX-2/PGE2 on aromatase activity. Use of COX-2 inhibitors in estrogen-dependent breast cancers warrants further investigation

  4. Comparing the effects of conventional and hypofractionated radiotherapies on early skin toxicity and cosmetic outcomes after breast cancer conserving surgery

    OpenAIRE

    Haddad, P; AR Sebzari; B Kalaghchi; F Amouzegar Hashemi; Z Shahabi

    2012-01-01

    Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.Methods: Fifty-two patients with operable...

  5. Second cancers after conservative surgery and radiation for stages I-II breast cancer: identifying a subset of women at increased risk

    International Nuclear Information System (INIS)

    Purpose: To assess the risk and patterns of second malignancy in a group of women treated with conservative surgery and radiation in a relatively contemporary manner for early-stage invasive breast cancer, and to identify a subgroup of these women at increased risk for a second cancer. Methods and Materials: From 1978 to 1994, 1,253 women with unilateral Stage I-II breast cancer underwent wide excision, axillary dissection, and radiation. The median follow-up was 8.9 years, with 446 patients followed for ≥10 years. The median age was 55 years. Sixty-eight percent had T1 tumors and 74% were axillary-node negative. Radiation was directed to the breast only in 78%. Adjuvant therapy consisted of chemotherapy in 19%, tamoxifen in 19%, and both in 8%. Factors analyzed for their association with the cumulative incidence of all second malignancies, contralateral breast cancer, and non-breast cancer malignancy were: age, menopausal status, race, family history, obesity, smoking, tumor size, location, histology, pathologic nodal status, region(s) treated with radiation, and the use and type of adjuvant therapy. Results: One hundred seventy-six women developed a second malignancy (87 contralateral breast cancers at a median interval of 5.8 years, and 98 non-breast cancer malignancies at a median interval of 7.2 years). Nine women had both a contralateral breast cancer and non-breast cancer second malignancy. The 5- and 10-year cumulative incidences of a second malignancy were 5% and 16% for all cancers, 3% and 7% for contralateral breast cancer, 3% and 8%, for all second non-breast cancer malignancies, and 1% and 5%, respectively, for second non-breast cancer malignancies, excluding skin cancers. Patient age was a significant factor for contralateral breast cancer and non-breast cancer second malignancy. Young age was associated with an increased risk of contralateral breast cancer, while older age was associated with an increased the risk of a second non-breast cancer

  6. Aesthetic Evaluation in Oncoplastic and Conservative Breast Surgery: A Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Michela Massa, MD

    2015-03-01

    Conclusions: In our experience, when the inclusion criteria are satisfied and the equipment is available, oncoplastic techniques associated with IORT should be considered the treatment of choice for breast cancer in early stage. The excellent cosmetic results and patient’s satisfaction encourage us to continue on this way.

  7. Cost-effectiveness of radiation therapy following conservative surgery for ductal carcinoma in situ of the breast

    International Nuclear Information System (INIS)

    Purpose: To assess the cost-effectiveness of radiation therapy (RT) in patients with ductal carcinoma in situ (DCIS) after breast-conserving surgery (BCS). Methods and materials: A Markov model was constructed for a theoretical cohort of 55-year-old women with DCIS over a life-time horizon. Probability estimates for local noninvasive (N-INV), local invasive (INV), and distant recurrences were obtained from National Surgical Adjuvant Breast and Bowel Project (NSABP) B-17. Utilities for eight nonmetastatic health states were collected from both healthy women and DCIS patients. Direct medical (2002 Medicare fee schedule) and nonmedical costs (time and transportation) of RT were ascertained. Results: For BCS + RT vs. BCS alone, the estimated N-INV and INV rates at 12 years were 9% and 8% vs. 16% and 18%, respectively. The incremental cost of adding RT was $3300 despite an initial RT cost of $8700 due to higher local recurrence-related salvage costs incurred with the BCS alone strategy. An increase of 0.09 quality-adjusted life-years (QALYs) primarily reflected the lower risk of INV with RT, resulting in an incremental cost-effectiveness ratio (ICER) of $36,700/QALY. Sensitivity analyses revealed the ICER to be affected by baseline probability of a local recurrence, relative efficacy of RT in preventing INV, negative impact of an INV on quality of life, and cost of initial RT. Cost of salvage BCS + RT and source of utilities (healthy women vs. DCIS patients) influenced the ICER albeit to a lesser degree. Conclusions: Addition of RT following BCS for patients with DCIS should not be withheld because of concerns regarding its cost-effectiveness

  8. Dosimetric evaluation of CR, 3DCRT and two types of IMRT for breast cancer after conservative surgery

    Institute of Scientific and Technical Information of China (English)

    Fuli Zhang; Yongqian Zhang; Yadi Wang

    2013-01-01

    Objective: The purpose of this study was to compare the dose distribution and dose volume histogram (DVH) of the planning target volume (PTV) and organs at risk (OARs) among conventional radiation therapy (CR), three-dimensional conformal radiation therapy (3DCRT), two-step intensity-modulated radiation therapy (TS-IMRT) and direct machine parameter optimization intensity-modulated radiation therapy (DMPO-IMRT) after breast-conserving surgery. Methods: For each of 20 randomly chosen patients, 4 plans were designed using 4 irradiation techniques. The prescribed dose was 50 Gy/2 Gy/25 f, 95% of the planning target volume received this dose. The cumulated DVHs and 3D dose distributions of CR, 3DCRT, TSIMRT and DMPO-IMRT plans were compared. Results: For the homogeneity indices, no statistically significant difference was observed among CR, 3DCRT, TS-IMRT and DMPO-IMRT while the difference of the conformality indices were statistically significant. With regard to the organs at risk, IMRT and 3DCRT showed a significantly fewer exposure dose to the ipsilateral lung than CR in the high-dose area while in the low-dose area, IMRT demonstrated a significant increase of exposure dose to ipsilateral lung, heart and contralateral breast compared with 3DCRT and CR. In addition, the monitor units (MUs) for DMPOIMRT were approximately 26% more than those of TS-IMRT and the segments of the former were approximately 24% less than those of the latter. Conclusion: Compared with CR, 3DCRT and IMRT improved the homogeneity and conformity of PTV, reduced the irradiated volume of OARs in high dose area but IMRT increased the irradiated volume of OARs in low dose area. DMPO-IMRT plan has fewer delivery time but more MUs than TS-IMRT.

  9. 乳腺癌保乳手术38例临床分析%Analysis of breast conserving surgery 38 cases

    Institute of Scientific and Technical Information of China (English)

    朱昱

    2011-01-01

    Objective To evaluate the clinical efficacy of line - conserving surgery for early breast cancer and cosmetic results were evaluated. Methods The hospital from January 2008 to December 2010 were treated 38 cases of breast cancer clinical data were retrospectively analyzed, according to Rose standards, the acceptance of breast - conserving surgery in patients with cosmetic results assessment. Results All patients recovered well without complications, postoperative patient satisfaction with breast appearance and quality of life. Conclusions Early breast cancer patients receiving breast - conserving surgery can lead to satisfactory clinical effect and cosmetic results.%目的 探讨早期乳腺癌行保乳手术的临床疗效并对美容效果进行评价.方法 对永煤集团总医院普外科2008年1月-2010年12月收治的38例乳腺癌患者的临床资料及治疗体会进行回顾性分析,并按Rose标准,对接受保乳手术的患者进行美容效果评价.结果 所有病例术后恢复良好,无1例出现并发症,患者对术后乳房外形及生活质量满意.结论 早期乳腺癌患者接受保乳手术治疗可取得满意的临床和美容效果,但术前应严格选择适应证和禁忌症.

  10. Results of conservative treatment with surgery and radiation therapy of 132 non-palpable ductal carcinomas in situ of the breast

    International Nuclear Information System (INIS)

    Retrospective analysis of results of treatment of 132 subclinical ductal carcinomas in situ, non-palpable. Patients were treated with limited surgery and 70 Gy radiation therapy (70 Gy). With a median follow-up of 7 years, the total recurrence rate was 6 % and the actuarial rate at 5 years 4 % and at 10 years 13 % at. These have no influence on recurrence on the specific actuarial survival rate which was 100 % at 10 years. In spite of five infiltrating recurrences of seven, no metastasis appeared 48 months after the salvage surgery. The global rate of breast. The global rate of breast preservation was 92 % at 7 years. Therapeutic indications were developed taking into account the present analysis and a literature review (2,338 in situ ductal carcinomas, palpable or not, treated with conservative surgery, with or without adjuvant radio-therapy). (author)

  11. Detection of multiple clustered microcalcifications by mammography following breast-conserving surgery

    Institute of Scientific and Technical Information of China (English)

    LI Juan; BAO Min; XU Hui-mian; WANG Zhen-ning

    2010-01-01

    @@ Breast cancer is the most common cause of cancer related death among women around the world.~1 Each year, 1.1 million more women are diagnosed with it, representing more than 10% of all new cancer cases annually. With more than 410 000 deaths each year, the disease accounts for more than 1.6% of all female deaths worldwide.~(2'3) Prompt diagnosis and appropriate treatment may increase life expectancy and recovery rate.

  12. Impact of the Radiation Boost on Outcomes After Breast-Conserving Surgery and Radiation

    International Nuclear Information System (INIS)

    Purpose: We examined the impact of radiation tumor bed boost parameters in early-stage breast cancer on local control and cosmetic outcomes. Methods and Materials: A total of 3,186 women underwent postlumpectomy whole-breast radiation with a tumor bed boost for Tis to T2 breast cancer from 1970 to 2008. Boost parameters analyzed included size, energy, dose, and technique. Endpoints were local control, cosmesis, and fibrosis. The Kaplan-Meier method was used to estimate actuarial incidence, and a Cox proportional hazard model was used to determine independent predictors of outcomes on multivariate analysis (MVA). The median follow-up was 78 months (range, 1-305 months). Results: The crude cosmetic results were excellent in 54%, good in 41%, and fair/poor in 5% of patients. The 10-year estimate of an excellent cosmesis was 66%. On MVA, independent predictors for excellent cosmesis were use of electron boost, lower electron energy, adjuvant systemic therapy, and whole-breast IMRT. Fibrosis was reported in 8.4% of patients. The actuarial incidence of fibrosis was 11% at 5 years and 17% at 10 years. On MVA, independent predictors of fibrosis were larger cup size and higher boost energy. The 10-year actuarial local failure was 6.3%. There was no significant difference in local control by boost method, cut-out size, dose, or energy. Conclusions: Likelihood of excellent cosmesis or fibrosis are associated with boost technique, electron energy, and cup size. However, because of high local control and rare incidence of fair/poor cosmesis with a boost, the anatomy of the patient and tumor cavity should ultimately determine the necessary boost parameters.

  13. A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone

    OpenAIRE

    Rakovitch, Eileen; Nofech-Mozes, Sharon; Hanna, Wedad; Baehner, Frederick L.; Saskin, Refik; Butler, Steven M.; Tuck, Alan; SenGupta, Sandip; Elavathil, Leela; Jani, Prashant A.; Bonin, Michel; Chang, Martin C; Robertson, Susan J.; Slodkowska, Elzbieta; Fong, Cindy

    2015-01-01

    Validated biomarkers are needed to improve risk assessment and treatment decision-making for women with ductal carcinoma in situ (DCIS) of the breast. The Oncotype DX® DCIS Score (DS) was shown to predict the risk of local recurrence (LR) in individuals with low-risk DCIS treated by breast-conserving surgery (BCS) alone. Our objective was to confirm these results in a larger population-based cohort of individuals. We used an established population-based cohort of individuals diagnosed with DC...

  14. Effect of breast augmentation after breast-conserving surgery for breast cancer on radiation dose. Silicone prosthesis and changes in radiation dose

    International Nuclear Information System (INIS)

    The results of a study simulating postoperative radiation therapy of remaining breast tissue with a silicone bag prosthesis implanted to examine the effects of the prosthesis on radiation dosage and surrounding tissue are reported. The evaluation was conducted in two stages: a water phantom was used to evaluate scattering effects of a prosthesis installed inside the phantom using glass rod detector (GRD) set around the prosthesis. Measurements were conducted on both entrance and rear sides of the prosthesis. A Rand phantom was used to measure radiation doses around the prosthesis. The first evaluation resulted in a less than 5.4% reduction in dose at the rear side of the prosthesis whereas the second evaluation, for opposing portal irradiation used with breast-conserving surgical treatment, showed the effects of the prosthesis on radiation dosage being within ±2%, the permitted treatment range. In conclusion, for treating breast cancer, combining surgical treatment of the cancer with implanting of prosthesis for breast reconstruction followed by radiation treatment appears feasible as no effects on dosage were observed on treatment effectiveness. (author)

  15. 早期乳腺癌保留乳房手术的临床可行性研究%Early breast conservation surgery clinical feasibility study

    Institute of Scientific and Technical Information of China (English)

    崔中林; 孙宁

    2015-01-01

    Objective To evaluate the effect of breact conservative surgery for early breast cancer.Methods From 2009 to 2014,breast conservative surgery was performed to 31 patients with early breast cancer. Clinical data were analyzed retrospectively. Results All operations were preformed successfully,Cosmetic results were satisfactory The follow-up time were 1 year to 5 years (median 2 years).no local recurrence distant metastasis and mortally were observed.Conclusion For the patients with early-stage breast cancer, the effects of breast conserving surgery were satisfactory either in the early time or in the long term.Applying to the indication strictly and the comprehensive treatment normatively insure achieving good reaults.%目的:探讨早期乳腺癌保留乳房手术的临床疗效.方法:回顾分析2009年1月至2014年12月经治的31例早期乳腺癌实施保乳手术的临床疗效.结果:全部病人手术过程顺利,近期乳房外形保持良好.术后随访1~5年(评均2年),无局部复发、远处转移和死亡病例.无放疗后合并症.结论:保乳手术治疗早期乳癌的近、远期疗效满意.术前严格掌握手术适应症,术后规范的综合治疗,是保乳手术获得良好的保证.

  16. Positive anterior margins in breast conserving surgery: Does it matter? A systematic review of the literature.

    Science.gov (United States)

    Ang, Su C; Tapia, Grace; Davidson, Emily J; Kahramangil, Bora; Mak, Cindy; Carmalt, Hugh; Warrier, Sanjay

    2016-06-01

    Positive margins are associated with an increased risk of ipsilateral breast tumor recurrence (IBTR); therefore re-excision of positive margins is recommended. Involvement of anatomically non-breast margins, such as anterior margins, has been associated to a lower risk of IBTR than radial margins. Although many surgeons do not re-excise positive anterior margins (PAM); there is no consensus regarding this approach. The objective of this study is to find evidence that assesses this practice. A systemic literature review was performed through six databases from January 1995 to July 2014. Studies that discussed anatomical location of involved margins in BCS were included. Six studies were identified evaluating PAM. One study reported a 2.5% rate of IBTR in patients with non-negative margins treated with radiotherapy (of which 23% had a PAM). Another study showed 4% of residual disease after re-excision of PAM, but did not report IBTR rates. A later observational study reported that 87.5% of positive anterior and posterior margins were re-excised. One survey from America and one from the UK showed that 47% and 71% of surgeons would not re-excise PAM, respectively. A later survey in the UK reported that 43.8% of surgeons would not re-excise PAM in DCIS, whilst 29.2% would not for invasive carcinoma. Common surgical practices to not re-excise PAM contradict current guidelines that recommend obtaining negative margins to reduce the risk of IBTR. However, there is little evidence detailing the relationship between PAM and IBTR rates. Low residual disease after re-excision of PAM supports the limited benefit of re-excise this margin; however further studies are required to evaluate this topic. PMID:27060552

  17. Status of Survival and Recurrence of Breast-conserving Surgery for Early Breast Cancer Patients%早期乳腺癌患者保乳手术后的生存和复发状况研究

    Institute of Scientific and Technical Information of China (English)

    章骏; 赵怡; 王群; 张舟; 邢戍健

    2015-01-01

    Objective To investigate the survival and recurrence of breast -conserving surgery for early breast cancer pa -tients.Methods 100 cases of early breast cancer patients were divided into breast -conserving surgery group (BCT group) and modified radical mastectomy group (radical groups) according to different treatment ,each with 50 cases.Surgical situation and prognosis of the 2 groups,and risk factors of local recurrence after breast -conserving surgery were compared .Results Operation time,blood loss,average drainage,length of hospital stay and complications of the 2 groups had statistically significant difference (P 0.05);BCT group had higher de-gree of satisfaction with the breast shape ;Age was independent factor for local recurrence of early breast cancer after breast -con-serving surgery.Conclusion Breast-conserving surgery for early breast cancer has better survival ,local control rate and cosmetic results.%目的:探讨早期乳腺癌患者保乳手术后的生存和复发状况。方法100例早期乳腺癌患者根据治疗方式的不同分为保乳术组(保乳组)50例及改良根治术组(根治组)50例。对比分析保乳术与根治术的手术情况和预后以及影响保乳术后局部复发的危险因素。结果保乳组手术时间、术中出血量、平均引流量、住院时间以及并发症发生率与根治组比较差异显著,具有统计学意义(P <0.05);两组患者术后的局部复发情况无明显差异(P >0.05);保乳术组对乳房外形满意度较高;年龄是影响早期乳腺癌患者保乳手术后局部复发的独立因素。结论早期乳腺癌患者行保乳术后能获得良好生存率、局部控制率和美容效果。

  18. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Fastner, Gerd; Zehentmayr, Franz; Kopp, Peter; Fussl, Christoph; Sedlmayer, Felix [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Hauser-Kronberger, Cornelia [Landeskrankenhaus, Paracelsus Medical University, Department of Pathology, Salzburg (Austria); Moder, Angelika [Landeskrankenhaus, Paracelsus Medical University, Institute of Inborn Errors in Metabolism, Salzburg (Austria); Reitsamer, Roland; Fischer, Thorsten [Landeskrankenhaus, Paracelsus Medical University, Department of Special Gynecology, Salzburg (Austria); Landeskrankenhaus, Paracelsus Medical University, Department of Gynecology, Salzburg (Austria); Deutschmann, Heinrich [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Paracelsus Medical University, Institute for Research and Development of Advanced Radiation Technologies (radART), Salzburg (Austria)

    2016-01-15

    The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation. A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median D{sub max}) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %). After a median follow-up of 97 months (range 4-170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03). Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3. (orig.) [German] Ziel der Studie war es, im Rahmen einer retrospektiven Analyse Ueberlebens- und Lokalkontrollraten bei triple-negativen Mammakarzinomen zu untersuchen. Die Tumoren waren in 5NP(5-Marker-negative)- und CB(core basal)-Subtypen klassifiziert und die Patientinnen hatten nach brusterhaltender Operation und

  19. Recurrence and mortality according to Estrogen Receptor status for breast cancer patients undergoing conservative surgery. Ipsilateral breast tumour recurrence dynamics provides clues for tumour biology within the residual breast

    International Nuclear Information System (INIS)

    the study was designed to determine how tumour hormone receptor status affects the subsequent pattern over time (dynamics) of breast cancer recurrence and death following conservative primary breast cancer resection. Time span from primary resection until both first recurrence and death were considered among 2825 patients undergoing conservative surgery with or without breast radiotherapy. The hazard rates for ipsilateral breast tumour recurrence (IBTR), distant metastasis (DM) and mortality throughout 10 years of follow-up were assessed. DM dynamics displays the same bimodal pattern (first early peak at about 24 months, second late peak at the sixth-seventh year) for both estrogen receptor (ER) positive (P) and negative (N) tumours and for all local treatments and metastatic sites. The hazard rates for IBTR maintain the bimodal pattern for ERP and ERN tumours; however, each IBTR recurrence peak for ERP tumours is delayed in comparison to the corresponding timing of recurrence peaks for ERN tumours. Mortality dynamics is markedly different for ERP and ERN tumours with more early deaths among patients with ERN than among patients with ERP primary tumours. DM dynamics is not influenced by the extent of conservative primary tumour resection and is similar for both ER phenotypes across different metastatic sites, suggesting similar mechanisms for tumour development at distant sites despite apparently different microenvironments. The IBTR risk peak delay observed in ERP tumours is an exception to the common recurrence risk rhythm. This suggests that the microenvironment within the residual breast tissue may enforce more stringent constraints upon ERP breast tumour cell growth than other tissues, prolonging the latency of IBTR. This local environment is, however, apparently less constraining to ERN cells, as IBTR dynamics is similar to the corresponding recurrence dynamics among other distant tissues

  20. Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer

    International Nuclear Information System (INIS)

    The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve 'adequate' or 'negative' surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS. Retrospective analysis of 204 BCS procedures performed for invasive breast cancer from August 2003 to June 2007, in which patients underwent a standard BCS resection and systematic sampling of nine standardized re-resection margins (superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, and deep-posterior). Multiple variables (including patient, tumor, specimen, and follow-up variables) were evaluated. 6.4% (13/204) of patients had positive BCS specimen margins (defined as tumor at inked edge of BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor within 1 mm or less of inked edge but not at inked edge of BCS specimen). 11.8% (24/204) of patients had at least one re-resection margin containing additional disease, independent of the status of the BCS specimen margins. 7.1% (13/182) of patients with negative BCS specimen margins (defined as no tumor cells seen within 1 mm or less of inked edge of BCS specimen) had at least one re-resection margin containing additional disease. Thus, 54.2% (13/24) of patients with additional disease in a re-resection margin would not have been recognized by a standard BCS procedure alone (P < 0.001). The nine standardized resection margins represented only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen. Our methodology accurately assesses the adequacy of surgical resection margins for determination of which

  1. Comparative Study on Breast-conserving Surgery and Modified Radical Mastectomy in Treatment of Breast Cancer%保乳术与改良根治术治疗乳腺癌的对比分析

    Institute of Scientific and Technical Information of China (English)

    王立新

    2015-01-01

    目的:对比乳腺癌患者采用保乳术与改良根治术的治疗效果。方法选取2013年6月~2014年7月收治的36例乳腺癌患者进行治疗,随机分组,实验组20例患者选择保乳术,对照组16例患者选择改良根治术,对比手术情况和治疗效果。结果实验组患者的手术情况和乳房美容效果明显好于对照组,差异显著,有统计学意义(P<0.05)。结论乳腺癌患者采用保乳术的治疗,效果显著,且术中的出血量较少,缩短住院时间,术后并发症的发生率较低,美容效果好,为早期乳腺癌患者治疗的首先方法。%Objective Treatment effects of breast-conserving surgery and modified radical mastectomy in treatment of breast cancer are to be comparatively analyzed. Methods Choose 36 patients with breast cancer who are treated in hospital from June 2013 to July 2014 and separate them into two groups at random; 20 patients in study group are given breast-conserving surgery treatment,while 16 patients in control group are given modified radical mastectomy,and then compare surgical treatment condition as wel as treatment effects between two groups. Results Patients’surgical treatment condition as wel as their breast cosmetic efficiency in study group is much more favorable than those in control group; there is a differential between two groups,and such a differential has statistic value(P<0.05). Conclusion Breast-conserving surgery treatment is of efficacy in treatment of breast cancer,it is conducive to reducing surgery bleeding loss and shortening patients’hospitalization days; and in addition,breast-conserving surgery is of few complication incidence and favorable cosmetic effect;thus,it is the fist choice in treatment of breast cancer patients.

  2. 保乳术与改良根治术治疗乳腺癌的对比分析%Comparative Study on Breast-conserving Surgery and Modified Radical Mastectomy in Treatment of Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    王立新

    2015-01-01

    Objective Treatment effects of breast-conserving surgery and modified radical mastectomy in treatment of breast cancer are to be comparatively analyzed. Methods Choose 36 patients with breast cancer who are treated in hospital from June 2013 to July 2014 and separate them into two groups at random; 20 patients in study group are given breast-conserving surgery treatment,while 16 patients in control group are given modified radical mastectomy,and then compare surgical treatment condition as wel as treatment effects between two groups. Results Patients’surgical treatment condition as wel as their breast cosmetic efficiency in study group is much more favorable than those in control group; there is a differential between two groups,and such a differential has statistic value(P<0.05). Conclusion Breast-conserving surgery treatment is of efficacy in treatment of breast cancer,it is conducive to reducing surgery bleeding loss and shortening patients’hospitalization days; and in addition,breast-conserving surgery is of few complication incidence and favorable cosmetic effect;thus,it is the fist choice in treatment of breast cancer patients.%目的:对比乳腺癌患者采用保乳术与改良根治术的治疗效果。方法选取2013年6月~2014年7月收治的36例乳腺癌患者进行治疗,随机分组,实验组20例患者选择保乳术,对照组16例患者选择改良根治术,对比手术情况和治疗效果。结果实验组患者的手术情况和乳房美容效果明显好于对照组,差异显著,有统计学意义(P<0.05)。结论乳腺癌患者采用保乳术的治疗,效果显著,且术中的出血量较少,缩短住院时间,术后并发症的发生率较低,美容效果好,为早期乳腺癌患者治疗的首先方法。

  3. Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions

    Directory of Open Access Journals (Sweden)

    Allen Laura J

    2009-07-01

    Full Text Available Abstract Background US Asian women with early-stage breast cancer are more likely to receive a modified radical mastectomy (MRM than White women, contrary to clinical recommendations regarding breast conserving treatment (BCT. Methods We surveyed physicians regarding treatment decision-making for early-stage breast cancer, particularly as it applies to Asian patients. Physicians were identified through the population-based Greater Bay Area Cancer Registry. Eighty (of 147 physicians completed a questionnaire on sociodemographics, professional training, clinical practices, and perspectives on the treatment decision-making processes. Results The most important factors identified by physicians in the BCT/MRM decision were clinical in nature, including presence of multifocal disease (86% identified this as being an important factor for selecting MRM, tumor size (71% for MRM, 78% for BCT, cosmetic result (74% for BCT, and breast size (50% for MRM, 55% for BCT. The most important reasons cited for the Asian treatment patterns were patient attitudes toward not needing to preserve the breast (53%, smaller breast sizes (25%, and fear and cultural beliefs (12%. Conclusion These survey results suggest that physicians perceive major roles of both clinical and cultural factors in the BCT/MRM decision, but cultural factors may be more relevant in explaining surgical treatment patterns among Asians.

  4. Feasibility and acute toxicity of 3-dimensional conformal external-beam accelerated partial-breast irradiation for early-stage breast cancer after breast-conserving surgery in Chinese female patients

    Institute of Scientific and Technical Information of China (English)

    LI Feng-yan; HE Zhen-yu; XUE Ming; CHEN Li-xin; WU San-gang; GUAN Xun-xing

    2011-01-01

    Background A growing number of studies worldwide have advocated the replacement of whole-breast irradiation with accelerated partial breast irradiation using three-dimensional conformal external-beam radiation (APBI-3DCRr) for early-stage breast cancer. But APBI can be only used in selected population of patients with early-staged breast cancer. It is not replacing the whole breast radiotherapy. This study aimed to examine the feasibility and acute normal tissue toxicity of the APBI-3DCRT technique in Chinese female patients who generally have smaller breasts compared to their Western counterparts.Methods From May 2006 to December 2009, a total of 48 Chinese female patients (with early-stage breast cancer who met the inclusion criteria) received APBI-3DCRT after breast-conserving surgery at Sun Yat-sen University Cancer Center. The total dosage from APBI-3DCRT was 34 Gy, delivered in 3.4 Gy per fractions, twice per day at intervals of at least six hours. The radiation dose, volume of the target area and volume of irradiated normal tissues were calculated.Acute toxicity was evaluated according to the Common Toxicity Criteria (CTC) 3.0.Results Among the 48 patients, the planning target volume for evaluation (PTVE) was (90.42±9.26) cm3, the ipsilateral breast volume (IBV) was (421.74±28.53) cm3, and the ratio between the two was (20.74±5.86)%. Evaluation of the dosimetric characteristics of the PTVE revealed excellent dosimetric results in 14 patients and acceptable results in 34 patients. The dose delivered to the PTVE ranged from 93% to 110% of the prescribed dose. The average ratio of the volume of PTVE receiving 95% of the prescription dose (V95) was (99.26±0.37)%. The habituation index (HI) and the conformity index (CI) were 1.08±0.01 and 0.72±0.02, respectively, suggesting good homogeneity and conformity of the dose delivered to the target field. The radiation dose to normal tissues and organs was within the dose limitation.Subjects experienced mild acute

  5. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: A study in mastectomy specimens using simulation lumpectomy

    OpenAIRE

    Viswambharan Jaiganesh; Kadambari D; Iyengar Krishnan; Srinivasan K

    2005-01-01

    BACKGROUND : The response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy (NACT) offers these patients previously treated by mastectomy, the chance for breast conservation. AIM : This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor 5 cm. SETTINGS, DESIGN : Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS : Thirty patients with LABC whose tumors reduced...

  6. Radiotherapy without boost in the tumor bed after conserving surgery in the treatment of early breast cancer

    International Nuclear Information System (INIS)

    The aim of this study is to analyse satisfactory local control and breast preservation with particular emphasis on the importance of the microscopic negative margin in patients who not receiving tumor bed boost therapy. Authors analysed 122 consecutive patients with breast cancer in pathological stages I and II, who were treated with quadrantectomy at full axillary dissection between 1992 and 1997. The median follow up was 34 months. The radiation treatment was started 60 - 80 day in 14 patients (11.5%) with high risk for metastases, because they underwent chemotherapy. The patients were treated with external beam radiation therapy on the entire breast to a mean total dose of 48.8 Gy. A boost to a tumor bed was not delivered. Only patients with follow-up period above 24 months were evaluated for the purpose of analysis of cosmetic results. Analyzed variables were: age, size, lymph node status, two-field versus three-field technique, operating scare. The major goal of breast conserving therapy is the preservation of cosmetically acceptable breast without local relapses in all patients of our study. A 43 years old patient with liver metastases and any regional and local relapses was dead 27 months after the radiotherapy. A single significant factor impairing excellent cosmetic outcome in our study is the surgical scar. The very high percent (51) of excellent cosmetic results and low percent of post radiotherapy injury is due to precise for breast conserving therapy, the prevailing number of young patients and precise CT and dosimetric planning on three level of treatment volume (author)

  7. Clinical study of oncoplastic breast-conserving surgery for the treatment of 30 cases of early breast cancer%近乳晕区早期乳腺癌整形保乳术30例临床研究

    Institute of Scientific and Technical Information of China (English)

    姜润学; 蔡海峰; 胡万宁; 孙志国

    2015-01-01

    Objective:To evaluate the clinical effects of oncoplastic breast-conserving surgery on patients with early breast can-cer near the mammary areola. Methods:A total of 60 patients with early breast cancer underwent breast-conserving surgery in the Sec-ond Department of Breast Surgery, Tangshan People's Hospital from February 2011 to November 2013. These patients were random-ized into two groups, namely, the experimental Group A (n=30) and the control Group B (n=30). Oncoplastic breast-conserving surgery was performed on the patients in Group A, whereas Group B underwent standard breast-conserving surgery. The specimen weight of the locally excised breast, the nearest distance of the tumor to the surgical margins, and the postoperative cosmetic result of the affected breast were compared between the two groups. Results: The specimen weights of the locally excised breast were 71.03 ± 12.92 and 41.53±7.13 g, and the nearest distances of the tumor to the surgical margins were 13.30±2.97 and 10.63±1.65 mm in Groups A and B, respectively, with significant differences between the two groups (P0.05). Con-clusion:A larger amount of excised breast tissue and a wider scope of surgical margins were observed in Group A patients. However, the postoperative cosmetic result of the affected breast was almost similar for both groups. Therefore, oncoplastic breast-conserving sur-gery is a feasible and effective approach for early breast cancer patients.%目的:评价近乳晕区早期乳腺癌患者行整形保乳术的临床效果。方法:将2011年2月至2013年11月唐山市人民医院乳腺外科(二)接受保乳手术治疗的60例近乳晕区早期乳腺癌患者随机分成两组,试验组30例行整形保乳术,对照组30例行标准保乳术,比较两组术中切除的乳腺局部标本质量,肿瘤距外科切缘最近的距离,术后患乳美容效果。结果:试验组与对照组患者术中切除的乳腺标本量为(71.03±12.92)g vs.(41

  8. Combined conservative surgery, chemotherapy and radiation therapy in treatment of the breast cancer patient: the influence of the interval between surgery and start of irradiation

    International Nuclear Information System (INIS)

    Purpose: To analyze our experience treating breast cancer patients with combined breast conserving surgery, chemotherapy and radiation therapy in the light of considerable discussion on the role of the interval between surgery and radiation therapy (S-RT). Materials and Methods: Between 1985 and 1992, 100 patients with invasive breast cancer underwent radiation treatment at our institution after conservative surgery with axillary dissection and some form of chemotherapy. Criteria for inclusion in this retrospective analysis were: Stage M0, no simultaneous malignancies, gross total resection of primary and involved lymph nodes, at least three cycles of postoperative polychemotherapy, complete radiation treatment, complete follow-up information. Seventy-four patients fulfilling these criteria form the basis of this report. For patients alive at last observation date, median follow-up time was five years (i.e., 59 months; range, 36-112 months). Age at diagnosis ranged between 20 and 69 years (median, 48 years). Fifty-four patients were pre- or perimenopausal (73%) and 20 were postmenopausal (27%). Tumors were staged using the AJCC-system. Distribution of T-Stage was: T1 (n=36), T2 (n=37), T3 (n=1). In 95% of patients, axillary lymph nodes were positive: 1-3 nodes (n=50), ≥ 4 nodes (n=20), and 0 nodes (n=3). Thus, 91% of patients were Stage II. In 65% of patients, final pathological margins were negative. Margins showed invasive and intraductal carcinoma in 5 and 11% of cases, respectively (margins unknown in 19%). Chemotherapy regimens and doses varied according to the referring physicians as well as during the study period. Seventy percent of patients received six cycles of chemotherapy (predominan CMF) before onset of irradiation. The median S-RT interval was 20.5 weeks (range, 8.4-31.9 weeks). Usually, the breast was treated to 50 Gy, 2 Gy per fraction, five fractions per week, using Cobalt-60 (n=66) or 5 MeV photons (n=8). Then the tumor bed was boosted with

  9. Fifteen year results of breast conservation therapy based on liberal patients selection criteria and less extensive surgery

    International Nuclear Information System (INIS)

    Between January 1, 1983 and December 31, 1997, 1,748 breasts of 1,687 patients visited our clinic, requesting breast conservation therapy (BCT). Of these, 1,543 breasts were preserved. The only criterion for patient selection was whether she could be satisfied with cosmetic result after BCT. Lumpectomy was done in such a way to obtain macroscopically clear margin. After 1987, axillary dissection was omitted for those with clinically negative axillae. Postoperatively, most patients received 50 Gy of external irradiation to the whole breast via tangential ports. Boost was not given. Separate axillary or supraclavicular ports were seldom used. Adjuvant postoperative chemo or hormone therapy were administered if indicated. One thousand five hundred and thirty patients, excluding patients with bilateral cancers or stage IV constituted this study. Median follow-up length was 50 months. Two hundred and fourteen patients experienced recurrences, including 95 in-breast recurrences, 31 regional nodal recurrences and 146 distant failures. Five year overall survival: All patients: 93.4%. Stage 0: 100%, I: 96.6%., II: 92.8%. III: 66%. Five year distant disease free survival: Stage 0: 100%, I: 94.1%, II: 86.2%, III: 59.2%. Five year freedom from in-breast recurrence: Stage 0: 84.1%, I: 94.0%, II: 93%, III: 90%. Positive margin, premenopausal state and multicentric tumors were judged to be independent risk factors for in-breast recurrence, but tumor size, location, nipple-tumor distance, EIC, receptor status and lymphatic permeation were not. Five year freedom from axillary recurrence: Axillary dissection 98.4%, axillary irradiation 97%. (K.H.)

