Mobile app for patient education about breast cancer surgical treatment / Aplicativo móvel para a educação de pacientes sobre o tratamento cirúrgico do câncer de mama

Abstract Introduction: Breast cancer is a relevant public health problem with high incidence, morbidity and mortality. Patients experience a feeling of uncertain future, low self-esteem, fear of death and mutilation. In this situation, the rational absorption of information is compromised and technology can help. Objective: To develop and validate a mobile application (app) for patient education on the surgical treatment of breast cancer. Patient education in breast cancer helps set patients' preoperative expec-tations and satisfaction with the surgical experience and outcomes. Methods: The app was created in five stages: 1. analysis - situational diagnosis and integrative literature review; 2. design - planning and creation of didactic content; 3. development - definition of the app navigation; 4. implementation - configuration of tools and creation of an environment to download the app from the internet; 5. testing - application of usability, performance, compatibility, and functional tests. The developed app was validated by 13 doctors experienced in the treatment of breast cancer and 19 female breast cancer patients, using the Delphi technique. Results: Consensus was achieved, with an excellent overall content validity index of 1.00, both among the doctors and the patients in the first round of consultation. Conclusion: The app, named OncoMasto Cirurgia App, was developed after an integrative literature review, tested and validated for content by specialist doctors and by breast cancer patients, showing great agreement among the study participants.

Resumo Introdução: O câncer de mama é um relevante problema de saúde pública com alta incidência, morbidade e mortalidade. Os pacientes experimentam uma sensação de futuro incerto, baixa autoestima, medo da morte e mutilação. Nessa situação, a absorção racional de informações fica comprometida e a tecnologia pode ajudar. Objetivo: Desenvolver e validar um aplicativo móvel (app) para a educação de pacientes sobre o tratamento cirúrgico do câncer de mama. A educação do paciente em câncer de mama ajuda a definir as expectativas pré-operatórias e a satisfação dos pacientes com a experiência e os resultados cirúrgicos. Métodos: O app foi elaborado em cinco etapas: 1. análise - diagnóstico situacional e revisão integrativa da literatura; 2. design - planejamento e criação de conteúdo didático; 3. desenvolvimento - definição da navegação do aplicativo; 4. implantação - configuração de ferramentas e criação de ambiente para download do aplicativo pela internet; 5. testes - aplicação de testes de usabilidade, desempenho, compatibilidade e funcionais. O aplicativo desenvolvido foi validado por 13 médicos com experiência no tratamento do câncer de mama e 19 mulheres diagnosticadas com a doença, utilizando a técnica Delphi. Resultados: O consenso foi alcançado, com um excelente índice de validade de conteúdo geral de 1,00, tanto entre os médicos quanto entre as pacientes, na primeira rodada de consulta. Conclusão: O app, denominado OncoMasto Cirurgia App, foi desenvolvido após revisão integrativa da literatura, testado e validado quanto ao conteúdo por médicos especialistas e por pacientes com câncer de mama, apresentando ótima concordância entre os participantes do estudo.

Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome

Background: In clinical practice all cases of locally advanced breast carcinoma (LABC) warrant chemotherapy followed by multimodality care. Neoadjuvant chemotherapy (NACT) has been the mainstay in the management of LABC. The main aim of NACT is to downstage and prevent systemic micrometastasis early.Methods: This was a prospective study conducted on 36 diagnosed cases of stage III locally advanced breast cancer coming to the Dept. of Surgery, Dr. D. Y. Patil Medical College and hospital, Pune for a period of 2 years from 2017-2019. The effectiveness of neoadjuvant chemotherapy was assessed based on clinical, pathological and radiological response.Results: Among 36 LABC cases, maximum number of patients fell in the 41-50 years (41.6%) and presented in the Infiltrating ductal carcinoma group with a clinical stage IIIA disease. The response to NACT showed that a total of 12 patients (33.3%) showed complete clinical response and 30 patients were downstaged after neoadjuvant chemotherapy which was statistically significant. Only 4 out of the total 12 complete clinical responders went for Breast conservative surgery. Seroma formation was found to be the most common post-operative complication.Conclusions: LABC subjected to neoadjuvant chemotherapy based on taxanes/Anthracyclines show good clinical and radiological response. Patients preferred modified radical mastectomy due to the lack of awareness and low socioeconomic strata.The type of surgery did not increase  the chance of recurrence in the follow up period.

