scholarly journals “Unplanned breast-conserving surgery after systemic therapy in locally advanced breast cancer: the results of level II oncoplastic techniques”

2021 ◽  
Author(s):  
mehmet gulcelik ◽  
Lütfi Doğan
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Axillary Recurrence ◽  
Free Survival ◽  
Level Ii ◽  
Significant Difference

BACKGROUND: In patients with breast cancer for whom neoadjuvant chemotherapy (NAC) is planned, it is recommended to mark the primary tumor before treatment (planned surgery). However, surgeons may have to perform breast-conserving surgery on patients whose tumors are not marked (unplanned surgery). This study focused on the results obtained with planned and unplanned level II oncoplastic surgery (OPS) techniques applied to patients after NAC. METHODS: Patient groups who underwent planned, unplanned OPS and mastectomy after NAC were compared. Surgical margin status, re-operation and re-excision requirements, ipsilateral breast tumor recurrence (IBTR) and axillary recurrence rates recorded. Long-term local recurrence-free survival (LRFS), disease-free survival and overall survival were evaluated. RESULTS: There was no significant difference between the planned and unplanned OPS groups in terms of surgical margin status, re-excision requirement, and mastectomy rates. During an average follow-up period of 43 months, 5.3% and 4% of the patients in the planned OPS group developed IBTR and axillary recurrence, respectively, whereas these rates were 6.6% and 5.3% in the unplanned OPS group. In the mastectomy group, the rates of IBTR and axillary recurrence were found to be 4.1% and 3.8%, respectively. There was no significant difference between the three groups in terms of IBTR (p: 0.06) and axillary recurrence (p: 0.08) rates. CONCLUSION: Breast conserving surgery can be applied using level II OPS techniques with the post-NAC radiological examination and marking even if primary tumor marking is not done in the pre-NAC period.

Outcome at 8 Years After Breast-Conserving Surgery and Radiation Therapy for Invasive Breast Cancer: Influence of Margin Status and Systemic Therapy on Local Recurrence

2000 ◽  
Vol 18 (8) ◽  
pp. 1668-1675 ◽  
Author(s):  
Catherine C. Park ◽  
Michihide Mitsumori ◽  
Asa Nixon ◽  
Abram Recht ◽  
James Connolly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Radiation Therapy ◽  
Local Recurrence ◽  
Systemic Therapy ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Positive Margins

PURPOSE: To examine the relationship between pathologic margin status and outcome at 8 years after breast-conserving surgery and radiation therapy. PATIENTS AND METHODS: The study population comprised 533 patients with International Union Against Cancer/American Joint Committee on Cancer clinical stage I or II breast cancer who had assessable margins, who received at least 60 Gy to the primary tumor bed, and who had more than 8 years of potential follow-up. Each margin was scored (according to the presence of invasive or in situ disease that touched the inked surgical margin) as one of the following: negative, close, focally positive, or extensively positive. Outcome at 8 years was calculated using crude rates of first site of failure. A polychotomous logistic regression analysis was performed. Median follow-up time was 127 months. RESULTS: At 8 years, patients with close margins and those with negative margins both had a rate of local recurrence (LR) of 7%. Patients with extensively positive margins had an LR rate of 27%, whereas patients with focally positive margins had an intermediate rate of LR of 14%. In the polychotomous logistic regression model, margin status and the use of systemic therapy were the only two variables that had significant effects on the risk ratio of LR to remaining alive and free of disease. Among the 45 patients with focally positive margins who received systemic therapy, the crude LR rate was 7% at 8 years (95% confidence interval, 1% to 20%). CONCLUSION: Pathologic margin status and the use of adjuvant systemic therapy are the most important factors associated with LR among patients treated with breast-conserving surgery and radiation therapy.