  10. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Risk-modifying factors

    Energy Technology Data Exchange (ETDEWEB)

    Hille-Betz, Ursula; Soergel, Philipp; Kundu, Sudip; Klapdor, Ruediger; Hillemanns, Peter [Hannover Medical School, Department of Obstetrics and Gynaecology, Hannover (Germany); Vaske, Bernhard [Hannover Medical School, Institute of Medical Biometry and Informatics, Hannover (Germany); Bremer, Michael; Henkenberens, Christoph [Hannover Medical School, Department of Radiation Oncology and Special Oncology, Hannover (Germany)

    2016-01-15

    The purpose of this work was to identify parameters influencing the risk of late radiation side effects, fair or poor cosmetic outcomes (COs) and pain in breast cancer patients after breast-conserving therapy (BCT) and three-dimensional conformal radiotherapy (3D-CRT). Between 2006 and 2013, 159 patients were treated at the Hannover Medical School. Physician-rated toxicity according to the LENT-SOMA criteria, CO and pain were assessed by multivariate analysis. LENT-SOMA grade 1-4 toxicity was observed as follows: fibrosis 10.7 %, telangiectasia 1.2 %, arm oedema 8.8 % and breast oedema 5.0 %. In addition, 15.1 % of patients reported moderate or severe breast pain, and 21.4 % complained about moderate or severe pain in the arm or shoulder. In multivariate analysis, axillary clearing (AC) was significantly associated with lymphoedema of the arm [odds ratio (OR) 4.37, p = 0.011, 95 % confidence interval (CI) 1.4-13.58]. Breast oedema was also highly associated with AC (OR 10.59, p = 0.004, 95 % CI 2.1-53.36), a ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C (OR 5.34, p = 0.029, 95 % CI 1.2-24.12). A ptosis grade 2/3 or pseudoptosis and a bra size ≥ cup C were the parameters significantly associated with an unfavourable CO (OR 3.19, p = 0.019, 95 % CI 1.2-8.4). Concerning chronic breast pain, we found a trend related to the prescribed radiation dose including boost (OR 1.077, p = 0.060, 95 % CI 0.997-1.164). Chronic shoulder or arm pain was statistically significantly associated with lymphoedema of the arm (OR 3.9, p = 0.027, 95 % CI 1.17-13.5). Chronic arm and breast oedema were significantly influenced by the extent of surgery (AC). Ptotic and large breasts were significantly associated with unfavourable COs and chronic breast oedema. Late toxicities exclusive breast pain were not associated with radiotherapy parameters. (orig.) [German] Ziel dieser Arbeit war es, Parameter zu identifizieren, die Spaetschaeden nach Radiotherapie, ein unguenstiges

  11. Analysis of Margin Index as a Method for Predicting Residual Disease After Breast-Conserving Surgery in a European Cancer Center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2011-06-03

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) × 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  12. Analysis of margin index as a method for predicting residual disease after breast-conserving surgery in a European cancer center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2012-02-01

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) x 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  13. Patients With T1 to T2 Breast Cancer With One to Three Positive Nodes Have Higher Local and Regional Recurrence Risks Compared With Node-Negative Patients After Breast-Conserving Surgery and Whole-Breast Radiotherapy

    International Nuclear Information System (INIS)

    Purpose: To evaluate locoregional recurrence according to nodal status in women with T1 to T2 breast cancer and zero to three positive nodes (0-3N+) treated with breast-conserving surgery (BCS). Methods and Materials: The study subjects comprised 5,688 women referred to the British Columbia Cancer Agency between 1989 and 1999 with pT1 to T2, 0-3N+, M0 breast cancer, who underwent breast-conserving surgery with clear margins and radiotherapy (RT) of the whole breast. The 10-year Kaplan-Meier local, regional, and locoregional recurrence (LR, RR, and LRR, respectively) were compared between the N0 (n = 4,433) and 1-3N+ (n = 1,255) cohorts. The LRR was also examined in patients with one to three positive nodes (1-3N+) treated with and without nodal RT. Multivariate analysis was performed using Cox regression modeling. Results: Median follow-up was 8.6 years. Systemic therapy was used in 97% of 1-3N+ and 41% of N0 patients. Nodal RT was used in 35% of 1-3N+ patients. The 10-year recurrence rates in N0 and 1-3N+ cohorts were as follows: LR 5.1% vs. 5.8% (p = 0.04); RR 2.3% vs. 6.1% (p < 0.001), and LRR 6.7% vs. 10.1% (p < 0.001). Among 817 1-3N+ patients treated without nodal RT, 10-year LRR were 13.8% with age <50 years, 20.3% with Grade III, and 23.4% with estrogen receptor (ER)-negative disease. On multivariate analysis, 1-3N+ status was associated with significantly higher LRR (hazard ratio [HR], 1.85; 95% confidence interval, 1.34-2.55, p < 0.001), whereas nodal RT significantly reduced LRR (HR, 0.59; 95% confidence interval, 0.38-0.92, p = 0.02). Conclusion: Patients with 1-3N+ and young age, Grade III, or ER-negative disease have high LRR risks approximating 15% to 20% despite BCS, whole-breast RT and systemic therapy. These patients may benefit with more comprehensive RT volume encompassing the regional nodes

  14. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    Energy Technology Data Exchange (ETDEWEB)

    Lalani, Nafisha; Paszat, Lawrence [University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Sutradhar, Rinku; Thiruchelvam, Deva [Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta [University of Toronto, Toronto, Ontario (Canada); Department of Anatomic Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Done, Susan J. [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Campbell Family Institute for Breast Cancer Research, Toronto, Ontario (Canada); Miller, Naomi; Youngson, Bruce [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Tuck, Alan [Pathology and Laboratory Medicine, London Health Sciences Centre and Saint Joseph' s Health Care, London, Ontario (Canada); Sengupta, Sandip [Department of Pathology and Molecular Medicine, Kingston General Hospital, Kingston, Ontario (Canada); Elavathil, Leela [Department of Anatomical Pathology, Juravinski Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Chang, Martin C. [Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Jani, Prashant A. [Department of Anatomical Pathology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario (Canada); Bonin, Michel [Pathology and Laboratory Medicine, Sudbury Regional Hospital, Sudbury, Ontario (Canada); and others

    2014-12-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  15. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    International Nuclear Information System (INIS)

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  16. Clinical Research on Breast Conserving Surgery for Early Stage Breast Cancer in 68 Cases%早期乳腺癌保乳手术治疗68例临床研究

    Institute of Scientific and Technical Information of China (English)

    夏艳华

    2015-01-01

    Objective To explore the clinical effect of breast-conserving surgery for early breast cancer.MethodsA total of 100 patients with early stage breast cancer patients were treated and divided into study group(68 cases)and control group(34 cases),study group underwent breast-conserving surgery, the control group underwent a modified radical mastectomy were compared clinical outcomes and cosmetic results.Results The study group of the surgery were better than the control group,the incidence of postoperative complications(4.4%)than the control group(15.6%),beauty good rate (97.1%)higher(20/32),the difference between groups was significant(P< 0.05).Conclusion For patients with early stage breast cancer,the use of breast-conserving surgery can reduce the incidence of postoperative complications and improve the cosmetic results of breast surgery,clinical application of higher value.%目的:探究保乳手术治疗早期乳腺癌的临床效果。方法将100例早期乳腺癌患者根据治疗方法的不同分为研究组(68例)和对照组(34例),研究组行保乳手术,对照组行改良根治术,比较两组临床治疗效果及美容效果。结果研究组各项手术指标均优于对照组,术后并发症发生率(4.4%)低于对照组(15.6%),美容优良率(97.1%)高于对照组(20/32),组间比较差异具有统计学意义(P<0.05)。结论对于早期乳腺癌患者,采用保乳手术治疗可降低术后并发症发生率,提高术后乳房美容效果。

  17. Nomogram for Predicting Breast Conservation after Neoadjuvant Chemotherapy

    OpenAIRE

    Kim, Min Kyoon; Han, Wonshik; Moon, Hyeong-Gon; Ahn, Soo Kyung; Kim, Jisun; Lee, Jun Woo; Kim, Ju-Yeon; Kim, Taeryung; Lee, Kyung-Hun; Kim, Tae-Yong; Han, Sae-Won; Im, Seock-Ah; Kim, Tae-You; Park, In Ae; Noh, Dong-Young

    2014-01-01

    Purpose The ability to accurately predict the likelihood of achieving breast conservation surgery (BCS) after neoadjuvant chemotherapy (NCT) is important in deciding whether NCT or surgery should be the first-line treatment in patients with operable breast cancers. Materials and Methods We reviewed the data of 513 women, who had stage II or III breast cancer and received NCT and surgery from a single institution. The ability of various clinicopathologic factors to predict the achievement of B...

  18. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  19. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs

  20. Prognostic significance of IGF-1R expression in patients treated with breast-conserving surgery and radiation therapy

    International Nuclear Information System (INIS)

    Background: Insulin-like growth factor (IGF) receptor is a key receptor in apoptotic protection, cell adhesion, longevity, and transformation into a cancerous cell and can induce malignant changes in the presence of the IGF ligand. Over-expression of IGF-1R has been associated with resistance to radiation. Inhibitors of IGF-1R have been shown to enhance tumor radiation sensitivity and amplify radiation therapy-induced apoptosis. The purpose of this study is to evaluate the prognostic significance of IGF-1R expression in patients with breast cancer treated with breast conserving therapy. Materials and methods: Paraffin specimens from 345 women with early stage breast cancer treated with BCT were constructed into tissue microarrays and stained for IGF-1R, COX-2 and p53. The molecular profiles were correlated with clinical-pathologic factors, overall, local, and distant relapse-free survival. The association between IGF-1R, other co-variables, and outcome was assessed. Results: IGF-1R over-expression was identified in 197 cases (57%). IGF-1R over-expression was found to be correlated with African-American race (p = 0.0233), p53 status (p = 0.0082) and COX-2 expression (p < 0.0001). While IGF-1R over-expression was associated with lower overall survival (p = 0.0224) in node-negative patients, there was no impact of IGF-1R expression on local control. Conclusions: In node-negative patients, patients with high levels of IGF-1R were found to have a significant reduction in overall survival, but no apparent effect on local control. Given the limited published data on IGF-1R in early stage, conservatively treated patients, further studies investigating IGF-1R expression in this cohort are necessary.

  1. Breast-conserving surgery with or without radiotherapy in women with ductal carcinoma in situ: a meta-analysis of randomized trials

    Directory of Open Access Journals (Sweden)

    Leon Paola G

    2007-08-01

    Full Text Available Abstract Background To investigate whether Radiation therapy (RT should follow breast conserving surgery in women with ductal carcinoma in situ from breast cancer (DCIS with objective of decreased mortality, invasive or non invasive recurrence, distant metastases and contralateral breast cancer rates. We have done a meta-analysis of these results to give a more balanced view of the total evidence and to increase statistical precision. Methods A meta-analysis of randomized controlled trials (RCT was performed comparing RT treatment for DCIS of breast cancer to observation. The MEDLINE, EMBASE, CANCERLIT, Cochrane Library databases, Trial registers, bibliographic databases, and recent issues of relevant journals were searched. Relevant reports were reviewed by two reviewers independently and the references from these reports were searched for additional trials, using guidelines set by QUOROM statement criteria. Results The reviewers identified four large RCTs, yielding 3665 patients. Pooled results from this four randomized trials of adjuvant radiotherapy showed a significant reduction of invasive and DCIS ipsilateral breast cancer with odds ratio (OR of 0.40 (95% CI 0.33 – 0.60, p Conclusion The conclusion from our meta-analysis is that the addition of radiation therapy to lumpectomy results in an approximately 60% reduction in breast cancer recurrence, no benefit for survival or distant metastases compared to excision alone. Patients with high-grade DCIS lesions and positive margins benefited most from the addition of radiation therapy. It is not yet clear which patients can be successfully treated with lumpectomy alone; until further prospective studies answer this question, radiation should be recommended after lumpectomy for all patients without contraindications.

  2. Dosimetric and clinical comparison between MammoSite and interstitial HDR brachytherapy in treatment of early stage breast cancer after conserving surgery

    International Nuclear Information System (INIS)

    Objective: To comparatively study dosimetric evaluation, side effects in early and late stage, and cosmetic outcome between MammoSite and interstitial using high-dose-rate (HDR) brachytherapy accelerated partial breast irradiation (APBI) in early stage breast cancer patient after conserving surgery. Methods: From January 2004 to December 2004, 10 breast cancer cases were treated with HDR 192Ir APBI after Lumpectomy surgery, 6 cases with interstitial brachytherapy, 4 cases with MammoSite. Sources were placed during the operation in all patients, distance from cavity to skin > 5-7 mm in interstitial brachytherapy group, one case is 6.5 mm, 3 cases > 10 mm in MammoSite group. Treatment Target area is 20 mm away from cavity in interstitial brachytherapy group with DHI 0.77, 10 mm away from Balloon margin in MammoSite with DHI 0.73. Results: Follow up 12-24 months while median follow-up was 18 months for the whole group (100%). During the treatment, grade III acute reactions were not seen in both group, grade I or II were seen including: erythema, edema, tenderness and infection. More late toxicity reaction including skin fibrosis, breast tenderness and fat necrosis were observed in interstitial brachytherapy group than that of MammoSite group. Cosmetic outcome evaluation were excellent in 12 months 100% (patient) and 83% (doctor) in interstitial brachytherapy, 100% in MammoSite group, respectively, none recurrence. Conclusions: Interstitial brachytherapy shows more uniformity in dose distribution as well as larger treatment volume, while MammoSite tends to be stable in repeatability and easy in use. Both groups show excellent cosmetic results, with same acute and late reactions. (authors)

  3. The Ethics of Breast Surgery.

    Science.gov (United States)

    Throckmorton, Alyssa; VanderWalde, Lindi; Brackett, Craig; Dominici, Laura; Eisenhauer, Thomas; Johnson, Nathalie; Kong, Amanda; Ludwig, Kandice; O'Neill, Jennifer; Pugliese, Matthew; Teller, Paige; Sarantou, Terry

    2015-10-01

    Breast surgery has evolved as a subspecialty of general surgery and requires a working knowledge of benign and malignant diseases, surgical techniques, shared decision-making with patients, collaboration with a multi-disciplinary team, and a basic foundation in surgical ethics. Ethics is defined as the practice of analyzing, evaluating, and promoting best conduct based upon available standards. As new information is obtained or as cultural values change, best conduct may be re-defined. In 2014, the Ethics Committee of the ASBrS acknowledged numerous ethical issues, specific to the practice of breast surgery. This independent review of ethical concerns was created by the Ethics Committee to provide a resource for ASBrS members as well as other surgeons who perform breast surgery. In this review, the professional, clinical, research and technology considerations that breast surgeons face are reviewed with guidelines for ethical physician behavior. PMID:26219240

  4. A 18-year Follow Up Study on Patients with Early Stage Breast Cancer after Breast Conservation Surgery%早期乳腺癌保留乳房治疗18年疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱宁生; 吕钢; 江歌丽; 刘晓渝

    2011-01-01

    Objective To evaluate the long-term effect of breast conservation surgery in early stage patients. Methods 35 patients from March 1990 to May 1993 in our hospital with stage Ⅰ , Ⅱ a breast cancer received conservation surgery combined with post-surgery radiation therapy, routine chemical therapy, and hormone therapy. Results In 18 years follow-up, local recurrence rate was 11.4%(4/35),overall survival rate was 82.9%(29/35),cosmetic satisfaction rate was 88. 6%(31/35). Conclusion The patients with early breast cancer benefit from conservation surgery for high survival rate and improved life quality.%目的 评价早期乳腺癌患者行保留乳房治疗的疗效.方法 选择1990年3月至1993年5月本院乳腺癌患者35例,乳腺癌TNM为Ⅰ期、Ⅱa期行保留乳房手术(BCS)患者,术后行放疗、化疗,受体阳性患者口服三苯氧胺.结果 BCS治疗后优良率为88.6%(31/35).经18年随访,局部复发4例(11.4%),死亡6例(其中4例死于远处转移,2例死于心血管疾病),总生存率为82.9%(29/35).结论 早期乳腺癌行保留乳房治疗的疗效肯定,不仅生存率等同于同期的改良根治术,而且生活质量明显提高.

  5. Age as a predictor of outcome for women with DCIS treated with breast-conserving surgery and radiation: The University of Texas M. D. Anderson Cancer Center experience

    International Nuclear Information System (INIS)

    Purpose: To analyze the long-term outcome of breast conservation therapy in patients with ductal carcinoma in situ (DCIS) in a single institution and to analyze the prognostic importance, if any, of young patient age. Methods and Materials: The hospital records of 150 patients with DCIS treated with surgical excision and radiotherapy at our institution between 1980 and 1997 were retrospectively reviewed. For most of the patients, intraoperative specimen radiographs or postoperative mammograms were available for use in assessing that an adequate surgical resection had been performed. The median patient age was 53 years (range 32-81), with 13% of patients ≤40 years old. Results: At a median follow-up of 63 months, 12 patients had local disease recurrence. The actuarial rate of local recurrence-free survival at 5 and 10 years was 96% and 88%, respectively. Local recurrence correlated with nuclear grade (p=0.002) but was not associated with patient age at diagnosis (<40 years vs. ≥40 years, p=0.39). In all cases of local recurrence, patients underwent surgery with or without chemotherapy, and disease control was achieved. Conclusion: The results of this study demonstrate high rates of long-term overall survival, disease-specific survival, and local control in patients with DCIS of the breast treated conservatively with segmental mastectomy and radiotherapy. On the basis of the excellent long-term local control and 100% disease-specific survival rates, we found that patient age does not affect the outcome if the margins are clear. Continued studies in young patients treated with breast conservative therapy for DCIS are needed

  6. Conservative treatment of upper extremity lymphedema after breast cancer surgery%乳腺癌术后上肢淋巴水肿的保守治疗

    Institute of Scientific and Technical Information of China (English)

    杨蓉

    2013-01-01

    Objective To analyze the clinical efficacy of conservative treatment for upper extremity lymphedema after breast cancer surgery. Methods 40 patients of upper extremity lymphedema after breast cancer surgery from March 2010 to December 2011 in our hospital were selected as the object of study.The patients were given conservative treatment(drug therapy,physical exercise,mechanical and physical therapy,massage,etc.),and the therapeutic effect of patients were observed. Results The upper extremity lymphedema of all patients had different degrees fadeaway,mild and moderate patients had better rehabilitation,while severe patients had slightly worse rehabilitation. Conclusion Conservative treatment of upper extremity lymphedema after breast cancer surgery has better efficacy,and can significantly improve the patient's condition,and clinical study may be further strengthened to enhance the application value.%目的:分析乳腺癌术后上肢淋巴水肿的保守治疗的临床疗效。方法选取2010年3月~2011年12月在我院实施乳腺癌手术且术后发生上肢淋巴水肿的患者40例为研究对象,实施保守治疗(药物治疗、肢体锻炼、机械物理疗法、按摩等),观察治疗效果。结果所有患者上肢淋巴水肿均有不同程度消退,轻度和中度患者康复较好,重度患者略差。结论保守疗法治疗乳腺癌术后淋巴水肿效果较好,能够显著改善患者病情,临床可以进一步加强研究,提升应用价值。

  7. Survey on nursing of breast cancer patients treated with radiotherapy following to breast-conserving surgery. Actual states and problems for nursing care by certified nurses in breast cancer nursing

    International Nuclear Information System (INIS)

    The purpose of the present study is to elucidate the actual states and problems of nursing care provided by certified nurses in breast cancer patients treated with radiotherapy following to breast-conserving surgery. The survey was conducted by a postal anonymous questionnaire. Participants were drawn from the list of certified nurses on the website of Japanese Nursing Association. The questionnaires consisted of multiple choice questions regarding the contents of care performed before, during and after radiotherapy, and free questionnaire on the related problems. The rate of valid replies was 41.2% (40 out of 97 subjects). Before radiotherapy, the accomplishing rate exceeded 70% in about half of all nursing cares. The accomplishing rates were 30 to 50% in about 90% of all cares and 40 to 60% in all cares during and after radiotherapy, respectively. Problems were classified into three categories high-quality practice of radiotherapy nursing, establishment of continuing care system and improvement of cooperation. It is recommended to achieve high quality radiotherapy nursing by certified nurses, the establishment of continuing care system and the improvement of cooperation in order to improve nursing care during and after radiotherapy. (author)

  8. Oncoplastic Approaches to Breast Conservation

    OpenAIRE

    Holmes, Dennis R.; Wesley Schooler; Robina Smith

    2011-01-01

    When a woman is diagnosed with breast cancer many aspects of her physical, emotional, and sexual wholeness are threatened. The quickly expanding field of oncoplastic breast surgery aims to enhance the physician commitment to restore the patient's image and self-assurance. By combining a multidisciplinary approach to diagnosis and treatment with oncoplastic surgery, successful results in the eyes of the patient and physician are significantly more likely to occur. As a way to aid oncoplastic t...

  9. Seven-year follow-up on 334 patients treated by breast conserving surgery and short course radical postoperative radiotherapy: a report of the Yorkshsire Breast Cancer Group

    International Nuclear Information System (INIS)

    A total of 334 patients have been entered into a prospective protocol of breast conserving treatment, which consisted of clinically complete excision, axillary dissection, and radical post-operative radiotherapy given in 20 fractions over 4 weeks. After 7 years' follow-up, 22 patients (6.6%) have had an isolated local recurrence and 24 (7.2%) a local recurrence associated with metastatic disease. Cosmetic assessment shows that patients are more satisfied with the result than their treating consultants, and that 81% have scored themselves as having an excellent or very good result more than 5 years after treatment. (author)

  10. Quality control in breast conservation

    International Nuclear Information System (INIS)

    Over the past 15 years, breast conservation has become an accepted option for treatment of Stages I and II carcinoma of the breast; in this practice in 1991, more than 80% of these patients were treated in this manner. A surgical procedure to excise the primary lesion and to dissect the axilla is generally required to prepare patients for breast conservation, concurrently maximizing esthetic appearance of the breast, minimizing the risk of local recurrence and providing appropriate information for recommendations concerning adjuvant therapy. The volume of breast tissue to be removed, significance of findings at surgical margins, and extent of the axillary dissection are all somewhat controversial subjects. Based upon a personal series of almost 800 patients undergoing breast conservation, observations that reflect the findings from this experience may be shared. (author)

  11. CLINICAL OBSERVATION OF EARLY BREAST CANCER TREATMENT IN THE 90 PATIENTS WITH BREAST CONSERVATION SURGERY%早期乳腺癌保乳手术治疗90例临床观察

    Institute of Scientific and Technical Information of China (English)

    卢振铎; 刘真真; 乔江华; 焦得闯

    2011-01-01

    [Objective] To discuss the clinical effect of breast-conserving surgery for early breast cancer, evaluate long-term effect of improved radiotherapy after breast-conserving surgery. [Methods] Devised a new program used in radiotherapy after breast-conserving surgery, improve single radiation dose when postoperative radiotherapy, but shorten the cycle of radiotherapy. Among the 90 patients, 49 patients received improved radiotherapy after breast-conserving surgery while the remaining 41 patients received conventional radiotherapy plan. The cosmetic result, relapse, metastasis and adverse reactions were compared by x2 analysis. [Results] The cosmetic results of breasts in two groups were not significantly different (P > 0.05). The incidence of radiodermatitis in improved radiotherapy group was significantly higher than another group (P 0.05), metastasis was different (P 0.05). [Conclusion] The improved radiotherapy after breast-conserving surgery could lower metastasis rate, increase patients' quality of life, which could be popularized in clinic to improve survival rate.%[目的]回顾分析早期乳腺癌保留乳房手术治疗的临床效果,评价保乳术后改良放疗对远期疗效的影响.[方法] 2004年1月~2006年1月就诊的90例早期乳腺癌患者,单盲随机将接受改良放疗保乳术治疗的49例患者分为改良组,其余41例分为对照组.X2检验对照分析术后患者对乳房美容效果评价结果、术后复发及转移结果和放疗不良反应结果. [结果]两组患者对乳房美容效果评价结果对照分析显示差异无统计学意义(P>0.05).改良组放射性皮炎高于对照组,差异有统计学意义(P<0.01).两组患者局部复发率及淋巴结复发率对照分析显示差异无统计学意义(P>0.05),而远处转移率差异有统计学意义(P<0.01).而血小板下降及白细胞下降等毒性反应差异无统计学意义(P>0.05).[结论]保乳术后改良放疗可有效降低远处转移

  12. The effects of sequence and type of chemotherapy and radiation therapy on cosmesis and complications after breast conserving surgery and radiation therapy in stage I and II breast cancer

    International Nuclear Information System (INIS)

    Purpose: Chemotherapy plays an increasingly important role in the treatment of both node negative and node positive breast cancer patients, but the optimal sequencing of chemotherapy and radiation therapy is not well established. Our goal is to evaluate the interaction of sequence and type of chemotherapy and hormonal therapy given with radiation therapy on the cosmetic outcome and the incidence of complications of stage I and II breast cancer patients treated with breast conserving therapy. Methods and Materials: The records of 1053 stage I and II breast cancer patients treated with curative intent with breast conserving surgery, axillary dissection and radiation therapy between 1977-91 were reviewed. Median follow-up after treatment was 80 months. 206 patients received chemotherapy alone, 141 patients received hormonal therapy alone, 94 patients received both and 612 patients received no adjuvant therapy. Patients who received chemotherapy +/- hormonal therapy were grouped according to sequence of chemotherapy: (a)concurrent = concurrent chemotherapy with radiation therapy followed by chemotherapy; (b)sequential = radiation followed by chemotherapy or chemotherapy followed by radiation; and (c)sandwich = chemotherapy followed by concurrent chemotherapy and radiation followed by chemotherapy. Compared to node negative patients, node positive patients more commonly received chemotherapy (77% vs. 9%, p2 cm difference in arm circumference) was 2% without chemotherapy vs. 9% with chemotherapy (p-.00001). However, the incidence of arm edema was not affected by sequencing or type of chemotherapy (all p>.40). Patients treated sequentially had a 10% incidence of grade 4 or 5 arm edema vs. 7% in the patients treated concurrently (p=.53). The incidence was 8% vs. 18% in patients treated with CMF vs. CAF (p=.19). The incidence of clinical pneumonitis and rib fracture was not influenced by use of chemotherapy, sequence of chemotherapy or use of hormonal therapy (all p>.13

  13. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: A study in mastectomy specimens using simulation lumpectomy

    Directory of Open Access Journals (Sweden)

    Viswambharan Jaiganesh

    2005-01-01

    Full Text Available BACKGROUND : The response of locally advanced breast cancer (LABC to neoadjuvant chemotherapy (NACT offers these patients previously treated by mastectomy, the chance for breast conservation. AIM : This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor 5 cm. SETTINGS, DESIGN : Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS : Thirty patients with LABC whose tumors reduced with NACT to 5 cm were included. Simulation lumpectomy was performed on the mastectomy specimens to achieve 1 to 2 cm clearance from tumor and hence margin negativity. Multiple sections of the inked margin were studied. STATISTICAL ANALYSIS : Margin positivity was correlated with patient factors. Chi square test and Fisher′s exact test used as appropriate. P value 0.05 was considered significant. RESULTS AND CONCLUSIONS : After three cycles of NACT, 4 patients (13% had complete clinical response including 2 with complete pathological response. Twenty-two (73% showed partial response and 4, no response. Fourteen out of thirty (47% had tumor involvement of margins. Tumors with post-chemotherapy size> 4 cm were margin positive in 10/13 (77%. Tumors with post-chemotherapy size>3 cm were margin positive in 13/24 (54%. Tumors with post-chemotherapy size 3 cm were margin negative in 5/6 (83%. Pre-chemotherapy tumor size and post-chemotherapy tumor size were significantly associated with margin positivity (P=0.003. Tumors in the subareolar location had significantly higher incidence of residual tumor in the nipple areola complex. (P=0.04. Margin positivity of lumpectomy on downstaged tumors can be reduced by removing the nipple areola complex in subareolar tumors and by limiting breast conservation to tumors with post-chemotherapy size 3 cm.

  14. Feasibility of breast conservation surgery in locally advanced breast cancer downstaged by neoadjuvant chemotherapy: A study in mastectomy specimens using simulation lumpectomy

    Directory of Open Access Journals (Sweden)

    Viswambharan Jaiganesh

    2005-01-01

    Full Text Available BACKGROUND: The response of locally advanced breast cancer (LABC to neoadjuvant chemotherapy (NACT offers these patients previously treated by mastectomy, the chance for breast conservation. AIM: This study aims to assess the feasibility of lumpectomy in patients with LABC treated by NACT, with residual tumor 5 cm. SETTINGS, DESIGN: Single group prospective study from August 2001 to June 2003 in a teaching hospital. MATERIALS AND METHODS: Thirty patients with LABC whose tumors reduced with NACT to 5 cm were included. Simulation lumpectomy was performed on the mastectomy specimens to achieve 1 to 2 cm clearance from tumor and hence margin negativity. Multiple sections of the inked margin were studied. STATISTICAL ANALYSIS: Margin positivity was correlated with patient factors. Chi square test and Fisher′s exact test used as appropriate. P value 0.05 was considered significant. RESULTS AND CONCLUSIONS: After three cycles of NACT, 4 patients (13% had complete clinical response including 2 with complete pathological response. Twenty-two (73% showed partial response and 4, no response. Fourteen out of thirty (47% had tumor involvement of margins. Tumors with post-chemotherapy size >4 cm were margin positive in 10/13 (77%. Tumors with post-chemotherapy size>3 cm were margin positive in 13/24 (54%. Tumors with post-chemotherapy size 3 cm were margin negative in 5/6 (83%. Pre-chemotherapy tumor size and post-chemotherapy tumor size were significantly associated with margin positivity (P=0.003. Tumors in the subareolar location had significantly higher incidence of residual tumor in the nipple areola complex. (P=0.04. Margin positivity of lumpectomy on downstaged tumors can be reduced by removing the nipple areola complex in subareolar tumors and by limiting breast conservation to tumors with post-chemotherapy size 3 cm.

  15. The cost-effectiveness of routine radiation therapy (RT) following conservative surgery (CS) for early-stage breast cancer

    International Nuclear Information System (INIS)

    Purpose: The routine use of RT following CS has been shown to decrease the rate of LR by at least 75%, but its ultimate impact on survival remains less clear. Given concerns about its toxicity, inconvenience, and cost, the need for routine RT has been questioned. These concerns, however, need to be balanced against the improved quality of life and reduced salvage costs associated with routine RT. We performed an incremental cost-utility analysis to evaluate whether, even in the assumed absence of a survival advantage, the use of RT in this situation would be considered cost-effective. Materials and Methods: A Markov decision analytic model was developed to examine the incremental impact of the addition of RT to CS on the relevant outcomes and costs from a societal perspective. Using a cycle length of one year, the analysis was performed on a theoretical cohort of 60 year old patients over a 10 year time horizon. To account for quality of life benefits, outcomes were measured in Quality Adjusted Life Years (QALYs). The LR, distant recurrence (DR), and overall survival rates used in the model were drawn principally from NSABP B-06. It was assumed for the baseline analysis that the addition of RT reduces the rate of LR by 75%, but has no impact on overall survival. Salvage for LR following CS and RT consisted of mastectomy and reconstructive surgery (MRS), while, following CS alone, it was assumed that equal numbers of patients would be salvaged by CS and RT and by MRS. The rate of DR was assumed to be constant with and without RT. The utilities of 97 patients with early-stage breast cancer treated with CS and RT were used to adjust the relevant local outcomes for quality of life, while expert judgement was used to estimate the utilities for the DR states. Baseline costs were determined using Medicare charges, ratios of costs to charges and RVUs, all at the Medical College of Virginia. When uncertainties existed, the model was biased against RT. Both benefits and

  16. 乳腺癌保乳手术前应用TAC化疗方案59例%Clinical Efficacy of TAC Scheme of Neoadjuvant Chemotherapy before Breast-Conserving Surgery in Patients with Stage Ⅱ,Ⅲ Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    王斌; 赵倩; 朱丽萍

    2014-01-01

    Objective To explore the application of the TAC scheme of neoadjuvant chemotherapy before breast-conserving surgery in the patients with stage Ⅱ,Ⅲ breast cancer. Methods 118 female cases of breast cancer undergoing breast-conserving surgery after neoadjuvant chemotherapy were divided into the treatment group and the control group. The treatment group received the TAC scheme and the control group was given the CEF scheme. The clinical efficacy and the cosmetic effects and side effects of breast-conserving surgery were observed. Results The clinical effective rate in the treatment group was 62. 71% , which was significantly higher than 44. 07% in the control group ( P﹤0. 05 );the satisfaction rate of the cosmetic effects after breast-conserving surgery in the treatment group was 88. 14%, which was significantly higher than 69. 49% in the control group ( P﹤0. 05 );the two groups had the good tolerance to the two chemotherapy regimens;the digestive system toxicity, neurotoxicity and reproductive toxicity had no statistically significant dif-ferences between the TAC group and the CEF group, but the toxic and side effects of hematologic toxicity, cardiac toxicity, skin and mucosal injury in the TAC group were higher than those in the CEF group, but which all were within the tolerable range ( P﹤0. 05 ) . Conclusion Two kinds of preoperative adjuvant chemotherapeutical schemes before surgery have good effects for stage Ⅱ, Ⅲ breast cancer, but the TAC scheme has better clinical efficacy and better long-term cosmetic effect relative to the CEF scheme, which is wor-thy of being widely used in the neoadjuvant chemotherapy.%目的:探讨TAC方案辅助化学治疗(简称化疗)在Ⅱ期、Ⅲ期乳腺癌患者保乳手术前的应用。方法选取在进行辅助化疗后进行保乳手术的乳腺癌女性患者118例,随机分为两组,各59例。治疗组应用TAC方案,对照组应用CEF方案,观察两组患者的临床疗效、保乳手术美容

  17. Usefulness of lesion image mapping with multidetector-row helical computed tomography using a dedicated skin marker in breast-conserving surgery

    International Nuclear Information System (INIS)

    To investigate the usefulness of computed tomography (CT) with skin-marker placement in determining the excision area and decreasing the positive or close margin rates in breast-conserving surgery (BCS). Multidetector-row helical computed tomography (MDCT) mapping images were reconstructed in subjects (n 117) diagnosed with primary breast cancer who had undergone MDCT using CT skin markers. Serial 5-mm-thick slices prepared from the surgical specimen were used for pathological analyses. A ''positive margin'' was defined as the presence of malignant cells at the surgical margin, and a ''close margin'' as a tumor within 5 mm of the surgical margin. The rates of positive and close margins were calculated. We identified the lesions in 111 of 117 cases (94.9%) on MDCT. Of these, 93 underwent BCS under the guidance of MDCT mapping and the remaining 18 underwent mastectomy. Among the 93 cases, 6 (6.5%) had positive or close margins and were diagnosed with ductal carcinoma in situ of low nuclear grade. MDCT mapping with a CT skin marker is feasible for simulating surgical positioning and determining the excision area. MDCT mapping could decrease the positive and close margin rates in BCS. (orig.)

  18. Study on Effect of Breast-conserving Surgery in Treatment of 40 Patients with Early Breast Cancer%早期乳腺癌保乳手术40例临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    宋云骏; 姜林鹤; 冷彦利

    2014-01-01

    Objective:To explore the effect of breast-conserving surgery in treatment of patients with e-raly breast cancer .Method:80 cases with early breast cancer were divided into the ovservation group ( breast conserving operation ) and control group ( modified radical mastectomy ) according to the different operation methods, then compared patients of two groups in peration time , amount of hemorrhage during operation , hospitalization time , cosmetic results excellent rate , the incidengce rates of complications , post-operative fo-cal recurrence rate , distant metastasis rate and three-year survival rate .Result:The operation time , amount of hemorrhage during operation , hospitalization time in observation group were statistically significantly lower than those in control group;Cosmetic results excellent rate of observation group was significantly higher than the control group;there was no statistically significant difference in the incidence rates of complications , post-operative focal recurrence rate , distant metastasis rate , three-year survival rate between observation group and control group.Conclusion:Breast-conserving surgery has the advantage of short operation time , fast, good cosmetic effect and high quality of life and so on ,can be used as the first choice for early breast cancer .%目的:探讨早期乳腺癌行保乳手术的临床疗效。方法:选取80早期乳腺癌,根据不同手术方法,分为实验组(保乳手术)和对照组(改良根治术),对比两组患者在手术时间、术中的出血量、住院时间、美容效果、手术并发症发病率及远处转移和局部复发情况。结果:实验组在手术时间、术中的出血量、住院时间、均明显低于对照组,美容效果优良率明显高于对照组,术后并发症发病率及远处转移和局部复发率与对照组比较差异无统计学意义。结论:保乳手术具有手术时间短,术后恢复快、美容效果好及能有效提

  19. Breast-preserving (conservative) therapy of cancer

    International Nuclear Information System (INIS)

    Conservative surgery (sectoral or segmental + axillary dissection) was performed in 278 patients with breast cancer (Tl-2N0M0) at the Institute Clinic in 1990-1995. Following thorough morphological examination, 148 patients were selected to form a clinical study group for an investigation of the role of postoperative radiotherapy in the conservative treatment of breast cancer. Two groups - irradiation of the remaining breast tissue and controls - were formed on the basis of randomized data. Follow-up continues 3-60 months (average duration - 37,7 months). Local recurrence was detected in 3 out of 73 patients of group 1. A similar relapse was detected in 6 out of 75 patients of group 2. No significant difference in total survival rates in the two groups was observed (97,3 and 96,0%)

  20. Ultrasound-guided breast-sparing surgery to improve cosmetic outcomes and quality of life. A prospective multicentre randomised controlled clinical trial comparing ultrasound-guided surgery to traditional palpation-guided surgery (COBALT trial)

    OpenAIRE

    Bergers Elisabeth; Taets van Amerongen Annette HM; Bosch Anne; de Roos Wilfred K; de Widt Louise; Poortman Pieter; Muller Sandra; van der Veen Henk; Rijna Herman; Lopes Cardozo Alexander MF; Schreurs Hermien WH; Zonderhuis Barbara M; Krekel Nicole MA; van der Linden Mecheline HM; de Lange de Klerk Elly SM

    2011-01-01

    Abstract Background Breast-conserving surgery for breast cancer was developed as a method to preserve healthy breast tissue, thereby improving cosmetic outcomes. Thus far, the primary aim of breast-conserving surgery has been the achievement of tumour-free resection margins and prevention of local recurrence, whereas the cosmetic outcome has been considered less important. Large studies have reported poor cosmetic outcomes in 20-40% of patients after breast-conserving surgery, with the volume...

  1. Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery – A case series

    Directory of Open Access Journals (Sweden)

    Pier Carlo Rassu

    2016-02-01

    Conclusion: During 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients.

  2. Lymph Drainage Studied by Lymphoscintigraphy in the Arms after Sentinel Node Biopsy Compared with Axillary Lymph Node Dissection Following Conservative Breast Cancer Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Celebioglu, F.; Perbeck, L.; Frisell, J.; Groendal, E.; Svensson, L.; Danielsson, R. [Dept. of Molecular Medicine and Surgery, Karolinska Inst., Karolinska Univ Hospital Solna, Stockholm (Sweden)

    2007-07-15

    Purpose: To investigate lymphatic drainage as measured by lymphoscintigraphy in the arms of patients undergoing either sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND). Material and Methods: From January 2001 to December 2002, 30 patients with unilateral invasive breast carcinoma underwent breast-conserving surgery with SNB and 30 patients with ALND. All patients received radiotherapy to the breast. Lymphoscintigraphy was performed, and skin circulation, skin temperature, and arm volume were measured 2-3 years after radiotherapy. Results: None of the 30 patients who underwent SNB showed any clinical manifestation of lymphedema. Of the 30 patients undergoing ALND, six (20%) had clinical lymphedema, with an arm volume that was >10% larger on the operated than on the non-operated side (P<0.01). Scintigraphically, visual analysis revealed lymphatic dysfunction in three patients, manifested as forearm dermal back flow. Two of these patients also had an increased arm volume. Quantitative analysis showed no differences between the groups, apart from a smaller amount of isotope in the axilla in the ALND group. There was no difference in skin circulation or skin temperature. Conclusion: Our study shows that lymph drainage in the operated arm compared with the non-operated arm was less affected by SNB than by ALND, and that morbidity associated with SNB was lower than with ALND. However, the results do not confirm our hypothesis that lymphoscintigraphy can reveal differences in lymph circulation that are not evident clinically in the form of manifest lymphedema. The most sensitive clinical method of assessing lymph drainage seems to be measurement of arm volume.

  3. Evaluation of Single Nucleotide Polymorphisms (SNPs) in the p53 Binding Protein 1 (TP53BP1) Gene in Breast Cancer Patients Treated With Breast-Conserving Surgery and Whole-Breast Irradiation (BCS + RT)

    International Nuclear Information System (INIS)

    Purpose: TP53BP1 is a key component of radiation-induced deoxyribonucleic acid damage repair. The purpose of this study was to evaluate the significance of a known common single nucleotide polymorphism in this gene (rs560191) in patients treated with breast-conserving surgery and whole-breast irradiation (BCS + RT). Methods and Materials: The population consisted of 176 premenopausal women treated with BCS + RT (median follow-up, 12 years). Genomic deoxyribonucleic acid was processed by use of TaqMan assays. Each allele for rs560191 was either C or G, so each patient was therefore classified as CC, CG, or GG. Patients were grouped as GG if they were homozygous for the variant G allele or CC-CG if they carried at least one copy of the common C allele (CC or CG). Results: Of the 176 women, 124 (71%) were CC-CG and 52 (29%) were GG. The mean age was 44 years for GG vs. 38 years for CC-CG (p < 0.001). GG was more common in African-American women than white women (69% vs. 13%, p < 0.001) and more commonly estrogen receptor negative (70% vs. 49%, p = 0.02). There were no significant correlations of rs560191 with other critical variables. Despite the fact that GG patients were older, the 10-year rate of local relapses was higher (22% for GG vs. 12% for CC-CG, p = 0.04). Conclusions: This novel avenue of investigation of polymorphisms in radiation repair/response genes in patients treated with BCS + RT suggests a correlation to local relapse. Additional evaluation is needed to assess the biological and functional significance of these single nucleotide polymorphisms, and larger confirmatory validation studies will be required to determine the clinical implications.