Male breast cancer a rare entity: the experience from North-East India

Background: Breast cancer is one of the most common malignancy among women but it is not common in men. Male breast cancer (MBC) is a rare disease and accounts for ∼1% of all cancers in men. There is lack of data related to MBC. The objective was to study the clinic-pathological characteristics and outcome of MBC patients at this institute.Methods: It is a retrospective study. Author analyzed clinico-pathological factors, management and follow up details of all patients with MBC from 2012 to 2018 at the cancer centre.Results: Total 20 patients were included in the study. No risk factor identified in any patient. The median age at diagnosis was 57.5 years. Most common location was central quadrant. Most common stage at presentation was stage 3. Fifteen patients underwent upfront surgery while neoadjuvant chemotherapy was given to two patients. One patient had complete pathological response (cPR). The median follow up was 24 months (4-60 months). Three patients developed local recurrence (3 chest wall and 1 axilla). Two patients developed distant metastasis (lung, liver and bone). Actual overall survival rate at 5 years was 67.5% with median disease-free survival was 55%.Conclusions: Multicentric trials are necessary to understand the predictive and prognostic markers and to improve the outcome in male breast cancer.

Adding bit of esthetics with science modification of batwing mastopexy for breast conservation in a young patient with giant fibroadenoma breast

A 19-year-old girl presented with a lump in her right breast and with a history of surgery for the similar complaint 3 years back. Ultrasound was suggestive of benign solitary lesion of size 16 cm × 10 cm. Core biopsy was suggestive of phyllodes tumor, and the histopathology report of previous surgery was also suggestive of phyllodes tumor. Wide excision of the tumor and reconstruction was done with batwing mastopexy and with a slight modification of the described technique so that to avoid contralateral reduction mammoplasty in a young unmarried girl. Postoperative histopathology was suggestive of fibroadenoma measuring 15 cm × 8 cm with all margins free of tumor, and it is probably one of the biggest fibroadenomas reported so far. On follow-up, no significant disparity noted between the appearances of both breasts

Does addition of postmastectomy radiotherapy improve outcome of patients with pT1-2, N0 triple negative breast cancer as compared to breast conservation therapy?

Background: Triple-negative breast cancers (TNBCs) form a heterogeneous group of cancers typically exhibiting an aggressive behavior resulting in increased risk of locoregional relapse (LRR) and distant metastases. The effect of radiotherapy on LRR risk and overall survival (OS) in women treated with mastectomy alone for early-stage TNBC remains unclear. Aim: The aim of this study is to compare the locoregional recurrence rate, disease-free survival (DFS), and OS following breast conservation therapy (BCT) or modified radical mastectomy (MRM) alone in women with stage I and IIA TNBC and to assess the impact of tumor and treatment-related factors. Materials and Methods: Patients with early-stage (pT1-2, N0) TNBC-treated between January 1, 2010, and December 31, 2011, were identified from the hospital-based registry records. The mean age was 48 years. Forty-nine patients underwent BCT, and 121 underwent MRM. The majority of the patients in both groups had T2 and grade 3 disease. None of the patients had margin positive status after surgery. Five patients had lymphovascular invasion (LVI). Results: At a median follow-up of 50 months (range: 4–83 months), there was no locoregional recurrence (LRR) in either arm. Eight patients relapsed, six developed distant metastases, and one patient each had a new primary in the contralateral breast and ovary. Two patients died of disseminated cancer, one each in the BCT and MRM groups. The five-year DFS was 95.8% and 91.1% for the BCT group and MRM group, respectively, (P = 0.83). The corresponding 5-year OS was 98% and 97.5% (P = 0.527). There was no statistically significant difference in outcome based on age, grade, LVI, or margin status between both groups. Conclusion: This retrospective analysis identified no statistically significant difference in outcome regarding LRR, DFS, or OS in patients treated without adjuvant radiation for women with pT1-T2N0 TNBC who underwent MRM in comparison to BCT

A single-center retrospective study on influence factors on surgical methods in DCIS patients / 中华内分泌外科杂志