The Analysis of Preoperative Wire Localization in Breast Conserving Surgery and Predictors of Surgical Margin Status

2021 ◽  
Vol 104 (10) ◽  
pp. 1617-1625
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Tumor Resection ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Positive Surgical Margin ◽  
Architectural Distortion ◽  
Wire Localization ◽  
Large Tumor

Background: At present, the breast conserving therapy (BCT) is considered a treatment of choice for early-stage breast cancer. BCT aims to achieve complete tumor resection with adequate margin and offers better cosmetic outcome. Objective: To describe the experience with preoperative wire localization technique for early breast cancer and analysis of factors affecting positive margin status. Materials and Methods: The authors retrospectively reviewed 190 patients with 206 malignant breast lesions treated by breast conserving surgery (BCS) after mammographic- or ultrasound- guided wire localization. Patient age, lesion type such as mass, mass with calcifications, calcifications alone, and architectural distortion, BI-RADS assessment categories, size, location, modalities of imaging guidance, number of wires used, radiological and surgical margin status, pathological diagnosis, and tumor focality were recorded. Results: A 14.56% of positive surgical margin rate was observed. Mixed-effects logistic regression analysis showed larger lesion size was a significant predictor for positive surgical margin status at larger than 1.5 cm versus 1.0 cm or smaller (p=0.033). Conclusion: The present study data suggested that larger tumor size is the only significant predictor for positive surgical margin status. To deal with non-palpable large tumor, surgeon and radiologist should pay particular attention to achieve adequate surgical margin. Keywords: Wire localization; Breast conserving surgery; Surgical margin status; Specimen radiography

scholarly journals Breast Conservation in Breast Cancer: A Bangladesh Experience

2019 ◽  
Vol 19 (2) ◽  
pp. 55-60
Author(s):  
Parveen shahida Akhtar ◽  
Syeeda Hasina Azam ◽  
Syed Khalid Hasan ◽  
Zafor Mohammad Masud ◽  
Nazrina Khatun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Local Recurrence ◽  
Hormone Therapy ◽  
Distant Metastasis ◽  
Locally Advanced ◽  
Breast Conserving Surgery ◽  
Breast Conserving Treatment ◽  
Free Survival

Background: Breast cancer is one of the most common cancers in Bangladeshi women. Breast sacrificing treatment is still now the common practice in our country. Now a day’s breast conservative treatment is the standard treatment of breast cancer without compromising the survival. Objective: To observe local recurrence and distant metastasis free survival and overall survival of patients with breast cancer. Methods: Between January 1996 and December 2010, breast conserving treatment was carried out in 237 female patients with breast cancer in different Institutions of Bangladesh. Clinical staging was recorded by physical examination, relevant investigations as well as surgical records. Revised breast conserving surgery was carried out in those who had positive surgical margins or palpable disease. The patients with large but operable cancer or locally advanced cancer were treated by neoadjuvant chemotherapy followed by breast conserving surgery. Systemic adjuvant therapy (chemotherapy and or hormone therapy) and adjuvant radiotherapy were given in all patients. After completion of treatment, the patients were followed up with a standard protocol and data were compiled and analysed. Results: Among 237 patients who underwent breast conserving therapy 13 patients were excluded from the study for various reasons. Total 224 female patients with breast cancer who followed all the treatment schedules and attended for regular follow up were included in the study. They were between 22- 74 years of age, mean age 42.35 years; premenopausal 152 (68%). Sixty five percent (146 patients) was localized cancer (T1-2N0M0), 31.6% was regional cancer (T1-3N1M0), five cases were locally advanced stage (T4bN12M0) and two metastastatic cancer (T2-3N1M1).  All most all (98%) were Infiltrating duct cell carcinoma except four which were Intraductal carcinoma in situ (IDIS).  Estrogen and progesterone receptors were positive in 57% , HER2 positive (+++) in 24% of Patients. Lumpectomy/quandrentectomy with/without axillary clearance was done in 158 patients, revised breast conserving surgery in 53 cases, mastectomy in 8 cases and only biopsy done but no surgical treatment in five cases.Chemotherapy was given in 192 patients (86%); adjuvant 122 cases and neoadjuvant 70 cases. Hormone therapy in 182 patients. Radiotherapy: in 222 cases. Follow up period  was 4 years  to 19 years, median 10 years. Overall survival (OS) and disease free survival (DFS) was 84% and 70% respectively. Local recurrence occurred in 14(6%) cases and distant metastasis in 54 cases (24%). Conclusion: Breast conserving treatment was satisfactory for appropriate case selection and optimized therapy. Survival was no way worse than breast sacrificing treatment. Journal of Surgical Sciences (2015) Vol. 19 (2) : 55-60

