scholarly journals TP8.1.10 Factors predicting residual disease on re-excision after breast conserving surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Duncan Simpson ◽  
Jennifer Allan ◽  
Brendan McFall
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Residual Disease ◽  
Tumour Size ◽  
Multivariable Analysis ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Linear Fashion ◽  
Initial Surgery ◽  
Disease Free

Abstract Introduction Breast conserving surgery is the standard of care for early breast cancer, however in a quarter of patients, satisfactory margins are not achieved, usually leading to re-excision. Residual disease is found in less than half of these re-excisions, leading to increased morbidity, poorer cosmesis and increased cost with no oncological benefit. Our study aimed to identify a group of patients with unsatisfactory margins but a low risk of residual disease, who may be able to avoid re-excision. Methods All patients from our unit undergoing re-excision for unsatisfactory margins after breast conserving surgery between January 2013 and October 2019 were identified. Pathological factors predicting residual disease were investigated using univariable and multivariable analysis. Results 220 patients were included. 90 (41%) had residual disease in the re-excision specimen. Residual disease was more likely in those having mastectomy than cavity shaves (61% vs 32%, p < 0.0001). Residual disease increased in a linear fashion with number of involved margins and with increasing tumour size. Tumour size <20mm (p = 0.045), a pathological to radiological tumour size ratio less than 1.5 (p < 0.0001) and disease-free cavity shaves taken at initial surgery (p = 0.041) were all significant predictors of a low chance of residual disease on multivariable analysis. Patients with all three factors had a 14% chance of residual disease. Conclusions More than half of patients undergo unnecessary re-excision, and patients with small, radiologically obvious tumours are less likely to have residual disease. The decision on re-excision should include these factors in addition to the margin status.

scholarly journals Postoperative radiotherapy after conservative surgery for early breast cancer: 5-year results

2004 ◽  
Vol 12 (1) ◽  
pp. 29-33
Author(s):  
Jasmina Mladenovic ◽  
Marko Dozic ◽  
Nenad Borojevic
Keyword(s):  
Breast Cancer ◽  
Survival Rate ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Systemic Therapy ◽  
Postoperative Radiotherapy ◽  
Breast Conserving Surgery ◽  
Breast Cancer Patients ◽  
Disease Free

BACKGROUND: Breast conserving surgery followed by postoperative radiotherapy, as alternative to radical mastectomy, has been accepted as an optimal method for loco- regional treatment of the majority of women with early stage of breast carcinoma. The aim of the study was to evaluate the results of postoperative radiotherapy after breast conserving surgery in the Institute for oncology and radiology of Serbia. METHODS: During the 3-year period, 109 breast cancer patients with stage I and II were treated with postoperative radiotherapy after breast conserving surgery. Ninety- four patients underwent quadrantectomy with axillary node dissection, and 15 patients underwent only tumorectomy. After surgery all patients received postoperative radiotherapy to the whole breast with tumor dose 50 Gy in 15 fractions every second day. In 52 patients radiotherapy was given to the regional lymphatics with tumor dose 45 Gy in 15 fractions every second day. Twenty-eight patients received a booster dose (10 Gy) to the tumor bed. Adjuvant systemic therapy was administered depending on the nodal involvement and steroid receptors content: 17 patients received adjuvant chemotherapy (CMF or FAC), 18 received adjuvant hormonal therapy (tamoxifen or ovarian ablation), and 6 patients received both chemo- and hormonotherapy. RESULTS: After median follow-up period of 62 months, there was no evidence of loco- regional recurrence in anyone of patients. Distant metastases occurred in 7 patients (6.4%) with median disease free interval of 27.6 months. At last follow-up 91 patients (83.4%) were alive, 4 patients (3.7%) were dead of disease, and the same number was dead of other causes. The 5-year overall survival rate was 92.9% and disease-free survival rate was 92.7%. CONCLUSION: According to our results the combined surgery and radiotherapy approach provides good local control of early breast cancer patients. Postoperative radiotherapy after breast conserving surgery with or without adjuvant systemic therapy has important role in adjuvant treatment of early breast cancer.