Objective To evaluate the influence factors on surgical methods in DCIS (Ductal carcinoma in situ) patients,and the prognosis of different surgical methods in a 10-year single-center retrospective study.Methods We retrospectively included 1557 DCIS patients who received treatments in our center from Jan.2006 to Nov.2016.T tests,Chi-square analysis and logistic regression analysis were used to analyze influence factors on surgical methods.Kaplan-Meier and Log-rank analysis were used to evaluate recurrence-free survival(RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods.Results Of the enrolled 1557 DCIS patients,surgical methods included modified radical mastectomy,simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation).The number of DCIS cases in our center increased (P＜0.001),so did the percentage of DCIS in annual malignant surgery cases (P=-0.026).Significant decrease was found in modified radical mastectomy (P=0.012).More than half of the patients received simple mastectomy after 2010,and more than one fifth of the patients received breast conservation surgery after 2008.About 13.99％ patients who received mastectomy had breast reconstruction.The independent influence factors of refusing breast conservation surgery were age ≥ 50(P＜0.001),medium nuclear grade (P=0.044),tumor size ＞ 15mm (P＜0.001) and spontaneous discharge (P＜0.001).Patients with smaller tumor size (≤ 15mm) and no spontaneous discharge had 4.18-fold and 7.04-fold greater preference for breast conservation surgery,respectively(OR=0.232,P＜0.001;OR=0.144,P＜0.001).There were no significant differences in RFS and LRRFS in patients with different surgical methods.Conclusion The evaluation in trends and influence factors of different surgical methods provides basis on surgical precision medicine in DCIS patients.

Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study is to compare the treatment outcomes of breast conserving surgery (BCS) plus radiotherapy (RT) versus mastectomy for patients with pT1-2N1 triple-negative breast cancer (TNBC). MATERIALS AND METHODS: Using two multicenter retrospective studies on breast cancer, a pooled analysis was performed among 320 patients with pT1-2N1 TNBC. All patients who underwent BCS (n=212) receivedwhole breast RTwith orwithoutregional nodal RT,while nonewho underwent mastectomy (n=108)received it. All patients received taxane-based adjuvant chemotherapy. The median follow-up periods were 65 months in the BCS+RT group, and 74 months in the mastectomy group. RESULTS: The median age of all patients was 48 years (range, 24 to 70 years). Mastectomy group had more patients with multiple tumors (p < 0.001), no lymphovascular invasion (p=0.001), higher number of involved lymph node (p=0.028), and higher nodal ratio ≥ 0.2 (p=0.037). Other characteristics were not significantly different between the two groups. The 5-year locoregionalrecurrence-free, disease-free, and overall survivalrates of BCS+RT group versus mastectomy group were 94.6% versus 87.7%, 89.5% versus 80.4%, and 95.0% versus 87.8%, respectively, and the differences were statistically significant after adjusting for covariates (p=0.010, p=0.006, and p=0.005, respectively). CONCLUSION: In pT1-2N1 TNBC, breast conservation therapy achieved better locoregional recurrencefree, disease-free, and overall survival rates compared with mastectomy.

A new method for asses sing symmetry of breast / 中华内分泌外科杂志

Objective To compare a novel mirror-overlap method with the traditional manual measurement and the subjective assessment in assessing breast symmetry after oncoplastic surgery.Methods 59 patients with breast cancer who underwent conservation/reconstruction surgery were recruited.The post-operative assessment for breast symmetry was conducted using manual measurement,subjective assessment by the patient,their family member and a nurse,and the mirror-overlap method respectively.The latter method involved using the Photoshop to assess the area differences in breast outlines and shadows created by a flashlight when bilateral images were overlapped in the axis of midline.Results The distance differences between bilateral breasts measured using manual method were negatively correlated with symmetric coefficients in the mirror-overlap method (P＜0.05).There was a positive correlation between the average scores in the subjective assessment and symmetric coefficients of mirror-overlap method (P＜0.05).Conclusion The mirror-overlap method is an easy,feasible and cheap method which collects 3D breast information and provides an effective approach to assess breast symmetry after oncoplastic surgery.