scholarly journals Local Recurrence after Breast-Conserving Surgery and Mastectomy Following Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer - a Meta-Analysis

Breast Care ◽  
2016 ◽  
Vol 11 (5) ◽  
pp. 345-351 ◽  
Author(s):  
Xiaodong Zhou ◽  
Yujie Li
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced Breast Cancer ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Breast Conserving Surgery ◽  
Recurrence Rates ◽  
Significant Difference ◽  
Mastectomy Group

Background: Breast-conserving surgery (BCS) in patients with large tumors shrunk by neoadjuvant chemotherapy (NCT) remains controversial. We conducted a meta-analysis to evaluate the local recurrence rates in locally advanced breast cancer (LABC) patients receiving NCT comparing BCS with mastectomy. Methods: Pubmed, Web of Knowledge, and Ovid's database were searched for studies concerning treatment for LABC from January 2000 to June 2015. A meta-analysis was performed to compare the recurrence rates of patients receiving BCS versus mastectomy following NCT. Results: 8 trials with a total of 3,215 patients were analyzed. The prevalence of local recurrence was 9.2% in the BCS group versus 8.3% in the mastectomy group without significant difference (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.28-1.48; p = 0.66). The 5-year local recurrence-free survival (LRFS) rate was lower in the mastectomy group than in the BCS group, but no significant difference was found between the 2 groups (OR 1.11, 95% CI 0.61-1.99; p = 0.74). Conclusion: BCS after NCT is safe in terms of local recurrence and LRFS in LABC women. Shrinking tumors with NCT provides the opportunity to apply BCS with no detriment to outcome.

The effect of margin status on local recurrence following breast conservation and radiation therapy for DCIS

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 597-597
Author(s):  
M. R. Kell ◽  
C. Dunne ◽  
C. Canning ◽  
M. Morrow
Keyword(s):  
Local Recurrence ◽  
Randomized Trials ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Surgical Margins ◽  
Significant Difference

597 Background: There is no consensus on what constitutes an adequate surgical margin in patients receiving breast conserving surgery (BCS) and postoperative irradiation (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncological benefit. Methods: A comprehensive search for published trials which examined outcomes after adjuvant RT following BCS for DCIS was performed using medline and cross referencing available data. Reviews of each study were conducted, and data were extracted. Fixed and random effects methods were used to combine data. Primary outcomes were in breast tumour recurrence (IBTR) related to surgical margins. Results: Analysis of 3,606 patients from randomized trials confirms that patients with negative margins are significantly less likely to recur than those with positive margins after RT (RR 0.53, 95% CI= 0.42 to 0.66, p<0.01). Combined data from randomized and non randomized trials, of 5,500 patients, demonstrates that where the margin status is close or unknown there is significant risk of IBTR compared to a negative margin (RR=1.68, 95% CI= 1.22–2.33, p<0.01). When specific margin thresholds are examined a 2 mm margin is superior to less than 2 mm (OR=0.67, 95% CI 0.51 -0.89, p<0.01), however we saw no significant difference in the rate of IBTR between a 2 mm margin and >5 mm (OR=1.49, 95% CI 0.54 to 4.9, p>0.05). Conclusions: Surgical margins negative for DCIS should be obtained following BCS for DCIS. A margin threshold of 2mm appears be as good as a larger margin when BCS for DCIS is combined with RT. No significant financial relationships to disclose.

scholarly journals Effect of LigaSure™, Monopolar Cautery, and Bipolar Cautery on Surgical Margins in Breast-Conserving Surgery