  4. 乳腺癌保乳术后放疗所致的皮肤反应及护理%Skin Reactions and Nursing after Breast Conservative Surgery of Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    刘海涛

    2013-01-01

    Objective:To observe and analyze skin reactions and nursing after breast conservative surgery of breast cancer and take appropriate measures. Method:80 patients with breast cancer were selected,and breast conservative radical cure operated. The total amount was 60 to 70 Gy,6 to 7 weeks completed. During the process,partial skin reactions were closely observed and appropriate measures were taken. Result:The results demonstrate that 80 patients were given radiotherapy on time,without fester,infections and level 4 skin reactions. The health of patients was obviously enhanced and improved. Conclusion:It does exists the skin reactions after radiotherapy of breast conservative surgery,however,the patients will feel less painful with fewer partial skin reactions and health improved greatly if timely and appropriate measures are taken.%  目的:观察分析乳腺癌保乳术后放疗所致的皮肤反应,制定相应的护理对策。方法:对80例适应保乳的乳腺癌患者术后行根治性放疗,总量60~70 Gy,6~7周完成,观察局部皮肤反应,制定相应护理措施。结果:80例全部按时完成放疗,无溃烂和感染,无4级皮肤反应发生,明显改善患者的生存质量,提高治疗效果。结论:乳腺癌保乳术后放疗所致的皮肤反应是存在的,但是,采取及时有效的护理干预,能减轻局部皮肤反应,减轻患者痛苦,提高疗效,提高生存质量。

  5. Dose and polymorphic genes xrcc1, xrcc3, gst play a role in the risk of articledeveloping erythema in breast cancer patients following single shot partial breast irradiation after conservative surgery

    International Nuclear Information System (INIS)

    To evaluate the association between polymorphisms involved in DNA repair and oxidative stress genes and mean dose to whole breast on acute skin reactions (erythema) in breast cancer (BC) patients following single shot partial breast irradiation (SSPBI) after breast conservative surgery. Acute toxicity was assessed using vers.3 criteria. single nucleotides polymorphisms(SNPs) in genes: XRCC1(Arg399Gln/Arg194Trp), XRCC3 (A4541G-5'UTR/Thr241Met), GSTP1(Ile105Val), GSTA1 and RAD51(untranslated region). SNPs were determined in 57 BC patients by the Pyrosequencing analysis. Univariate(ORs and 95% CI) and logistic multivariate analyses (MVA) were performed to correlate polymorphic genes with the risk of developing acute skin reactions to radiotherapy. After SSPBI on the tumour bed following conservative surgery, grade 1 or 2 acute erythema was observed in 19 pts(33%). Univariate analysis indicated a higher significant risk of developing erythema in patients with polymorphic variant wt XRCC1Arg194Trp, mut/het XRCC3Thr241Met, wt/het XRCC3A4541G-5'UTR. Similarly a higher erythema rate was also found in the presence of mut/het of XRCC1Arg194Trp or wt of GSTA1. Whereas, a lower erythema rate was observed in patients with mut/het of XRCC1Arg194Trp or wt of XRCC1Arg399Gln. The mean dose to whole breast(p = 0.002), the presence of either mut/het XRCC1Arg194Trp or wt XRCC3Thr241Met (p = 0.006) and the presence of either mut/het XRCC1Arg194Trp or wt GSTA1(p = 0.031) were confirmed as predictors of radiotherapy-induced erythema by MVA. The Whole breast mean dose together with the presence of some polymorphic genes involved in DNA repair or oxidative stress could explain the erythema observed after SSPBI, but further studies are needed to confirm these results in a larger cohort. ClinicalTrials.gov Identifier: http://www.clinicaltrials.gov/ct2/show/NCT01316328

  6. Outcome and prognostic factors for local recurrence in mammographically detected ductal carcinoma in situ of the breast treated with conservative surgery and radiation therapy

    International Nuclear Information System (INIS)

    Purpose: We have retrospectively reviewed our institution's experience treating a predominantly mammographically detected population of ductal carcinoma in situ (DCIS) patients with conservative surgery and radiation therapy (CSRT) to determine outcome and prognostic factors for local recurrence. Methods and Materials: Between January 1, 1982 and December 31, 1988, 52 consecutive cases of DCIS of the breast were treated with CSRT at William Beaumont Hospital. Forty-six (88%) were mammographically detected nonpalpable lesions. All patients underwent at least an excisional biopsy and 28 (54%) were reexcised. The axilla was surgically staged in 41 (79%) and all were N0. The entire breast was irradiated to 45-50 Gy over 5-6 weeks. The tumor bed was boosted in 49 (94%) so that the minimum dose was 60 Gy. The three patients not boosted received a minimum dose of 50 Gy to the entire breast. Pathologic materials were reviewed by one of the authors. Results: The predominant DCIS pattern was comedo in 40%, cribriform in 28%, solid in 17%, and micropapillary in 15%. The predominant nuclear grade was Grade I in 51%, Grade II in 49%, and Grade III in 0%. The median follow-up is 68 months. There have been three recurrences in the treated breast at a median time to failure of 30 months. The 5- and 8-year actuarial local recurrence rate is 6%. One patient recurred with invasive ductal cancer at 28 months, and the other two recurrences were DCIS at 30 and 50 months. All three patients were treated with salvage mastectomy. The patient who recurred locally with an invasive cancer developed metastasis and died at 64 months. The 5- and 8-year actuarial cause-specific survival rates are 100% and 97%, respectively. The following pathologic factors were analyzed for an association with local recurrence: predominant DCIS histology, predominant nuclear grade, and highest nuclear grade. Of these, the predominant nuclear grade was the best predictor of local recurrence (p = 0.070). No

  7. Impact of radiotherapy technique on the outcome of early breast cancer treated with conservative surgery: A multicenter observational study on 1,176 patients

    International Nuclear Information System (INIS)

    Purpose: To quantify the impact of radiotherapy technique on cosmetic outcome and on 5-year local control rate of early breast cancer treated with conservative surgery and adjuvant radiation. Methods and MaterialsPurpose: A total of 1,176 patients irradiated to the breast in 1997 were entered by eight centers into a prospective, observational study. Surgical procedure was quadrantectomy in 97% of patients, with axillary dissection performed in 96%; pT-stage was T1 in 81% and T2 in 19% of cases; pN-stage was N0 in 71%, N + (1-3) in 21%, and N + (>3) in 8% of cases. An immobilization device was used in 17% of patients; external contour-based and computed tomography-based treatment planning were performed in 20% and 72% of cases, respectively; 37% of patients were treated with a telecobalt unit and 63% with a linear accelerator; portal verification was used in 55% of patients; a boost dose to the tumor bed was delivered in 60% of cases. Results: With a median follow-up of 6.2 years, local, regional, and distant control rates at 5 years are 98%, 99%, and 92%, respectively. Use of less sophisticated treatment technique was associated with a less favorable cosmetic outcome. Local control was comparable between centers despite substantial technical differences. In a multivariate analysis including clinical and technical factors, only older age and prescription of medical adjuvant treatment significantly predicted for better local control, whereas use of portal verification was of borderline significance. Conclusions: Radiation technical factors impacted negatively on cosmetic outcome, but had relatively small effects on local control compared with other clinical factors

  8. Breast reshaping with displacement of residual gland following breast conserving surgery%残留腺体转位整形法在乳腺癌保乳手术中的应用

    Institute of Scientific and Technical Information of China (English)

    周围; 王泽强; 郭琼; 胡壹; 廖妮

    2012-01-01

    目的:探讨乳腺癌保乳手术中采用残留腺体转位整形法应用的可行性,并评估其美学效果.方法:对2009年10月-2011年11月收治的47例肿瘤直径≤3 cm的乳腺癌患者行保乳手术,其中36例采用残留腺体转位整形法(观察组),11例仅直接缝合皮肤(对照组),分别评估两组患者的术后及放疗后的美学效果.结果:全部患者随访9~33个月,中位随访时间21个月,无1例复发及转移.术后3个月,观察组与对照组达到优或良美学效果的分别为31例(86.1%)和8例(72.7%),两组差异无统计学意义(P>0.05);放疗后3个月,观察组与对照组在放疗后达到优或良美学效果的分别为30例(83.3%)和6例(54.5%),观察组的美学效果优于对照组,差异有统计学意义(x2=3.895,P<0.05).结论:对于肿瘤直径≤3cm的乳腺癌患者,采用残留腺体转位整形法是一种简单、有效、创伤小、术后乳房美学效果满意的方法.%Objective: To investigate the feasibility and assess the cosmetic effect of mammaplasty with displacement of residual glandular tissue following breast conserving surgery. Methods: Breast conserving surgery was performed in 47 patients whose lesion size was less than 3 cm and admitted between October 2009 and November 2011. Of the patients, 36 cases received oncoplastic volume displacement (observation group) and 11 cases had only direct skin closure without treatment of the post-resection defect (control group) following breast conserving surgery. The cosmetic results of the two groups were evaluated after operation and radiotherapy, respectively. Results: All patients were followed up for 9-33 months with median follow-up of 21 months, and no recurrence or metastasis occurred in any of the patients. Three months after surgery, the excellent or good cosmetic outcome was achieved in 31 cases (86.1%) in observation group and 8 cases (72.7%) in control group respectively, and there was no statistical difference

  9. Clinical observation of combination of breast-conserving surgery with postoperative radiotherapy for early stage of breast cancer%早期乳腺癌保乳手术联合放射治疗的临床观察

    Institute of Scientific and Technical Information of China (English)

    郭梅花; 李殿祖; 乔丽

    2010-01-01

    目的 观察早期乳腺癌保乳手术联合放射治疗的近期疗效、美容效果及副反应.方法 42例早期乳腺癌行保乳手术,术后联合放射治疗,采用常规切线野照射46~50 Gy/23~25次,后瘤床补量10~14 Gy/5~7次.结果 随访12~48个月,1年生存率100%,3年生存率97.62%,3年局部复发率4.76%.近期美容效果满意和一般占92.86%.2例局部复发,2例远处转移,2例出现3级放射性肺炎,3例Ⅲ度放射性皮肤反应,无Ⅲ~Ⅳ度骨髓抑制.结论 早期乳腺癌行保乳手术联合放射治疗的近期生存率与乳腺癌根治术相同,近期美容效果满意,放射治疗的并发症可以接受.对符合条件的早期乳腺癌可推广此治疗方法.%Objective To observe the short effect, cosmetic effect and toxicity of combination of breastconserving surgery with postoperative radiotherapy for early stage of breast cancer. Methods Forty-two patients with early stage of breast cancer received combination of breast-conserving surgery with postoperative radiotherapy, whole breast received 46 to 50 Gy in 23 to 25 fractions delivered by conventional tangent field and boost to tumor bed with 10 to 14 Gy in 5 to 7 fractions was given after whole breast irradiation. Results Followed up for 12 to 48 months, 1-year survival rate was 100% ,3-year survival rate was 97.62% ,3-year local recurrent rate was 4. 76%, recent satisfaction rate of cosmetic result was 92. 86%. Local recurrence was found in 2 patients,distant metastasis was found in 2 patients. Two patients appeared 3 grade of radiation-induced pneumonitis and three patients appeared 3 grade of radiation-induced dermatitis. Conclusion Recent survival rate and cosmetic result is satisfactory for the patients with early stage of breast cancer treated with combination of breast-conserving surgery and radiotherapy, the acute toxicity is acceptable.

  10. Simultaneous Integrated Boost Irradiation After Breast-Conserving Surgery: Physician-Rated Toxicity and Cosmetic Outcome at 30 Months' Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Bantema-Joppe, Enja J.; Schilstra, Cornelis [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bock, Geertruida H. de [Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Dolsma, Wil V.; Busz, Dianne M.; Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Maduro, John H., E-mail: j.h.maduro@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

    2012-07-15

    Purpose: To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age. Methods and Materials: Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0-III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed. Results: At 3 years, toxicity scores of 436 patients were available. Grade {>=}2 fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7% of cases. Radiotherapy before chemotherapy was significantly associated with grade {>=}2 boost fibrosis at 3 years (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.3-6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95% CI 1.2-4.0) and larger tumors (OR 1.1, 95% CI 1.0-1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95% CI 1.2-3.7) and younger age (OR 0.4, 95% CI 0.2-0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95% CI 2.4-8.5), after regional radiotherapy (OR 2.9, 95% CI 1.2-7.1), and in larger tumors (OR 1.1, 95% CI 1.0-1.1). Conclusions: Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.

  11. Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity

    International Nuclear Information System (INIS)

    The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity. From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34–83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59 %), luminal-B 24 pts (24 %), basal-like 10 pts (10 %), Her-2 like 7 pts (7 %). 82 pts (82 %) received hormonal therapy, 9 pts (9 %) neo-adjuvant chemotherapy, 81pts (81 %) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation. Within a median follow-up of 50 months (range 19–82), 6 (6 %) pts died, 1 pt (1 %) had local progression disease, 2 pts (2 %) developed distant metastasis and 1 subject (1 %) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27 %) presented lymphedema, but only 10 cases (10 %) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis. Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related

  12. Simultaneous Integrated Boost Irradiation After Breast-Conserving Surgery: Physician-Rated Toxicity and Cosmetic Outcome at 30 Months’ Follow-Up

    International Nuclear Information System (INIS)

    Purpose: To evaluate toxicity and cosmetic outcome (CO) in breast cancer survivors treated with three-dimensional conformal radiotherapy with a hypofractionated, simultaneous integrated boost (3D-CRT-SIB) and to identify risk factors for toxicity, with special focus on the impact of age. Methods and Materials: Included were 940 consecutive disease-free patients treated for breast cancer (Stage 0–III) with 3D-CRT-SIB, after breast-conserving surgery, from 2005 to 2010. Physician-rated toxicity (Common Terminology Criteria for Adverse Events version 3.0) and CO were prospectively assessed during yearly follow-up, up to 5 years after radiotherapy. Multivariate logistic regression analyses using a bootstrapping method were performed. Results: At 3 years, toxicity scores of 436 patients were available. Grade ≥2 fibrosis in the boost area was observed in 8.5%, non-boost fibrosis in 49.4%, pain to the chest wall in 6.7%, and fair/poor CO in 39.7% of cases. Radiotherapy before chemotherapy was significantly associated with grade ≥2 boost fibrosis at 3 years (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.3–6.0). Non-boost fibrosis was associated with re-resection (OR 2.2, 95% CI 1.2–4.0) and larger tumors (OR 1.1, 95% CI 1.0–1.1). At 1 year, chest wall pain was significantly associated with high boost dosage (OR 2.1, 95% CI 1.2–3.7) and younger age (OR 0.4, 95% CI 0.2–0.7). A fair/poor CO was observed more often after re-resection (OR 4.5, 95% CI 2.4–8.5), after regional radiotherapy (OR 2.9, 95% CI 1.2–7.1), and in larger tumors (OR 1.1, 95% CI 1.0–1.1). Conclusions: Toxicity and CO are not impaired after 3D-CRT-SIB. Fibrosis was not significantly associated with radiotherapy parameters. Independent risk factors for fibrosis were chemotherapy after radiotherapy, re-resection, and larger tumor size. Re-resection was most predictive for worse CO. Age had an impact on chest wall pain occurrence.

  13. Breast-conserving surgery and combined therapy for women breast cancer:a report of 216 cases%216例女性乳腺癌保乳手术及综合治疗的临床分析

    Institute of Scientific and Technical Information of China (English)

    Xianju Qin; Junxue Chen; Hongwei Zhang; Dafang Zhao; Hua Zhang; Wenjie Luo; Qian Huang; Shixian Lian; Hanxing Tong

    2007-01-01

    Objective:To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage Ⅰand stage Ⅱ breasl cancer.Methods:216 female patients with breast cancer underwent breast-conserving therapy from December 1993 to October 2004.Their data were analyzed retrospectively.The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast,postoperative radiotherapy.chemotherapy and endocrine therapy.of them.209 patients underwent axillary lymph node dissection.Results:There were no operative complications.216patients were followed-up 3 to 147 months.the medial follow-up time was 78 months.The local recurrence rate was 1.85%.Two patients died and one of them was not related with breast cancer.Presence or absence of fibrosis,shape of breast,asymmetry,pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon.Breasts were scored cosmetically asexcellent and good in 199 patients.the rate of satisfactory was92.13%.Conclusion:Breast-conserving therapy for early breast cancer is a safe and effective therapy.It has less trauma and less complications and can also raise the quality of life in the patients.But we must obey the strict indications and reasonable techniques.

  14. Eleven cases of breast conservation

    International Nuclear Information System (INIS)

    Eleven patients with T1 and small T2 breast cancer were treated by a combination of quadrantectomy, axillary dissection and radiotherapy. The mean age of the patients was 44.6 years. Mean follow-up period was 7.1 months. Six patients had clinical stage I, and five patients had clinical stage II. Four patients had involvement of axillary content (36.3%) on histological examination. There were eight scirrhous carcinomas and three papillotubular carcinomas. The incidence of local and distant recurrence was none in our group. The multifocality of breast cancer based on pathologic studies had been shown. On the basis of these findings we concluded that the patients undergoing breast conservation should be subjected to postoperative radiotherapy. Psychological morbidity was compared in 10 patients treated by breast conservation and 23 patients treated by mastectomy. There were no statistically significant differences between two groups in the estimation of adjustment disorder, depression, anxiety and stress. The patients in breast conservation group had a significant excess or nervousness and the patients of the mastectomy group had an anger. (author)

  15. Delayed breast cellulitis: An evolving complication of breast conservation

    International Nuclear Information System (INIS)

    Purpose: Delayed breast cellulitis (DBC) is characterized by the late onset of breast erythema, edema, tenderness, and warmth. This retrospective study analyzes the risk factors and clinical course of DBC. Methods and Materials: From 1985 through 2004, 580 sequential women with 601 stage T0-2N0-1 breast cancers underwent breast conserving therapy. Cases of DBC were identified according to accepted clinical criteria: diffuse breast erythema, edema, tenderness, and warmth occurring >3 months after definitive surgery and >3 weeks after radiotherapy. Potential risk factors analyzed included patient comorbidity, operative technique, acute complications, and details of adjunctive therapy. Response to treatment and long-term outcome were analyzed to characterize the natural course of this syndrome. Results: Of the 601 cases, 16%, 52%, and 32% were Stage 0, I, and II, respectively. The overall incidence of DBC was 8% (50/601). Obesity, ecchymoses, T stage, the presence and aspiration of a breast hematoma/seroma, removal of >5 axillary lymph nodes, and arm lymphedema were significantly associated with DBC. The median time to onset of DBC from the date of definitive surgery was 226 days. Ninety-two percent of DBC patients were empirically treated with antibiotics. Fourteen percent required more invasive intervention. Twenty-two percent had recurrent episodes of DBC. Ultimately, 2 patients (4%) underwent mastectomy for intractable breast pain related to DBC. Conclusion: Although multifactorial, we believe DBC is primarily related to a bacterial infection in the setting of impaired lymphatic drainage and may appear months after completion of radiotherapy. Invasive testing before a trial of antibiotics is generally not recommended

  16. Clinical outcome and cosmetics in breast cancer patients treated with conservative surgery and radiotherapy%97例乳腺癌保乳治疗的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    温凤云; 马特; 于洪

    2012-01-01

    [Objective] To evaluate the effectiveness and the cosmetic result of radiotherapy after breast conserving surgery for early breast cancer. [ Methods ] A total of 97 early invasive breast carcinoma in women who had undergone previous breast - conserving surgery were treated with postoperative irradiation. [ Results ] The median follow - up time was 60 months,the overall survival rate was 97. 3% and the locoregional recurrence rate was 3.21% ,as calculated using the Kaplan - Meier method. Excellent and good cosmetic result was noted in 91 patients. [Conclusion] Breast - conserving therapy , consisting of breast - conserving surgery followed by breast radiotherapy, has therefore become the standard regimen for treatment of eariy invasive breast cancer.%[目的]观察乳腺癌保乳手术加放疗的临床疗效及美容效果.[方法]97例乳腺癌行保乳手术后接受术后放疗,用6MV -X射线照射全乳房,采用乳房切线野照射,每次2Gy,每周照射5次,至DT 50Gy/25f/35d.瘤床区加量采用9~ 12 MeV电子线,每次2Gy,共5次,DT10Gy.有腋窝淋巴结转移,给以同时行锁骨上区预防性照射DT 50Gy/25f/35d.[结果]中位随访时间为60个月(30 ~72个月),总生存率为97.3%,局部复发率为3.21%,无病生存率为94.7%.乳房美容效果好,优良率达93.8%.[结论]乳腺癌保乳手术加放疗可以获得满意的控制率和美容效果.

  17. 1998-1999 Patterns of Care Study process survey of national practice patterns using breast-conserving surgery and radiotherapy in the management of Stage I-II breast cancer

    International Nuclear Information System (INIS)

    Purpose: The Patterns of Care Study survey process evaluation has been an effective means of assessing the evaluation and treatment practices used by radiation oncologists in the United States for Stage I-II breast cancer. The current 1998-1999 report updates the previous 1989 and 1993-1994 analyses and reflects the recent changes in surgery and systemic therapy observed nationally in the management of early-stage disease. Methods and Materials: A weighted sample size of 71,877 patient records of women treated with breast-conserving surgery and radiotherapy (RT) was obtained from a stratified two-stage sampling of 353 patient records. These cases were centrally reviewed from academic and private radiation oncology practices across the United States. The data collected included patient characteristics, clinical and pathologic factors, and surgical and RT details. The results were compared with those of previous Patterns of Care Study survey reports. Results: Of the patients in the current survey, 97% had undergone mammography before biopsy. A review of the primary tumor pathologic findings indicated improved quantification of an intraductal component from 7.0% in 1993-1994 to 20.4% in 1998-1999 (p = 0.01). The tumor characteristics were better defined, with estrogen and progesterone receptor measurement performed in 91.4% and 91.3% in the 1998-1999 survey vs. 83.7% and 80.3% in the 1989 survey, respectively (p = 0.03 and p = 0.002, respectively). Axillary dissection was performed in 82.2% in the present survey compared with 93.6% in the 1993-1994 survey (p = 0.0004); sentinel node biopsy was performed in 20.1% of the present cases. The use of CT for planning was increased in the current survey, with 22.9% cases CT planned vs. 9% in 1993-1994 (p = 0.10). In the present survey, 100% had received whole breast RT. When a supraclavicular field was added, the dose was prescribed to a specified depth in 67.5% of cases, most commonly 3 cm. When an axillary field was added

  18. Accelerated Partial Breast Irradiation: 5-Year Results of the German-Austrian Multicenter Phase II Trial Using Interstitial Multicatheter Brachytherapy Alone After Breast-Conserving Surgery

    International Nuclear Information System (INIS)

    Purpose: To evaluate the impact of accelerated partial breast irradiation on local control, side effects, and cosmesis using multicatheter interstitial brachytherapy as the sole method for the adjuvant local treatment of patients with low-risk breast cancer. Methods and Materials: 274 patients with low-risk breast cancer were treated on protocol. Patients were eligible for the study if the tumor size was 35 years, hormone receptors were positive, and histologic grades were 1 or 2. Of the 274 patients, 175 (64%) received pulse-dose-rate brachytherapy (Dref = 50 Gy). and 99 (36%) received high-dose-rate brachytherapy (Dref = 32.0 Gy). Results: Median follow-up was 63 months (range, 9-103). Only 8 of 274 (2.9%) patients developed an ipsilateral in-breast tumor recurrence at the time of analysis. The 5-year actuarial local recurrence-free survival probability was 98%. The 5- year overall and disease-free survival probabilities of all patients were 97% and 96%, respectively. Contralateral in-breast malignancies were detected in 2 of 274 (0.7%) patients, and distant metastases occurred in 6 of 274 (2.2%). Late side effects ≥Grade 3 (i.e., breast tissue fibrosis and telangiectasia) occurred in 1 patient (0.4%, 95%CI:0.0-2.0%) and 6 patients (2.2%, 95%CI:0.8-4.7%), respectively. Cosmetic results were good to excellent in 245 of 274 patients (90%). Conclusions: The long-term results of this prospective Phase II trial confirm that the efficacy of accelerated partial breast irradiation using multicatheter brachytherapy is comparable with that of whole breast irradiation and that late side effects are negligible.

  19. Cone-beam computed tomography guided study on silver clips displacement in breast cancer patients treated by three-dimensional conformal partial breast irradiation assisted by active breathing control after breast-conserving surgery

    International Nuclear Information System (INIS)

    Objective: To study the displacement of silver clips guided by cone-beam computed tomography (CBCT) to explore the margin of clinical target volume (CTV) to planning target volume (PTV) for breast cancer patients treated by three-dimensional conformal external-beam partial breast irradiation (EB-PBI) assisted by active breathing control (ABC) after breast-conserving surgery. Methods: All patients received CT simulated positioning assisted by ABC to get CT images based on the respiratory condition of moderate deep inspiration breath hold (mDIBH), and the images were transferred to Varian Eclipse treatment planning system. Four silver clips located at the cephal, pedal, lateral border and bottom of the cavity were delineated respectively and the cavity based on all of the clips were delineated as gross tumor volume (GTV). The treatment planning for EB-PBI was performed in Varian 23 EX linear accelerator equipped with kilovoltage(kV) CBCT image-guided system named On-Board Imager (OBI) system. Before each irradiation, kV-CBCT were carried out twice for patients on the respiratory condition of mDIBH assisted by ABC device with the same threshold as CT simulated positioning to get the CBCT images. 3D-3D automatic registration based on pixel between the CBCT image and the planning CT image was finished and the displacement on LAT, LNG and VRT directions were recorded, and then the marked clips were registered by hand movement based on the automatic registration and the shifts and directions were also recorded. A total of eight groups data of displacement of each marked clip for each patient were got from four fractions with two groups data during each fraction. Based on the registration data of the marked clips, the intrafraction and interfraction group systematic errors (Σintra vs Σinter) and group random errors (σintra vs σinter) were analysed. General group systematic error Σgeneral and general random error σgeneral were calculated based on combination of

  20. The value of radiotherapy in breast-conserving treatment

    International Nuclear Information System (INIS)

    Breast conserving treatment owes its legitimacy to the ability of radiotherapy (RT), in conjunction with limited surgery, to provide local control equivalent to that associated with total mastectomy. This paper will be concerned exclusively with the treatment of the breast, since indications for RT of lymph node areas are independent of the type of breast surgery employed. Randomized trials have enabled quantitation of the effect of reduction in recurrence risk compared to surgery alone. Even though local recurrence is a predictor of metastatic disease, its prevention by breast RT has not yet been shown to improve survival. Thus the main benefits of breast RT relate to preventing the consequences of local failure, namely breast loss. With modern RT techniques, cosmetic results should be satisfactory in 90% of preserved breast. The main clinical research areas concern the optimal sequencing of surgery, RT and chemotherapy, the improvement of local control in high-risk patients, the extension of breast conservation to more advanced cases by the use of neo-adjuvant chemotherapy and RT, the identification of early-stage patients who could be treated with wide excision alone, and the value of RT in ductal in situ carcinomas. (author)

  1. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS)

    International Nuclear Information System (INIS)

    Standard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy. Between 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24–77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19. After 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema. In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005). Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade

  2. Cosmetic Analysis Following Breast-Conserving Surgery and Adjuvant High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer: A Prospective Clinical Study

    Energy Technology Data Exchange (ETDEWEB)

    Garsa, Adam A.; Ferraro, Daniel J.; DeWees, Todd [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Margenthaler, Julie A. [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Naughton, Michael [Department of Medicine, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Aft, Rebecca [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Department of Surgery, John Cochran Veterans Hospital, St. Louis, Missouri (United States); Gillanders, William E.; Eberlein, Timothy [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Matesa, Melissa A. [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Zoberi, Imran, E-mail: izoberi@radonc.wustl.edu [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-03-15

    Purpose: To prospectively evaluate cosmetic outcomes in women treated with accelerated partial breast irradiation using high-dose-rate interstitial brachytherapy for early-stage breast cancer. Methods and Materials: Between 2004 and 2008, 151 patients with early-stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients had stage Tis-T2 tumors of ≤3 cm that were excised with negative margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. Both the patients and the treating radiation oncologist qualitatively rated cosmesis as excellent, good, fair, or poor over time and ascribed a cause for changes in cosmesis. Cosmetic outcome was evaluated quantitatively by percentage of breast retraction assessment (pBRA). Patients also reported their satisfaction with treatment over time. Results: Median follow-up was 55 months. The rates of excellent-to-good cosmesis reported by patients and the treating radiation oncologist were 92% and 97% pretreatment, 91% and 97% at 3 to 4 months' follow-up, 87% and 94% at 2 years, and 92% and 94% at 3 years, respectively. Breast infection and adjuvant chemotherapy were independent predictors of a fair-to-poor cosmetic outcome at 3 years. Compared to pretreatment pBRA (7.35), there was no significant change in pBRA over time. The volume receiving more than 150 Gy (V150) was the only significant predictor of pBRA. The majority of patients (86.6%) were completely satisfied with their treatment. Conclusions: Patients and the treating physician reported a high rate of excellent-to-good cosmetic outcomes at all follow-up time points. Acute breast infection and chemotherapy were associated with worse cosmetic outcomes. Multicatheter interstitial brachytherapy does not significantly change breast size as measured by pBRA.

  3. Cosmetic Analysis Following Breast-Conserving Surgery and Adjuvant High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer: A Prospective Clinical Study

    International Nuclear Information System (INIS)

    Purpose: To prospectively evaluate cosmetic outcomes in women treated with accelerated partial breast irradiation using high-dose-rate interstitial brachytherapy for early-stage breast cancer. Methods and Materials: Between 2004 and 2008, 151 patients with early-stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients had stage Tis-T2 tumors of ≤3 cm that were excised with negative margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. Both the patients and the treating radiation oncologist qualitatively rated cosmesis as excellent, good, fair, or poor over time and ascribed a cause for changes in cosmesis. Cosmetic outcome was evaluated quantitatively by percentage of breast retraction assessment (pBRA). Patients also reported their satisfaction with treatment over time. Results: Median follow-up was 55 months. The rates of excellent-to-good cosmesis reported by patients and the treating radiation oncologist were 92% and 97% pretreatment, 91% and 97% at 3 to 4 months' follow-up, 87% and 94% at 2 years, and 92% and 94% at 3 years, respectively. Breast infection and adjuvant chemotherapy were independent predictors of a fair-to-poor cosmetic outcome at 3 years. Compared to pretreatment pBRA (7.35), there was no significant change in pBRA over time. The volume receiving more than 150 Gy (V150) was the only significant predictor of pBRA. The majority of patients (86.6%) were completely satisfied with their treatment. Conclusions: Patients and the treating physician reported a high rate of excellent-to-good cosmetic outcomes at all follow-up time points. Acute breast infection and chemotherapy were associated with worse cosmetic outcomes. Multicatheter interstitial brachytherapy does not significantly change breast size as measured by pBRA

  4. A Prospective Longitudinal Clinical Trial Evaluating Quality of Life After Breast-Conserving Surgery and High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: To prospectively examine quality of life (QOL) of patients with early stage breast cancer treated with accelerated partial breast irradiation (APBI) using high-dose-rate (HDR) interstitial brachytherapy. Methods and Materials: Between March 2004 and December 2008, 151 patients with early stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients included those with Tis-T2 tumors measuring ≤3 cm excised with negative surgical margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, version 3.0, and QLQ-BR23 questionnaires. The QLQ-C30 and QLQ-BR23 questionnaires were evaluated during pretreatment and then at 6 to 8 weeks, 3 to 4 months, 6 to 8 months, and 1 and 2 years after treatment. Results: The median follow-up was 55 months. Breast symptom scores remained stable in the months after treatment, and they significantly improved 6 to 8 months after treatment. Scores for emotional functioning, social functioning, and future perspective showed significant improvement 2 years after treatment. Symptomatic fat necrosis was associated with several changes in QOL, including increased pain, breast symptoms, systemic treatment side effects, dyspnea, and fatigue, as well as decreased role functioning, emotional functioning, and social functioning. Conclusions: HDR multicatheter interstitial brachytherapy was well tolerated, with no significant detrimental effect on measured QOL scales/items through 2 years of follow-up. Compared to pretreatment scores, there was improvement in breast symptoms, emotional functioning, social functioning, and future perspective 2 years after treatment

  5. A Prospective Longitudinal Clinical Trial Evaluating Quality of Life After Breast-Conserving Surgery and High-Dose-Rate Interstitial Brachytherapy for Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Garsa, Adam A.; Ferraro, Daniel J.; DeWees, Todd A. [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Deshields, Teresa L. [Department of Medicine, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Margenthaler, Julie A.; Cyr, Amy E. [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Naughton, Michael [Department of Medicine, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Aft, Rebecca [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Department of Surgery, John Cochran Veterans Hospital, St. Louis, Missouri (United States); Gillanders, William E.; Eberlein, Timothy [Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Matesa, Melissa A.; Ochoa, Laura L. [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States); Zoberi, Imran, E-mail: izoberi@radonc.wustl.edu [Department of Radiation Oncology, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri (United States)

    2013-12-01

    Purpose: To prospectively examine quality of life (QOL) of patients with early stage breast cancer treated with accelerated partial breast irradiation (APBI) using high-dose-rate (HDR) interstitial brachytherapy. Methods and Materials: Between March 2004 and December 2008, 151 patients with early stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients included those with Tis-T2 tumors measuring ≤3 cm excised with negative surgical margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, version 3.0, and QLQ-BR23 questionnaires. The QLQ-C30 and QLQ-BR23 questionnaires were evaluated during pretreatment and then at 6 to 8 weeks, 3 to 4 months, 6 to 8 months, and 1 and 2 years after treatment. Results: The median follow-up was 55 months. Breast symptom scores remained stable in the months after treatment, and they significantly improved 6 to 8 months after treatment. Scores for emotional functioning, social functioning, and future perspective showed significant improvement 2 years after treatment. Symptomatic fat necrosis was associated with several changes in QOL, including increased pain, breast symptoms, systemic treatment side effects, dyspnea, and fatigue, as well as decreased role functioning, emotional functioning, and social functioning. Conclusions: HDR multicatheter interstitial brachytherapy was well tolerated, with no significant detrimental effect on measured QOL scales/items through 2 years of follow-up. Compared to pretreatment scores, there was improvement in breast symptoms, emotional functioning, social functioning, and future perspective 2 years after treatment.

  6. The Suitability of Absorbable Mesh Insertion for Oncoplastic Breast Surgery in Patients with Breast Cancer Scheduled to Be Irradiated

    OpenAIRE

    Kim, Taehyun; Cho, Heunglae

    2013-01-01

    Purpose The objective of this study was to investigate the influence of radiotherapy on the cosmetic outcome after immediate breast reconstruction using an absorbable mesh in breast cancer. Methods From July 2008 to July 2009, 35 breast cancer patients who received immediate breast reconstruction with absorbable mesh insertion at the time of breast conserving surgery followed by radiotherapy were retrospectively studied. Results In 91% of cases there was an excellent or good cosmetic outcome ...

  7. Surgery for Breast Cancer in Men

    Science.gov (United States)

    ... to help prevent or reduce the effects of lymphedema are discussed in the section " What happens after treatment for breast cancer in men? " If your arm is swollen, tight, or painful after lymph node surgery, be sure to tell someone ... lymphedema after breast surgery, see our document Lymphedema: What ...

  8. 早期老年乳腺癌保乳手术的临床疗效观察%The Therapy Discussion of Breast Cancer by Conserving Surgery in the Aged Women

    Institute of Scientific and Technical Information of China (English)

    何志刚; 欧阳立志; 尹宏

    2013-01-01

    objective:To compare the therapeutic effect of breast-conserving surgery and modified radical mastectomy in the treatment of elderly patients with early-stage breast cancer.Methods:According to their surgical method,48 elderly patients with early-stage breast cancer were divided into 2 groups.The observation group included 24 patients and received breast-conserving surgery,and the control group included 24 patients and received modified radical mastectomy.After being dischargde,al patients were fol owde up for 3 years.Results:The postoperative breast cosmetic efficacy of the observation group was bet er than that of the control group(P0.05).Conclusion:It shows the advantages of little pain,good cosmetic results and good functions of the breast conserving surgery for early stage breast cancer in the aged women.With the strictly handling of the indication,it does not increase the risk of recurrence and metastasis.%目的:比较早期老年乳腺癌患者保乳术与改良根治术的疗效。方法:将48例早期乳腺癌患者按治疗方式分为2组:观察组24例,接受保乳术治疗;对照组24例,接受改良根治术治疗。在患者出院后,再对其进行长达3年的随访。结果:观察组术后乳房美容效果显著优于对照组,两组比较差异有统计学意义(P<0.01)。两组患者的局部复发率,远处转移率,3年生存率差异无统计学意义(P>0.05)。结论:早期老年乳腺癌行保乳治疗具有机体创伤小、组织器官破坏少、美容效果好和保存功能的优点,在严格掌握手术适应证的前提下,并不增加复发及远处转移的风险。

  9. Breast abscesses after breast conserving therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fujiwara, Kazuhisa [National Kyoto Hospital (Japan)

    2001-09-01

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  10. Breast abscesses after breast conserving therapy for breast cancer

    International Nuclear Information System (INIS)

    Breast abscess after breast conserving therapy is a rare complication and the study of this cause has not been reported. A retrospective review of 190 patients undergoing breast conserving therapy in our institution revealed 4 patients with breast abscess (mean age, 50.6 years; range, 47-57 years and median follow up 4 months; 1-11 months). Risk factors which were common to all patients were: fine needle aspiration (FNA), surgical treatment; wide excision, adjuvant therapy; oral administration of tamoxifen (TAM), radiation therapy (RT) to ipsilateral whole breast; total dose of 50 Gy and skin desquamation by RT; level I or II. Other important risk factors in 3 patients were repeated aspirations of seroma post operatively and 2 patients received chemotherapy; CAF. Cultures from one abscess grew staphylococcus aureus, one grew staphylococcus epidermidis, and two were sterile. Breast abscess may be caused by a variety of factors and it is often difficult to specify the cause. This suggests that careful observation will be necessary to determine the cause. (author)

  11. Retrospective analysis of conservative surgery in 226 cases of early breast cancer%早期乳腺癌保乳手术226例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    张国强; 单明; 庞达

    2011-01-01

    To evaluate the prognosis and cosmetic effect of conservative surgery for breast cancer, and approach the risk factors for the recurrence of conservative surgery. Methods Conservative surgery was performed in 226 patients with early breast cancer, from January 2000 to December 2007, postoperative chemotherapy and radiotherapy were administered. All patients were followed-up for 30 to 106 months. Results The 3 and 5-year total survival rates for all cases were 97.5% and 96.1% ,The 3 and 5-year disease free survival rates were 93.5% and 91.2%. Of all the cases postoperative relapse was found in 8 local recurrence and metastasis was seen in 16 cases.Single and multiple factor analysis showed that the size of tumour and the cutting edge from the solitary tumour were the risk factors for the recurrence of conservative surgery. Conclusion Prognosis for patients treated with conservative surgery for breast cancer is satisfactory, and the cosmetic effect is excellent. But for the sellection of indication, the size of tumour and the cutting edge must be considered.%目的 分析乳腺癌保乳手术后的疗效及美容效果,探讨影响其局部复发的高危因素.方法 选取我院2000年1月到2007年12月同意接受乳腺癌保乳手术的226例患者为研究对象.术后给予放、化疗,并进行长期随访.结果 全组3年和5年的总存活率分别为97.5%、96.1%,全组3年和5年的无病存活率分别为93.5%、91.2%;16例(7.1%)患者出现远处转移,8例(3.5%)患者出现同侧乳腺肿瘤局部复发;单因素及多因素分析表明,肿瘤大小和切缘远近为影响复发的高危因素.结论 乳腺癌的保乳手术从疗效和美容效果上均令人满意,在适应证的选择上,应多注意肿瘤的大小和切缘浸润的情况.