Predictive factor for residual tumor after lumpectomy for close margins

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11538-e11538
Author(s):  
V. Ozmen ◽  
S. Ozkan Gurdal ◽  
M. Muslumanoglu ◽  
A. Igci ◽  
S. S. Tuzlali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Ductal Carcinoma ◽  
Residual Disease ◽  
Surgical Margin ◽  
Residual Tumor ◽  
Excisional Biopsy ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Breast Cancer Patients

e11538 Background: It is critical to obtain clear margins to minimize local recurrence after breast conserving surgery(BCS). When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for re-excision(s) or mastectomy. The aim of the present study was to identify factors predicting a histologically positive re-excision specimen. Methods: Our prospective breast cancer database was queried for all invasive breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCS. Close margins are defined as ≤ 2 mm for invasive carcinoma and presence of ductal carcinoma in situ(DCIS). Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Between February 1997 and August 2008, 2054 patients with early breast cancer underwent surgical treatment in our breast unit. 939(45.7%) of them had BCS. In 543 patients(26.4%), re-excision required due to close margins on the permanent section analysis of their initial surgical specimens. 186 patients(34.3%) had previous excisional biopsy in other clinics. Median age of 543 patients was 50 years. In 290 patients(53.4%), mastectomy was performed due to positive surgical margin or poor cosmetic results. There were no residual tumors in re-excision(65.6 %) or mastectomy(42.4%) specimens of patients. The factors associated with tumor positive re-excision specimen were, age ≤50 years(p=0.044), lymphovascular invasion (p=0.029), multifocality(p<0.001), tumor size >2cm(p=0.008), presence of DCIS(p=0.018), focal margin positivity(p<0.001), DCIS at resection margin(p=0.008) and node positivity (p<0.001). Conclusions: Most of our patients with early breast cancer had unnecessary re-excisions or mastectomy to obtain clear surgical margins. In subset group of patients, re-excision or mastectomy may not be required. No significant financial relationships to disclose.

scholarly journals Disease-free and overall survival after neoadjuvant chemotherapy in breast cancer: breast-conserving surgery compared to mastectomy in a large single-centre cohort study

2020 ◽  
Author(s):  
Janine M. Simons ◽  
Julien G. Jacobs ◽  
Joost P. Roijers ◽  
Maarten A. Beek ◽  
Leandra J. M. Boonman-de Winter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Pathologic Complete Response ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Breast Conserving Surgery ◽  
Prognostic Indicators ◽  
Free Survival ◽  
Disease Free

Abstract Purpose The extended role of breast-conserving surgery (BCS) in the neoadjuvant setting may raise concerns on the oncologic safety of BCS compared to mastectomy. This study compared long-term outcomes after neoadjuvant chemotherapy (NAC) between patients treated with BCS and mastectomy. Methods All breast cancer patients treated with NAC from 2008 until 2017 at the Amphia Hospital (the Netherlands) were included. Disease-free and overall survival were compared between BCS and mastectomy with survival functions. Multivariable Cox proportional hazard regression was performed to determine prognostic variables for disease-free survival. Results 561 of 612 patients treated with NAC were eligible: 362 (64.5%) with BCS and 199 (35.5%) with mastectomy. Median follow-up was 6.8 years (0.9–11.9). Mastectomy patients had larger tumours and more frequently node-positive or lobular cancer. Unadjusted five-year disease-free survival was 90.9% for BCS versus 82.9% for mastectomy (p = .004). Unadjusted five-year overall survival was 95.3% and 85.9% (p < .001), respectively. In multivariable analysis, clinical T4 (cT4) (HR 3.336, 95% CI 1.214–9.165, p = .019) and triple negative disease (HR 5.946, 95% CI 2.703–13.081, p < .001) were negative predictors and pathologic complete response of the breast (HR 0.467, 95% CI 0.238–0.918, p = .027) and axilla (HR 0.332, 95% CI 0.193–0.572, p = .001) were positive predictors for disease-free survival. Mastectomy versus BCS was not a significant predictor for disease-free survival when adjusted for the former variables (unadjusted HR 2.13 (95%CI: 1.4–3.24), adjusted HR 1.31 (95%CI: 0.81–2.13)). In the BCS group, disease-free and overall survival did not differ significantly between cT1, cT2 or cT3 tumours. Conclusion BCS does not impair disease-free and overall survival in patients treated with NAC. Tumour biology and treatment response are significant prognostic indicators.

scholarly journals The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jacopo Nori ◽  
Maninderpal Kaur Gill ◽  
Icro Meattini ◽  
Camilla Delli Paoli ◽  
Dalmar Abdulcadir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Laser Ablation ◽  
Residual Disease ◽  
Performance Status ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Breast Cancers ◽  
Breast Cancer Patients ◽  
Small Breast

Background and Objectives. Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC). Methods. Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC. Results. At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure. Conclusions. Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.