Breast Care ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 194-199 ◽  
Author(s):  
Ahmet Türkan ◽  
Gökhan Akkurt ◽  
Metin Yalaza ◽  
Gürkan Değirmencioğlu ◽  
Mehmet Tolga Kafadar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Thermal Damage ◽  
False Negative ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Bipolar Cautery ◽  
Tissue Sections ◽  
Significant Difference ◽  
Lumpectomy Specimen

Background: We compared the differences in thermal damage at the surgical margin between monopolar cautery, bipolar cautery, and LigaSure™ in breast cancer lumpectomy specimens and assessed the effect of these techniques on the evaluation of the surgical margins. Methods: 30 patients scheduled for breast-conserving surgery for breast cancer were included in this study. During lumpectomy, each of the superior, inferior, lateral, and medial borders of the tumour was excised using one of the following: a scalpel, monopolar cautery, bipolar cautery, and LigaSure technology. The surgical margins of frozen and paraffin-embedded tissue sections of the lumpectomy specimen were evaluated. Thermal damage was defined as the maximum depth of thermal damage (in mm) from the surgical margin, and the level was categorized as none, low (≤1 mm), or high (>1 mm). Results: There was no statistically significant difference between monopolar cautery, bipolar cautery, and LigaSure in terms of thermal damage. There was no thermal damage at the surgical margin in tissues dissected by scalpel. Conclusion: Thermal damage due to the excision method may cause false-negative and false-positive results in the surgical margin evaluation of lumpectomy specimens. More research is needed on the effects of different energy modalities on surgical margin evaluation in breast-conserving surgery.

Preoperative Chemotherapy in Primary Operable Breast Cancer: Results From the European Organization for Research and Treatment of Cancer Trial 10902

2001 ◽  
Vol 19 (22) ◽  
pp. 4224-4237 ◽  
Author(s):  
Jos A. van der Hage ◽  
Cornelis J.H. van de Velde ◽  
Jean-Pierre Julien ◽  
Michelle Tubiana-Hulin ◽  
Cecile Vandervelden ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Preoperative Chemotherapy ◽  
Breast Conserving Surgery ◽  
Operable Breast Cancer ◽  
Postoperative Chemotherapy ◽  
Phase Iii ◽  
Cancer Trial ◽  
Free Survival ◽  
Significant Difference ◽  
Primary Operable Breast Cancer

PURPOSE: To evaluate whether preoperative neoadjuvant chemotherapy in patients with primary operable breast cancer results in better overall survival (OS) and relapse-free survival rates and whether preoperative chemotherapy permits more breast-conserving surgery procedures than postoperative chemotherapy. PATIENTS AND METHODS: Six hundred ninety-eight breast cancer patients (T1c, T2, T3, T4b, N0 to 1, and M0) were enrolled onto a randomized phase III trial that compared four cycles of fluorouracil, epirubicin, and cyclophosphamide administered preoperatively versus the same regimen administered postoperatively (the first cycle administered within 36 hours after surgery). Patients were followed up for OS, progression-free survival (PFS), and locoregional recurrence (LRR). RESULTS: At a median follow-up of 56 months, there was no significant difference in terms of OS (hazards ratio, 1.16; P = .38), PFS (hazards ratio, 1.15; P = .27), and time to LRR (hazards ratio, 1.13; P = .61). Fifty-seven patients (23%) were downstaged by the preoperative chemotherapy, whereas 14 patients (18%) underwent mastectomy and not the planned breast-conserving therapy. CONCLUSION: The use of preoperative chemotherapy yields similar results in terms of PFS, OS, and locoregional control compared with conventional postoperative chemotherapy. In addition, preoperative chemotherapy enables more patients to be treated with breast-conserving surgery. Because preoperative chemotherapy does not improve disease outcome compared with postoperative chemotherapy, future trials should involve quality-of-life studies to investigate whether patients will benefit from this treatment modality.