External validation of IBTR! 2.0 nomogram for prediction of ipsilateral breast tumor recurrence

PURPOSE: IBTR! 2.0 nomogram is web-based nomogram that predicts ipsilateral breast tumor recurrence (IBTR). We aimed to validate the IBTR! 2.0 using an external data set. MATERIALS AND METHODS: The cohort consisted of 2,206 patients, who received breast conserving surgery and radiation therapy from 1992 to 2012 at our institution, where wide surgical excision is been routinely performed. Discrimination and calibration were used for assessing model performance. Patients with predicted 10-year IBTR risk based on an IBTR! 2.0 nomogram score of 10% were assigned to groups 1, 2, 3, and 4, respectively. We also plotted calibration values to observe the actual IBTR rate against the nomogram-derived 10-year IBTR probabilities. RESULTS: The median follow-up period was 73 months (range, 6 to 277 months). The area under the receiver operating characteristic curve was 0.607, showing poor accordance between the estimated and observed recurrence rate. Calibration plot confirmed that the IBTR! 2.0 nomogram predicted the 10-year IBTR risk higher than the observed IBTR rates in all groups. High discrepancies between nomogram IBTR predictions and observed IBTR rates were observed in overall risk groups. Compared with the original development dataset, our patients had fewer high grade tumors, less margin positivity, and less lymphovascular invasion, and more use of modern systemic therapies. CONCLUSIONS: IBTR! 2.0 nomogram seems to have the moderate discriminative ability with a tendency to over-estimating risk rate. Continued efforts are needed to ensure external applicability of published nomograms by validating the program using an external patient population.

Clinical characteristics and prognosis of patients with ipsilateral breast tumor recurrence after breast conservation therapy / 中华肿瘤杂志

Objective@#To analyze the clinical features and prognosis of the ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery.@*Methods@#From 1999 to 2013, 63 women with IBTR after breast conserving surgery were retrospectively reviewed. All patients had adequate information on tumor location both at first presentation and at recurrence, with or without regional recurrence or distant metastasis. The histologic changes between true local recurrence and elsewhere recurrence groups were compared. The local recurrence, the overall survival after IBTR (IBTR-OS), the disease-free survival after IBTR (IBTR-DFS) were also compared.@*Results@#All patients had undergone lumpectomy, including 38 cases with additional axillary lymph node dissection and 13 cases with sentinel lymph node biopsy. There were 11.3% (7/63) cases received neoadjuvant systemic therapy, 68.3% (43/63) had adjuvant radiotherapy, 60.3% (38/63) underwent adjuvant chemotherapy and 47.6% (30/63) received hormonal therapy. Forty-five cases (71.4%) had recurrence in the same quadrant, and 18 cases (28.6%) had elsewhere recurrence. Compared with histology at presentation, 10.3% of the patients (6/58) had different ones at recurrence and 28.9% of patients (13/45) had different molecular subtypes. The conversion rate of estrogen receptor status (33.3% vs 9.5%, P=0.012) and progesterone receptor status (56.3% vs 19.0%, P=0.005) in patients with elsewhere recurrence was significantly higher than that in patients with same quadrant recurrence. Fifty-nine cases had undergone surgery after IBTR, with 48 cases of secondary breast-conserving surgery and 11 cases of salvage mastectomy. The median time to IBTR of same quadrant recurrence and elsewhere recurrence groups were 26 months and 62 months (P=0.012), respectively. There were 84.4% and 44.4% cases who had local recurrence within 5 years after breast conserving surgery, respectively. Of all cases, the overall 5-year IBTR-OS and 5-year IBTR-DFS rates were 79.4% and 60.4%, respectively. There were no significant differences in 5-year IBTR-OS (77.4% vs. 83.6%, P=0.303) or 5-year IBTR-DFS (60.0% vs. 62.8%, P=0.780) between same quadrant recurrence and elsewhere recurrence groups. Univariate analysis showed that pN0-1 (P<0.001), luminal subtype (P=0.026), adjuvant endocrine therapy (P=0.007) at first presentation, recurrent tumor < 3 cm (P=0.036) and having surgery after IBTR(P=0.002) were favorable factors of IBTR-OS. pN0-1 (P<0.001) at first presentation, recurrent tumor stage Ⅰ-Ⅱ (P<0.001) and having surgery after IBTR(P=0.001) were favorable factors of IBTR-DFS. There was no significant difference between second breast-conserving surgery and salvage mastectomy in IBTR-OS and IBTR-DFS (P>0.05).@*Conclusions@#The IBTR after breast conserving surgery mainly occurred at the original quadrant. Second breast-conserving surgery did not affect patient′s prognosis. There were significant differences in biological features between the same quadrant recurrence and elsewhere recurrence, requiring different therapeutic strategies in the future.