  12. Prognostic Value of p53 and bcl-2 Expression in Patients Treated with Breast Conservative Therapy

    OpenAIRE

    Kim, Kyubo; Chie, Eui Kyu; Han, Wonshik; Noh, Dong-Young; Park, In Ae; Oh, Do-Youn; Im, Seock-Ah; Kim, Tae-You; Bang, Yung-Jue; Sung W Ha

    2010-01-01

    Prognostic value of p53 and bcl-2 expression on treatment outcome in breast cancer patients has been extensively evaluated, but the results were inconclusive. We evaluated the prognostic significance of these molecular markers in patients treated with breast conserving surgery and radiotherapy. One hundred patients whose immunostaining of p53 and bcl-2 expression was available among 125 patients who underwent radiotherapy after breast conserving surgery and axillary lymph node dissection were...

  13. How does knowledge of three-dimensional excision margins following breast conservation surgery impact upon clinical target volume definition for partial-breast radiotherapy?

    International Nuclear Information System (INIS)

    Background and purpose: To compare partial-breast clinical target volumes generated using a standard 15 mm margin (CTVstandard) with those generated using three-dimensional surgical excision margins (CTVtailored30) in women who have undergone wide local excision (WLE) for breast cancer. Material and methods: Thirty-five women underwent WLE with placement of clips in the anterior, deep and coronal excision cavity walls. Distances from tumour to each of six margins were measured microscopically. Tumour bed was defined on kV-CT images using clips. CTVstandard was generated by adding a uniform three-dimensional 15 mm margin, and CTVtailored30 was generated by adding 30 mm minus the excision margin in three-dimensions. Concordance between CTVstandard and CTVtailored30 was quantified using conformity (CoI), geographical-miss (GMI) and normal-tissue (NTI) indices. An external-beam partial-breast irradiation (PBI) plan was generated to cover 95% of CTVstandard with the 95% isodose. Percentage-volume coverage of CTVtailored30 by the 95% isodose was measured. Results: Median (range) coronal, superficial and deep excision margins were 15.0 (0.5-76.0) mm, 4.0 (0.0-60.0) mm and 4.0 (0.5-35.0) mm, respectively. Median CoI, GMI and NTI were 0.62, 0.16 and 0.20, respectively. Median coverage of CTVtailored30 by the PBI-plan was 97.7% (range 84.9-100.0%). CTVtailored30 was inadequately covered by the 95% isodose in 4/29 cases. In three cases, the excision margin in the direction of inadequate coverage was ≤2 mm. Conclusions: CTVs based on 3D excision margin data are discordant with those defined using a standard uniform 15 mm TB-CTV margin. In women with narrow excision margins, the standard TB-CTV margin could result in a geographical miss. Therefore, wider TB-CTV margins should be considered where re-excision does not occur.

  14. Cosmetic results of conservative treatment for early breast cancer

    International Nuclear Information System (INIS)

    This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the stemal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (NO versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0,0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary

  15. Cosmetic results of conservative treatment for early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Kyoung; Shin, Seong Soo; Kim, Seong Deok; Ha, Sung Whan; Noh, Dong Young [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2001-03-01

    This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the stemal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (NO versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0,0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without

  16. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conservative surgery enhances late toxicities; La chimiotherapie concomitante de la radiotherapie augmente la toxicite tardive apres chirurgie conservatrice du cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Toledano, A. [Hopital Tenon, Service d' oncologie-radiotherapie 75 - Paris (France); Garaud, P.; Body, G.; Le Floch, O.; Calais, G. [Centre Hospitalier Universitaire Bretonneau, 37 - Tours (France); Serin, D. [Institut Sainte-Catherine, 84 - Avignon (France); Fourquet, A. [Institut Curie, 75 - Paris (France); Bosset, J.F.; Miny-Buffet, J. [Centre Hospitalier Universitaire Minjoz, 25 - Besancon (France); Favre, A. [Centre Hospitalier Universitaire La Source, 45 - Orleans (France); Azria, D. [Centre de Lutte Contre le Cancer Val d' Aurelle, 34 Montpellier (France)

    2006-06-15

    In 1996, a multicenter randomized study comparing after breast-conservative surgery. sequential vs concurrent adjuvant chemotherapy (CT) with radiation therapy (RT) was initiated (ARCOSEIN study). Seven hundred sixteen patients were included in this trial. After a median follow-up of 6.7 (4.3 -9) years, we decided to prospectively evaluate the late effects of these two strategies. Patients and methods - A total of 297 patients were asked to follow-up from the five larger including institutions. Seventy-two percent (214 patients) were eligible for late toxicity. After breast-conserving surgery with axillary dissection, patients were treated either with sequential treatment with CT first followed by RT (arm A) or CT administered concurrently with RT (arm B). In all patients, CT regimen combined mitoxantrone (12 mg/m{sup 2}). 5-FU (500 mg/m{sup 2}), and cyclophosphamide (500 mg/m{sup 2}), 6 cycles (day 1-day 21). In arm B, patients received concurrently the first 3 cycles of CT with RT. In arm A, RT started 3 to 5 weeks after the 6. cycle of CT. Conventional RT was delivered to the whole breast using a 2 Gy-fraction protocol to a total dose of 50 Gy ({+-} boost to the primary tumour bed). The assessment of toxicity was blinded to treatment and was graded by the radiation oncologist according to the LENT-SOMA scale. Skin pigmentation was also evaluated using a personal 5-points scoring system (excellent, good, moderate, poor, very poor). Results - Among the 214 evaluated patients, 107 were treated in each arm. The two populations were homogeneous for patients', tumors' and treatment characteristics. Subcutaneous fibrosis (SF), telangiectasia (T), skin pigmentation (SP), and breast atrophy (BA) were significantly increased in arm B. Twenty patients experienced grade superior or equal to 2 (SF) in arm B vs five in arm A (P 0.003). Twenty-five and seven patients showed grade superior or equal to 2 (T) in ann B and A, respectively (P = 0.001). Forty-four and

  17. SEROMA FORMATION IN CANCER BREAST SURGERY

    Directory of Open Access Journals (Sweden)

    Sitaram

    2015-01-01

    Full Text Available Post - operative breast surgery for malignancy has a common side effect of seromas, whose formation and drainage requires a special attention to prevent as much as possible and as early as possible to avoid morbidity. How best we can prevent the dead space is the problem. In this study a review of various methods adopted all over the world is reviewed includ ing early discharge of the patient with drain. It is always preferable to remove the drain when the collection of serum is less than 25ml in 24 hours the chance of re accumulation of fluid is less likely . INTRODUCTION: Carcinoma breast has remained the sec ond leading cause of cancer death among women worldwide over the past three decades [ 1 ] and contributes significantly to cancer surgical load. Surgical treatment for breast cancer includes breast conservation therapy and mastectomy with or without axillary dissection depending on disease stage. Seroma formation is the most frequent postoperative Side effect seen after mastectomy and axillary surgery with an incidence of 3% to 85% . OBSERVATIONS: TYPE OF SURGERY : Surgical treatment for breast cancer has undergone a paradigm shift from Halstead's radical mastectomy to breast conservation. It has been demonstrated that radical mastectomy increases seroma formation compared with that of simple mastectomy , but the association is inconclusive when radical mastectomy is compared with modified radical mastectomy (MRM . SURGICAL DEVICES : Various electro - mechanical devices are used during surgery to reduce blood loss and operating time. These include electrocautery, laser scalpel, argon diathermy, ultrasonic scalpel, ultrasonic scissors, and vessel sealing systems. All of these devices have been investigated in an effort to reduce seroma formation. Randomized trials have shown that the use of electrocautery for dissecting flaps is significantly associated with increased seroma formation when compared to that of scalpel dissection . However

  18. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    Carstensen, Lena Felicia; Rose, Michael; Bentzon, Niels;

    2015-01-01

    INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level of...... surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all...

  19. The UK HeartSpare Study (Stage IB): Randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery

    International Nuclear Information System (INIS)

    Purpose: To compare mean heart and left anterior descending coronary artery (LAD) doses (NTDmean) and positional reproducibility in larger-breasted women receiving left breast radiotherapy using supine voluntary deep-inspiratory breath-hold (VBH) and free-breathing prone techniques. Materials and methods: Following surgery for early breast cancer, patients with estimated breast volumes >750 cm3 underwent planning-CT scans in supine VBH and free-breathing prone positions. Radiotherapy treatment plans were prepared, and mean heart and LAD doses were calculated. Patients were randomised to receive one technique for fractions 1–7, before switching techniques for fractions 8–15 (40 Gy/15 fractions total). Daily electronic portal imaging and alternate-day cone-beam CT (CBCT) imaging were performed. The primary endpoint was the difference in mean LAD NTDmean between techniques. Population systematic (Σ) and random errors (σ) were estimated. Within-patient comparisons between techniques used Wilcoxon signed-rank tests. Results: 34 patients were recruited, with complete dosimetric data available for 28. Mean heart and LAD NTDmean doses for VBH and prone treatments respectively were 0.4 and 0.7 (p < 0.001) and 2.9 and 7.8 (p < 0.001). Clip-based CBCT errors for VBH and prone respectively were ⩽3.0 mm and ⩽6.5 mm (Σ) and ⩽3.5 mm and ⩽5.4 mm (σ). Conclusions: In larger-breasted women, supine VBH provided superior cardiac sparing and reproducibility than a free-breathing prone position

  20. Multivariate Study of Local Recurrence of HER-2 Positive Breast Cancer after Breast-conserving Surgery%HER-2阳性乳腺癌保乳术后局部复发的多因素研究

    Institute of Scientific and Technical Information of China (English)

    王敏; 王先明

    2013-01-01

    目的 研究人类表皮生长因子受体2 (HER-2)阳性乳腺癌保乳治疗后影响局部复发的风险因素. 方法 收集我院2002年6月~2012年6月间收治的82例HER-2阳性乳腺癌保乳治疗后的随访资料,分析年龄、HER-2状态、雌激素受体(ER)/孕激素受体(PR)状态、淋巴结转移状态、肿瘤大小、抗HER-2治疗对局部复发的影响. 结果 82例中位随访52 (8~118)个月,同侧乳房局部复发9例(10.97%),远位转移11例(13.4%),5年无病生存率82.9%,5年无远处转移生存率93.9%,5年总体生存率98.7%.单因素分析显示,淋巴结状态是影响局部复发的风险因素;复发高峰时间为术后第2年至第3年,以及第5年至第6年;多因素分析显示淋巴结状态及HER-2状态是局部复发的独立影响因素.82例病人中,接受曲妥珠单抗治疗35例,112个月出现1例局部复发,复发率2.86% (1/35);未接受者47例,11~108个月出现局部复发8例,复发率17.02% (8/47).差异有显著性统计学意义(P<0.001).结论 保乳治疗后出现两个局部复发高峰时间段,淋巴结状态和HER-2表达状态是局部复发的独立影响因素,抗HER-2治疗可降低局部复发和远处转移.对于具有高危因素的患者更需积极治疗.%Objective To study risk factors of postsurgical local recurrence after breast-conserving surgery in human epidermal growth factor receptor 2 (HER-2) positive breast cancer.Methods The follow-up medical data of 82 patients with HER-2 positive breast cancer after breast-conserving therapy in our hospital during 6 years from June 2002 to June 2012 were collected,and the influences of age,HER-2 status,estrogen receptor (ER)/progesterone hormone receptor (PR) status,lymph node metastasis status,tumor size and antiHER-2 therapy over local recurrences were analyzed.Results The median follow-up period was 52 (8 ~118)months; 9 cases (10.97%) had ipsilateral breasts local recurrence,while 11 cases (13.4

  1. 乳腺癌保乳术前的动态增强MRI和X线摄影联合评估%Evaluation of Breast Cancer before Breast- conserving Surgery by Dynamic- enhanced MRI and Mammography

    Institute of Scientific and Technical Information of China (English)

    林光武; 刘伟; 嵇鸣; 李尉萍; 叶春涛; 朱振方; 臧雪如

    2012-01-01

    目的:探讨动态增强MRI和钼靶X线摄影在乳腺癌行保乳术(BCS)的术前评估价值.方法:分析106例经手术和病理证实的乳腺癌患者的术前动态增强MRI及钼靶X线摄影资料,观测动态增强MRI和钼靶X线摄影片上乳腺癌病灶的数目、位置、大小、形态、侵犯范围和淋巴结转移情况,按乳腺癌保乳术所需条件与术后大体解剖标本及镜下病理相对照,分析单独和联合运用动态增强MRI与钼靶X线摄影对乳腺癌保乳术前的评估准确性.结果:动态增强MRI判断40例(37.8%)可行BCS,判定准确性为96.2%;钼靶X线摄影判断37例(34.9%)可行BCS,判定准确性为89.6%;动态增强MRI与钼靶X线摄影联合运用,判断41例(38.7%)可行BCS,判定准确性为97.2%.结论:联合运用动态增强MRI和钼靶X线摄影能为乳腺癌患者筛选是否适合BCS提供较全面和准确的信息.%Purpose: To investigate the feasibility and value of MRI and mammography in assessing breast conserving surgery (BCS) of breast cancer. Methods: MB scanning and mammography were performed on 106 patients with breast cancer before operation. The location, size, extent, number of breast cancer, as well as the status of the skin of mammary gland, chest wall and axillary nodes were analyzed for all the patients on the MRI and mammography images. The macroscopic and microscopic features of these resected specimens were observed. The results of MRI, mammography and histopathology were comparatively analyzed to determine if they were eligible for BCS. Results: Forty patients (37.8% ) were considered eligible for BCS by MRI alone and the diagnoisis accuracy of MRI was 96.2%. Thirty - seven patients(34.9% ) were considered eligible for BCS by mammography alone and the accuracy was 89.6%. And when MRI was combined with mammography, 41 patients (38.7%) were considered eligible for BCS and the accuracy was 97.2% .Conclusion: Combined dynamic - enhanced MRI with mammography

  2. The cosmetic results after oncoplastic breast surgery in Iranian women

    Directory of Open Access Journals (Sweden)

    Kaviani A

    2010-07-01

    Full Text Available "nBackground: The oncoplastic surgery has been revolutionized breast conservative surgery. The aim of our study was to represent the cosmetic outcome of oncoplastic breast surgery in Iran and to evaluate its determinants. "n"nMethods: Fifty eight patients with unilateral breast neoplasm operated with single surgeon in Imam Khomeini Hospital, Tehran, Iran. Three view photographs were obtained pre and post operatively and were put in separate PowerPoint slides. The photographs were evaluated by six health related professionals. They scored the cosmetic outcome with modified questionnaire containing general and specific questions. Weighted kappa used for intra and inters rater reliability and ANOVA was used for analyzing cosmetic outcome determinants. "n"nResults: Generally, 72.2% of the photographs got the excellent or good score in a single breast evaluation part. Its items breast size, nipple deviation and scar quality scored 94.2, 67.9 and 88.8 respectively. "In comparison with contra-lateral breast" part shape asymmetry, need for surgery of contra lateral breast and size asymmetry scored 68.9, 75.8 and 69% respectively. Tumor size greater than two cm had poorer outcome (p=0.039 upper outer quadrant tumor had the worst and upper inner quadrant tumors had the best outcomes (p<0.0001. Patient with 50 to 60 years of age had the poorest outcomes (p<0.0001. Weighted kappa for inter and intra rater kappa was 0.12 and 0.58 respectively. "n"nConclusions: Acceptable cosmetic outcome is obtained in the first experience of oncoplastic breast surgery in Iran. Long term monitoring of oncologic and cosmetic outcomes in greater numbers of patients is recommended.

  3. Breast education in general surgery residency.

    Science.gov (United States)

    Wilson, Jason P; Miller, Austin; Edge, Stephen B

    2012-01-01

    Breast cancer treatment has changed substantially with increased specialization. Overall, the number of cases performed by residents upon completion of residency has decreased and the introduction of sentinel lymph node biopsy has reduced the number of axillary lymph node dissections being performed. Our objective was to evaluate the breast surgery education being provided by general surgery residency programs. A survey was administered to applicants to the Roswell Park Cancer Institute surgical oncology fellowship program in the fall of 2009. This survey examined the type of training program, the breast surgery exposure, and applicant comfort with the medical and surgical aspects of breast cancer. The survey was completed by 29 of 35 applicants. Of the respondents, 83 per cent were chief residents. Overall, participants had comfort levels above 8 (of 10) with breast related cases. For modified radical mastectomies and axillary lymph node dissections the comfort level dropped below 8. Participants were least comfortable discussing the medical management of breast cancer. General surgery residents completing training were less comfortable operating in the axilla compared with the breast. The study suggests careful attention should be paid to assuring adequate breast education in surgical residency. PMID:22273306

  4. Breast cancer survival and season of surgery

    DEFF Research Database (Denmark)

    Teilum, Dorthe; Bjerre, Karsten D; Tjønneland, Anne M;

    2012-01-01

    Background Vitamin D has been suggested to influence the incidence and prognosis of breast cancer, and studies have found better overall survival (OS) after diagnosis for breast cancer in summer-autumn, where the vitamin D level are expected to be highest. Objective To compare the prognostic...... outcome for early breast cancer patients operated at different seasons of the year. Design Open population-based cohort study. Setting Danish women operated 1978-2010. Cases 79 658 adjusted for age at surgery, period of surgery, tumour size, axillary lymph node status and hormone receptor status...

  5. Intra-operative radiotherapy in breast-conserving surgery of early breast cancer patients%早期乳腺癌保乳手术术中放疗59例

    Institute of Scientific and Technical Information of China (English)

    周士福; 时伟锋; 孟东; 孙春雷; 金建荣; 赵于天

    2011-01-01

    目的 研究早期乳腺癌保乳手术术中放疗的可行性,评价术后并发症、乳房美容效果及肿瘤复发事件.方法 2007年6月至2010年12月,115例患者做保乳手术,59例(研究组)做术中放疗,同期有56例(对照组)术后做全乳放疗,在术后1个月评估切口愈合状况及并发症;术后1年比较两组乳房美容效果;术后随访肿瘤复发及死亡事件.结果 研究组切口愈合天数为13 ~22d,对照组为9 ~14d.研究组2例出现切口脂肪液化,16例有切口水肿,对照组未见切口脂肪液化、水肿;两组均未出现术后切口感染或血肿.术后1年乳房美容评价:研究组41例中优秀或好的有36例、一般或差的5例;对照组37例中优秀或好的有25例、一般或差的有12例(P=0.031).随访3~42个月(中位24个月),研究组局部复发2例(3.39%),其中1例(1.7%)死亡;对照组局部复发1例(1.8%),无死亡.结论 早期乳腺癌保乳手术术中放疗安全可靠、美容效果好、局部控制满意.%Objective To evaluate intra-operative radiotherapy after breast conservative surgery in early breast cancer patients in terms of postoperative complications,cosmetic outcome and recurrence events.Methods From June 2007 to Dec 2010,115 early breast cancer patients received breast conserving surgery.Fifty-nine patients (study group) received intra-operative radiotherapy,compared with 56 patients (control group) receiving routine postoperative radiotherapy.Postoperative complications were evaluated 1 month after surgery; cosmetic outcome was evaluated 1 year postoperatively; recurrence and death events were followed up.Results The average wound healing time was 13 -22 days in study group and 9 - 14days in control group.In the study group,2 patients developed fat deliquescence,16 patients showed wound edema while no such side effects were found in control group.No infection or hematoma were found in either group.Overall cosmetic outcome was rated 1 year

  6. Video-assisted breast surgery and 3-dimensional computed tomographic mammary lymphography (1). Aesthetic results and curability of video-assisted breast surgery

    International Nuclear Information System (INIS)

    I have studied endoscopic surgery for breast diseases and have studied 3-dimensional computed tomographic lymphography for sentinel node biopsy. In this chapter, I introduced my works of the endoscopic breast surgery. I devised a new endoscopic operation for breast diseases: video-assisted breast surgery. The goal of endoscopic breast surgery is to obtain better cosmetic outcomes. A 2.5-cm axillary or periareolar skin incision was made. Under video assistance, the mammary gland was partially or totally resected with a gasless method. A transaxillary retromammary route approach was used even for tumors of the medial aspect of the breast. For malignant tumors, sentinel node biopsy was performed, and axillary nodes were dissected. Breast reconstruction was performed simultaneously. Cosmetic results were assessed with a standard 4-step method and the method described in the Japanese guidelines for breast-conserving therapy. More-objective quantitative methods are breast retraction assessment, the method reported by the research group of Sawai, and ABNSW, a 5-item, 4-step method that evaluates asymmetry (A), breast shape (B), nipple deformation (N), skin condition (S), and wound scar (W). The cosmetic results in endoscopic breast surgery showed that almost 90% of patients received a total score greater than 11 points, which indicates that this video-assisted breast surgery achieves better cosmetic results. The reconstruction methods in breast-conserving therapy are mammary gland translocation, the lateral tissue flap filling method, and absorbable thread mesh filling. The filling methods are superior to the translocation at the point of less deformation of the breast shape. Reconstruction with filling methods will allow wider excision of the mammary gland while achieving better cosmetic results. Video-assisted breast surgery is less invasive, produces no scars on the breast skin, and achieves better aesthetic outcomes for patients with breast cancer. It also improves

  7. DEGRO practical guidelines for radiotherapy of breast cancer I. Breast-conserving therapy

    International Nuclear Information System (INIS)

    Background: The present paper is an update of the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). These recommendations have been elaborated on the basis of the S3 guidelines of the German Cancer Society that were revised in March 2007 by an interdisciplinary panel. Methods: The DEGRO expert panel performed a comprehensive survey of the literature, comprising lately published meta-analyses, data from recent randomized trials and guidelines of international breast cancer societies, referring to the criteria of evidence-based medicine. In addition to the more general statements of the German Cancer Society, this paper emphasizes specific radiotherapeutic aspects. It is focused on radiotherapy after breast-conserving surgery. Technique, targeting, and dose are described in detail. Results: Postoperative radiotherapy significantly reduces rates of local recurrence. The more pronounced the achieved reduction is, the more substantially it translates into improved survival. Four prevented local recurrences result in one avoided breast cancer death. This effect is independent of age. An additional boost provides a further absolute risk reduction for local recurrence irrespective of age. Women > 50 years have a hazard ratio of 0.59 in favor of the boost. For DCIS, local recurrence was 2.4% per patient year even in a subgroup with favorable prognostic factors leading to premature closure of the respective study due to ethical reasons. For partial-breast irradiation as a sole method of radiotherapy, results are not yet mature enough to allow definite conclusions. Conclusion: After breast-conserving surgery, whole-breast irradiation remains the gold standard of treatment. The indication for boost irradiation should no longer be restricted to women ≤ 50 years. Partial-breast irradiation is still an experimental treatment and therefore discouraged outside controlled

  8. Four cases of radiation pneumonia after breast conservative therapy for breast cancer

    International Nuclear Information System (INIS)

    Between 1983 and 1996, a series of 240 patients with early stage breast cancer were treated with breast conservative treatment, and 201 patients of them all received irradiation at a dose of 46-60 Gy to the affected breast. Among the 201 patients who received breast irradiation, four (2.0%) patients experienced radiation pneumonia. These four patients with radiation pneumonia presented with coughing from 7 to 20 weeks after irradiation. Chest X-ray film revealed interstitial pneumonia in a lung field where coincided with the irradiated field in them. Three out of four patients demanded steroids, but all patients got well within 4 months. Radiation pneumonia following conservative surgery and radiotherapy for breast cancer is an infrequent complication, but attention should be paid to radiation pneumonia if the patient suffers from persistent coughing after radiotherapy. (author)

  9. Knowledge and opinions on oncoplastic surgery among breast and plastic surgeons

    DEFF Research Database (Denmark)

    Carstensen, Lena; Rose, Michael; Bentzon, Niels;

    2015-01-01

    surgeons and 22 plastic surgeons; the response rate was 67%. All breast surgery units had an established cooperation with plastic surgeons. Most breast surgeons used unilateral displacement techniques; plastic surgeons also included breast reduction techniques and replacement with local flaps. Almost all......INTRODUCTION: More than 4,000 Danish women are diagnosed with operable breast cancer annually, and 70% receive breast conserving surgery. Without the use of oncoplastic surgery (OPS), 20-30% will get an unsatisfactory cosmetic result. The aim of this study was to illustrate the level of...... implementation of OPS in Denmark. METHODS: An electronic questionnaire was sent to breast and plastic surgeons performing breast cancer treatment. The questionnaire included demographics, education, experience with operative procedures and opinions on OPS. RESULTS: The questionnaire was sent to 50 breast...

  10. 左侧乳腺癌保乳术后三种调强放疗的剂量学研究%Dosimetric Study of 3 Intensity-modulated Radiotherapy for Left Breast Cancer after Breast Conserving Surgery

    Institute of Scientific and Technical Information of China (English)

    张云; 胡海芹; 王小平; 丁生苟

    2014-01-01

    目的:比较左侧乳腺癌保乳术后3种不同射野数调强放疗方式( IMRT)的靶区及周围正常组织受照剂量的差异。方法选取8例左侧乳腺癌保乳术后患者,应用Pinnacle8.0计划系统分别设计3种不同射野数的调强计划:4野、5野、6野IMRT计划,用剂量体积直方图( DVH)和等剂量曲线评估3种计划的PTV和周围正常组织受照剂量。结果6F-IMRT靶区剂量分布最优,其剂量均匀性和适形度最好,5F-IMRT其次,4F-IMRT最差。与4F-IMRT比较,5F-IMRT和6F-IMRT的PTV最大剂量以及高剂量所包含的体积显著降低。3种计划左肺照射剂量差异较小,均不超过5%;然而心脏照射剂量4F-IMRT最小,与5F-IMRT和6F-IMRT比较,心脏V5、V10、V20、V30以及V40分别降低了42.37%、17.65%、5.87%、5.72%、23.38%和42.85%、30.84%、16.31%、6.45%、24.65%。结论左侧乳腺癌保乳放疗中,调强射野数的增加可以提高靶区PTV覆盖率、适形度和均匀性,但是也会增高左肺低剂量照射体积和平均剂量,右侧肺和心脏的受照剂量也会明显增高,故应根据患者实际情况应用合适的放疗计划进行放疗。%Objective To compare the dosimetric difference in target area and normal organs between 4F-IMRT,5F-IM-RT and 6F-IMRT for left breast cancer after breast conserving surgery .Methods For each of 8 randomly chosen patients ,3 IM-RT plans (4F-IMRT,5F-IMRT and 6F-IMRT) were designed with Pinnacle 8.0.95%of target volume received prescribed dose 50 Gy,the dose distributions in target area and normal organs with the DVH and isodose curves .Results The dose uniformity in target area was improved with increasing of the numbers of beam .Compared with 4F-IMRT,the maximum dose of 5F-IMRT and 6F-IMRT in PTV and high dose of the volume was significantly reduced .With regard to the normal organs for 3 plans,the ad-sorbed dose and volume in left lung were

  11. Attitudes towards breast conservation in patients aged over 70 with breast cancer

    OpenAIRE

    Smith, L. I.; Dayal, S.; Murray, J; Lannigan, A

    2016-01-01

    Background The majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. The aim of this study was to investigate the attitudes of this age group towards BCS, and factors which may influence their treatment decision-making. Methods A questionnaire was sent to all patients who were aged 70 or over at the time they had breast cancer surgery in NHS Lanarkshire between 1999 and 2013. This d...

  12. The psychological safety of breast implant surgery.

    Science.gov (United States)

    McGrath, Mary H

    2007-12-01

    One positive consequence of the challenge to silicone breast implants has been renewed interest in the psychological dimensions of plastic surgery. When asked questions about the psychological outcomes of women with breast implants, plastic surgery responded with work that is changing the very framework on which concepts such as body image and quality of life are founded. In the course of exploring the psychological impact of breast augmentation, traditional ways of thinking about patient characteristics and motivations have been called into question. There is a new focus on evidence-based outcomes research and an active search for methods that are valid, reliable, and sensitive enough to recognize and measure the emotional impact of changing physical appearance. With more information about psychiatric comorbidities and the identification of variables that influence patients' attitudes, augmentation mammaplasty with implants is better understood. Meanwhile, a new generation of investigators has been stimulated to study and reinterpret the psychodynamics of the aesthetic surgery experience. PMID:18090819

  13. Cosmetic evaluation of breast conserving treatment for mammary cancer. 2

    International Nuclear Information System (INIS)

    The effects on surgical treatment techniques, radiation doses and fraction sizes on cosmetic outcome were analysed in patients with stage I and II breast cancer treated with breast conserving surgery and a wide range of radiotherapy doses. The individual impact of different treatment parameters and patient-related factors was assessed by using both qualitative scoring and quantitative measurements. The validity of the system was tested by correlating the measurements with the subjective scoring, for each of the different factors assessed. (author). 23 refs; 9 figs.; 2 tabs

  14. [Postoperative inconveniences after breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Callesen, T.; Kroman, N.;

    2008-01-01

    The most common postoperative inconveniences after breast cancer surgery are pain, nausea and vomiting, which contribute to reduced patient satisfaction, prolonged hospital stays and delayed courses of rehabilitation. This article summarizes the literature regarding available procedure......-specific evidence for prophylactic nausea, vomiting and pain treatment supported by transferable evidence from similar types of surgery. We propose a prophylactic combination of Dexametason, Ondansteron, Paracetamol, Celecoxib, Gabapentin and Detromethorphan as future treatment Udgivelsesdato: 2008/6/2...

  15. Preparing for Breast Reconstruction Surgery

    Science.gov (United States)

    ... Cancer? Breast Cancer Colon/Rectum Cancer Lung Cancer Prostate Cancer Skin Cancer Show All Cancer Types News and Features Cancer Glossary ACS Bookstore Cancer Information Cancer Basics Cancer Prevention & Detection Signs & Symptoms of Cancer Treatments & Side Effects ...

  16. Dosimetry Study on Intensity Modulated Radiation Therapy for Left Side Breast Cancer after Conservative Surgery%左侧乳腺癌保乳术后调强放疗的剂量学研究

    Institute of Scientific and Technical Information of China (English)

    艾秀清; 木妮热・木沙江; 司马义力・买买提尼亚孜; 朱相露

    2014-01-01

    目的:分析左侧乳腺癌保乳术后调强放疗( IMRT)靶区以及心脏、同侧肺的照射剂量分布情况。方法对保乳术后接受调强放疗的37例左侧乳腺癌患者采取CT 定位并行调强放射治疗,采用IMRT 及3D-CRT 2种照射计划,总剂量均为50 Gy,1次/d,5 d/周,共照射25次。观察比较两种计划的剂量学差异。结果 IMRT 计划D95剂量高于3D-CRT 计划,而IMRT 的V105%、V110%、HI 明显低于3D-CRT,具有统计学差异(P <0.05)。IMRT 的肺V20、V30、V40以及心脏V5、V30、V40均显著低于3D-CRT 的,具有统计学差异(P <0.05)。15例患者左侧乳腺体积超过500 cm3,22例小于500 cm3,经比较发现,两组患者IMRT 计划的D95、V105、V110、HI 比较无显著差异。结论 IMRT 靶区剂量更接近于处方剂量,靶区剂量分布较3D-CRT 更均匀,有更好的适形性,能更好地保护肺脏、心脏等周围组织,而且IMRT 放射治疗受CTV 影响较小,靶区内剂量均匀性较好。%Objective To investigate dosimetry study on intensity modulated radiation therapy ( IMRT) on heart,left lung of breast cancer patients after conservative surgery .Methods 37 female patients received IMRT after left side breast cancer conservative surgery were selected in our study .All patients were given conventional radiotherapy ( CRT) plan using same CT in-formation.Prescription dose was 50 Gy in breast volume with X-ray,1 time each week,5 days per-week,and 25 times total.Clini-cal target volume(CTV),planning tumor volume (PTV),and heart were evaluated and compared in the 2 plans.Results The D95 of IMRT were higher than that of 3D-CRT,and the V105%,V110%,HI of IMRT were lower than 3D-CRT,the differences had statistical significance (P500 cm3 .Conclusion IMRT has higher efficacy of taking tumor volume irradiation and has lower volume of high dose compared with 3D-CRT.IMRT can improve dose distribution and reduce the cardiac dose and

  17. Cosmetic effects of oncoplastic volume displacement technique in breast-conserving surgery%乳腺癌保乳术中残存乳腺的处理方法

    Institute of Scientific and Technical Information of China (English)

    罗健; 郑晓东; 郭黎; 谢明社; 喻霞; 付曦

    2010-01-01

    Objective To explore the cosmetic effect of oncoplastic volume displacement in breastconserving surgery.Methods 43 cases of breast cancer in stages I and Ⅱ with pathological diagnosis by core needle biopsy were operated by extended resection of tumor combined with axillary lymph nodes dissection.Among the patients,wound cavity was repaired by direct skin suture without suture of mammary gland deletion in 22 cases,and another 21 cases were repaired by oncoplastic volume displacement technique in which skin suture followed by freeing remaining breast tissue flap and translocation to repair the mammary defect.All of them were treated with three-dimension conformal radiotherapy,standard chemotherapy and endocrine therapy after operation.3 years after partial removal of breast,a retrospective historical control study had been fulfilled to analyze breast cosmetic results between two groups.Results In direct suture group,the cosmetology score was 4.3 points and fine rate was 40.9% (9/22).In breast reconstruction group.the score was 4.8 points and fine rate was 71.4% (15/21).The breast cosmetic effect in breast reconstruction group was significantly better than that in direct suture group (P<0.01).Conclusion It will get better breast cosmetic results after operation to utilize oncoplastic volume displacement suture technique in breast-conserving surgery.%目的 探讨乳腺癌保乳手术中残存乳腺直接缝合法与美学重塑法的效果比较.方法 43例经穿刺活检确诊的Ⅰ、Ⅱ期乳腺癌患者,均行肿瘤扩大切除术及腋淋巴结清扫术.其中,直接缝合组22例,术中对乳腺体缺损不予缝合,直接缝合皮肤封闭创腔;乳腺美学重塑组21例,游离剩余乳腺组织瓣,转移修复乳腺腺体缺损,再缝合皮肤.术后均给予全乳三维放射治疗、规范化疗和内分泌治疗.术后3年,自拟美学评分标准,对两组患者乳房的美学效果进行回顾性分析.结果 直接缝合组美学评分4.3

  18. IMRT technique in patients with breast cancer treated with breast conserving therapy - obstacles and advantages

    International Nuclear Information System (INIS)

    Breast cancer is the most frequently occurring type of malignant tumour in women in Poland. About 12 thousand new cases of breast cancer are registered annually, among which the greater part (70-80%) is represented by women in the early phase of the disease. Conserving therapy is the standard approach in early breast cancer. The role of radiotherapy as a supplement to surgical treatment is also underlined. For over 100 years radiotherapy has been one of the basic methods to treat patients with malignant tumour of the breast. Nowadays the use of ionizing radiation has become an integral method of the multidisciplinary and modern treatment of patients with breast cancer after conserving surgery. Within the last few years the improvement of radiotherapy techniques has been observed to correct the therapeutic index of radiation. The modulation of the intensity of the beam (intensity modulated radiation therapy, IMRT) is a new method of radiotherapy which assures delivery of the highest possible radiation dose into the area of the tumour with the simultaneous maximum protection of healthy tissues. The purpose of this study is to set out the present state of knowledge on possibilities of using the technique of IMRT on patients with breast cancer after conserving therapy. In the article available literature is reviewed and an analysis of the advantages and disadvantages of using IMRT in breast cancer compared to standard conformal techniques is presented. (authors)

  19. Clinical Comparative Study of Breast-conserving Surgery and Modifi ed Radical Mastectomy in the Treatment of Patients with Early-stage Breast Cancer%保乳术与改良根治术治疗乳腺癌的临床对比研究

    Institute of Scientific and Technical Information of China (English)

    周联合

    2012-01-01

    Objective:To compare the therapeutic effect of breast-conserving surgery and modified radical mastectomy in the treatment of patients with early-stage breast cancer. Methods:From September 2004 to June 2011, 57 patients with early-stage breast cancer were admitted into our department. According to their surgical treatment way, these before-mentioned patients were divided into 2 groups, the observation group included 31 patients and received breast-conserving surgery, and the control group included 26 patients and received modified radical mastectomy. Now we compare the therapeutic effect between the observation group and the control group in this paper. Results:①There were significant differences in operation time, hospitalization time, blood loss during surgery, incidence rate of postoperative complication, postoperative cosmetic results between the two groups. ②There were no significant differences in local recurrence rate, distant metastasis rate between the two groups. Conclusion:The therapeutic effect is same between the breast-conserving surgery and the modified radical mastectomy for early-stage breast cancer, but the breast-conserving surgery is of shorter operation time and hospitalization time, less blood loss during surgery, lower incidence rate of postoperative complication, better postoperative cosmetic results, so this surgical treatment way is preferred for patients with early-stage breast cancer.%目的:比较早期乳腺癌患者保乳术与改良根治术的疗效.方法:2004年9月~2011年6月期间,我科共收治57例早期乳腺癌患者.根据手术方式将前述乳腺癌患者分成2组,观察组31例,接受保乳术;对照组26例,接受改良根治术.现比较两组患者的临床疗效.结果:①两组患者的手术时间、住院时间、术中出血量、术后并发症发生率、术后美容效果相比差异有统计学意义(P均<0.05).②经过3年时间的随访,两组患者的术后局部复发率、远处转移率等

  20. The impact of the number of excised axillary nodes and of the percentage of involved nodes on regional nodal failure in patients treated by breast-conserving surgery with or without regional irradiation

    International Nuclear Information System (INIS)

    Purpose: After breast-conserving surgery, recommendations for regional nodal radiotherapy are usually based on the number of positive nodes. This number is dependent on the number of nodes removed during the axillary dissection. This study examines whether the percentage of positive nodes may help to select patients for regional radiotherapy. Methods and Materials: A retrospective study was conducted on 1,372 T1-T2 node-positive breast cancer patients treated at L'Hotel-Dieu de Quebec Hospital between 1972 and 1997. Results: Among the patients who did not receive regional radiotherapy, the percentage of involved nodes was significantly associated with axillary failure. Ten-year axillary control rates were 97% and 91% when the percentage of involved nodes was 3 nodes). Conclusions: The percentage of involved nodes should be taken into consideration in selecting patients for regional radiotherapy. Irradiation of the axilla should be reserved for patients with a specific ratio: >40% involved nodes if N1-3 and ≥50% involved nodes if N>3 nodes

  1. Breast conserving therapy for early stage invasive cancer and ductal carcinoma in-situ

    International Nuclear Information System (INIS)

    Purpose/Objective: To discuss a number of clinical, pathologic, and treatment related issues in the management of early stage invasive breast cancer and ductal carcinoma in situ. In the last 10 years, prospective randomized trials as well as retrospective series have established the role of conservative surgery and radiation in the treatment of early stage invasive breast cancer. This course will focus on some of the unresolved issues in breast conservation therapy including patient selection, the extent of surgery in the breast, and the importance of microscopic resection margins. The impact of adjuvant systemic therapy (chemotherapy or tamoxifen) on breast recurrence will be presented. Factors predicting for an increased risk of recurrence in the treated breast will be presented. Potential candidates for conservative surgery alone with minimally invasive breast cancer will be identified. The impact of improved local control on survival will be discussed. Treatment options for ductal carcinoma in situ (DCIS) including observation, radiation and mastectomy. Results from prospective randomized trials as well as retrospective series will be presented in an attempt to identify appropriate treatment strategies for the different clinical presentations and histologic subtypes of DCIS. As cost effective strategies are developed, the role of conservative surgery and radiation in minimally invasive breast cancer and DCIS must be defined

  2. Acellular dermal matrices: Use in reconstructive and aesthetic breast surgery

    OpenAIRE

    Macadam, Sheina A; Lennox, Peter A

    2012-01-01

    Acellular dermal matrices (ADMs) were first described for use in breast surgery in 2001. Since this initial report, ADMs have become an increasingly common component of implant-based breast procedures. ADMs have shown promise for use in both aesthetic and reconstructive breast surgery; however, concerns about their use remain because of the significant costs associated with these products. The present article reviews the history of ADM use in breast surgery and the outcomes reported to date. ...