AQP5 variant associated with prognosis in patients with early breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11505-e11505
Author(s):  
Ho Yong Park ◽  
Soo Jung Lee ◽  
Yee Soo Chae ◽  
Jong Gwang Kim ◽  
Byung Woog Kang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Disease Free Survival ◽  
Breast Conserving Surgery ◽  
Prognostic Impact ◽  
Curative Surgery ◽  
Free Survival ◽  
Aqp5 Expression ◽  
Functional Relevance ◽  
Disease Free

e11505 Background: Our previous study showed the association of AQP5 expression with unfavorable prognosis in patients with early breast cancer (EBC). In addition, we analyzed the prognostic impact of polymorphisms of AQP5 gene in the chromosomal region 12q13 on breast cancer. Methods: The genomic DNA was extracted from paraffin-embedded tumor-free tissue from 609 early breast cancer (EBC) patients underwent curative surgery and then genotyped for 3 polymorphisms (rs3736309, rs1964676, and rs74091167) using the Sequenom Mass array system. Results: The median age of patients was 49 years (range 23-79). 106 (18.2%) patients underwent breast conserving surgery and adjuvant chemotherapy was given to 562 (92.3%) patients. Among enrolled subjects, 447 (73.3%) were hormone-responsive, 94 (15.3%) for HER2 overexpressed, and 98 (16.1%) for triple negative EBC. Among the 3 polymorphisms, AQP5 rs74091167 was significantly associated with disease-free survival (DFS) and distant disease-free survival (DDFS) in a dominant model (P < 0.001 and P = 0.021, respectively). Moreover, multivariate survival analysis revealed that the GG genotype of AQP5 rs74091167 was significantly associated with better DFS (HR = 0.377; 95% CI 0.179-0.793; P = 0.010) when compared with the combine GC/CC genotype adjusted to clinicopathological variables. However, no difference in AQP5 rs74091167 polymorphism was observed based on patient and tumor characteristics. Conclusions: AQP5 rs74091167 variant can be considered as a prognostic marker in patients with EBC after curative operation. In the future, functional relevance of this variant needs to be clarified.

scholarly journals Breast Conserving Treatment for Breast Cancer: Dosimetric Comparison of Sequential versus Simultaneous Integrated Photon Boost

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Hilde Van Parijs ◽  
Truus Reynders ◽  
Karina Heuninckx ◽  
Dirk Verellen ◽  
Guy Storme ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Helical Tomotherapy ◽  
Organs At Risk ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Conventional Technique ◽  
Breast Conserving Treatment ◽  
Safe Alternative ◽  
Dosimetric Comparison ◽  
Sequential Boost

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.

scholarly journals Contrast-enhanced spectral mammography in the radiological assessment of response to neoadjuvant chemotherapy in breast cancer

2021 ◽  
pp. e521
Author(s):  
Anna Grażyńska ◽  
Sofija Antoniuk ◽  
Katarzyna Steinhof-Radwańska
Keyword(s):  
Breast Cancer ◽  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Tumour Size ◽  
Breast Cancer Diagnosis ◽  
Chemotherapy Response ◽  
Resonance Imaging ◽  
Contrast Enhanced

Accurate morphological assessment and measurement of the residual disease following neoadjuvant chemotherapy are vital for the effective surgical treatment in patients with breast cancer. Neoadjuvant chemotherapy response is measured by RECIST 1.1 criteria (Response Evaluation Criteria in Solid Tumors), and the classification of the specific therapeutic responses is based on the difference in the tumour size prior to and after chemotherapy. There are currently a few methods of imaging used in the assessment of the neoadjuvant chemotherapy response. Conventional mammography remains the most popular method, whereas magnetic resonance imaging is considered the most effective ones. Nonetheless, the available methods tend to be imperfect and limited, and therefore, new methods are constantly investigated. Contrast-enhanced spectral mammography is a relatively new method used in breast cancer diagnosis, which involves the phenomenon of neoangiogenesis of cancerous tumours, allowing contrast enhancement in the areas of vessel proliferation in the background of the surrounding breast tissue. Contrast-enhanced spectral mammography presents sensitivity similar to magnetic resonance imaging in breast cancer detection, and can be an efficient method used in monitoring neoadjuvant chemotherapy response.

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