scholarly journals Breast Cancer Survival in Sri Lanka

2020 ◽  
pp. 589-599
Author(s):  
Jayantha Balawardena ◽  
Thurairajah Skandarajah ◽  
Wasantha Rathnayake ◽  
Nuradh Joseph
Keyword(s):  
Breast Cancer ◽  
Sri Lanka ◽  
De Novo ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Breast Conserving Surgery ◽  
Free Survival ◽  
End Point ◽  
Localized Disease ◽  
Clinical Records

PURPOSE In this study, we report survival data of the largest cohort of patients with breast cancer in Sri Lanka. PATIENTS AND METHODS All female patients with histologically confirmed breast cancer treated at a single unit at the National Cancer Institute of Sri Lanka between 1994 and 2006 were included in the study. Clinical records were reviewed and data obtained on the following clinical and pathologic factors: age, histology, stage at presentation, grade, and immunohistochemistry profile. Treatment details such as type of surgery and use of systemic chemotherapy, hormonal therapy, trastuzumab, and radiation therapy were also collected. In localized cancer, disease-free survival (DFS) was the primary end point, while in patients who presented with de novo metastases, progression-free survival (PFS) was the primary end point. RESULTS A significant proportion of patients presented with de novo metastases (14%) and locally advanced disease (18%). While 57% of patients had hormone-sensitive tumors, human epidermal growth factor receptor 2 overexpression was seen in 14%, and 29% had triple-negative tumors. Only 3% of patients with localized disease were treated with breast-conserving surgery, with the rest undergoing modified radical mastectomy. The 5- year DFS rate was 71.6% (95% CI, 69.2 to 74.0) in patients with localized disease. The median PFS in patients with metastatic disease was 20 months (95% CI, 18 to 22 months), while the median overall survival was 30 months (95% CI, 32 to 35 months). On multivariable analysis, immunohistochemical group and stage were prognostic factors in localized disease, while in patients with metastases, immunohistochemical group and tumor grade were associated with PFS. CONCLUSION More effective screening and early detection programs along with increasing breast-conserving surgery will improve breast cancer outcomes in Sri Lanka.

scholarly journals Impact of the line of treatment on progression-free survival in patients treated with T-DM1 for metastatic breast cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Migeotte ◽  
V. Dufour ◽  
A. van Maanen ◽  
M. Berliere ◽  
J. L. Canon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Growth Factor Receptor ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Prior Treatment ◽  
Her2 Positive ◽  
Free Survival ◽  
Significant Difference

Abstract Background Trastuzumab emtansine (T-DM1) is indicated as second-line treatment for human epidermal growth factor receptor 2 (HER2)-positive metastatic or unresectable locally advanced breast cancer, after progression on trastuzumab and a taxane-based chemotherapy. We wished to determine if the line of treatment in which T-DM1 is administered has an impact on progression-free survival (PFS) and in particular, if prior treatment with capecitabine/lapatinib or pertuzumab modifies PFS of further treatment with T-DM1. Patients and methods We performed a multicenter retrospective study in 3 Belgian institutions. We evaluated PFS with T-DM1 in patients treated for HER2 positive metastatic or locally advanced unresectable breast cancer between January 1, 2009 and December 31, 2016. Results We included 51 patients. The median PFS was 9.01 months. The line of treatment in which T-DM1 (1st line, 2nd line, 3rd line or 4+ lines) was administered had no influence on PFS (hazard ratio 0.979, CI95: 0.835–1.143). There was no significant difference in PFS whether or not patients had received prior treatment with capecitabine/lapatinib (9.17 vs 5.56 months, p-value 0.875). But, patients who received pertuzumab before T-DM1 tended to exhibit a shorter PFS (3.55 months for T-DM1 after pertuzumab vs 9.50 months for T-DM1 without pretreatment with pertuzumab), even if this difference was not statistically significant (p-value 0.144). Conclusion Unlike with conventional chemotherapy, the line of treatment in which T-DM1 is administered does not influence PFS in our cohort of patients with advanced HER2-positive breast cancer.

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