  3. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes

    Science.gov (United States)

    Voineskos, Sophocles H.; Frank, Simon G.

    2015-01-01

    Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes. In autologous breast reconstruction, radiation, increased BMI, certain previous abdominal surgery, smoking, and delayed reconstruction are associated with higher complication rates. Though a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is the most common type of flap used for autologous breast reconstruction, pedicled TRAMs are more likely to be associated with fat necrosis than a free TRAM or deep inferior epigastric perforator (DIEP) flap. Fat grafting can also be used to improve aesthetic outcomes in autologous reconstruction. This article focuses on factors, both patient and surgical, that are predictors of complications and outcomes in breast reconstruction. PMID:26645003

  4. Breast-conservation treatment of breast cancer in elderly women

    International Nuclear Information System (INIS)

    In the recent 3 years, 8 elderly women with breast cancer of various stages were treated with breast-conservation treatment (BCT) combined with endocrine therapy and/or systemic chemotherapy mainly based on patients' obvious desire. Until now, one out of these 8 patients had died of heart failure with no evidence of breast cancer progression, and the other 7 patients are alive with no evidence of disease. As for side effects of the therapy, no severe sequelae have been experienced so far. Cosmetic results of the therapy were considerably sufficient. (author)

  5. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    International Nuclear Information System (INIS)

    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast

  6. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sedlmayer, F. [Paracelsus Medical Univ. Hospital, Salzburg (Austria). Dept. of Radiotherapy and Radiation Oncology; Sautter-Bihl, M.L. [Staedtisches Klinium Karlsruhe (Germany). Klinik fuer Radioonkologie und Strahlentherapie; Budach, W. [University Hospital Duesseldorf (Germany)] [and others

    2013-10-15

    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing

  7. Objective assessment of breast skin reactions after breast-conserving therapy

    International Nuclear Information System (INIS)

    The objective of this study was to determine an objective method for assessing skin reactions after radiotherapy following breast-conserving surgery. 116 patients who had breast-conserving therapy were studied. The Mexameter MX 18 (melanin and erythema index meter: Integral, distributor for Courage+Khazaka Electronic GmbH) was used to measure the erythema and melanin indices of the breast skin. The results were compared to those obtained from the non-irradiated contra lateral breast skin, and their evolution over time was examined. For both the erythema and the melanin indices, the ratio of the irradiated-side index to the non-irradiated-side index was calculated. The erythema index ratio of the skin was high in patients who had just undergone radiotherapy but low in patients who had undergone radiotherapy more than one year earlier. There was a significant decrease in the erythema index ratio up to one year after radiotherapy. The patients who showed high melanin index ratio (≥1) increased significantly at one year after radiotherapy. In areas that had received electron beam irradiation, there were only small decreases in the erythema index ratio with time following radiotherapy. Our study suggests the present method was useful in providing an objective method of assessing skin reactions following breast-conserving therapy. (author)

  8. Local tumor control and cosmetic outcome following breast-conserving surgery and radiation up to a total dose of 56 Gy without boost in breast cancer patients; Lokale Tumorkontrolle und kosmetisches Ergebnis nach brusterhaltender Operation und Strahlentherapie bis 56 Gy Gesamtdosis ohne Boost beim Mammakarzinom

    Energy Technology Data Exchange (ETDEWEB)

    Bayerl, A. [Abteilung fuer Radioonkologie und Strahlentherapie Wiener Neustadt (Austria); Technische Univ. Muenchen (Germany). Inst. und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Frank, D.; Lenz, A.; Feldmann, H.J.; Molls, M. [Technische Univ. Muenchen (Germany). Inst. und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Hoess, C. [Technische Univ. Muenchen (Germany). Frauenklinik und Poliklinik; Lukas, P. [Universitaetsklinik fuer Strahlentherapie und Radioonkologie, Innsbruck (Austria)

    2001-01-01

    Purpose: To evaluate overall survival, local tumor control and cosmetic outcome after breast-conserving surgery followed by radiotherapy without boost irradiation. Patients and Methods: In a retrospective study 270 breast cancer patients were treated with breast conserving surgery combined with a homogenous radiation of the tumor bearing breast up to a total dose of 56 Gy without local boost irradiation. Mean follow-up was 48 months. Local tumor control, side effects, cosmetic results and contentment with treatment were assessed using physical examinations and interviews based on a standardized questionnaire. Results: Cause-specific survival at 5 years after treatment was 88.3%, actuarial disease-free survival at 5 years was 76.1%. Within 23 to 78 months after treatment 12 patients suffered from ipsilateral breast recurrence. The actuarial freedom from local recurrence (single tumor manifestation) was 96.8% at 5 years after treatment, 89% at 10 years. The occurrence of local failures was not significantly correlated to tumor size, margins, grading, nodal status, age or lymphangiosis. 15.6% of the patients developed distant metastases. In all patients treatment was performed without interruption. Side effects were predominantly of mild degree, no severe side effects were detected. 73% of physicians and 81% of patients scored their cosmetic outcome as excellent or good. 93% of patients would again decide in favor of this procedure. Whereas, use of adjuvant chemotherapy as well as subcutaneous reconstruction of breast tissue did not significantly affect breast cosmesis, analysis demonstrated impaired cosmetic results related to a larger breast size. Conclusion: The data of this study show that tumor control achieved by breast conserving surgery in combination with a radiation technique up to a total dose of 56 Gy which omits boost irradiation is within the range of literature data. Side effects of the therapy were tolerable. The treatment displayed a good

  9. Application of ambulatory surgery in breast cancer. Hospital 'V. I Lenin' 1996 - 2006

    International Nuclear Information System (INIS)

    Breast cancer ranks among the top in incidence and mortality from oncological diseases worldwide. In our country and our province behaves similarly, represents a major health problem. To compare the results of traditional outpatient surgery in patients diagnosed with breast cancer. Was performed a case-series study of patients operated for malignancy in breast oncology service at the 'Hospital Universitario V. I. Lenin'. It involved 1140 cases, including 260 by the traditional method and 880 (77.19%) for the outpatient method. Modified radical mastectomy was performed to 1010 patients and conservative surgery, 30 of them. The rate of complications present in the operated cases was not significant. (Author)

  10. Validation of a Web-Based Tool to Predict the Ipsilateral Breast Tumor Recurrence (IBTR! 2.0) after Breast-Conserving Therapy for Korean Patients

    OpenAIRE

    Jung, Seung Pil; Hur, Sung Mo; Lee, Se Kyung; Kim, Sangmin; Choi, Min-Young; Bae, Soo Youn; Kim, Jiyoung; Kim, Min Kuk; Kil, Won Ho; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo; Nam, Seok Jin; Bae, Jeoung Won; Lee, Jeong Eon

    2013-01-01

    Purpose IBTR! 2.0 is a web-based nomogram that predicts the 10-year ipsilateral breast tumor recurrence (IBTR) rate after breast-conserving therapy. We validated this nomogram in Korean patients. Methods The nomogram was tested for 520 Korean patients, who underwent breast-conserving surgery followed by radiation therapy. Predicted and observed 10-year outcomes were compared for the entire cohort and for each group, predefined by nomogram-predicted risks: group 1, 10%. Results In overall pati...

  11. Significant negative impact of adjuvant chemotherapy on Health-Related Ouality of Life (HR-OoL) in women with breast cancer treated by conserving surgery and postoperative 3-D radiotherapy. A prospective measurement

    Energy Technology Data Exchange (ETDEWEB)

    Galalae, R.M.; Michel, J.; Kimmig, B. [Clinic for Radiation Therapy (Radiooncology), Univ. Hospital Schleswig-Holstein, Campus Kiel (Germany); Siebmann, J.U.; Kuechler, T.; Eilf, K. [Dept. of General and Thoracic Surgery/Reference Center on Quality of Life in Oncology, Univ. Hospital Schleswig-Holstein, Campus Kiel (Germany)

    2005-10-01

    Purpose: to prospectively assess health-related quality of life (HR-QoL) in women after conserving surgery for breast cancer during/after postoperative 3-D radiotherapy. Patients and methods: 109 consecutively treated patients were analyzed. HR-QoL was assessed at initiation (t1), end (t2), and 6 weeks after radiotherapy (t3) using the EORTC modules QLQ-C30/BR23. Patients were divided into three therapy groups. Group I comprised 41 patients (radiotherapy and adjuvant chemotherapy), group II 45 patients (radiotherapy and adjuvant hormonal therapy), and group III 23 patients (radiotherapy alone). Reliability was tested. Scale means were calculated. Univariate (ANOVA) and multivariate (MANCOVA) analyses were performed. Results: reliability testing revealed mean Cronbach's {alpha} > 0.70 at all measurement points. ANOVA/MANCOVA statistics revealed significantly better HR-QoL for patients in group II versus I. Patients receiving radiotherapy alone (group III) showed the best results in HR-QoL. However, scale mean differences between groups II and III were not significant. Conclusion: HR-QoL measurement using EORTC instruments during/after radiotherapy is reliable. Adjuvant chemotherapy significantly lowered HR-QoL versus hormones or radiotherapy alone. Chemotherapy patients did not recover longitudinally (from t1 to t3). (orig.)

  12. Significant negative impact of adjuvant chemotherapy on Health-Related Quality of Life (HR-OoL) in women with breast cancer treated by conserving surgery and postoperative 3-D radiotherapy. A prospective measurement

    International Nuclear Information System (INIS)

    Purpose: to prospectively assess health-related quality of life (HR-QoL) in women after conserving surgery for breast cancer during/after postoperative 3-D radiotherapy. Patients and methods: 109 consecutively treated patients were analyzed. HR-QoL was assessed at initiation (t1), end (t2), and 6 weeks after radiotherapy (t3) using the EORTC modules QLQ-C30/BR23. Patients were divided into three therapy groups. Group I comprised 41 patients (radiotherapy and adjuvant chemotherapy), group II 45 patients (radiotherapy and adjuvant hormonal therapy), and group III 23 patients (radiotherapy alone). Reliability was tested. Scale means were calculated. Univariate (ANOVA) and multivariate (MANCOVA) analyses were performed. Results: reliability testing revealed mean Cronbach's α > 0.70 at all measurement points. ANOVA/MANCOVA statistics revealed significantly better HR-QoL for patients in group II versus I. Patients receiving radiotherapy alone (group III) showed the best results in HR-QoL. However, scale mean differences between groups II and III were not significant. Conclusion: HR-QoL measurement using EORTC instruments during/after radiotherapy is reliable. Adjuvant chemotherapy significantly lowered HR-QoL versus hormones or radiotherapy alone. Chemotherapy patients did not recover longitudinally (from t1 to t3). (orig.)

  13. Factors influencing cosmetic results after conservation therapy for breast cancer

    International Nuclear Information System (INIS)

    Purpose: Host, tumor, and treatment-related factors influencing cosmetic outcome are analyzed for patients receiving breast conservation treatment. Methods and Materials: Four-hundred and fifty-eight patients with evaluable records for cosmesis evaluation, a subset of 701 patients treated for invasive breast cancer with conservation technique between 1969 and 1990, were prospectively analyzed. In 243 patients, cosmetic evaluation was not adequately recorded. Cosmesis evaluation was carried out from 3.7 months to 22.3 years, median of 4.4 years. By pathologic stage, tumors were 62% T1N0, 14% T1N1, 15% T2N0, and 9% T2N1. The majority of patients were treated with 4-6 MV photons. Cosmetic evaluation was rated by both patient and physician every 4-6 months. A logistic regression analysis was completed using a stepwise logistic regression. P-values of 0.05 or less were considered significant. Excellent cosmetic scores were used in all statistical analyses unless otherwise specified. Results: At most recent follow-up, 87% of patients and 81% of physicians scored their cosmetic outcome as excellent or good. Eighty-two percent of physician and patient evaluations agreed with excellent-good vs. fair-poor rating categories. Analysis demonstrated a lower proportion of excellent cosmetic scores when related to patient age > 60 years (p = 0.001), postmenopausal status (p = 0.02), black race (p = 0.0034), and T2 tumor size (p = 0.05). Surgical factors of importance were: volume of resection > 100 cm3 (p = 0.0001), scar orientation compliance with the National Surgical Adjuvant Breast Project (NSABP) guidelines (p = 0.0034), and > 20 cm2 skin resected (p = 0.0452). Extent of axillary surgery did not significantly affect breast cosmesis. Radiation factors affecting cosmesis included treatment volume (tangential breast fields only vs. three or more fields) (p = 0.034), whole breast dose in excess of 50 Gy (p = 0.0243), and total dose to tumor site > 65 Gy (p = 0.06), as well as

  14. Breast Conserving Treatment for Breast Cancer: Dosimetric Comparison of Sequential versus Simultaneous Integrated Photon Boost

    Directory of Open Access Journals (Sweden)

    Hilde Van Parijs

    2014-01-01

    Full Text Available Background. Breast conserving surgery followed by whole breast irradiation is widely accepted as standard of care for early breast cancer. Addition of a boost dose to the initial tumor area further reduces local recurrences. We investigated the dosimetric benefits of a simultaneously integrated boost (SIB compared to a sequential boost to hypofractionate the boost volume, while maintaining normofractionation on the breast. Methods. For 10 patients 4 treatment plans were deployed, 1 with a sequential photon boost, and 3 with different SIB techniques: on a conventional linear accelerator, helical TomoTherapy, and static TomoDirect. Dosimetric comparison was performed. Results. PTV-coverage was good in all techniques. Conformity was better with all SIB techniques compared to sequential boost (P = 0.0001. There was less dose spilling to the ipsilateral breast outside the PTVboost (P = 0.04. The dose to the organs at risk (OAR was not influenced by SIB compared to sequential boost. Helical TomoTherapy showed a higher mean dose to the contralateral breast, but less than 5 Gy for each patient. Conclusions. SIB showed less dose spilling within the breast and equal dose to OAR compared to sequential boost. Both helical TomoTherapy and the conventional technique delivered acceptable dosimetry. SIB seems a safe alternative and can be implemented in clinical routine.

  15. Breast conserving therapy for early state invasive cancer and ductal carcinoma in-situ

    International Nuclear Information System (INIS)

    Purpose/Objective: To discuss a number of clinical, pathologic, and treatment related issues in the management of early stage invasive breast cancer and ductal carcinoma in situ. In the last 10 years, prospective randomized trials as well as retrospective series have established the role of conservative surgery and radiation in the treatment of early stage invasive breast cancer. This course will focus on some of the unresolved issues in breast conservation therapy including patient selection, the extent of surgery in the breast, and the importance of microscopic resection margins. The impact of adjuvant systemic therapy (chemotherapy or tamoxifen) on breast recurrence and complications will be presented. The role of neoadjuvant chemotherapy will be reviewed. Factors predicting for an increased risk of recurrence in the treated breast will be presented. The diagnosis and treatment of a breast recurrence will be discussed. Treatment options for ductal carcinoma in situ (DCIS) including observation, radiation and mastectomy. Results from prospective randomized trials as well as retrospective series will be presented in an attempt to identify appropriate treatment strategies for the different clinical presentations and histologic subtypes of DCIS. As cost effective strategies are developed, the role of conservative surgery and radiation in minimally invasive breast cancer and DCIS must be defined

  16. Early breast cancer: influence of type of boost (electrons vs iridium-192 implant) on local control and cosmesis after conservative surgery and radiation therapy

    International Nuclear Information System (INIS)

    Between December 1981 and December 1988, 329 consecutive patients with stage I and II breast cancers who underwent wide excision (n = 261) or quadrantectomy (n = 68) with (n = 303) or without (n = 26) axillary dissection were referred to radiotherapy. Final margins of resection were microscopically free from tumor involvement in all cases. Radiotherapy consisted in 40-45 Gy over 4-4.5 weeks to the breast, with (n = 168) or without (n = 161) regional nodal irradiation of 45-50 Gy over 4.5-5 weeks. A mean booster dose of 15 Gy was delivered to the primary site by iridium-192 implant in 169 patients (group 1) or by electrons in 160 patients (group 2). Twenty-seven percent (n = 88) of patients received tamoxifen for ≥ 2 years. Adjuvant chemotherapy was administered in 22% (n = 71) of patients. Groups 1 and 2 were not strictly comparable. Group 1 patients were significantly younger, had smaller tumors, were treated with cobalt at 5 x 2 Gy per week and axillary dissection was more frequently performed. Group 2 patients were more frequently bifocal and more frequently treated by quadrantectomy and tamoxifen, and irradiation used accelerator photons at 4 x 2.50 Gy per week. No difference in terms of follow-up and survival rates was observed between the two groups. For all patients the 5- and 10-year local breast relapse rates were 6.7% and 11%, respectively. No difference was observed regarding local control either by the electron or the iridium-192 implant boosts. Axillary dissection and age had an impact on the breast cosmetic outcome. Furthermore, the cosmetic results seemed to be poorer in group 1 than in group 2. This may be related to other factors; group 1 patients were treated with telecobalt and axillary dissection was more frequently performed; on the other hand, group 2 patients were treated with accelarator photons

  17. Breast conservation in BRCA1 or BRCA2 mutation carriers with early stage breast cancer

    International Nuclear Information System (INIS)

    The role of breast conservation therapy (limited surgery and irradiation of the breast with/without axilla) in the approximately 5% of breast cancer patients who harbour a germline mutation in BRCA1 or BRCA2, is a largely unexplored area and is seen by some as controversial. The relatively high cumulative risk of second primary cancers in such patients and concern about a possible decreased ability of mutation carriers to repair DNA damage caused by radiation has fuelled this controversy. Published studies of breast conservation therapy in carriers of a mutation in BRCA1 or BRCA2 are reviewed, with particular attention to their methodology. These studies have not demonstrated any increase in radiation sensitivity of normal tissues in mutation carriers, either in terms of increased early or late toxicity or tumourigenesis. Likewise, tumour sensitivity to radiotherapy, which might be expected based on the known functions of the BRCA1 and BRCA2 genes, has not been documented to date in mutation carriers. Further, methodologically rigorous studies of large numbers of breast cancer patients who carry a mutation in BRCA1 or BRCA2 are required to fully elucidate these issues. Copyright (2001) Blackwell Science Pty Ltd

  18. Analysis of radiation pneumonitis outside the radiation field in breast conserving therapy for early breast cancer

    International Nuclear Information System (INIS)

    In a retrospective study of radiation-induced pulmonary changes for patients with breast conserving therapy for early breast cancer, we sent questionnaires to the main hospitals in Japan. In this study, we analyzed pulmonary changes after tangential whole-breast irradiation. The purpose of this study was to determine the incidence and risk factors for radiation pneumonitis outside the radiation field. The questionnaires included patients data, therapy data, and lung injury information between August 1999 and May 2000. On the first questionnaires, answer letters were received from 107 institutions out of 158 (67.7%). On the second questionnaires, response rate (hospitals which had radiation pneumonitis outside the radiation field) was 21.7% (23/106). We could find no risk factors of this type of pneumonitis. We suggested that lung irradiation might trigger this type of pneumonitis which is clinically similar to BOOP (bronchiolitis obliterans organizing pneumonia). It developed in 1.5-2.1% among the patients with breast conserving surgery and tangential whole-breast irradiation. And it is likely appeared within 6 months after radiotherapy. (author)

  19. Breast carcinoma conservative treatment. Stages I and II

    International Nuclear Information System (INIS)

    From 1981 to 1988, 265 patients with breast cancer stages I and II (UICC-1987), were evaluated after conservative treatment with quadrantectomy plus axillectomy, radiotherapy and chemotherapy. After surgical treatment, the patients were submitted to radiation therapy in the breast. One hundred and fifty six (58,8%) patients were submitted to adjuvant chemotherapy. The median clinical follow-up period was 42.8 months with a minimum of 24 and a maximum of 99 months. Six (2,3%) patients presented local recurrence and 48 (18,1%) presented distant metastasis. After five years the total survival rate was 89,7% and the disease free survival rate was 75% in the same period. The study did not show significant differences among the clinical stages classified after surgery and the use of adjuvant chemotherapy did not influence the results of the many stages. (author). 194 refs, 33 figs, 6 tabs

  20. Clinical observation of breast-conserving surgery and modified radical mastectomy in the treatment of early-stage breast cancer%保乳手术与改良根治术治疗早期乳腺癌的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    邓丁梅; 王西跃; 曹茵

    2014-01-01

    目的:探讨保乳手术与改良根治术治疗早期乳腺癌的临床效果。方法回顾性分析2009年11月~2011年6月本院收治的早期乳腺癌行保乳手术的患者45例为观察组,选择同期行改良根治术的早期乳腺癌患者45例为对照组,比较两组患者的手术效果,术后并发症的发生率,美容效果满意率,5年生存率,局部复发率及远处转移率等情况。结果观察组患者手术时间、术中出血量,住院时间及术后并发症的发生率均少于对照组(P<0.05)。观察组患者美容效果优良率明显高于其对照组(P<0.05);两组患者5年生存率,局部复发率和远处转移率比较,差异无统计学意义(P>0.05)。结论早期乳腺癌保乳手术治疗效果明显优于改良根治术,具有手术时间短,创伤小,术中出血少,美容效果好及术后并发症少等优点,值得临床推广应用。%Objective To explore the clinical effect of breast-conserving surgery and modified radical mastectomy in the treatment of early-stage breast cancer. Methods 45 cases with early-stage breast cancer patients of breast-conserving surgery from November 2009 to June 2011 in the observation group were analyed.45 patients with early-stage breast cancer patients of modified radical mastectomy in the same period were selected as control group.The effect of surgery,the incidence of postoperative complications,cosmetic results satisfaction rate,5-year survival rate of local recurrence and distant metastasis rates of two groups were observed. Results The operative time,blood loss,hospital stay and postoperative complication rate of the observation group was significantly less than that of control group(P0.05). Conclusion Early breast conserving surgery is better than modified radical mastectomy,with a shorter operative time,less trauma,less bleeding,better cosmetic results and fewer complications,it should be widely conducted.

  1. Surgical Procedures for Breast Cancer - Mastectomy and Breast Conserving Therapy (Beyond the Basics)

    Science.gov (United States)

    ... performed BCT procedure in the United States and Canada. (See "Breast conserving therapy" .) Radiation therapy Invasive breast ... breast cancer The following organizations also provide reliable health ... and undertakings, oral or written, are hereby expressly superseded and canceled. ...

  2. 早期乳腺癌保留乳房手术联合术中放射治疗的近期疗效%Short-term efficacy of breast-conserving surgery plus intraoperative radiotherapy for early stage breast ;cancer

    Institute of Scientific and Technical Information of China (English)

    俞伟; 马林; 鞠忠建; 李席如; 王建东; 张艳君; 孔庆龙; 巩汉顺

    2015-01-01

    目的:分析早期乳腺癌保留乳房(简称保乳)手术联合术中放射治疗的近期疗效、不良反应及美容效果。方法回顾性分析解放军总医院2008年12月至2012年3月收治的75例早期乳腺癌患者行保乳手术联合术中放射治疗的临床资料。所有患者于肿瘤切除前行电子线术中放射治疗,剂量为8 Gy或15 Gy。观察术后近期治疗效果、不良反应及美容效果。采用Kaplan-Meier法计算局部复发率和生存率。结果中位随访54个月(30~66个月),2例(2.7%,2/75)患者出现术后血肿,6例(8.0%,6/75)患者出现轻微的乳腺纤维化,1例(1.3%,1/75)患者出现术后感染,16例(21.3%,16/75)患者出现1级放射性肺损伤。术后美容效果优、良率分别为57.3%(43/75)和30.7%(23/75)。患者术后3年的局部复发率为5.3%(4/75),3年的无瘤生存率为94.7%(71/75)。结论早期乳腺癌保乳手术联合术中放射治疗的近期疗效和美容效果均良好,且不良反应轻微。%Objective To evaluate the short-term efficacy, adverse reaction and cosmetic effect of breast-conserving surgery plus intraoperative electron radiotherapy ( IOERT ) for early stage breast cancer. Methods We retrospectively analyzed the clinical data of 75 breast cancer patients who underwent breast-conserving surgery combined with IOERT in General Hospital of Chinese PLA from December 2008 to March 2013. All patients were treated with IOERT at the dosage of 8 or 15 Gy before tumor resection. The short-term efficacy, adverse reaction and cosmetic effect were evaluated after operation. Kaplan-Meier method was used to calculate the local recurrence and overall survival. Results Median follow-up period was 54 months (30-60) months. Two ( 2. 7%, 2/75 ) patients developed postoperative hematoma. Six ( 8. 0%, 6/75 ) patients developed mild breast fibrosis. One ( 1. 3%, 1/75 ) patient experienced postoperative infection. Sixteen (21. 3%, 16/75) patients developed grade 1

  3. Local recurrences after breast-conserving treatments in breast cancer: risk factors and effect on survival

    International Nuclear Information System (INIS)

    To determine the risk factors for local and distant failure in node-negative breast cancer treated with breast-conservative surgery and radiotherapy and to determine the relationship between these two events. We retrospectively selected 908 patients who received conservative surgery and radiotherapy but no chemotherapy between 1980 and 1995, for a mode-negative breast cancer. Patients were divided in two groups according to the status of the margins of resection. All pathology specimens were reviewed. In case of negative margins, the risk factors for local recurrences picked up by the Cox model were histologic multi-focus (P=0.0076), peritumoral vessel invasion (P=0.021) and age ≥40 years (P=0.024), and in case of involved margins, negative oestrogen receptors (P=0.0012), histologic multi-focus (P=0.0028), and absence of hormonal therapy (P=0.017). The 10-year local recurrence rate was 18 % in case of negative margins and 29 % in case of involved margins, although in the latter case patients received high-dose adjuvant radiotherapy. Accordingly, the 10-year distant failure rates were 16 % and 27 %, respectively. Many arguments suggest that local and distant failures are closely related. Patients with histologic multi-focus or positive margins are at high risk of local failure and then of distant failure, and require a more aggressive initial treatment. (author)

  4. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Laura E.G. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-11-15

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.

  5. Management of the Regional Lymph Nodes Following Breast-Conservation Therapy for Early-Stage Breast Cancer: An Evolving Paradigm

    International Nuclear Information System (INIS)

    Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit

  6. Evolution in breast cancer suspicion and extent of surgery at a radio-oncology center

    International Nuclear Information System (INIS)

    Introduction: Breast cancer diagnosis and treatment ad evolved over the past quarter century. From self-examination to mammography as main suspicion tool and from radical to conservative surgery plus radiotherapy as prefered treatment. The aim of this review was to assess the evolution of presentation and local management of breast cancer at a Chilean radio-oncology center. Materials and Methods: We analyzed 1.204 breast cancer patients who received postoperative irradiation on two four-years periods.The first period included 223 patients and coincides with the introduction of mammography and conservative surgery. The second included 981 patients managed according to current guidelines. The variables analyzed were type of clinical suspicion, time between clinical suspicion and diagnosis confirmation, type of surgery, histology and tumor size. Data were obtained from medical records and analyzed using STATA 2. Results: In the second period mammographic suspicion reached 39.88%. Time between clinical suspicion and histological diagnosis was reduced to 50%, the proportion of tumors larger than 2 cm was reduced from 61 to 45%, the proportion of DCIS was tripled from 6 to 18%, use of conservative surgery as an absolute increase of 28%. All of these differences were statistically significant (p < 0.01). Conclusion: The introduction of mammography and conservative management allowed early diagnosis of breast cancer in the analyzed population

  7. Oncoplastic surgery in the treatment of breast cancer

    OpenAIRE

    Rancati, Alberto; Gonzalez, Eduardo; Dorr, Julio; Angrigiani, Claudio

    2013-01-01

    Advances in reconstructive breast surgery with new materials and techniques now allow us to offer our patients the best possible cosmetic results without the risks associated with oncological control of the disease. These advances, in both oncological and plastic surgery, have led to a new specialisation, namely oncoplastic breast surgery, which enables us to undertake large resections and, with advance planning, to prevent subsequent deformities. This is particularly important when more than...

  8. Comparison of different treatment plannings for whole breast irradiation with tumor bed boost after breast-conservative surgery%乳腺癌保乳术后全乳加瘤床补量照射不同治疗计划的比较

    Institute of Scientific and Technical Information of China (English)

    李建彬; 卢洁; 范廷勇; 刘娟; 白瞳; 孙涛; 邢军; 王永胜; 邵倩

    2008-01-01

    目的 探讨乳腺癌保乳术后全乳加瘤床照射不同治疗计划靶区剂量适形度、靶区剂量分布均匀性及肺脏、心脏和对侧乳腺受照剂量体积的差异.方法 选择术腔各边界放置银夹且无腋窝淋巴结转移的12例左侧乳腺癌保乳术后患者,每例患者分别制定常规放疗(CRT)、无挡肺子野调强放疗(IMRT-F)、挡肺子野调强(IMRT-F-L)和瘤床同步整合补量调强放疗(SIB-IMRT)计划.比较不同治疗计划全乳靶区和瘤床靶区的剂量适形度和剂量分布均匀性,对比不同治疗计划肺脏、心脏和对侧乳腺受照剂量体积.结果 各计划中V处方剂量-PTV1/VPTV1、VPTV1-处方剂量/VPTV2、V处方剂量-PTV2/VPTV2/VPTV2、VPTV2-处方剂量/VPTV2组间差异均有统计学意义;CRT计划中患侧肺V20显著高于不同方式的IMRT计划,但不同方式的IMRT计划之间V20差异无统计学意义;CRT计划中心脏受照剂量显著高于IMRT和SIBIMRT计划.CRT计划中对侧乳腺最大照射剂量Dmax和平均剂量Dmean明显高于不同实现方式的IMRT计划,但不同实现方式的IMRT计划中Dmax和Dmean差异无统计学意义.结论 IMRT-F、IMRT-F-L、SIBIMRT计划均显著优于CRT计划,而不同方式IMRT计划间除个别参数外差异无统计学意义.%Objective To explore the difference of conformity and homogeneity of dose distribution in the whole breast and tumor bed targets and dose-volume parameters of the irradiated heart,lung and contralateral breast between the different treatment plannings for whole breast irradiation with tumor bed boost after breast-conservative surgery.Methods Twelve left-side breast cancer patients received breast-conservative surgery with negative axillary lymph node and with silver slips set in the cavity were selected.The different plannings including conventional radiotherapy(CRT),forward intensity-modulated radiotherapy with no lung block segments(IMRT-F),forward intensity-modulated radiotherapy with

  9. Breast-conserving therapy: its relation to pneumonopathy

    International Nuclear Information System (INIS)

    Time-dependent changes in the lungs induced by radiotherapy after breast-conserving surgery were monitored by high-resolution CT (HR-CT), and acute and delayed radiation effects were assessed. The subjects were 55 patients who had undergone tangential irradiation after breast-conserving surgery (age: 34-86 years). Patients were irradiated with 4-MV linear accelerator X-rays, 50 Gy/25 fr/5 w, within 50 days after surgery. Based on a histopathological findings in the stump, 10 Gy/5 fr/1 w boost irradiation was added to the base of the tumor with a 9-12 MeV electron beam. The lymph nodes of some patients were also irradiated. Regular CT examinations were as a rule performed before radiotherapy and 1-2 months (acute phase), 6 months (subacute phase), and 12 months (late phase) after radiotherapy. Whenever possible additional examinations were performed at 24 and 36 months. All images were interpreted by three radiotherapists and classified into the following 7 patterns; septal line, nodular opacity, ground glass opacity, consolidation, curvilinear opacity, air-cyst accumulation, and irregular pleural surface. Pathological changes in the lungs were found in a total of 49 of the 55 patients (89%) within 12 months. In 31 patients they were observed every time examined (1-12 months), and in 6 patients at 1-6 months alone. A septal line was observed throughout the entire 1-to-12 month period. Nodular opacities, ground glass opacities, and consolidation occurred in the acute phase (1-2 months, 41 patients). Air-cyst accumulation and irregularity of the pleural surface appeared in the subacute-late phase, and 33 patients had these findings from 12 months onward. Curvilinear opacities were observed from 6 months onward. The frequency of the findings after 24 and 36 months, was the same as up to 12 months, but the pathological changes in the pleura became more severe with the passage of time, and the irregularity of the pleural surface was the main finding (60-64%). The

  10. Attitudes and treatment outcome of breast conservation therapy for stage I and II breast cancer using peroperative iridium-192 implant boost to the tumour bed

    International Nuclear Information System (INIS)

    Breast conservation therapy for early breast cancer is an established but grossly under-utilized treatment option in India for various reasons. Breast conservation therapy was offered to 200 suitable breast cancer patients between June 1993 and June 1998. Fifty-one patients (25%) opted for breast conservation and the remaining preferred mastectomy. In patients agreeing to conservation therapy, surgery was performed first along with peroperative implantation of iridium-192 to deliver a boost. Whole breast irradiation of 45 Gy was delivered 3-4 weeks after the boost. Cosmesis was assessed at the end of 6 months from completion of therapy. The main reason for refusal of breast conservation therapy was fear of recurrence in the remaining breast (60%). There were no loco-regional failures in our study at a median follow up of 42 months; one patient experienced a systemic relapse. Cosmesis was good to excellent in 80% of patients. Breast conservation therapy using peroperative iridium-192 implant provides excellent loco-regional disease control and cosmesis. The results of our study indicate that patient preference for mastectomy is an important reason for the under-utilization of breast conservation therapy in India. Copyright (2001) Blackwell Science Pty Ltd

  11. Breast prosthesis: Management of patients after plastic surgery

    OpenAIRE

    Bassetti, E.; Pediconi, F.; Luciani, M.L.; Santucci, E.; Miglio, E.; Candreva, R.

    2011-01-01

    Breast augmentation and breast reconstruction are increasingly common operations. All radiologists need to be able to recognize the normal appearances of the more commonly used implants on various imaging modalities and breast radiologists in particular are facing new challenges when imaging the women involved. This work aims to review the normal and abnormal findings in women undergoing breast implant surgery using ultrasonography, mammography, and magnetic resonance imaging.

  12. Treatment of early breast cancer with conservation of the breast

    International Nuclear Information System (INIS)

    This paper reviews the current status of conservative treatment for early breast cancer. Radiotherapy to the breast after local tumour excision is important to prevent local breast relapse, but it is not clear whether it has any influence on the risk of distant metastases. Several questions remain to be answered. While most investigators agree that the breast should receive a radiation dose of about 50 Gy in 5 weeks, there is no general agreement about the need for a tumour bed booster dose. Considering patients with tumour infiltration at the surgical resection line for whom it is not possible for cosmetic reasons to perform re-resection, it is not clear whether an acceptable local control rate can be achieved through application of a high booster dose in the tumour bed. More trials are needed to show whether certain patients with small invasive carcinomas should be treated with wide local excision without radiotherapy. The need for radiotherapy after local excision for small intraductal (ductal carcinoma in situ) cancers is being addressed in ongoing trials. (orig.)

  13. Controversies on cosmetic outcomes in black women after breast conservation therapy: hyperperception or hyperpigmentation?

    OpenAIRE

    Edwards-Bennett, Sophia M.; Brown, Carol L.

    2011-01-01

    Sophia M Edwards-Bennett1, Carol L Brown21Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL; 2Department of Gynecologic Oncology and Surgery, Memorial Sloan Kettering Cancer Center, NY, USAAbstract: Multiple studies have reported inferior cosmetic outcomes after breast conservation surgery and adjuvant radiation therapy in black women. However, cosmetic analysis scales contemporarily utilized in the field of radiation oncology rely largely on subjective visual and tactile per...

  14. Preliminary analysis of a clinical trial for threedimensional conformal radiation therapy after conservative surgery

    Institute of Scientific and Technical Information of China (English)

    Hui Yao; Jinlan Gong; Li Li; Yun Wang; Xiaofeng Wu; Kezhu Hou

    2012-01-01

    Objective: The aim of this study was to evaluate the efficacy, complications and cosmetic results of three-dimensional conformal radiation therapy for early breast cancer after conservative surgery. Methods: Among 80 patients, 44 were treated by modified radical mastectomy followed by adjuvant radiotherapy (modified radical mastectomy, MMT), 36 were treated with breast conservative surgery with adjuvant irradiation [breast-conservation therapy (BCT)]. Tangential fields were used to deliver 6 MV X-ray beams to a total dose of 50 Gy. Another 16 Gy was added to the tumor bed with 6-9 MeV electron beams for BCT. Results: In MMT group, the local control, metastasis-free and death were 41, 41 and 1 respectively; in BCT group, the local control, metastasis-free and death were 35, 35 and 0. The difference of the above two indicators between the two groups showeed no statistical insignificance (P > 0. 05). In MMT group, 32 patients suffer radiation dermatitis above 2-level, 12 patients suffer radiation pneumonia, and 10 patients suffer edema of illness-side upper extremity; in BCT group, the above indicators were only 6, 2 and 1 respectively. Three months, six months and one year after radiation therapy, 90%, 92% and 95% patients were assessed as excellence in fine cosmetic state in BCT group. Conclusion: The effects of threedimensional conformal radiation therapy after conservative surgery are the same as that of modified radical mastectomy, while the former has better cosmetic results and lower radiation therapy induced complications.