Impact of different breast cancer surgery combined with intensity modulated radiation therapy on the living quality and sexual life of female patients / 局解手术学杂志

Objective To explore the impact of breast conservation surgery and modified radical mastectomy combined with intensity modulated radiation therapy respectively on the living quality and sexual life for patients with early-stage breast cancer.Methods From January 2011 to December 2016, 89 patients with breast cancer were admitted and divided into two groups according to different surgical methods.Patients in the conservation group (n=24) received breast conservation surgery combined with intensity modulated radiation therapy, while patients in the modified radical group (n=65) received breast radical surgery combined with intensity modulated radiation therapy.The quality of life and sexual satisfaction of patients were measured by questionnaire investigation.And the data were calculated by SPSS 16.0.Results Different surgical methods combined with radiotherapy affectted the score of living quality a lot.The average score was (87.500±7.940) points in the conservation group, while it was (65.350±8.490) points in the modified radical group, the difference was statistically significant (P<0.01).At the same time,the degree of self acceptance and sexual satisfaction in the conservation group after surgery was better than that in the modified radical group,and the difference was statistically significant (P<0.01).Conclusion Breast conservation surgery combined with intensity modulated radiation therapy for breast cancer patients could receive better quality of life and sexual satisfaction compared with modified radical mastectomy combined with intensity modulated radiation therapy.

An analysis of response to neo‑adjuvant chemotherapy in patients with locally advanced breast cancer with emphasis on pathological complete response.

CONTEXT: In India, most breast cancer women present at a locally advanced stage. Routine practice in majority of the cancer centers is to administer neo‑adjuvant chemotherapy (NACT) followed by loco‑regional treatment. Surgery is scheduled after 3 or 4 cycles. The patients who achieve pathological complete response (pCR) are expected do well. AIMS: The present study was conducted to analyze our results with NACT, to know pCR rate, to compare pCR rates among various subgroups and to determine the factors which predict pCR. SETTINGS AND DESIGN: The study was conducted in a tertiary care university affiliated cancer hospital in South India. SUBJECTS AND METHODS: All patients with non‑metastatic locally advanced breast cancer and agreed by the hospital tumor board to receive NACT were included. At each visit, response was assessed according to RECIST criteria. Re‑staging work up and mammography was done prior to surgery. STATISTICAL ANALYSIS USED: Chi square test was used to analyze categorical variables and uni and multivariate analysis were performed to determine the factors predicting pCR rates. RESULTS: A total of 84 patients received NACT. Median age was 46 years (ranged from 28 to 66), 46 patients were premenopausal. Totally 72 patients completed the full course before surgery. Clinical response was complete in 26, partial in 52 and 3 had local progression, one stable and two patient developed distant metastasis. Forty‑eight patients underwent modified radical mastectomy and breast could be conserved in 34 patients, pCR rate was 36%. CONCLUSIONS: Compared with historical controls particularly from India, we could achieve higher pCR rates.

Study on lobular involution of glands around breast cancer / 中华内分泌外科杂志

Objective To study lobular involution of tissues around breast tumor,and to assess the consistency of lobular involution of tissues from different parts of the breast.Methods 22 patients receiving breast conservation surgery in Breast Surgery Department of Peking Union Medical College Hospital from Dec.1 st,2010to Dec.1 st,2011 were collected.88 pieces of HE staining were measured in terms of lobular area and number of acini per lobular,and lobular involution was evaluated.Bivatiate correlation analysis was applied to explore correlation between lobular area and acini per lobular.ANOVA,crosstabs and reliability analysis were applied to explore involution consistency of different parts of breast (P ＜ 0.05).Results The average area of lobuli was (90 248.5 +56 909.4) μm2 and the number of acini was 25.68 ± 18.86 per lobular.The lobular area and number of acini were correlated with each other significantly(Pearson r =0.78,P ＜ 0.01).Involution status of different parts of breast had good consistency(for lobular area 19 cases showed no difference in ANOVA analysis and for lobular area/number of acini 18 cases showed no difference; Kappa coefficient =0.65; ICC =0.73).Conelusions Lobuli around breast tumor have comparatively poor involution,with big lobuli and large number of acini,which are correlated with each other.Involution status of different parts of a breast has good consistency.Biopsy from one site to evaluate involution extent of the whole breast is practicable.

