Audit of local recurrence rates following ‘ultra’-conservative surgery for invasive breast cancer—a boost to the breast?

PURPOSE To assess patients' preferences regarding the trade-off between risks and benefits of radiation therapy after conservative surgery for early-stage breast cancer. PATIENTS AND METHODS Utilities (measures of preference) of 97 early-stage breast cancer patients treated with conservative surgery and radiation therapy and 20 medical oncology nurses were assessed for five health states using standard gambles. RESULTS Patients had the highest mean utility for treatment with conservative surgery and radiation therapy without a local recurrence (0.92), intermediate utilities for treatment with conservative surgery alone followed either by no local recurrence or by a local recurrence salvaged by conservative surgery and radiation therapy (0.88 and 0.87, respectively), and the lowest utilities for treatment with or without radiation therapy followed by a local recurrence salvaged by mastectomy and reconstructive surgery (0.82 and 0.81, respectively). All differences between health states' utilities were significant (P < .0001), except between the two intermediate and two lowest rated health states. None of the clinical or sociodemographic factors examined explained more than 5% of the variability in the patients' utilities or their differences. Nurses' utilities were similar to those of the patients. CONCLUSIONS These results strongly suggest that fear of a local recurrence and an actual local recurrence leading to mastectomy have such a negative impact on quality of life that patients are willing to accept the risks and inconvenience of radiation therapy to avoid them. There is also considerable interpatient variability that was not explained by the clinical or sociodemographic factors examined.

Download Full-text

Immediate reconstruction with autologous fat grafting: influence in loco regional recurrence in breast cancer

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912017002012 ◽

2017 ◽

Vol 44 (2) ◽

pp. 179-186 ◽

Cited By ~ 5

Author(s):

CAMILE CESA STUMPF ◽

JORGE VILLANOVA BIAZUS ◽

FERNANDO SCHUH ÂNGELA ERGUY ZUCATTO ◽

RODRIGO CERICATTO ◽

JOSÉ ANTÔNIO CRESPO CAVALHEIRO ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Conservative Surgery ◽

Fat Grafting ◽

Safe Procedure ◽

Autologous Fat Grafting ◽

Immediate Reconstruction ◽

Autologous Fat ◽

Systemic Recurrence ◽

Surgery Group

ABSTRACT Objective: to evaluate local and systemic recurrence of breast cancer in patients submitted to autologous fat grafting in the immediate reconstruction after conservative surgery for breast cancer. Methods: this is a historical cohort study comparing 167 patients submitted to conservative surgery without reconstruction (conservative surgery group) with 27 patients submitted to conservative treatment with immediate graft reconstruction, following the Coleman's technique (lipofilling group). All patients had invasive carcinoma and were operated by a single surgeon from 2004 to 2011. The postoperative follow-up time was 36 months. Results: the overall incidence of local recurrence was 2.4%. No patient in the lipofilling group had local recurrence during the study period. For systemic recurrence, the rates obtained were 3.7% (one patient) for the fat grafting group and 1.8% (three patients) for the conservative surgery group without reconstruction. Conclusion: there was no significant difference for local or systemic recurrence in the groups studied. Immediate autologous fat grafting appears to be a safe procedure.

Download Full-text