  15. Conservative mastectomies and Immediate-DElayed AutoLogous (IDEAL) breast reconstruction: the DIEP flap

    Science.gov (United States)

    Nestle-Krämling, Carolin; Fertsch, Sonia; Hagouan, Mazen; Munder, Beatrix; Richrath, Philip; Stambera, Peter; Abu-Ghazaleh, Alina; Andree, Christoph

    2016-01-01

    Background With the development of conservative mastectomies, there are an increasing number of women seeking immediate implant based and autologous breast reconstruction. Despite the oncologic safety of the procedures, the focus will be on the timing of reconstruction. Methods Our plastic surgery unit is focused primarily on autologous breast reconstruction and is part of an interdisciplinary breast center. We offer immediate breast reconstruction (IBR) with autologous tissue for patients with positive BRCA 1 and 2, ductal carcinoma in situ (DCIS), invasive cancer without margin problems to the skin, as well as to correct poor oncologic and aesthetic breast conserving therapy (BCT) outcomes. In the majority of cases we prefer an Immediate-DElayed AutoLogous (IDEAL) breast reconstruction concept with a two-stage procedure. Results Over the last 10 years we performed more than 1,600 breast reconstructions with free flaps, performing the deep inferior epigastric perforator (DIEP) flap as our first choice for autologous tissue. We recommend IDEAL breast reconstruction, however approximately 15% of our cases are immediate one stage conservative mastectomies and breast reconstruction with the DIEP flap. Conclusions For immediate reconstruction, the aesthetic outcome should not take precedence over oncologic considerations. Immediate one-stage, breast reconstruction with autologous tissue can be offered to the suitable patients which is most likely a healthy women with a small-to-medium sized non ptotic breast receiving a conservative mastectomy. In all other cases, we recommend an IDEAL breast reconstruction approach in order to achieve a final result that is both satisfyingly pleasing and oncologically safe. PMID:26855905

  16. Ambulatory surgery for the patient with breast cancer: current perspectives

    OpenAIRE

    Tan, Ern Yu; Pek, Chong Han; Tey,Boon Lim, John

    2016-01-01

    Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefit...

  17. Breast conserving operation and radiation therapy in early breast cancer: interim analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Kim, Ok Bae; Kim, You Sah [College of Medicine, Keimyung Univ., Taegu (Korea, Republic of)

    2001-03-01

    To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. Ac cording to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were lIa, and nine were llb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. Five year disease free survival rate (5YDFS) was 95.8%. According to stage, 5YDFS was 100%, 96.9%, 96% and 88.9% in stage 0, I, lIa and llb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patient of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic

  18. Breast conserving operation and radiation therapy in early breast cancer: interim analysis

    International Nuclear Information System (INIS)

    To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. Ac cording to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were lIa, and nine were llb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. Five year disease free survival rate (5YDFS) was 95.8%. According to stage, 5YDFS was 100%, 96.9%, 96% and 88.9% in stage 0, I, lIa and llb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patient of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic

  19. Surgical treatment of early breast cancer in day surgery.

    Science.gov (United States)

    Marrazzo, Antonio; Taormina, Pietra; David, Massimo; Riili, Ignazio; Lo Gerfo, Domenico; Casà, Luigi; Noto, Antonio; Mercadante, Sebastiano

    2007-01-01

    Quadrantectomy and associated sentinel lymph node biopsy (SLNB) is currently employed in most breast surgery centres as the gold standard in the treatment of early breast cancer. This approach has a modest morbidity and can usually be performed in a day-surgery regimen, leading to best acceptance by the patients. This reports outlines the experience of our Breast Unit with quadrantectomy and SLNB in day surgery for early breast cancer. One hundred patients presenting to our institution with primary invasive breast cancer measuring less than 3 cm and clinically negative axillary nodes underwent quadrantectomy and SLNB in day surgery. For 60 women with breast cancer the sentinel node was negative, so the only definitive surgical treatment was performed in the day-surgery regimen; 40 patients with positive sentinel nodes were hospitalised a second time for axillary dissection. In these patients that needed clearance of the axilla, SLNB was performed on the only positive node in 22 cases (55%). None of the patients admitted for quadrantectomy and SLNB in day surgery required re-hospitalisation after discharge. All patients proved to be fully satisfied with early discharge from hospital when questioned on the occasion of subsequent monitoring. Short-stay surgical programs in early invasive breast cancer treatment are feasible today owing to the availability of less invasive approaches such as quadrantectomy and SLNB. There are two main pointers to a distinct advantage for this kind of approach, i.e. recovery and psychological adjustment. Recovery from surgery is faster and the patient tends to play down the seriousness of the operation and to have a better mental attitude to neoplastic disease. Moreover, when performing quadrantectomy with SLNB in day surgery fewer than 50% of breast cancer patients (40% in our experience) require another surgical treatment, concluding the surgery in a single session. PMID:18019641

  20. Pulsed dose rate brachytherapy as the sole adjuvant radiotherapy after breast-conserving surgery of T1-T2 breast cancer: First long time results from a clinical study

    International Nuclear Information System (INIS)

    Background and purpose: To evaluate the long time outcome with regard to local tumour control, cosmetic outcome and side effects of a short (5 days) accelerated interstitial brachytherapy treatment delivered to the surroundings of the operated sector. Patients and methods: Between 1993 and 2003 we treated 50 women with early T1 and T2 breast cancer. Radical sector resection was performed and followed later with an interstitial pulsed dose rate (PDR) brachytherapy of 50 Gy in 5 days. The treatment was centred on the tumour with a margin of 30 mm. One patient was treated bilaterally. The patients were followed for a median of 86 (32-126) months. Results: Ipsilateral breast cancer recurrence was seen in 3 patients (6%). Two of them occurred outside the treated volume. The 5- and 7-year rates of actuarial local control were 96% and 96%, respectively, overall survival 88% and 85%, disease free survival 88% and 88%, respectively. A dosimetrical analysis showed that the partial breast irradiation covered a median of 31% of the total breast volume. Fat necrosis was seen in 12% and local (moderate-strong) fibrosis in 26% of the patients. Independent cosmetic scoring showed good or excellent result in 56% of the patients. Conclusions: Local outcome is favourable and very similar to other published studies of accelerated partial breast irradiation. Our long time cosmetic results are lower than other published results

  1. Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour

    NARCIS (Netherlands)

    Sivell, S.; Elwyn, G.; Edwards, A.; Manstead, A.S.; BresDex, g.

    2013-01-01

    BACKGROUND: Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided res

  2. The national survey of breast cancer treatment pattern in Korea (1998): the use of breast-conserving treatment

    International Nuclear Information System (INIS)

    In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast-conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted

  3. Superficial thrombophlebitis (Mondor′s Disease) after breast augmentation surgery

    OpenAIRE

    Viana Giovanni Andre; Okano Fabricio

    2008-01-01

    Although the aetiology of Mondor′s disease remains unclear, the most commonly cited cause is trauma of some sort. Although surgical trauma has frequently been quoted, reports that specifically implicate aesthetic breast surgery are unusual in the literature. In this article, the authors report a case of superficial thrombophlebitis of the anterolateral chest wall secondary to breast augmentation surgery in a woman, five months after the procedure. The authors performed an analysis of t...

  4. Superficial thrombophlebitis (Mondor's Disease) after breast augmentation surgery

    OpenAIRE

    Viana, Giovanni André P.; Okano, Fabrício M.

    2008-01-01

    Although the aetiology of Mondor's disease remains unclear, the most commonly cited cause is trauma of some sort. Although surgical trauma has frequently been quoted, reports that specifically implicate aesthetic breast surgery are unusual in the literature. In this article, the authors report a case of superficial thrombophlebitis of the anterolateral chest wall secondary to breast augmentation surgery in a woman, five months after the procedure. The authors performed an analysis of the dise...

  5. Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial

    International Nuclear Information System (INIS)

    Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were ≥55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results: For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion: In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity

  6. Locoregional Treatment for Breast Carcinoma After Hodgkin's Lymphoma: The Breast Conservation Option

    International Nuclear Information System (INIS)

    Purpose: To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin’s lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. Methods and Materials: Medical records of 72 women who developed either ductal carcinoma in situ or Stage I–III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. Results: Median age at HL diagnosis was 23 years (range, 14–53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5–40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0–2 tumors (82%), 5 cN1–3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64–88%) and 82% (95% CI, 72–93%) for invasive carcinoma and 100% (95% CI, 100 –100%) and 92% (95% CI, 79–100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69–91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). Conclusions: Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the

  7. Locoregional Treatment for Breast Carcinoma After Hodgkin's Lymphoma: The Breast Conservation Option

    Energy Technology Data Exchange (ETDEWEB)

    Haberer, Sophie, E-mail: sophie.haberer@wanadoo.fr [Department of Radiation Oncology, Institut Curie, Paris (France); Belin, Lisa [Department of Biostatistics, Institut Curie, Paris (France); Le Scodan, Romuald; Kirova, Youlia M. [Department of Radiation Oncology, Institut Curie, Paris (France); Savignoni, Alexia; Stevens, Denise [Department of Biostatistics, Institut Curie, Paris (France); Moisson, Patricia [Department of Radiation Oncology, Institut Curie, Paris (France); Decaudin, Didier; Pierga, Jean-Yves [Department of Medical Oncology, Institut Curie, Paris (France); Reyal, Fabien [Department of Surgery, Institut Curie, Paris (France); Campana, Francois; Fourquet, Alain; Bollet, Marc A. [Department of Radiation Oncology, Institut Curie, Paris (France)

    2012-02-01

    Purpose: To report clinical and pathologic characteristics and outcome of breast cancer (BC) after irradiation for Hodgkin's lymphoma (HL) in women treated at the Institut Curie, with a special focus on the breast-conserving option. Methods and Materials: Medical records of 72 women who developed either ductal carcinoma in situ or Stage I-III invasive carcinoma of the breast after HL between 1978 and 2009 were retrospectively reviewed. Results: Median age at HL diagnosis was 23 years (range, 14-53 years). Median total dose received by the mediastinum was 40 Gy, mostly by a mantle-field technique. Breast cancers occurred after a median interval of 21 years (range, 5-40 years). Ductal invasive carcinoma and ductal carcinoma in situ represented, respectively, 51 cases (71%) and 14 cases (19%). Invasive BCs consisted of 47 cT0-2 tumors (82%), 5 cN1-3 tumors (9%), and 20 Grade 3 tumors (35%). Locoregional treatment for BCs consisted of mastectomy with (3) or without (36) radiotherapy in 39 patients and lumpectomy with (30) or without (2) adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast-conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were, respectively, 74.5% (95% confidence interval [CI], 64-88%) and 82% (95% CI, 72-93%) for invasive carcinoma and 100% (95% CI, 100 -100%) and 92% (95% CI, 79-100%) for in situ carcinoma. In patients with invasive tumors, the 5-year distant disease-free survival rate was 79% (95% CI, 69-91%), and 13 patients died of progressive BC. Contralateral BC was diagnosed in 10 patients (14%). Conclusions: Breast-conserving treatment can be an option for BCs that occur after HL, despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position, to protect the underlying heart

  8. Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy

    OpenAIRE

    Heil, J.; Czink, E.; Golatta, M.; Schott, S.; Hof, H.; Jenetzky, E.; Blumenstein, M.; Maleika, A.; Rauch, G.; Sohn, C.

    2011-01-01

    Abstract Purpose We analyzed changes in aesthetic and functional outcome over time after breast conserving therapy. Our special interest resides in the question of whether these aspects gain or loose their influence on quality of life (QoL) with temporal progress. Patients and methods This prospective single centre cohort study included 138 patients, treated with breast conserving surgery and consecutive radiotherapy. Patients completed two question...

  9. Breast cancer surgery in elderly patients: postoperative complications and survival

    OpenAIRE

    Rocco, Nicola; Rispoli, Corrado; Pagano, Gennaro; Rengo, Giuseppe; Compagna, Rita; Danzi, Michele; Accurso, Antonello; Amato, Bruno

    2013-01-01

    Aims and background Old age is associated with comorbidity and decreased functioning which influences treatment decisions in elderly breast cancer patients. The purpose of this study was to identify risk factors for complications after breast cancer surgery in elderly patients, and to assess mortality in patients with postoperative complications. Methods We retrospectively considered all female patients aged 65 years and older with invasive and in situ breast cancer who were diagnosed and tre...

  10. Dosimetric Study of Different Radiotherapy Techniques in Thirty Three Patients With Stage I Breast Cancer After Breast-conserving Surgery%33例Ⅰ期乳腺癌保乳术后不同放射治疗方式的剂量学研究

    Institute of Scientific and Technical Information of China (English)

    包虹

    2011-01-01

    目的:探讨Ⅰ期乳腺癌保乳术后三种常见的放射治疗方式在剂量学上的优劣.方法:选择33例接受保乳手术的TIN0M0Ⅰ期乳腺癌病例,其中左侧乳腺癌25例,右侧乳腺癌8例,应用三维治疗计划系统(TPS)为每例患者设计常规切线野(CR),三维适形放射治疗野(3D-CRT)以及三维适形调强放射治疗野(IMRT)三种全乳放射治疗计划,处方剂量均为DT50 Gy/25次.用剂量体积直方图(dose volume histograms,DVH)来比较3种计划中计划靶体积(planning target volume,PTV)、危及器官(organs at risks,OARs)的剂量学差异.结果:在三种计划靶区覆盖度的比较中,CR计划的PTV接受处方剂量的95%的体积要明显小于3D-CRT和IMRT,三者之间存在统计学差异;在三种计划剂量均匀性的统计中,IMRT明显优于CR和3D-CRT,三者之间存在统计学差异.结论:三维适形调强放射治疗(IMRT)作为一种目前较为先进的放射治疗技术,其在Ⅰ期乳腺癌保乳术后的辅助放射治疗中在靶区覆盖率以及靶区内剂量的均匀性上均体现出了剂量学的优势,并且对于同侧肺以及心脏的照射体积也显著低于常规的放射治疗和三维适形放疗治疗,但是由于其显著增加患侧肺低剂量受照射区域,因此有可能产生增加肺部第二原发肿瘤的隐患.%Objective: To compare dosimetrically three different techniques in patients with Stage Ⅰ breast cancer after Breast-conserving surgery. Materials and Methods: Thirty three patients with Stage Ⅰ (T1N0M0) breast cancer after Breast-conserving surgery, 25 patients with left-sided breast cancer and 8 patients with right-sided breast cancer, based on three-dimensional treatment planning system (TPS), every patient planned with three techniques: conventional tangential field radiotherapy(CR), three-dimensional conformal radiotherapy(3D-CRT), intensity-modulated radiation therapy (IMRT), the prescribed dose in all cases is 50 Gy/25 fractions, dose

  11. Outcomes After Breast Conservation Treatment With Radiation in Women With Prior Nonbreast Malignancy and Subsequent Invasive Breast Carcinoma

    International Nuclear Information System (INIS)

    Purpose: Little information has been reported regarding outcomes after treatment for patients with early-stage invasive breast cancer and a prior nonbreast malignancy. This report analyzes the outcomes in patients with Stage I and II breast cancer after breast conservation treatment (BCT) with a prior nonbreast malignancy. Methods and Materials: The study cohort comprised 66 women with invasive breast cancer and a prior nonbreast malignancy. All patients were treated with breast conservation surgery followed by definitive breast irradiation between 1978 and 2003. Median ages at diagnosis of invasive breast cancer and prior malignancy were 57 and 50 years, respectively. The median interval between the prior malignancy and breast cancer was 7.0 years. Median and mean follow-up times after BCT were 5.3 and 7.0 years. Results: The 5-year and 10-year overall survival rates were 94% (95% confidence interval [CI], 82-98%) and 78% (95% CI, 59-89%), respectively. There were 4 patients (6%) with local failure and 10 patients (15%) with distant metastases. The 10-year rate of local failure rate was 5% (95% CI, 2-16%) and freedom from distant metastases was 78% (95% CI, 61-88%). No obvious differences in survival or local control were noted compared with the reported results in the literature for patients with invasive breast cancer alone. Conclusions: Both overall survival and local control at 5 and 10 years were comparable to rates observed in early-stage breast cancer patients without a prior malignancy. Prior nonbreast malignancy is not a contraindication to BCT, if the primary cancer is effectively controlled

  12. Satisfaction and quality of life in women who undergo breast surgery: A qualitative study

    OpenAIRE

    Klok Jennifer; Scott Amie; Pusic Andrea L; Klassen Anne F; Cano Stefan J

    2009-01-01

    Abstract Background In cosmetic and reconstructive breast surgery, measurement of patient-reported outcomes has become increasingly important to research efforts and clinical care. We aimed to describe how breast conditions and breast surgery impact on patient satisfaction and quality of life. Methods We conducted qualitative, in-depth interviews with 48 women who had undergone either breast reduction (n = 15), breast augmentation (n = 12), or breast reconstruction (n = 21) surgery in order t...

  13. Breast conservation treatment of early stage breast cancer: patterns of failure

    International Nuclear Information System (INIS)

    Purpose: This study retrospectively assesses the patterns of failure in conservatively treated early stage breast cancer patients by correlating various clinical, pathologic, and treatment-related factors with local, axillary, and distant relapse. Methods and Materials: Between 1973 and 1990, 796 patients (817 breasts) received breast conservation surgery followed by radiotherapy. Local recurrences were counted as events even if they occurred simultaneously or after the appearance of axillary or distant metastases. Results: The 10-year actuarial relative disease-free survival (DFS) rate for T1N0, T2N0, and T1-2N1 was 82%, 71%, and 54%, respectively. Stage N0 patients had a significant DFS advantage over N1 patients (p = 0.02). The 15-year actuarial local recurrence-free rate for T1 and T2 tumors was 82% and 87%, respectively (p = nonsignificant). Univariate analysis identified three significant risk factors for local relapse: (a) 48 breasts with tumors showing an extensive intraductal component had a crude local recurrence rate of 23% compared to 8% for 769 breasts without intraductal component (p 0.0016); (b) the actuarial 10-year local recurrence-free rate for patients under age 40 years was 64% compared to 88% for patients over 40 years (p < 0.0001); (c) the 10-year actuarial local recurrence-free rate for 416 postmenopausal women without adjuvant tamoxifen was 83% compared to 97% for 107 postmenopausal women with tamoxifen (p = 0.0479). Salvage therapy for operable local recurrent patients resulted in a 8-year actuarial DFS rate of 47%, significantly lower than that obtained with primary treatment. The incidence of axillary relapse as the first sign of recurrence was 2%, and could be correlated with the lack of axillary dissection (p < 0.0000005) and primary tumor size (p = 0.03). Radiotherapy to the axilla did not influence axillary relapse. Actuarial 5-year DFS rate after treatment of isolated axillary recurrence was 27%. Axillary failure was a marker for

  14. Fast-track surgery for breast cancer is possible

    DEFF Research Database (Denmark)

    Mertz, Birgitte G; Kroman, Niels; Williams, Helene;

    2013-01-01

    INTRODUCTION: Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast...... cancer patients after implementation of a fast-track surgery programme. MATERIAL AND METHODS: A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support. RESULTS: The...... overall mean length of stay (LOS) decreased from 3.6 days before introduction of fast-track surgery to 1.2 days after its implementation. The largest decrease was observed among patients undergoing mastectomy, where LOS was reduced from 5.0 to 1.6 days. The number of beds at the department was reduced by...

  15. 左乳腺癌保乳术后CRT和FIF-IMRT及逆向IMRT剂量学比较%Dosimetry of conformal radiotherapy, field-in-field intensity-modulated radiotherapy, and inverse-planned intensity-modulated radiotherapy after breast-conserving surgery for left-sided breast cancer: a comparative analysis

    Institute of Scientific and Technical Information of China (English)

    霍雯; 宁博; 胡静; 许梅; 刘刚

    2016-01-01

    目的 比较左乳腺癌保乳术后CRT、FIF-IMRT和IMRT剂量学差异.方法 随机选取31例左乳腺癌保乳术后患者,分别制定CRT、FIF-IMRT、IMRT计划.通过DVH图进行自身对照研究,采用非参数检验法比较靶体积及OAR受量分布差异.结果 3种方法均能达到处方剂量要求.CRT组靶区V105高、心脏V30、Dmax较高(P=0.000、0.000、0.000);IMRT组V5、Dmean较高(P=0.000、0.000),左肺V5较高(P=0.000)、V40较低(P=0.000);FIF-IMRT组Dmean最低(P=0.000),IMRT组右肺及脊髓Dmean、Dmax均高于其他两组(P=0.000、0.000、0.000、0.000).单次跳数FIF-IMRT组明显低于其他两组(P=0.000).结论 CRT在靶区有较好的剂量分布但对周围组织损伤较大,相比而言FIF-IMRT对OAR保护更好且对机器损耗小.%Objective To investigate the differences in dosimetry between conformal radiotherapy (CRT),field-in-field intensity-modulated radiotherapy (FIF-IMRT),and intensity-modulated radiotherapy (IMRT) after breast-conserving surgery for left-sided breast cancer.Methods A total of 31 patients who underwent breast-conserving surgery for left-sided breast cancer were randomly selected,and the plans for CRT,FIF-IMRT,and IMRT were developed.The dose-volume histogram (DVH) was used for self-control study,and the non-parametric test was used to compare the differences in target volume and doses to organs at risk (OARs).Results All the three methods met the requirements of the prescribed doses.The CRT group had a higher V105 of the target volume and higher heart V30 and Dmax (P=0.000,0.000,0.000).The IMRT group had higher V5 and Dmean (P=0.000,0.000),as well as a higher lung V5 and a lower lung V40 (P=0.000,0.000).The FIF-IMRT group had the lowest Dmean (P=0.000),and the IMRT group had significantly higher Dmean and Dmax of the right lung and the spinal cord than the other two groups (P=0.000,0.000,0.000,0.000).The FIF-IMRT group had a significantly lower single hop count than the other two groups (P=0

  16. Dosimetric Differences between Conventional Tangential Irradiation and SIB-IMRT after Breast-conserving Surgery of Breast Cancer%乳腺癌保乳术后切线野照射与瘤床同步整合补量调强放射治疗的剂量学区别

    Institute of Scientific and Technical Information of China (English)

    李楠; 李光; 赵欣宇; 张硕; 夏兵; 王志宇

    2011-01-01

    Abstract Objective To evaluate the dosimetric benefits of the simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) after breast-conserving surgery of breast cancer. Methods 45 patients who had received breast-conserving surgery were selected. Each patient was given two plans by three dimensional treatment planning system: SIB-IMRT plan and conventional tangential irradiation plan. Dosimetric comparisons of PTV and OARs between the two plans were performed on each patient by DVH. The data were analyzed statistically. Results The PTV1 and PTV2 coverages in SIB-IMRT plan were similar to those of the conventional plan (99.5% vs.99.2% and 99.1% vs.98.6% ). Compared to the conventional plan,obvious reduction in the doses of OARs was achieved in SIB-IMRT plan:the mean dose (Dmean) of heart decreased from 769.12 cGy to 425.12 cGy;the Dmean of ipsilateral lung decreased from 1586.67 cGy to 1 125.77 cGy,while percentage of volume receiving more than 20 Gy (V20) decreased from 27.3% to 21.4%;the Dmean of contralateral breast decreased from 73.5 cGy to 21.2 cGy. Conclusion SIB-IMRT maintains a good coverage of PTV,and reduces the exposure dose and volume of OARs as well as the overall therapeutic time.%目的 评价瘤床同步整合补量调强放射治疗(SIB- IMRT)在乳腺癌保乳术后放射治疗中的剂量学优势.方法选择45例保乳术后的乳腺癌患者,利用三维治疗计划系统为每例患者分别设计切线野照射计划与SIB-IMRT计划2种放射治疗计划.在剂量体积直方图(DVH)上比较靶区覆盖率、靶区内剂量分布均匀性,计划靶体积(PTV)和危及器官(OARs)在2种计划中的剂量学差异,进行统计学分析.结果SIB-IMRT技术的瘤床区和全乳靶区覆盖率,与切线野照射技术相似,分别为99.5%和99.2%,99.1%和98.6%.与切线野技术相比较,SIB-IMRT计划中左侧乳腺癌患者心脏的平均剂量(Dmean)从769.12 cGy减少到425.12 Gy

  17. Patients with early breast conserving surgery and radical improvement of the clinical efficacy of the treatment comparisons%早期乳腺癌患者应用保乳手术及改良根治术治疗的临床疗效比较

    Institute of Scientific and Technical Information of China (English)

    范红星; 倪建勋

    2015-01-01

    Objective Comparison of patients with early breast conserving surgery and modified radical mastectomy clinical effica-cy of treatment. Methods Data were randomly selected patients with early breast cancer in April 2013—2014 April hospital for treatment of 108 patients divided into two groups according to different treatment, the control group of 54 patients underwent modi-fied radical mastectomy, study group of 54 patients who underwent breast-conserving surgery; observed and compared the two groups of patients with treatment-related indicators, the cosmetic results of breast lesions local recurrence and metastasis. Results Research group therapy-related indicators are better than the control group, the rate of 92.59% excellent cosmetic breast than the control group (77.78%) high, were statistically significant (P 0.05). Conclusion Patients with early breast conserving surgery and treatment were modified radical mastectomy does not happen more local recurrence and metastatic lesions, but the clinical effect of breast-conserving surgery is better, and has a good cosmetic effect.%目的:比较早期乳腺癌患者应用保乳手术及改良根治术治疗的临床疗效。方法资料随机选取2013年4月—2014年4月该院诊治的早期乳腺癌患者108例,按照不同治疗方式分为两组,对照组54例患者行改良根治术,研究组54例患者行保乳手术;观察并比较两组患者治疗相关性指标,乳房美容效果,病灶局部复发及转移情况。结果研究组治疗相关性指标均优于对照组,乳房美容优良率92.59%比对照组77.78%高,差异有统计学意义(P<0.05);研究组病灶局部复发及转移率均略低于对照组,但比较差异无统计学意义(P>0.05)。结论早期乳腺癌患者应用保乳手术及改良根治术治疗均不会发生较多的病灶局部复发及转移,但保乳手术临床效果更佳,且具有良好的美容作用。

  18. Toxicity and cosmetic result of partial breast high-dose-rate interstitial brachytherapy for conservatively operated early breast cancer

    International Nuclear Information System (INIS)

    Objective: Objective To study the method, side effects and cosmetic outcome of high- dose-rate (HDR) accelerated partial breast interstitial irradiation (APBI) alone in early stage breast cancer' after conservative surgery. Methods: From February 2002 to June 2003,47 breast cancer lesions from 46 patients suffering from stage I/II breast cancer were treated with HDR 192Ir APBI after conservative surgery. All patients were over 40 year-old, with T1-2N0-1 (≤3 lymph nodes positive), surgical margin > 1-2 mm, but those having lobular or inflammatory breast cancer were excluded. HDR brachytherapy with 34 Gy, 10 fractions/5 days was used after surgery, toxic reaction and cosmetic outcome were observed in one month, 6 and 12 months respectively. Results: Follow up of 1846 months, 34 months was carried out for the whole group. During the treatment, acute reactions including: erythema, edema, tenderness and infection, all under I-II grade, none of III-IV grade were observed in 21 patients(46%); late toxicity reactions: skin fibrosis, breast tenderness, fat necrosis, and telangiectasia, totally 20 patients (43%) were observed: 2 patients in III grade but one patient received 6 cycle chemotherapy. The result of cosmetic outcome evaluation was excellent or good, at 6 months 95% and 12 months 98%, respectively, but there was no recurfence. Conclusions: Excellent and favorable cosmetic results are noted after APBI by interstitial alone. Acute and late reactions are few. Long term observation is necessary for the rate of' local control. (authors)

  19. Dosage studies on simplified inverse intensity modulated radiotherapy in patients with early-stage breast cancer after breast-conserving surgery%早期乳腺癌保乳术后简化逆向调强放疗的剂量学研究

    Institute of Scientific and Technical Information of China (English)

    郝福荣; 吕春燕; 王金鹏; 王培合; 李勇; 马瑞忠; 王明臣

    2014-01-01

    Objective To compare the dosage characteristics between three-dimensional conformal radiotherapy (3DCRT)plan and simplified inverse dynamic intensity modulated radiotherapy (IMRT)in patients with early-stage breast cancer after breast-conserving surgery.Methods 3DCRT and IMRT treament plans were designed for 14 female patients with early-stage breast cancer after breast-conserving surgery,4 of whom were left breast cancer cases.A dose of 50 Gy in 25 fractions to the whole ipsilateral breast was delivered using 6 MV photons for 3DCRT or IMRT.For 3DCRT plans,tangential field irradiation was adopted.While for IMRT,reverse dynamic intensity modulated technology was done through two pairs of tangential-likely fields, and 10 Gy was boosted to the tumor bed concomitantly in 25 fractions.The conformity index (CI),heterogenei-ty index (HI),dose and volume of organs at risk were evaluated by dose volume histograms (DVH).Results Compared with 3DCRT plans for ipsilateral lung,the high dose volumes were reduced and the low dose volumes were increased in IMRT plans.The same phenomenon was also observed for the heart of the patient with left breast cancer.The crosspoint doses of 3DCRT DVH and IMRT DVH for lung or heart were (25.16 ±9.11) Gy,(28.63 ±10.41 )Gy respectively.There was no difference between the two plans in the V10 of contra-lateral breast [IMRT(4.13 ±5.17)%∶3DCRT(1.99 ±2.43)%,t=2.11,P>0.05],but the D30 and mean of IMRT plan were higher than that of 3DCRT [(2.23 ±1.77)Gy ∶(1.20 ±0.46)Gy,t=2.58,P0.05].While the CI of IMRT plans were improved compared with 3DCRT [(0.75 ±0.07)∶(0.62 ±0.09),t =5.68,P<0.000 1]. Conclusion Compared with 3DCRT plan in patients with early-stage breast cancer after breast-conserving surgery,the main advantages of four fields simplified inverse dynamic IMRT are concomitant tumor boosting, decreasing the high dose volumes of ipsilateral lung,and improving the CI of planning target volume at the same time,but the HI is not improved

  20. 影响乳腺癌保乳术后美容效果相关因素的分析%Factors Associated with Cosmetic Outcome in Breast Conserving Surgery

    Institute of Scientific and Technical Information of China (English)

    贾海霞; 夏婷; 曹腾飞; 胡小戊; 章乐虹

    2012-01-01

      目的探讨影响乳腺癌保乳术后美容效果的相关因素.方法对2005年9月-2010年9月于我院收治的221例保乳患者进行美容效果的评价.分析乳房体积、切除边缘次数以及肿瘤大小对于保乳术后美容效果的影响.结果保乳术后患者总体满意率为83.3%(184/221).肿瘤大小≤3cm与>3cm患者术后满意率分别为86.8%和45.5%(P3cm, respectively(P<0.05). Breast volume and excision times had no effects on cosmetic result. Conclusion Tumor size is the important factor that influences the breast conserving cosmetic outcome, not breast volume and excision times.

  1. Current status of ultrasound-guided surgery in the treatment of breast cancer

    OpenAIRE

    Volders, José H.; Haloua, Max H; Krekel, Nicole MA; Meijer, Sybren; van den Tol, Petrousjka M.

    2016-01-01

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision v...

  2. Breast conserving treatment in Denmark, 1989-1998. A nationwide population-based study of the Danish Breast Cancer Co-operative Group

    DEFF Research Database (Denmark)

    Ewertz, Marianne; Kempel, Mette Moe; Düring, Maria;

    2008-01-01

    BACKGROUND: Randomised studies have shown that breast conserving surgery followed by radiotherapy is associated with a prognosis similar to mastectomy alone. This formed the basis for recommending breast conserving surgery combined with radiotherapy as a standard treatment for suited breast cancer...... patients in Denmark. PATIENTS AND METHODS: To evaluate the results of this treatment, we performed a nationwide population-based follow-up study of patients aged less than 75 years treated in Denmark from 1989 to 1998 based on the database of Danish Breast Cancer Cooperative Group. RESULTS: At 15 years of.......0, 19.9, and 6.0% respectively, when analysed in a competing risk setting. The risk of loco-regional recurrences was significantly decreased in patients aged 50 years or more and increased with increasing tumour size. There was a pronounced beneficial effect of adjuvant radiotherapy with those not...

  3. Impact of Screening and Risk Factors for Local Recurrence and Survival After Conservative Surgery and Radiotherapy for Early Breast Cancer: Results From a Large Series With Long-Term Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Kunkler, Ian H., E-mail: I.Kunkler@ed.ac.uk [Edinburgh Cancer Centre, Western General Hospital, Edinburgh (United Kingdom); Kerr, Gillian R. [Edinburgh Cancer Centre, Western General Hospital, Edinburgh (United Kingdom); Thomas, Jeremy S. [Department of Pathology, Western General Hospital, Edinburgh (United Kingdom); Jack, Wilma J.L. [Edinburgh Breast Unit, Western General Hospital, Edinburgh (United Kingdom); Bartlett, John M.S. [Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh (United Kingdom); Pedersen, Hans C. [DAKO (Denmark); Cameron, David A. [Edinburgh Cancer Centre, Western General Hospital, Edinburgh (United Kingdom); Dixon, J. Michael; Chetty, Udi [Edinburgh Breast Unit, Western General Hospital, Edinburgh (United Kingdom)

    2012-07-01

    Purpose: To investigate conventional prognostic factors for ipsilateral breast tumor recurrence (IBTR), distant metastasis (DM), and survival after breast-conserving therapy (BCT) in screen-detected and symptomatic cases on surveillance up to 25 years. Patients and Methods: A total of 1812 consecutive patients in three cohorts (1981-1989, 1990-1992, and 1993-1998) with T12N01M0 invasive breast cancer were treated with BCT (median follow-up, 14 years). Tumor type and grade were reviewed by a single pathologist. Hormone receptor status was measured by immunohistochemistry on tissue microarrays. A Cox proportional hazards model was used to assess independent prognostic variables for relapse and survival. Results: A total of 205 IBTR occurred, with 5-, 10-, 15-, and 20-year actuarial relapse rates of 4.5% (95% confidence interval [CI] 3.35-5.5%), 8.4% (95% CI 7.1-9.8%), 14.1% (95% CI 12.0-16%), and 17.4% (95% CI 14.5-20.2%). Number of nodes, young age, pathologic tumor size, and multifocality were significant factors for IBTR. Three hundred seventy-eight patients developed DM. The actuarial metastatic rate was 12% at 5 years and 17.9% at 10 years. Young age, number of positive nodes, pathologic tumor size, and tumor grade were significant factors for DM relapse. When conventional prognostic indices were taken into account screen-detected cancers showed no improvement in overall relapse or survival rate compared with symptomatic cases but did show a reduced risk of DM after IBTR. After 10 years IBTR relapse continued at a constant rate of 0.87% per annum. Conclusions: The Edinburgh BCT series has shown that screen-detected invasive breast cancers do not have significantly different clinical outcomes compared with symptomatic cases when pathologic risk factors are taken into account. This suggests that these patients be managed in a similar way.

  4. Impact of Screening and Risk Factors for Local Recurrence and Survival After Conservative Surgery and Radiotherapy for Early Breast Cancer: Results From a Large Series With Long-Term Follow-Up

    International Nuclear Information System (INIS)

    Purpose: To investigate conventional prognostic factors for ipsilateral breast tumor recurrence (IBTR), distant metastasis (DM), and survival after breast-conserving therapy (BCT) in screen-detected and symptomatic cases on surveillance up to 25 years. Patients and Methods: A total of 1812 consecutive patients in three cohorts (1981–1989, 1990–1992, and 1993–1998) with T12N01M0 invasive breast cancer were treated with BCT (median follow-up, 14 years). Tumor type and grade were reviewed by a single pathologist. Hormone receptor status was measured by immunohistochemistry on tissue microarrays. A Cox proportional hazards model was used to assess independent prognostic variables for relapse and survival. Results: A total of 205 IBTR occurred, with 5-, 10-, 15-, and 20-year actuarial relapse rates of 4.5% (95% confidence interval [CI] 3.35–5.5%), 8.4% (95% CI 7.1–9.8%), 14.1% (95% CI 12.0–16%), and 17.4% (95% CI 14.5–20.2%). Number of nodes, young age, pathologic tumor size, and multifocality were significant factors for IBTR. Three hundred seventy-eight patients developed DM. The actuarial metastatic rate was 12% at 5 years and 17.9% at 10 years. Young age, number of positive nodes, pathologic tumor size, and tumor grade were significant factors for DM relapse. When conventional prognostic indices were taken into account screen-detected cancers showed no improvement in overall relapse or survival rate compared with symptomatic cases but did show a reduced risk of DM after IBTR. After 10 years IBTR relapse continued at a constant rate of 0.87% per annum. Conclusions: The Edinburgh BCT series has shown that screen-detected invasive breast cancers do not have significantly different clinical outcomes compared with symptomatic cases when pathologic risk factors are taken into account. This suggests that these patients be managed in a similar way.

  5. Two cases of bronchiolitis obliterans organizing pneumonia (BOOP) induced radiotherapy after surgery of breast cancer

    International Nuclear Information System (INIS)

    We report two cases of bronchiolitis obliterans organizing pneumonia (BOOP) induced radiotherapy after surgery of breast cancer. One of the patients was a 58-year-old woman. She underwent a conserving surgery for bilateral breast cancers, and received radiation therapy to the remaining part of bilateral breasts. Two months after the termination of irradiation, cough, fever and general fatigue developed. We clinically diagnosed this case as BOOP after radiation therapy. After initiation of oral steroid therapy, the clinical symptoms and radiographic findings disappeared. Another patient was a 57 year-old woman. She underwent radical mastectomy for right breast cancer. A month after the operation, she suffered from local recurrence, so radiation therapy to the thoracic wall was performed. After irradiation, resection of the thoracic wall lesion was performed because of malignancy from local skin biopsy specimen. Two months after the termination of irradiation, cough, dyspnea and fever developed. We clinically diagnosed this case as radiation-induced BOOP by bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) findings. After an initiation of steroid therapy, the clinical symptoms and radiographic findings disappeared. It is important to be aware of BOOP as a complication in the patient who was given radiation after surgery of breast cancer. (author)

  6. Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Ken; Takenaka, Tadashi; Tanaka, Eiichi; Kuriyama, Keiko; Yoshida, Mineo [National Hospital Organization Osaka National Hospital (Japan). Dept. of Radiology; Yamazaki, Hideya; Nishimura, Tsunehiko [Kyoto Prefectural Univ. of Medicine (Japan). Dept. of Radiology; Kotsuma, Tadayuki [Osaka Univ. Graduate School of Medicine (Japan). Dept. of Radiation Oncology; Fujita, Yuka [Osaka Univ. Graduate School of Medicine (Japan). Dept. of Diagnostic and Interventional Radiology; Masuda, Norikazu [National Hospital Organization Osaka National Hospital (Japan). Dept. of Surgery

    2010-11-15

    To evaluate radiation dermatitis objectively in patients with breast cancer who had undergone post-operative radiotherapy after breast-conserving surgery. Skin color (L{sup *}, a{sup *}, and b{sup *} values) and moisture analyses were performed for both breasts (before, after, 1 month, 6 months, and 1 year after radiotherapy) to examine irradiated and non-irradiated skin divided into four quadrants in 118 patients. These patients underwent breast conservative surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost irradiation (10 Gy/5 fractions). L{sup *}, a{sup *}, and moisture values were changed by irradiation and maximized at completion or 1 month after radiotherapy. One year after radiotherapy, the skin color had returned to the range observed prior to radiotherapy. However, moisture did not return to previous values even 1 year after treatment. The lateral upper side (quadrant C) showed greater changes than other quadrants in the L{sup *} value (darker) at the end of radiotherapy. The Common Toxicity Criteria version 3 scores were found to correlate well with a{sup *} and L{sup *} values at the completion and 1 month after radiotherapy. Boost radiotherapy intensified reddish and darker color changes at the completion of radiotherapy, while chemotherapy did not intensify the skin reaction caused by radiotherapy. Moisture impairment as a result of irradiation lasts longer than color alterations. Objective assessments are useful for analyzing radiation dermatitis. (orig.)

  7. Two cases of bronchiolitis obliterans organizing pneumonia syndrome after the radiation of breast-conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Komuro, Youko; Nakagomi, Hiroshi; Akaike, Hidenori; Chiba, Shigehiro; Miyashita, Yoshihiro; Obu, S.; Yamaguchi, Motoshi; Oyama, Toshio [Yamanashi Prefectural Central Hospital, Kofu (Japan)

    2001-12-01

    Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome is a recently reported complication of the adjuvant radiotherapy of breast-conserving surgery. We report two cases of BOOP syndrome in 100 patients who underwent breast-conserving therapy. A 75 year-old woman had a cough 3 months after radiation therapy for cancer of the left breast. Chest radiography and computed tomography showed consolidation with air bronchograms in the upper left lung. Transbronchial lung biopsy showed lymphocyte infiltration and fibrosis in the alveoli. A 45-year old woman with bilateral breast cancer had a cough and palpitations for 3 month after radiation therapy for cancer of the right breast. Chest radiography and computed tomography showed consolidation in upper and middle fields of the left lung. Transbronchial lung biopsy showed granulation formation in the alveolar duct, which is a typical feature of BOOP. The symptoms and radiographic findings improved with oral administration of prednisolone. BOOP syndrome may occur as a complication of breast-conserving therapy. (author)

  8. Two cases of bronchiolitis obliterans organizing pneumonia syndrome after the radiation of breast-conserving therapy

    International Nuclear Information System (INIS)

    Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome is a recently reported complication of the adjuvant radiotherapy of breast-conserving surgery. We report two cases of BOOP syndrome in 100 patients who underwent breast-conserving therapy. A 75 year-old woman had a cough 3 months after radiation therapy for cancer of the left breast. Chest radiography and computed tomography showed consolidation with air bronchograms in the upper left lung. Transbronchial lung biopsy showed lymphocyte infiltration and fibrosis in the alveoli. A 45-year old woman with bilateral breast cancer had a cough and palpitations for 3 month after radiation therapy for cancer of the right breast. Chest radiography and computed tomography showed consolidation in upper and middle fields of the left lung. Transbronchial lung biopsy showed granulation formation in the alveolar duct, which is a typical feature of BOOP. The symptoms and radiographic findings improved with oral administration of prednisolone. BOOP syndrome may occur as a complication of breast-conserving therapy. (author)

  9. Conservation irradiation in the treatment of breast cancer

    International Nuclear Information System (INIS)

    Techniques of treatment and cosmetic results of 130 patients with breast cancer are presented. All patients received conservative treatment, with lumpectomy and radiotherapy at Centro de Oncologia Campinas. (M.A.C.)

  10. Ultrasound screening of contralateral breast after surgery for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Ja [Department of Radiology, Seoul Metropolitan Government Seoul National University, Boramae Medical Center (Korea, Republic of); Chung, Se-Yeong; Chang, Jung Min; Cho, Nariya [Department of Radiology, Seoul National University Hospital (Korea, Republic of); Han, Wonshik [Department of Surgery, Seoul National University Hospital (Korea, Republic of); Moon, Woo Kyung, E-mail: moonwk@snu.ac.kr [Department of Radiology, Seoul National University Hospital (Korea, Republic of)

    2015-01-15

    Highlights: • The addition of supplemental US to mammography depicted additional 5.0 cancers per 1000 postoperative women. • Positive biopsy rate of mammography-detected lesions was 66.7% (4 of 6) and that of US-detected lesions was 40.0% (6 of 15). • US can be helpful to detect mammographically occult breast cancer in the contralateral breast in women with previous history of cancer and dense breast. - Abstract: Objective: To determine whether supplemental screening ultrasound (US) to mammography could improve cancer detection rate of the contralateral breast in patients with a personal history of breast cancer and dense breasts. Materials and methods: During a one-year study period, 1314 screening patients with a personal history of breast cancer and dense breasts simultaneously underwent mammography and breast US. BI-RADS categories were given for mammography or US-detected lesions in the contralateral breast. The reference standard was histology and/or 1-year imaging follow-up, and the cancer rate according to BI-RADS categories and cancer detection rate and positive biopsy rate according to detection modality were analyzed. Results: Of 1314 patients, 84 patients (6.4%) were categorized as category 3 with one interval cancer and one cancer which was upgraded to category 4A after 6-month follow-up US (2.5% cancer rate, 95% CIs 1.5–9.1%). Fifteen patients (1.1%) had category 4A or 4B lesions in the contralateral breast. Four lesions were detected on mammography (two lesions were also visible on US) and 11 lesions were detected on US and 5 cancers were confirmed (33.3%, 95% CIs 15.0–58.5%). Six patients (0.5%) had category 4C lesions, 2 detected on mammography and 4 on US and 4 cancers were confirmed (66.7%, 95% CIs 29.6–90.8%). No lesions were categorized as category 5 in the contralateral breast. Cancer detection rate by mammography was 3.3 per 1000 patients and that by US was 5.0 per 1000 patients, therefore overall cancer detection rate by

  11. Ultrasound screening of contralateral breast after surgery for breast cancer

    International Nuclear Information System (INIS)

    Highlights: • The addition of supplemental US to mammography depicted additional 5.0 cancers per 1000 postoperative women. • Positive biopsy rate of mammography-detected lesions was 66.7% (4 of 6) and that of US-detected lesions was 40.0% (6 of 15). • US can be helpful to detect mammographically occult breast cancer in the contralateral breast in women with previous history of cancer and dense breast. - Abstract: Objective: To determine whether supplemental screening ultrasound (US) to mammography could improve cancer detection rate of the contralateral breast in patients with a personal history of breast cancer and dense breasts. Materials and methods: During a one-year study period, 1314 screening patients with a personal history of breast cancer and dense breasts simultaneously underwent mammography and breast US. BI-RADS categories were given for mammography or US-detected lesions in the contralateral breast. The reference standard was histology and/or 1-year imaging follow-up, and the cancer rate according to BI-RADS categories and cancer detection rate and positive biopsy rate according to detection modality were analyzed. Results: Of 1314 patients, 84 patients (6.4%) were categorized as category 3 with one interval cancer and one cancer which was upgraded to category 4A after 6-month follow-up US (2.5% cancer rate, 95% CIs 1.5–9.1%). Fifteen patients (1.1%) had category 4A or 4B lesions in the contralateral breast. Four lesions were detected on mammography (two lesions were also visible on US) and 11 lesions were detected on US and 5 cancers were confirmed (33.3%, 95% CIs 15.0–58.5%). Six patients (0.5%) had category 4C lesions, 2 detected on mammography and 4 on US and 4 cancers were confirmed (66.7%, 95% CIs 29.6–90.8%). No lesions were categorized as category 5 in the contralateral breast. Cancer detection rate by mammography was 3.3 per 1000 patients and that by US was 5.0 per 1000 patients, therefore overall cancer detection rate by

  12. Therapeutic effects of cytoprotective agent on breast reconstruction after breast cancer surgery

    OpenAIRE

    He, Xinjia; Wang, Lihua; Li, Wei; Yu, Zhuang; Wang, Xingang

    2015-01-01

    Most patients will choose breast reconstruction after breast cancer surgery, while radiotherapy will damage skin and soft tissue so that will have adverse effect on reconstruction. In this study, we assume that the usage of Amifostine can reduce the incidence of complications after breast reconstruction so that provides more choices of reconstruction operation. Dividing SD rats into surgical placement expansion material group (include 15 ml normal saline) and simple operation group. Then furt...

  13. Cosmetic results of breast conserving therapy

    International Nuclear Information System (INIS)

    Mean follow-up time of 192 women (pT1: 71.9%, pT2: 28.1%) was 4.5 years (median: 4.0 years). 26.6% of them were nodal positive. Positive nodal status correlated with high tumor grading (p=0.0001). Ten patients developed distant metastases; one of them subsequent to having suffered a loco-regional failure. Eight loco-regional failures occurred, 3 of them before radiotherapy (salvage). Following radiotherapy altogether 5 loco-regional failures (=2.6%) were found; 3 women concerning were pre-, 2 postmenopausal. Three of these patients died, in 1 case occurred distant metastasis. Seventeen patients died, 3 of them presenting loco-regional failure, 8 of them showing distant metastasis. Sixty-four women were examined for cosmesis with the following result: a poor result was observed twice, a fair result 13 times, a good result 34 and an excellent result 15 times. Self-assessment was significantly better than observer's assessment. Third-degree late sequelae were found once, second-degree was seen 11 times, first-degree 38 times and no visible late sequelae were observed 14 times. The use of wedges was followed with borderline significance (p=0.06) either by a better cosmesis and fewer late sequelae. Neither the type of surgery nor the width of the fields nor the quality of radiation (Co60 or 6 MVX) nor boost-application influenced the cosmetic result. Measured circumferences and distances showed no significant differences in the groups of the patients with poor or fair and good or excellent cosmesis. The temperature of the seized and contralateral breast showed no significant difference as well. With increasing distance from primary therapy the cosmetic results deteriorated. (orig./MG)

  14. A dosimetric comparison of volumetric modulated Arc therapy with conventional intensity-modulated radiotherapy for breast cancer radiotherapy after breast-conserving surgery%快速旋转调强与五野动态调强在乳腺癌保乳术后放疗中的剂量学比较

    Institute of Scientific and Technical Information of China (English)

    郑亚琴; 邢晓汾; 马永强; 崔桐; 郑旭亮; 褚薛刚; 孟慧敏

    2013-01-01

    Objective To compare the dosimetric differences between two plans of RapidArc and 5F-IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Eight female patients with left-sided breast cancer after breast-conserving surgery were selected.A dose of 50 Gy in 25 fractions was prescribed for plans of RapidArc and 5F-IMRT.Target conformity index (CI),homogeneity index (HI),target coverage,exposure dose volume delivered to organ at risk were compared between two plans.At the same time,treatment delivery time and monitor units (MU) were also compared.Results The target conformity index (CI) in RapidArc plan (·0.88 ±0.03) was higher than that in 5F-IMRT plan (0.79 ±0.02,t =8.28,P < 0.05).The homogeneity index (HI) in RapidArc plan 9.01 ± 0.73 was significantly lower than that in 5F-IMRT plan10.44 ± 1.08 (t =-2.73,P <0.05).For the dose volume delivered to the ipsilateral lung in two plans,the values of V10,V20,V30,and Dmean in RapidArc plan were lower than those in 5F-IMRT plan(t =-7.53,-7.20,-8.39,-7.80,P < 0.05).However,the value of V5 in RapidArc plan was higher than that in 5F-IMRT plan (t =5.67,P <0.05).For the heart,the values of V5,V10 and Dmean in RapidArc plan were higher than those in IMRT plan(t =10.46,28.76,5.40,P < 0.05),while the value of V30 in RapidArc plan was lower than that in 5F-IMRT plan(t =-6.12,P <0.05).The values of V5 in contralateral lung and breast were higher in RapidArc plan than those in 5F-IMRT plan(lung:t =21.50,P <0.05;breast:t =5.44,P <0.05).The MU in RapidArc plan was decreased by 25%,and the average treatment delivery time was saved by 60%,compared with that of 5F-IMRT plan.Conclusions During breast cancer radiotherapy after breast-conserving surgery,compared with 5F-IMRT plan,the RapidArc plan could improve the target HI,and reduce both the irradiated dose in high-dose volume and MU,and shorten the treatment time,but increased the exposed volume in low-dose volume of normal tissues.%目的

  15. Superficial thrombophlebitis (Mondor′s Disease after breast augmentation surgery

    Directory of Open Access Journals (Sweden)

    Viana Giovanni Andre

    2008-01-01

    Full Text Available Although the aetiology of Mondor′s disease remains unclear, the most commonly cited cause is trauma of some sort. Although surgical trauma has frequently been quoted, reports that specifically implicate aesthetic breast surgery are unusual in the literature. In this article, the authors report a case of superficial thrombophlebitis of the anterolateral chest wall secondary to breast augmentation surgery in a woman, five months after the procedure. The authors performed an analysis of the disease′s main etiologic components and preponderant clinical aspects, and determined all appropriate therapeutic measures.

  16. Innovative computer-based learning for breast cancer surgery.

    Science.gov (United States)

    Wingfield, Karen Louise

    Discussions with student nurses when they have been on placement on the breast cancer surgery ward highlighted their lack of knowledge about breast cancer surgery. This lack of knowledge by student nurses necessitated the development of a computer-based learning tool. A distance-learning tool was found to be an effective way of providing education, due to lack of facilities and workload on the ward. The student nurses using this tool will have better understanding of the treatments their patients are undergoing, leading to improved patient care. PMID:17353818

  17. Early experiences of breast-conservation treatment without axillary dissection for breast cancer patients with clinically-negative axillary nodes

    International Nuclear Information System (INIS)

    Nineteen patients with breast cancer who had clinically negative axillary nodes were treated with breast-conservation treatment, consisting of lumpectomy, irradiation, endocrine therapy (tamoxifen), and adjuvant chemotherapy. They were all women, whose ages ranged from 35 to 84 years with a mean of 53.8 years. Preoperative UICC staging was I in 10 patients, IIA in 8, and IIB in one; and postoperative staging was I in 7 and IIA in 12. Among evaluable 13 patients, 5 (38.5%) had microscopically positive margin. Radiation therapy was started within two to three weeks after breast-conserving surgery. Patients received irradiation to the ipsilateral breast and chest wall, including the ipsilateral axillary region, using opposed tangential fields to a dose of 4400 cGy at 275 cGy per fraction. Boost irradiation using an electron beam was delivered with a dose of 1000 cGy in 2 fractions in the last week of radiotherapy in all patients. In addition, adjuvant chemotherapy (cyclophosphamide, pirarubicin or epirubicin, 5-fluorouracil) and endocrine therapy (tamoxifen) were given. With a mean follow up of 20.7 months, one patient aged 80 died of cardiac failure and pneumonia without evidence of breast cancer progression. The other 18 patients are alive without either local failure or distant metastases. Cosmetic evaluation showed each 9 patients to be 'excellent' or 'good'. No patients have serious adverse effects as of this writing. Although the follow-up period is short and the number of patients is limited, the preliminary results of breast-conservation treatment for axillary negative breast cancer seem to be sufficiently good. (N.K.)

  18. Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal

    Institute of Scientific and Technical Information of China (English)

    Romano Demicheli; Ilaria Ardoino; Federico Ambrogi; Roberto Agresti; Elia Biganzoli

    2013-01-01

    To analyze the pattern over time (dynamics) of further recurrence and death after ipsilateral breast tumor recurrence (IBTR) in breast cancer patients undergoing breast conserving treatment (BCT).Methods:A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT.The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment.Results:In a time frame with the time origin at the surgical treatment for IBTR,the hazard rate for further recurrence displays a bimodal pattern (peaks at the second and at the sixth year).Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive (N+) patients receiving mastectomy as primary surgery,apart from the first two-three years,when IBTR patients do worse.If the patients with time to IBTR longer than 2.5 years are considered,differences disappear.Conclusions:The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal.In particular,patients with time to IBTR in excess of 2.5 years behave like N+ patients following primary tumor removal.Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which,as suggested by the systemic model of breast cancer,would have reached the clinical level according to their own dynamics.

  19. Clinical trial of a minimally invasive operation for early breast cancer. One of the methods of day surgery

    International Nuclear Information System (INIS)

    Surgical management for primary breast cancer has become less invasive. We performed breast-conserving therapy (wide excision: Bp) and sentinel lymph node biopsy (SLNB) with local anesthesia as a clinical trial. We hypothesized that it is possible to manage early breast cancer by day surgery employing this method. Twenty-three patients with early breast cancer (maximum diameter: 2.0 cm, and no evidence of metastases of lymph nodes on preoperative image examinations) underwent this method. The treatment was completed without any complications in all cases. There were no disadvantages in the local anesthesia group compared with the general anesthesia group regarding oncological findings. In conclusion, this method is one of the options to manage early breast cancer in day surgery. (author)

  20. Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

    Science.gov (United States)

    Kennedy, Brendan F.; Wijesinghe, Philip; Allen, Wes M.; Chin, Lixin; Latham, Bruce; Saunders, Christobel M.; Sampson, David D.

    2016-03-01

    Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

  1. The Proportion of Women Who Have a Breast 4 Years after Breast Cancer Surgery: A Population-Based Cohort Study

    Science.gov (United States)

    Mennie, Joanna C.; Mohanna, Pari-Naz; O’Donoghue, Joseph M; Rainsbury, Richard; Cromwell, David A.

    2016-01-01

    Background There are numerous pathways in breast cancer treatment, many of which enable women to retain a breast after treatment. We evaluated the proportion of women who have a breast, either through conserving surgery (BCS) or reconstruction, at 4-years after diagnosis, and how this varied by patient group. Methods and Findings We identified women with breast cancer who underwent initial BCS or mastectomy in English National Health Service (NHS) hospitals between January 2008 and December 2009 using the Hospital Episode Statistics (HES) database. Women were assigned into one of four patient groups depending on their age at diagnosis and presence of comorbidities. The series of breast cancer procedure (BCS, mastectomy, immediate, or delayed reconstruction) undergone by each women was identified over four years, and the proportion of women with a breast calculated. Variation was examined across patient groups, and English Cancer Networks. Between 2008 and 2009, 60,959 women underwent BCS or mastectomy. The proportion with a breast at 4 years was 79.3%, and 64.0%, in women less than 70 years without, and with comorbidities. Whilst in women aged 70 and over without, and with comorbidities, proportions were 52.6%, and 38.2%, respectively. Comorbidities were associated with lower proportions of BCS, but had little effect on reconstruction rates unlike age. Networks variation of 15% or more was found within each patient group, and Cancer Networks tended to have either a high or low proportion across all four patient groups. However, while 14% of women under 70 years had undergone reconstruction, less than 2% of women aged 70 or more had this treatment option. Conclusion The proportion of women diagnosed with breast cancer who retain a breast at 4 years is strongly associated with age, and presence of comorbidities. There was significant variation between Cancer Networks indicating that women’s experience in England was dependent on their geographical location of

  2. Topics in plastic surgery of the breast

    OpenAIRE

    Lapid, O.

    2014-01-01

    The breast is an integral part of both the female and the male body. Its evolutionary role is the feeding of offspring, although in males it has no function and can be considered an atavistic remnant. Breasts are not essential for life as one can live without them, and in the present era they are not essential for the feeding of newborns since the advent of bottle feeding. However, breasts are important for the completeness of the body image and for sexuality, as well as typifying masculinity...

  3. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: Recommendations of the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009)

    International Nuclear Information System (INIS)

    Purpose: To give recommendations on patient selection criteria for the use of accelerated partial-breast irradiation (APBI) based on available clinical evidence complemented by expert opinion. Methods and materials: Overall, 340 articles were identified by a systematic search of the PubMed database using the keywords 'partial-breast irradiation' and 'APBI'. This search was complemented by searches of reference lists of articles and handsearching of relevant conference abstracts and book chapters. Of these, 3 randomized and 19 prospective non-randomized studies with a minimum median follow-up time of 4 years were identified. The authors reviewed the published clinical evidence on APBI, complemented by relevant clinical and pathological studies of standard breast-conserving therapy and, through a series of personal communications, formulated the recommendations presented in this article. Results: The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for APBI: (1) a low-risk group for whom APBI outside the context of a clinical trial is an acceptable treatment option; including patients ageing at least 50 years with unicentric, unifocal, pT1-2 (≤30 mm) pN0, non-lobular invasive breast cancer without the presence of an extensive intraductal component (EIC) and lympho-vascular invasion (LVI) and with negative surgical margins of at least 2 mm, (2) a high-risk group, for whom APBI is considered contraindicated; including patients ageing ≤40 years; having positive margins, and/or multicentric or large (>30 mm) tumours, and/or EIC positive or LVI positive tumours, and/or 4 or more positive lymph nodes or unknown axillary status (pNx), and (3) an intermediate-risk group, for whom APBI is considered acceptable only in the context of prospective clinical trials. Conclusions: These recommendations will provide a clinical guidance regarding the use of APBI outside the context of a clinical trial before large-scale randomized

  4. Mediators of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients: Response Expectancies and Emotional Distress

    Science.gov (United States)

    Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

    2010-01-01

    Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years;…

  5. Can saline be an alternative to aesthetic surgery in extended breast quadrantectomy

    International Nuclear Information System (INIS)

    Objective was to explore other simpler options sparing the patients the morbidity and cost in extended breast quadrantectomy. This prospective was undertaken at King Fahd Hospital of the University, Al-Khobar Eastern Province of Saudi Arabia between 1999-2005. Factors considered for patients undergoing breast-conserving surgery were based on age, tumor size, pathological characteristics, and patient's preference. Frozen section was adopted in all procedures to insure negative margins. After extended quadrantectomy, 200-400 cc was injected into the cavity to retain breast contour. Magnetic resonance imaging was used for postoperative assessment. Twenty-four patients were included, aged 28-43 years and tumor size 3-5 cms. All margins were negative on frozen section. The contour of the breast was restored with saline, MRI was employed for follow up at the immediate post operative period and at 4-6 months, it demonstrated restored breast contour and the saline filled cavity replaced by lipo-fibrous tissue. Follow up after 4-24 months showed that all patients noticed some degree of asymmetry, yet were satisfied with the result, none required or requested additional surgery. In large issue excision injecting saline into cavities temporarily prevents the caving in of the redundant skin, which has the tendency to permanently adhere to the fascia thereby preventing gross deformities. It has proven effective, contour storing and scored high satisfaction among patients. It certainly does not replace cosmetic breast surgery, however, it should be considered in centers were once-plastic surgery is not readily available. (author)

  6. What to Expect After Breast Reconstruction Surgery

    Science.gov (United States)

    ... Cancer? Breast Cancer Colon/Rectum Cancer Lung Cancer Prostate Cancer Skin Cancer Show All Cancer Types News and Features Cancer Glossary ACS Bookstore Cancer Information Cancer Basics Cancer Prevention & Detection Signs & Symptoms of Cancer Treatments & Side Effects ...

  7. Cosmetic outcome with interstitial implant as part of breast-conservation therapy in rural population of Maharashtra

    International Nuclear Information System (INIS)

    In early stages of carcinoma breast, breast conservation therapy is the preferred method as it gives local control rate along with survival comparable to more radical surgery. While irradiating the tumor bed by interstitial implant, dose homogeneity is the most important parameter for achieving good cosmesis. As per ICRU (International Commission on Radiation Units and Measurement), dose homogenetity index (DHI) is defined as ratio of peripheral dose to the central dose

  8. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    Directory of Open Access Journals (Sweden)

    Huizhuang Xie

    2014-01-01

    CONCLUSION: Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.

  9. Results of conservative surgery and radiation for mammographically detected ductal carcinoma in situ (DCIS)

    International Nuclear Information System (INIS)

    Purpose: The role of conservative surgery and radiation for mammographically detected ductal carcinoma in situ (DCIS) is controversial. In particular, there is little data for outcome with radiation in a group of patients comparable to those treated with local excision and surveillance (mammographic calcifications ≤2.5cm, negative resection margins, negative post biopsy mammogram). This study reports outcome of conservative surgery and radiation for mammographically detected DCIS with an emphasis on results in patients considered candidates for excision alone. Methods and Materials: >From 1983 to 1992, 110 women with mammographically detected DCIS (77% calcifications ± mass) and no prior history of breast cancer underwent needle localization and biopsy with (55%) or without a re excision and radiation. Final margins of resection were negative in 62%, positive 7%, close 11%, and unknown 20%. The median patient age was 56 years. The most common histologic subtype was comedo (54%), followed by cribriform (22%). The median pathologic tumor size was 8 mm (range 2 mm to 5 cm). Forty-seven percent of patients with calcifications only had a negative post biopsy mammogram prior to radiation. Radiation consisted of treatment to the entire breast (median 50.00 Gy) and a boost to the primary site (97%) for a median total dose of 60.40 Gy. Results: With a median follow-up of 5.3 years, three patients developed a recurrence in the treated breast. The median interval to recurrence was 8.8 years and all were invasive cancers. Two (67%) occurred outside the initial quadrant. The 5- and 10-year actuarial rates of recurrence were 1 and 15%. Cause-specific survival was 100% at 5 and 10 years. Contralateral breast cancer developed in two patients. There were too few failures for statistical significance to be achieved with any of the following factors: patient age, family history, race, mammographic findings, location primary, pathologic size, histologic subtype, re excision, or

  10. Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a Prospective Phase I trial

    Directory of Open Access Journals (Sweden)

    El-Sayed Mohamed I

    2010-08-01

    Full Text Available Abstract Background Neoadjuvant chemotherapy is the standard care for locally advanced breast cancer. Our study aimed at evaluating the feasibility of breast conversation surgery (BCS after neoadjuvant chemotherapy. Patients and methods Forty five patients had stage IIB (except those with T2N1 disease and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤5 cm underwent a tentative BCS while patients who had tumour size >5 cm underwent radical surgery. Negative margin is essential for BCS. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients. Results Thirty four patients had BCS. Response to chemotherapy was the only statistically significant factor which influences the BCS. Incidence of local recurrence was 5.9% for patients who had BCS at a median follow up 24 months. Conclusion Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤4 cm after chemotherapy are the best candidates for BCS.

  11. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Nesvold, Inger-Lise (Dept. of Cancer Rehabilitation-Physiotherapy, Rikshospitalet, Univ. of Oslo, Div. The Norwegian Radium Hospital, Montebello, Oslo (Norway)); Dahl, Alv A.; Fossaa, Sophie D. (Dept. of Clinical Cancer Research, Rikshospitalet, Univ. of Oslo: Division The Norwegian Radiumhospital, Montebello, Oslo (Norway)); Loekkevik, Erik (Dept. of Oncology, Rikshospitalet, Montebello, Oslo (Norway)); Marit Mengshoel, Anne (Inst. of Nursing and Health Sciences, Univ. of Oslo: Medical Faculty, Oslo (Norway))

    2008-06-15

    Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

  12. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

    International Nuclear Information System (INIS)

    Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

  13. Local complications after cosmetic breast augmentation: results from the Danish Registry for Plastic Surgery of the breast

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B; Hölmich, Lisbet R; Henriksen, Trine F;

    2009-01-01

    BACKGROUND: Prospective long-term data on the occurrence of complications following breast augmentation are sparse and the reported frequencies differ substantially. METHODS: The Danish Registry for Plastic Surgery of the Breast has prospectively registered preoperative, perioperative, and postop...

  14. Breast conserving therapy for early stage invasive cancer and ductal carcinoma in situ

    International Nuclear Information System (INIS)

    Purpose/Objective: To discuss a number of clinical and treatment related issues in the management of early stage invasive breast cancer and ductal carcinoma in situ. Prospective randomized trials as well as retrospective series have established the role of conservative surgery and radiation as an alternative equal to mastectomy in the patient selection, the importance of microscopic margins of research, radiotherapy technique including the role of the boost and regional node irradiation and the integration of systemic therapy (tamoxifen or chemotherapy) with radiation. A subgroup of patients with minimally invasive breast cancer for whom radiation may be omitted after conservative surgery will be identified. Factors predicting for an increased risk of recurrence in the treated breast will be reviewed. The diagnosis and treatment of a breast recurrence will be presented as well as the impact of a local recurrence on distant metastases. Treatment options for ductal carcinoma in situ (DCIS) including observation, radiation and mastectomy will be reviewed. Results from prospective randomized trials as well as retrospective series will be presented in an attempt to identify appropriate treatment strategies for the different clinical presentations and histologic subtypes of DCIS

  15. BREAST CONSERVING THERAPY IN STAGE T1 & T2 BREAST CANCER PATIENTS

    Institute of Scientific and Technical Information of China (English)

    FAN Jiang; LIU Bang-ling; SHEN Zhen-zhou; SHAO Zhi-ming; WU Jiong; LU Jin-song; WANG Lei; HOU Yi-feng; WANG Jie; DI Gen-hong; SHEN Kun-wei; HAN Qi-xia

    2005-01-01

    Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.

  16. Current status of ultrasound-guided surgery in the treatment of breast cancer.

    Science.gov (United States)

    Volders, José H; Haloua, Max H; Krekel, Nicole Ma; Meijer, Sybren; van den Tol, Petrousjka M

    2016-02-10

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast

  17. Breast conserving therapy with sole high-dose-rate interstitial brachytherapy. Results of Osaka Medical Center for Cancer and Cardiovascular Diseases

    International Nuclear Information System (INIS)

    The results of breast conserving surgery combined with sole high-dose-rate interstitial brachytherapy were analyzed. Between May 1998 and May 2003, 20 patients with breast cancer smaller than 2 cm, without clinically lymph node metastases were recruited in our study. The 5-year local control rate, distant-free survival and overall survival were 92.9%, 92.9% and 92.9%, respectively. These results were the equal to those of breast conserving surgery with conventional whole breast 45-50 Gy irradiation in our institute. Though fat necrosis was occurred in one of 20 patients and radiation induced pneumonitis was also seen in one patient, the safety and cosmetic results of brachytherapy was acceptable. This technique can shorten the period of the breast conserving therapy and can become one of the treatment options of it. (author)

  18. The current pattern of reconstructive surgery for breast cancer

    OpenAIRE

    A. Kh. Ismagilov; A. R. Khamitov; A. S. Vanesyan

    2015-01-01

    In Russia, breast cancer (BC) occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %). While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in referen...

  19. Results of breast conserving therapy for early breast cancer and the role of mammographic follow-up

    International Nuclear Information System (INIS)

    Purpose: The following article is a review of 23 years of breast-conserving therapy in our hospital. This study was performed to assess and improve the follow-up care of women with early breast cancer and to evaluate whether or not biannual mammogram is useful. Methods and Materials: Between 1972 and December 1995, 3072 women with pathological size pT1 and pT2 breast cancer were treated with conservative surgery and radiation therapy. Eighty-five patients developed a recurrence in the treated breast as the first site of failure, 12 of which had positive axillary nodes. In the following patient study, those with an noninvasive recurrence were excluded. A retrospective assessment of the entire mammographic course was made, starting with the mammogram at the time of original diagnosis to the mammogram of the recurrence. Results: In our study group the probability for local failure ranged from 1 to 2% per year. At 5 and 10 years the actuarial rates were 5 and 10%. The median time to recurrence was 41 months (range 8-161). Twenty-six (31%) recurrences were detected by mammography alone, 10 (12%) by clinical examination only, and 35 (41%) by both methods. For the patients with an ipsilateral recurrence, the overall actuarial 5- and 10-year survival after treatment was 87 and 70%, respectively. The 5-year actuarial rate of survival from salvage mastectomy was 61%. Conclusion: Considering the high percentage of recurrences detectable by mammography and the possibility of detection within a short-term interval, we think biannual mammographic follow-up is appropriate for the first years following breast-conserving therapy

  20. Risk factors for recurrence after conservative treatment in early breast cancer; Preliminary report

    International Nuclear Information System (INIS)

    To evaluate our experience in the breast-conserving treatment for early breast cancer with special regard to recurrence pattern and related risk factors. Two hundred and sixteen patients with AJC stage I and II beast cancer who received breast conserving treatment between January 1991 and December 1994 were evaluated. Age distribution ranged from 23-80 year old with a median age of 44. One hundred and seventeen patients had T1 lesions and 99 patients had T2 lesions. Axillary lymph nodes were involved in 73 patients. All patients received a breast conserving surgery (wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Ninety six patients received chemotherapy before or after radiotherapy. During the follow-up period (3-60 months, median 30 months), local recurrence were noted in six patients (true; 3, elsewhere; 1, skin; 2). Sixteen patients developed distant metastases as the first sign of recurrence at 8-38 months (median 20 months) after surgery. Among them, three patients simultaneously developed local recurrence with distant metastases. Contralateral breast cancer developed in one patient and non-mammary cancers developed in three patients. The actuarial 5 year survival rate was 88.4% (stage I: 96.7%, stage IIa: 95.2%, stage IIb 69.9%). Age, T stage, number of involved axillary lymph nodes, and AJC stage were risk factors for distant metastases in univariate analysis. In the multivariate analysis, the number of involved axillary lymph nodes was the most significant risk factor for metastases. Local recurrence was not common in the early years after radiotherapy. Distant metastases occurred at a steady rate during the first three years and was more common in the patients with larger tumors, higher number of involved axillary nodes, and younger age. (author)

  1. A Phase II Study of Radiotherapy and Concurrent Paclitaxel Chemotherapy in Breast-Conserving Treatment for Node-Positive Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: Administering adjuvant chemotherapy before breast radiotherapy decreases the risk of systemic recurrence, but delays in radiotherapy could yield higher local failure. We assessed the feasibility and efficacy of placing radiotherapy earlier in the breast-conserving treatment course for lymph node–positive breast cancer. Methods and Materials: Between June 2000 and December 2004, 44 women with node-positive Stage II and III breast cancer were entered into this trial. Breast-conserving surgery and 4 cycles of doxorubicin (60 mg/m2)/cyclophosphamide (600 mg/m2) were followed by 4 cycles of paclitaxel (175 mg/m2) delivered every 3 weeks. Radiotherapy was concurrent with the first 2 cycles of paclitaxel. The breast received 39.6 Gy in 22 fractions with a tumor bed boost of 14 Gy in 7 fractions. Regional lymphatics were included when indicated. Functional lung volume was assessed by use of the diffusing capacity for carbon monoxide as a proxy. Breast cosmesis was evaluated with the Harvard criteria. Results: The 5-year actuarial rate of disease-free survival is 88%, and overall survival is 93%. There have been no local failures. Median follow-up is 75 months. No cases of radiation pneumonitis developed. There was no significant change in the diffusing capacity for carbon monoxide either immediately after radiotherapy (p = 0.51) or with extended follow-up (p = 0.63). Volume of irradiated breast tissue correlated with acute cosmesis, and acute Grade 3 skin toxicity developed in 2 patients. Late cosmesis was not adversely affected. Conclusions: Concurrent paclitaxel chemotherapy and radiotherapy after breast-conserving surgery shortened total treatment time, provided excellent local control, and was well tolerated.

  2. A Phase II Study of Radiotherapy and Concurrent Paclitaxel Chemotherapy in Breast-Conserving Treatment for Node-Positive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen, William C. [Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH (United States); Kim, Janice [Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA (United States); Kim, Edward [Department of Radiation Oncology, Ohio State University Medical Center, Columbus, OH (United States); Silverman, Paula [Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (United States); Overmoyer, Beth [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Cooper, Brenda W. [Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH (United States); Anthony, Sue [Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH (United States); Shenk, Robert; Leeming, Rosemary [Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH (United States); Hanks, Shelli H. [Arizona Institute of Urology, Tucson, AZ (United States); Lyons, Janice A., E-mail: janice.lyons@uhhospitals.org [Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH (United States)

    2012-01-01

    Purpose: Administering adjuvant chemotherapy before breast radiotherapy decreases the risk of systemic recurrence, but delays in radiotherapy could yield higher local failure. We assessed the feasibility and efficacy of placing radiotherapy earlier in the breast-conserving treatment course for lymph node-positive breast cancer. Methods and Materials: Between June 2000 and December 2004, 44 women with node-positive Stage II and III breast cancer were entered into this trial. Breast-conserving surgery and 4 cycles of doxorubicin (60 mg/m{sup 2})/cyclophosphamide (600 mg/m{sup 2}) were followed by 4 cycles of paclitaxel (175 mg/m{sup 2}) delivered every 3 weeks. Radiotherapy was concurrent with the first 2 cycles of paclitaxel. The breast received 39.6 Gy in 22 fractions with a tumor bed boost of 14 Gy in 7 fractions. Regional lymphatics were included when indicated. Functional lung volume was assessed by use of the diffusing capacity for carbon monoxide as a proxy. Breast cosmesis was evaluated with the Harvard criteria. Results: The 5-year actuarial rate of disease-free survival is 88%, and overall survival is 93%. There have been no local failures. Median follow-up is 75 months. No cases of radiation pneumonitis developed. There was no significant change in the diffusing capacity for carbon monoxide either immediately after radiotherapy (p = 0.51) or with extended follow-up (p = 0.63). Volume of irradiated breast tissue correlated with acute cosmesis, and acute Grade 3 skin toxicity developed in 2 patients. Late cosmesis was not adversely affected. Conclusions: Concurrent paclitaxel chemotherapy and radiotherapy after breast-conserving surgery shortened total treatment time, provided excellent local control, and was well tolerated.

  3. Time Course of Mild Arm Lymphedema After Breast Conservation Treatment for Early-Stage Breast Cancer

    International Nuclear Information System (INIS)

    Purpose: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer. Methods and Materials: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms. Results: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema. Conclusions: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients.

  4. Breast Retraction Assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer

    International Nuclear Information System (INIS)

    Breast Retraction Assessment (BRA) is an objective evaluation of the amount of cosmetic retraction of the treated breast in comparison to the untreated breast in patients who receive conservative treatment for breast cancer. A clear acrylic sheet supported vertically and marked as a grid at 1 cm intervals is employed to perform the measurements. Average BRA value in 29 control patients without breast cancer was 1.2 cm. Average BRA value in 27 patients treated conservatively for clinical Stage I or II unilateral breast cancer was 3.7 cm. BRA values in breast cancer patients ranged from 0.0 to 8.5 cm. Patients who received a local radiation boost to the primary tumor bed site had statistically significantly less retraction than those who did not receive a boost. Patients who had an extensive primary tumor resection had statistically significantly more retraction than those who underwent a more limited resection. In comparison to qualitative forms of cosmetic analysis, BRA is an objective test that can quantitatively evaluate factors which may be related to cosmetic retraction in patients treated conservatively for breast cancer

  5. Breast-Conserving Treatment With Partial or Whole Breast Irradiation for Low-Risk Invasive Breast Carcinoma-5-Year Results of a Randomized Trial

    International Nuclear Information System (INIS)

    Purpose: To report the 5-year results of a randomized study comparing the survival and cosmetic results of breast-conserving treatment with partial breast irradiation (PBI) or conventional whole breast irradiation (WBI). Methods and Materials: Between 1998 and 2004, 258 selected patients with T1 N0-1mi, Grade 1-2, nonlobular breast cancer without presence of extensive intraductal component and resected with negative margins were randomized after breast-conserving surgery to receive 50 Gy/25 fractions WBI (n = 130) or PBI (n = 128). The latter consisted of either 7 x 5.2 Gy high-dose-rate (HDR) multicatheter brachytherapy (BT; n = 88) or 50 Gy/25 fractions electron beam (EB) irradiation (n = 40). Results: At a median follow-up of 66 months, the 5-year actuarial rate of local recurrence was 4.7% and 3.4% in the PBI and WBI arms, respectively (p = 0.50). There was no significant difference in the 5-year probability of overall survival (94.6% vs. 91.8%), cancer-specific survival (98.3% vs. 96.0%), and disease-free survival (88.3% vs. 90.3%). The rate of excellent to good cosmetic result was 77.6% in the PBI group (81.2% after HDR BT; 70.0% after EB) and 62.9% in the control group (52.2% after telecobalt; 65.6% after 6-9-MV photons; pWBI/PBI = 0.009). Conclusions: Partial breast irradiation using interstitial HDR implants or EB to deliver radiation to the tumor bed alone for a selected group of early-stage breast cancer patients produces 5-year results similar to those achieved with conventional WBI. Significantly better cosmetic outcome can be achieved with carefully designed HDR multicatheter implants compared with the outcome after WBI

  6. Relationship of family history and outcome after breast conservation therapy in women with ductal carcinoma in situ of the breast

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to evaluate the relationship between a family history of breast or ovarian cancer and outcome after breast-conserving surgery and radiation in women presenting with an initial diagnosis of ductal carcinoma in situ (DCIS) of the breast. Methods and Materials: A total of 146 consecutive women with a pathologic diagnosis of ductal carcinoma in situ as their first diagnosis of any breast cancer were identified; 28 (19%) had a positive family history of breast or ovarian cancer in a first-degree relative, 27 (19%) had a positive family history in a second-degree relative, and 91 (62%) had no family history. Pathologic, clinical, and treatment factors, and clinical outcomes for each family history group were compared. Cosmesis and complications were recorded at each follow-up. Patients were treated between 1978 and 1995, and the median follow-up was 7.1 years. Results: Patients with a positive family history in a first- or second-degree relative each had an 8% incidence of local failure at 10 years, while the negative family history group demonstrated a 16% local failure rate (p = 0.33). Overall survival at 10 years for patients with a positive family history in a first- or second-degree relative was 100% and for those with a negative family history was 91% (p = 0.08). The negative family history group had a higher median age that may account for the difference in overall survival. Cause-specific survival (CSS) was 97%, 100%, and 99%, respectively, at 10 years (p = 0.25). There were no differences in the cosmetic results or complication rates between women with a positive or negative family history. Conclusion: We have shown that a family history of breast and/or ovarian cancer is not associated with an adverse outcome for women treated with breast conservation therapy for DCIS. Local recurrence, cause-specific survival, overall survival, cosmesis, and complication rates were comparable to that of similarly treated women with

  7. 乳腺癌保乳手术38例临床分析%Analysis of breast conserving operation in 38 patients with early stage breast cancer

    Institute of Scientific and Technical Information of China (English)

    朱运新; 龚建军; 翟新发; 秦文祥

    2010-01-01

    Objective To study the effects of breast conserving surgery for early stage breast cancer. Methods The record of 38 patients with 0-IIa-stage breast cancer who received breast conserving surgery from Jan. 2005 to Feb.2010 was reviewed. The short-term effect was analyzed and the cosmetic effect was evaluated according to Rose standard. Results All patients recovered well and they were all satisfied with the shape of their breasts. No complication occurred. During the follow-up, no local recurrence and distant metastasis occurred. Conclusion Satisfactory clinical and cosmetic effect can be achieved by breast-conserving surgery in patients with early stage breast cancer.%目的 总结保乳手术治疗早期乳腺癌的临床经验及疗效观察.方法 回顾性分析2005年1月至2010年2月新疆石河子人民医院收治的38例临床0~IIa期、非乳晕区单发肿瘤的乳腺癌患者的临床资料.分析其近期疗效,并按Rose标准,对接受保乳手术的患者进行美容效果评价.结果 所有病例术后恢复良好,无1例出现并发症,随访未见局部复发及远处转移,患者对术后乳房外形及生活质量满意.结论 早期乳腺癌患者接受保乳手术治疗可取得满意的临床和美容效果.

  8. Diagnostic value of mammography flowing plastic and reconstructive breast surgery

    International Nuclear Information System (INIS)

    Breast cancer is the most frequent malignant neoplasm in women. Due to the growing knowledge and self- consciousness about the disease itself as well as regarding treatment options among breast cancer patients. Main indications for reconstruction after mastectomy include fear of both physical and psychological damage and, in a broader sense, the lack of contraindications for the procedure. Altogether, these factors are in fact directly responsible for the increase in the number of reconstructive procedures, which have become one of the important elements in breast cancer treatment. Year by year, the number of plastic surgery procedures has been growing. Assessment of the breast aimed at discerning the presence diminishing procedures. In women with prostheses implanted for cosmetic reasons, mamsaography provides an opportunity to correctly diagnose and confirm implant damage. Women who have undergonew such procedures should be screened mammographically in the same way as the rest of the female population is. The aim of this paper is to summarize the value of diagnostic mammagraphy after plastic and reconstructive surgery. (authors)

  9. 年轻女性乳腺癌保乳术前动态增强磁共振成像检查的必要性%The essentiality of dynamic contrast enhanced magnetic resonance imaging examination before breast-conserving surgery in breast cancer patients with young women

    Institute of Scientific and Technical Information of China (English)

    高明; 钮亚珍; 邢亮; 冯娜

    2013-01-01

    Objective To explore the essentiality of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) examination before breast-conserving surgery (BCS) in breast cancer patients with young women.Methods The data of DCE-MRI and mammography X-ray in 30 breast cancer patients with young women (< 40 years old) who received surgery with pathology-proven were retrospectively analyzed.The detection rate of breast lesion,number,size,extent of invasive and lymph node metastasis of preoperative were observed.The DCE-MRI was assessed accuracy of BCS in accordance with indications for BCS and histopathology results.Results The breast cancer detection rate of DCE-MRI was significantly higher than mammography X-ray [100.00%(30/30) vs.73.33%(22/30),P =0.002].The maximum tumor diameter of DCE-MRI was (3.55 ± 1.50) cm,mammography X-ray was (3.38 ± 1.70) cm,postoperative pathology was (3.51 ± 1.20) cm,and DCE-MRI was closer to postoperative pathology than mammography X-ray.The discovery of additional lesions of DCE-MRI was more than mammography X-ray (P < 0.05).The surrounding tissue invasion of DCE-MRI was detected in 22 cases,mammography X-ray was in 9 cases,postoperative pathology was in 19 cases,there was no significant difference between DCE-MRI and postoperative pathology (P =0.598),there was significant difference between mammography X-ray and postoperative pathology (P =0.010).The number of axillary fossa lymph node metastasis of DCE-MRI was in 127,mammography X-ray was in 48,compared with postoperative pathology (91),there was significant difference (P =0.026,0.034).The detection of microcalcification of mammography X-ray was better than DCE-MRI (7 cases vs.0 case,P =0.001).The number of BCS of postoperative pathology was in 12 cases,DCE-MRI was in 11 cases,mammography X-ray was in 8 cases,DCE-MRI was higher than mammography X-ray,but there was no significant difference (P=0.132).Conclusion DCE-MRI provides comprehensive and accurate information for breast

  10. Satisfaction and quality of life in women who undergo breast surgery: A qualitative study

    Directory of Open Access Journals (Sweden)

    Klok Jennifer

    2009-05-01

    Full Text Available Abstract Background In cosmetic and reconstructive breast surgery, measurement of patient-reported outcomes has become increasingly important to research efforts and clinical care. We aimed to describe how breast conditions and breast surgery impact on patient satisfaction and quality of life. Methods We conducted qualitative, in-depth interviews with 48 women who had undergone either breast reduction (n = 15, breast augmentation (n = 12, or breast reconstruction (n = 21 surgery in order to begin to build a theoretical understanding of patient satisfaction and quality of life in breast surgery patients. Interviews were audio-taped, transcribed verbatim and analyzed thematically. Results The patient interviews revealed that breast conditions and breast surgery impact women in the following six main areas: satisfaction with breasts; satisfaction with overall outcome; psychosocial well-being; sexual well-being; physical well-being; and satisfaction with the process of care. We used these six themes to form the basis of a conceptual framework of patient satisfaction and quality of life in women who undergo breast surgery. Conclusion Our conceptual framework establishes the main issues of concern for breast surgery patients. This new framework can be used to help develop local guidelines for future clinical assessment, management and measurement, establish the validity of the current management strategies, and develop evidence-based guidance for the development of new patient reported outcome measures for future outcomes research.

  11. Mammotome HH biopsy - the future of minimal invasive breast surgery?

    International Nuclear Information System (INIS)

    Vacuum-assisted breast biopsy / Mammotome HH '' R '' Breast Biopsy System/ is the milestone in the diagnosis of breast lesions. This system has proven to be as diagnostically reliable as open surgery, but without scarring, deformations and hospitalizations associated with an open procedure. The aim of our study was to assess the role and possibilities of using this biopsy in treatment of benign breast lesions like fibroadenoma. From 2001 to 2004, about 1118 Mammotome biopsies were performed in our Department. Among 445 Mammotome biopsies performed under US control there were 211 cases of fibroadenomas. Follow-up was performed in 156 patients with this result at 6 and 12 months after biopsy. In our study we took into considerations the size, localizations as well as performers. In 2002 there were 70.8% patients with total lesion excision, 16.7% with residual lesion and 12.5% women with hematomas or scars. In 2003-2004 there were more women with total lesion excision (84.3%), fewer residual tumors and other lesions. In future, Mammotome breast biopsy can replace scalpel, and will become an alternative method to open surgical excision of fibroadenomas. It is important especially in the cases of young women to prevent cosmetic deformations and scars. (author)

  12. A Position Statement on Optimizing the Role of Oncoplastic Breast Surgery

    OpenAIRE

    Andree, Christoph; Farhadi, Jian; Goossens, Dennis; Masia, Jaume; Sarfati, Isabelle; Germann, Günter; MacMillan, R. Douglas; Scheflan, Michael; Van Not, Hans-Pieter; Catanuto, Giuseppe; Nava, Maurizio Bruno

    2012-01-01

    Objectives: To propose initiatives and actions that could improve access to and outcomes from oncoplastic breast surgery. Methods: The author group met in May 2010 to draft position statements on key unmet needs in oncoplastic breast surgery and how these may be addressed. At a second meeting in December 2010, the statements were voted upon and adjusted as necessary to achieve unanimous agreement. Results: It was agreed that every patient undergoing breast cancer surgery should be assessed by...

  13. [Evaluation of asymmetric implants in breast augmentation surgery].

    Science.gov (United States)

    Fitoussi, A D; Couturaud, B

    2005-10-01

    Since more than 30 years, the quality of breast implants has continued to evolve in order to improve the aesthetic results of prosthetic augmentation. Shapes and materials of these implants have also evolved to obtain stronger and more reliable prostheses almost similar to the natural breast. Therefore it can be considered that the use of asymmetric implants is the last step in implant technology before using made to measure implants. Asymmetric implants allow obtaining different contours in harmony to the different breast shapes capable to reproduce faithfully, in all dimensions, the anatomy of the female breast, including the differences between each side which maximise the naturalness of the result. Such implants have an axis directed towards the exterior and lower part of the chest wall, are wider than high with a thinner part on their inner edge and a concave rear side moulding the curves of the chest wall. In our own experience, we placed between 2002 and 2004, asymmetric implants in 100 patients. Such implants were easy to place and no secondary rotation was observed. The control of secondary displacements even in case of prosthesis change seems to be linked to their concave rear side, roughness and asymmetry. When analysing retrospectively the medical records, no distinctive features were observed when compared to symmetric classic implants in easiness in the surgical procedure or in complications except a slightly higher rate of seroma formation. However asymmetric implants are less appropriate in case of major breast ptosis, patients being unsatisfied by the "too natural" breast shape. Moreover a high risk of secondary rotation seems to be real in such cases. In summary, for all these reasons, asymmetric implants, are gradually considered to be a first-rank choice for implants in breast augmentation cosmetic surgery. PMID:16198044

  14. Worry over femininity loss and emotional reaction after hypothetical breast removal surgery

    OpenAIRE

    Yiu, Yui-tsi, Dara.; 姚睿祉.

    2012-01-01

    Breast cancer patients consistently reported psychosocial adjustment difficulty in their sense of femininity after breast removal surgery. In view of this, the present study aimed to explore the effects of three femininity-related concepts on emotional reactions towards breast removal surgery – femininity schema, femininity loss appraisals, and femininity contingency of self-worth. 212 women without breast cancer history participated in this study. They completed a questionnaire which includ...

  15. Obesity predicts for arm edema in conservatively treated breast cancer patients

    International Nuclear Information System (INIS)

    This paper identifies risk factors for arm edema (AE) following breast-conserving surgery and radiation therapy. Upper and lower arm circumferences were measured at interval follow-up visits in 284 patients. A different of 2.5 cm or more in either measurement (treated vs untreated arms) defined AE. Possible predictors for AE examined by univariate and multivariate analysis included level of dissection; number of nodes removed; number involved; tumor size and location; use of supraclavicular fields; patient age, weight, and size (tangent separation measurement); and systemic therapy

  16. An Adequate Margin of Breast Conserving Surgery for Ductal Carcinoma in Situ: A Meta Analysis%乳腺导管原位癌保乳手术最佳切缘距离的系统评价

    Institute of Scientific and Technical Information of China (English)

    叶长生; 姚广裕; 李学瑞; 陈睿婷

    2011-01-01

    much higher in ac - celerated phase/blast crisis. Conventional cytogenetic analysis is helpful to the diagnosis of CML and analysis of the pro -gress. On the basis of conventional cytogenetic analysis , FISH analysis technology can significantly promote the diagnosis rate and the accuracy in detection of chromosomal ahnormalities , and is effective in the detection of der (9) deletions.%@@ 1 文献来源 Dunne C, Burke JP, Morrow M, et al.Effect of margin status on local recurrence after breast conser-vation and radiation therapy for ductal carcinoma in situ[J].J Clin Oncol, 2009, 28 (10) : 1615-1620.

  17. Risk factors for local recurrence after breast-conserving therapy

    International Nuclear Information System (INIS)

    Breast-conserving therapy has been widely accepted as a standard treatment for early breast cancer both in Western countries and in Japan. In Western countries, many studies have investigated the risk factors for local recurrence after breast-conserving therapy (BCT), but few such studies have been done in Japan. To determine the risk factors for local recurrence in 399 breast cancer patients (stage I and II, n=396; stage III, n=3) who had undergone BCT with or without postoperative radiation therapy, we evaluated their clinicopathological features by univariate and multivariate analyses. The patients were treated at Osaka National Hospital between February 1988 and December 1997. Univariate analysis showed that a young age (≤45 years; P=0.0005) was a significant risk factor for local recurrence, while radiation therapy (P=0.0058) and adjuvant endocrine therapy (P=0.0041) significantly reduced the risk of local recurrence. In patients with BCT, without radiation therapy a positive surgical margin significantly increased the risk of local recurrence (P=0.0470). Multivariate analysis showed that a young age (P=0.0285) was a significant independent risk factor for local recurrence, while radiation therapy (P=0.0457) significantly decreased recurrence. In patients with a negative surgical margin, radiation therapy (P=0.0158) and adjuvant endocrine therapy (P=0.0421) significantly reduced the relative risk of local recurrence, to 0.160 and 0.366, respectively. In patients with a positive surgical margin, radiation therapy marginally significantly (P=0.0756) reduced the relative risk of local recurrence, to 0.181, and adjuvant endocrine therapy significantly (P=0.0119) reduced the risk, to 0.076. Young age and lack of radiation therapy or adjuvant endocrine therapy were risk factors for local recurrence in breast cancer patients treated with breast conserving therapy, with surgical margin status also being a possible risk factor. (author)

  18. Combined re-excision and perioperative interstitial brachytherapy for salvage of breast conservation therapy recurrences

    International Nuclear Information System (INIS)

    Purpose: To evaluate local control, survival and cosmetic outcome of combined second lumpectomy and interstitial brachytherapy as salvage treatment for isolated local recurrence of breast cancer after breast conserving therapy. Materials and Methods: Between 1983 and 1996, 32 patients with isolated breast recurrence previously treated by breast conserving therapy, underwent salvage lumpectomy and perioperative brachytherapy. Initial staging and treatment were performed between 1975 and 1994. Median age at diagnosis was 45 years (range 31-67 years), 79% were pre or peri menopausal. Tumors were staged according to the AJCC-system with pathologic findings. Distribution of stage was T1 (n=24), T2 (n=8), in 79% of the patients axillary lymph nodes were negative and all were free of systemic disease. Breast conserving treatment consisted of lumpectomy plus axillary lymph nodes dissection, the mean excised breast tissue volume was 290 cc. All patient received external beam radiation therapy to a dose of 50 Gy/25 fr delivered on breast and nodal areas. Tumor bed was boosted to a total dose of 56 Gy (range 52-66 Gy) by external beam irradiation. Cosmetic outcome after initial therapy was excellent to good in all patients. The mean interval from the initial treatment and first local recurrence was 51 months. The tumor size at recurrence range between 0.2-2.5cm (median 1cm). Recurrence occurs on the boost area of the primary tumor in 13 patients, in other part of the breast in 14 and in the field edge in 5 patients. Treatment of the recurrence consisted of salvage lumpectomy, with a mean excised tissue volume of 51 cc. In all cases perioperative brachytherapy was also performed by introperative plastic tubes positioning. The implant target volume was determined according to surgery findings. Iridium wires were placed into the tubes with a delay of 3 to 4 days. Brachytherapy set up included one (n=20) or two (n=12) planes implants. The mean implant volume determined according

  19. CT findings of organizing pneumonia after radiation therapy in breast-conserving therapy for breast cancer

    International Nuclear Information System (INIS)

    Organizing pneumonia is known as a rare complication after radiation therapy in breast-conserving therapy for breast cancer. CT findings consist of consolidation and ground-glass opacities including the irradiated lung and patchy infiltrates in the nonirradiated lung. Steroid therapy is very effective, but relapse is frequently seen. In relapsed disease, lesions tend to appear in the different site from prior lesions. Radiologists should notice that organizing pneumonia is one form of radiation lung injury with good prognosis. (author)

  20. Cosmesis with bilateral mammoreduction for conservative breast cancer treatment.

    Science.gov (United States)

    Goffman, Thomas E; Schneider, Heather; Hay, Karen; Elkins, David E; Schnarrs, Robert A; Carman, Claire

    2005-01-01

    Over 7 years, 57 women with breast cancer underwent lumpectomy and bilateral mammoreduction. Physical complaints about large or lax breast shape were the predominate rationale. Two patients were immediately lost to follow-up, 55 patients remained and were followed every 3 months for an average of 1.6 years. This is the largest series traceable by computer and literature search. Chart review and patient examination in this retrospective review were utilized as the basis for data within the article. Collated notes from patients' doctors were assessed, as well as documented patient responses to the procedure. Pictures without head/face for identifiers were taken of the patients. Chart data were collected by clinicians, but were reviewed blindly by a statistician. The overall control and cosmesis rates as well as alleviation of heavy breast problems were noted. Only 6% of women had fair to poor cosmetic results; the majority (82%) had excellent to good results. Women with very large breasts or markedly relaxed breast tissue of concern to the patients proved optimal candidates for lumpectomy of cancer and bilateral mammoreduction in the conservative treatment of these cancers. There was a significant reduction in the physical complaints of the patients as well. For women with very pendulous or extremely large breasts, lumpectomy and bilateral mammoreduction may prove to be the optimal course of action. PMID:15871705

  1. National Trends in the Use of Inpatient Hospitalization for Combined Abdominoplasty and Breast Surgery

    OpenAIRE

    Shaterian, Ashkaun; Masoomi, Hossein; B Martin, Jenna; Paydar, Keyianoosh; A. Wirth, Garrett

    2015-01-01

    BACKGROUND Combined procedures involving elective breast surgery at the time of abdominoplasty are frequently performed procedures in aesthetic plastic surgery. While found to be safe outpatient procedures, many surgeons elect to perform combined abdominoplasty/breast surgery as inpatient surgery. This study was performed to explore the practice of performing the combined procedure as an inpatient in the United States. METHODS The Nationwide Inpatient Sample database was evaluated using ICD-9...

  2. An analysis of long term complications in breast cancer patients after conservative therapy

    International Nuclear Information System (INIS)

    Background: Breast conserving surgery followed by irradiation and subsequent systematic application of therapy has been recognized as an efficient method for the treatment of early breast cancer for many years. The results of conservative treatment show a relatively low percentage of local relapses and good cosmetic results. Aim: The aim of the paper was to analyse the frequency and intensity of late complications after conservative treatment in breast carcinoma patients. Materials/Methods: A group of 67 patients with stage I and II breast carcinoma, according to the TNM classification, and who underwent conservative treatment in the Lower-Silesian Centre for Oncology between 1995 and 2001 were included in the study. All patients underwent irradiation of the breast after conservative treatment. In 93% the total dose was 50 Gy and in the remaining 7% the dose amounted to 46 - 48 Gy. The dose was around 10 Gy higher at the tumour site. Irradiation of the lymph nodes was applied in 25 % of cases and chemotherapy was used in 40 %. The occurrence and intensity of late complications were assessed at 3-6 monthly intervals. Complications included: lymphatic swelling of the ipsilateral upper limb, necrosis of the soft tissues, post-radiation pneumonia, lung fibrosis, post-radiation rib fractures, plexopathy, late skin reaction and telangiectasia. Intensity was assessed using our own 4 level scale. Results: Level 2 complications were observed in 22 % of the patients and Level 3 complications were seen in 6 %. No Level 4 complications were observed. Lymphatic swelling of the ipsilateral upper limb was the most frequent complication and occurred in 22 % of the patients. Level 2 and Level 3 swelling was observed in 14.5 %. Level 2 and 3 late post-radiation reactions were observed in 9 % of the patients. Telangiectasia within the boost area was observed in 4.5 % of the patients and outside the boost area in 9 %. No local recurrence of carcinoma was observed. Conclusions: The

  3. Clinical application of thoracic paravertebral anesthetic block in breast surgeries

    Directory of Open Access Journals (Sweden)

    Sara Socorro Faria

    2015-04-01

    Full Text Available INTRODUCTION: Optimum treatment for postoperative pain has been of fundamental importance in surgical patient care. Among the analgesic techniques aimed at this group of patients, thoracic paravertebral block combined with general anesthesia stands out for the good results and favorable risk-benefit ratio. Many local anesthetics and other adjuvant drugs are being investigated for use in this technique, in order to improve the quality of analgesia and reduce adverse effects. OBJECTIVE: Evaluate the effectiveness and safety of paravertebral block compared to other analgesic and anesthetic regimens in women undergoing breast cancer surgeries. METHODS: Integrative literature review from 1966 to 2012, using specific terms in computerized databases of articles investigating the clinical characteristics, adverse effects, and beneficial effects of thoracic paravertebral block. RESULTS: On the selected date, 16 randomized studies that met the selection criteria established for this literature review were identified. Thoracic paravertebral block showed a significant reduction of postoperative pain, as well as decreased pain during arm movement after surgery. CONCLUSION: Thoracic paravertebral block reduced postoperative analgesic requirement compared to placebo group, markedly within the first 24 h. The use of this technique could ensure postoperative analgesia of clinical relevance. Further studies with larger populations are necessary, as paravertebral block seems to be promising for preemptive analgesia in breast cancer surgery.

  4. Results of conservative surgery and radiation for mammographically detected ductal carcinoma in situ (DCIS)

    International Nuclear Information System (INIS)

    Purpose: The role of conservative surgery and radiation for mammographically detected DCIS is controversial. In particular, there is a paucity of data for outcome with radiation in a group of patients comparable to those treated with local excision and surveillance (mammographically detected DCIS ≤2.5 cm, negative resection margins, negative post-biopsy mammogram). The purpose of this study is to report long term outcome of conservative surgery and radiation for mammographically detected DCIS with emphasis on the results in patients (pts.) considered candidates for excision alone. Materials and Methods: From 1983 to 1992, 110 women with mammographically detected DCIS (calcifications 72%, mass ± calcifications 27%) and no prior history of breast cancer underwent needle localization biopsy followed by radiation. The median age of the patient population was 56 yrs. (range 37-81). The median followup was 5.3 yrs. (range .5-12). Re-excision was performed in 55%. Final margins of resection were negative in 62%, positive 7%, close 11%, and unknown 20%. Axillary dissection was performed in 31 pts. and all had negative nodes. 31% had a positive family history of breast cancer (1 affected relative-25 pts., two-7 pts., three-2 pts.). The most common predominant histologic subtype was comedo (54%) followed by cribriform (22%). The median pathologic tumor size was 8 mm (range 2 mm to 5 cm). A post-biopsy mammogram prior to radiation was performed in 46% of the patients. Radiation consisted of treatment to the entire breast (median 5000 cGy) with a boost to the primary site (97%) of an additional 1000 cGy. The median total dose to the primary site was 6040 cGy (range 5000 to 6660). Results: Three patients developed a recurrence in the treated breast at 52, 106, and 107 months. All 3 recurrences were invasive ductal cancers and all were treated with mastectomy. The location of the recurrence was in the same quadrant as the primary in 1 pt. and in a separate quadrant in 2 pts

  5. Patient-Reported Outcomes Following Breast Reconstruction Surgery and Therapeutic Mammoplasty: Prospective Evaluation 1 Year Post-Surgery with BREAST-Q Questionnaire.

    Science.gov (United States)

    Shekhawat, Laxmi; Busheri, Laleh; Dixit, Santosh; Patel, Chaula; Dhar, Upendra; Koppiker, Chaitanyanand

    2015-12-01

    Breast Cancer (BC) treatment leads to mutilation and destruction of breast shape with negative effects on body image and self-esteem.One of the main goals of reconstructive and oncoplastic breast surgery is to satisfy patients and improve their quality of life (QoL).Therefore, it is important to assess the patient experience post-surgery by means of patient-reported outcome measures (PROMs) that focus on the patient's perception of the surgery and surgical care, as well as psychosocial well-being and physical functioning. The objective of the current study was to identify predictors of patient satisfaction such as breast appearance including implant type in a selective sample of women who underwent breast reconstruction surgery using implants. Participants in this prospective study were women, (age 26-75 years) that were newly diagnosed with breast carcinoma. All consecutive patients who underwent breast reconstruction between January 2013 and October 2014 were asked to complete the BREAST-Q questionnaire 1 year after surgery. 120 patients underwent unilateral breast reconstruction using implant. While 38 patients underwent reconstruction with opposite breast reduction symmertization, 27 patients underwent therapeutic mammoplasty. The response rate for BREAST-Q questionnaire completion was 98 % with 147 out of 150 study participants completed the questionnaire. From the data collected from 147 patients, the responses could be distributed into 4 distinct groups based on the reconstruction outcomes namely "very much satisfied" (93 %) or "definitely and mostly satisfied" (94 %) or "satisfied" with the outcome (88 %) or "definitely agree on having reconstruction rather than the alternative of having no breast "(91 %).The results showed significant improvement in all four areas that were evaluated after surgery namely satisfaction with the appearance of the breasts, psychosocial, sexual and physical well-being. While the reconstruction surgery had an overall

  6. Clinical investigation of predictors of radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy

    International Nuclear Information System (INIS)

    We investigated 710 patients with breast cancer who received radiotherapy after breast-conserving surgery at our institution to evaluate the incidence of radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome focusing on the interval from irradiation to onset and the clinical presentation. The predictive value of age (≤50 or >50), chemotherapy and hormone therapy was statistically analyzed to determine whether these are risk factors for BOOP syndrome. Radiation-induced BOOP syndrome was seen in 1.3% (9/710). In most cases, the symptoms were mild and none of the patients required hospitalization. Eight patients (88.9%) responded well to steroid administration, but 5 of these patients relapsed after or during tapering of steroids. Although we could not detect significant risk factors for BOOP syndrome, a higher patient age was associated with a higher incidence of radiation-induced BOOP syndrome after breast-conserving therapy. (author)

  7. Aichi Cancer Center 10-year experience with conservative breast treatment of early breast cancer: retrospective analysis regarding failure patterns and factors influencing local control

    International Nuclear Information System (INIS)

    Purpose: We analyzed the clinical results of conservative breast therapy in our institute to determine the risk factors influencing local and distant disease recurrence. Methods and Materials: From 1989 to 1997, 301 breasts of 295 women with early breast cancer were treated with conservative surgery and adjuvant radiotherapy. There were 212 incidences of Stage I breast cancer, and 89 of Stage II. Patients were routinely treated with local resection, axillar dissection, and 46-50 Gy irradiation given in 23-25 fractions. Some also received a radiation boost to the tumor bed. Results: The 5-/8-year overall survival, disease-free survival, and local control rates were 93.2/91.5%, 86.0/80.6%, and 95.1/92.5%, respectively. Using both univariate and multivariate analyses, tumor volume, estrogen receptor status, and age <40 years were significant prognostic factors for disease-free survival. Both age <40 years and surgical method had a strong effect on local control by uni- and multivariate analysis. Surgical margin status was a significant prognostic factor for local control at the univariate level (p<0.0001), though it had only borderline significance at the multivariate level (p 0.08). No patient experienced severe morbidity due to radiotherapy. Conclusion: The results obtained are comparable to previously reported data. Although the follow-up period was too short to draw definite conclusions about long-term outcomes, the outcome from conservative breast treatment was acceptable

  8. Radiographic and CT features of radiation-induced organizing pneumonia syndrome after breast-conserving therapy

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate radiographic and computed tomography features of radiation-induced organizing pneumonia syndrome after breast-conserving surgery. The appearances and distribution of lung parenchymal abnormalities were retrospectively analyzed on chest radiographs (n=12) and computed tomography scan images (n=10) of 12 women (range 37-78 years, mean 55.8 years) with radiation-induced organizing pneumonia syndrome after breast-conserving surgery. The principal radiographic feature was an airspace filling pattern in all patients that involved the middle and lower lung zones in 10 of the 12 patients. Multi-focal lesions manifesting airspace consolidation surrounded by ground-glass opacities were the predominant CT finding in all 10 of these patients. The main lesion was predominantly located in the lung periphery in nine patients and contiguously extended to the central portion of the lung in seven patients. Frequent ancillary findings were airway dilation within the consolidation and lobar volume loss in nine and eight patients, respectively. All had solitary (6/10) or multifocal (4/10) distant lung opacities, mostly consistent with the finding of ground-glass opacities (9/10). Migration of the lung disease was observed in ten patients on subsequent radiographs. The cardinal radiologic feature of this syndrome is airspace consolidation surrounded by ground-glass opacification with airway dilation and volume loss, involving primarily the irradiated, subpleural area, along with distant opacities. (author)

  9. Perioperative intravenous lidocaine decreases the incidence of persistent pain after breast surgery.

    LENUS (Irish Health Repository)

    Grigoras, Anca

    2012-09-01

    Breast cancer surgery is associated with a high incidence of persistent postsurgical pain (PPSP). The aim of this study was to evaluate the impact of intravenous (IV) lidocaine on acute and PPSP, analgesic requirements, and sensation abnormalities in patients undergoing surgery for breast cancer.

  10. Conservative management of operable breast cancer. Ten years experience at the Foundation Curie

    International Nuclear Information System (INIS)

    514 patients were treated for a surgically operable (T1, T2, T3, N0, N1a, N1b) infiltrating breast carcinoma at the Foundation Curie, Paris, France, from 1960 to 1970 inclusive. Patients with tumors 3 cm or less and without axillary adenopathy had lumpectomy followed by radiotherapy. Patients with larger tumors and all patients with clinically significant lymph nodes (N1b) had exclusive radiotherapy (without lumpectomy). 120 had lumpectomy and 394 had exclusive radiotherapy. The five and ten years absolute survivals, free of disease (N.E.D.), for the lumpectomy group are 85% and 75%, respectively. 12% had secondary surgery for local recurrence. The cosmetic results were satisfactory in 98%, with no severe radiation sequelae. The five and ten years, N.E.D., of the exclusive radiotherapy group are 68% and 43%. 55% had secondary surgery for persistent or recurrent disease. The cosmetic results were satisfactory in 85%. There were only three patients with severe radiation sequelae. The overall survival for 514 patients at five and ten years are 72% and 51%. Two-thirds of patients, alive at five years, had a preserved breast. Our conservative treatment resulted in survival at five and ten years comparable to those of radical surgery

  11. A simulation framework for modeling tumor control probability in breast conserving therapy

    International Nuclear Information System (INIS)

    Background and purpose: Microscopic disease (MSD) left after tumorectomy is a major cause of local recurrence in breast conserving therapy (BCT). However, the effect of microscopic disease and RT dose on tumor control probability (TCP) was seldom studied quantitatively. A simulation framework was therefore constructed to explore the relationship between tumor load, radiation dose and TCP. Materials and methods: First, we modeled total disease load and microscopic spread with a pathology dataset. Then we estimated the remaining disease load after tumorectomy through surgery simulation. The Webb–Nahum TCP model was extended by clonogenic cell fraction to model the risk of local recurrence. The model parameters were estimated by fitting the simulated results to the observations in two clinical trials. Results: Higher histopathology grade has a strong correlation with larger MSD cell quantity. On average 12.5% of the MSD cells remained in the patient’s breast after surgery but varied considerably among patients (0–100%); illustrating the role of radiotherapy. A small clonogenic cell fraction was optimal in our model (one in every 2.7 * 106 cells). The mean radiosensitivity was estimated at 0.067 Gy−1 with standard deviation of 0.022 Gy−1. Conclusion: A relationship between radiation dose and TCP was established in a newly designed simulation framework with detailed disease load, surgery and radiotherapy models

  12. Techniques of tumour bed boost irradiation in breast conserving therapy: Current evidence and suggested guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Jalali, Rakesh; Singh, Suruchi; Budrukkar, Ashwini [Tata Memorial Hospital, Mumbai (India)

    2007-10-15

    Breast conservation surgery followed by external beam radiotherapy to breast has become the standard of care in management of early carcinoma breast. A boost to the tumour bed after whole breast radiotherapy is employed in view of the pattern of tumour bed recurrences in the index quadrant and was particularly considered in patients with some adverse histopathological characteristics such as positive margins, extensive intraductal carcinoma (EIC), lymphovascular invasion (LVI), etc. There is however, now, a conclusive evidence of improvement in local control rates after a boost radiotherapy dose in patients even without such factors and for all age groups. The maximum absolute reduction of local recurrences by the addition of boost is especially seen in young premenopausal patients. At the same time, the addition of boost is associated with increased risk of worsening of cosmesis and no clear cut survival advantage. Radiological modalities such as fluoroscopy, ultrasound and CT scan have aided in accurate delineation of tumour bed with increasing efficacy. A widespread application of these techniques might ultimately translate into improved local control with minimal cosmetic deficit. The present article discusses the role of radiotherapy boost and the means to delineate and deliver the same, identify the high risk group, optimal technique and the doses and fractionations to be used. It also discusses the extent of adverse cosmetic outcome after boost delivery, means to minimise it and relevance of tumour bed in present day scenario of advanced radiotherapy delivery techniques like (IMRT)

  13. Techniques of tumour bed boost irradiation in breast conserving therapy: Current evidence and suggested guidelines

    International Nuclear Information System (INIS)

    Breast conservation surgery followed by external beam radiotherapy to breast has become the standard of care in management of early carcinoma breast. A boost to the tumour bed after whole breast radiotherapy is employed in view of the pattern of tumour bed recurrences in the index quadrant and was particularly considered in patients with some adverse histopathological characteristics such as positive margins, extensive intraductal carcinoma (EIC), lymphovascular invasion (LVI), etc. There is however, now, a conclusive evidence of improvement in local control rates after a boost radiotherapy dose in patients even without such factors and for all age groups. The maximum absolute reduction of local recurrences by the addition of boost is especially seen in young premenopausal patients. At the same time, the addition of boost is associated with increased risk of worsening of cosmesis and no clear cut survival advantage. Radiological modalities such as fluoroscopy, ultrasound and CT scan have aided in accurate delineation of tumour bed with increasing efficacy. A widespread application of these techniques might ultimately translate into improved local control with minimal cosmetic deficit. The present article discusses the role of radiotherapy boost and the means to delineate and deliver the same, identify the high risk group, optimal technique and the doses and fractionations to be used. It also discusses the extent of adverse cosmetic outcome after boost delivery, means to minimise it and relevance of tumour bed in present day scenario of advanced radiotherapy delivery techniques like (IMRT)

  14. ERYSIPELAS OF UPPER LIMB: A COMPLICATION OF BREAST CANCER SURGERY

    Directory of Open Access Journals (Sweden)

    Natalia Cireap

    2010-05-01

    Full Text Available Erysipelas of upper limb is a well-known complication following breast cancer therapy, but few cases are reported in the literature. We undertook a 5-year retrospective study at the Department I of Infectious Diseases. For each patient we recorded the age, past medical history, clinical findings, laboratory parameters, treatment, outcome and recommended prophylaxis. From 145 erysipelas identified, 12 cases were erysipelas of upper limb. All patients had a breast surgery and lymphadectomy. The erysipelas appeared with an average of 5.5 years after cancer treatment. Associated pathology: obesity (5 cases, diabetes (6 cases and thrombophlebitis (1 case. Lymphedema was noticed in 9 patients and the site of involvement was the homolateral upper limb of the treated breast. The diagnosis of erysipelas was essentially clinical. The clinical aspect was an inflammatory plaque with raised edges in 7 cases, blisters, cellulitis and purpura in one case, respectively. The portal of entry was not found in 6 cases. Laboratory parameters: increased leucocytes with predominance of neutrophils (4; normal white count (5 and leucopenia (3; the erythrocyte sedimentation rate and fibrinogen elevated in 5 cases; CRP levels elevated in 8 cases. The most commonly used antibiotic was penicillin G intravenous route of administration. The outcome was favorable for all the patients. At discharge, prophylactic treatment was recommended for all the patients. In three of our patient, despite the prophylaxis, recurrences occurred with a frequency of 3-6 episodes in 5 years. All these patients displayed an immune suppressive status with decreased CD4+.

  15. Assessment of radiation dermatitis using objective analysis for patients with breast cancer treated with breast-conserving therapy. Influence of body weight

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the effect of patient factors on radiation dermatitis for patients with breast cancer who underwent postoperative radiotherapy after breast-conserving surgery. The study population comprised 87 patients who underwent breast-conserving surge