Prognostic value of post-mastectomy radiation therapy in node-positive breast cancer patients treated with breast conservation therapy / 中国肿瘤临床

Objective:To evaluate the prognostic value of post-mastectomy radiation therapy (PMRT) in patients with axillary lymph node-positive breast cancer treated with breast conservation surgery and to establish the candidates for PMRT based on different pN stages and lymph node ratios (LNR). Methods:A retrospective analysis of the clinical data of the patients was conducted. The pa-tients had positive lymph nodes (n=152) between 1998 and 2007 and underwent breast conservation surgery. A comparison of the dis-ease-free survival (DFS) and overall survival (OS) rates was conducted based on LNR and pN staging and with PMRT as a prognostic factor. Results:A total of 152 cases were studied, of which 114 were pN1, 23 were pN2, and 15 were pN3. Among these cases, 114 had an LNR ranging from 0.01 to 0.20, 26 had an LNR from 0.21 to 0.65, and 12 had an LNR>0.65. Univariate analysis showed that the number of dissected lymph nodes, LNR, pN stage, estrogen and progesterone receptor status, and radiotherapy were the prognostic fac-tors for DFS and OS rates (P0.05). In the subgroup analysis, PMRT had significant effect on DFS and OS (P<0.05) in patients with pN1 and LNR<0.21. Conclusion:LNR is an independent prognostic factor in axillary lymph node-positive breast cancer patients treated with breast conservation surgery, and a candidate for PMRT should be established based on different LNR risks.

Meta-analysis of radiotherapy on triple-negative breast cancer after breast conservation surgery / 中华放射肿瘤学杂志

Objective To systematically evaluate the influence of radiotherapy on triple-negative breast cancer (TNBC) patients treated with breast conservation surgery.Methods Electronic databases including PubMed,Ovid,CBM,VIP and CNKI and seven journals in Chinese (including the Chin J Breast Cancer,Chin J Clin Oncol,Chin J Radiat Oncol,Chin J Cancer,Chin J Oncol,J Pract Oncol and Tumor)were searched.Clinical trials comparing survival rates of patients with TNBC and non TNBC treated with breast conservation surgery and radiotherapy were reviewed.The quality assessment and data extraction were performed by two reviewers independently.RevMan5.1 software developed by the Cochrane collaboration was used for Meta-analysis.The 5-year distant metastasis-free survival (DMFS),overall survival (OS) and local recurrence-free survival (LRFS) rates were the primary end points.Results Five trials including 2345 patients with breast cancer were included in this systematic review.417 patients had TNBC and 1928 patients had non TNBC.Meta-analysis showed that the 5-year DMFS and OS rates of patients with TNBC were lower compared with non TNBC (Z =5.29,P =0.000 and Z =3.35,P =0.001).There was no statistical significant difference in 5-year LRFS rate between patients with TNBC and non TNBC (Z =1.35,P =0.180).Conclusion Radiotherapy provides good local control for patients with TNBC after breast conservation surgery.

Breast conserving surgery for breast cancer: Single institutional experience from Southern India.

Context: In India, breast conservation rates vary anywhere from 11 to 34%. This is in contrast to western world where breast conservation rates exceed 70% for early breast cancer. Aims: The present study was conducted to analyze the results of breast conservation surgery (BCS) at our institute and compare with that of other facilities in world. Settings and Design: The study was a prospective, outcome analysis study. All patients who underwent BCS were included. Data pertaining to clinical, pathological characteristics and treatment related outcomes were recorded. Materials and Methods: The study comprised of retrospective collection of prospective data of 88 patients who underwent breast conservation treatment (BCT) till December 2009. Statistical Analysis Used: The statistical analysis included Kaplan-Meier survival analysis for disease-free (DFS) and overall survivals (OS), and univariate analyses to assess each prognostic factor separately using SPSS 16.0 for windows. Results: Most common tumor location was upper outer quadrant and most common histology was infiltrating duct carcinoma. Median age was 45 years. Eighteen patients received preoperative chemotherapy to conserve the breast. Pathological complete response (pCR) in this subgroup was 39%. Majority had node negative disease and 42 tumors were hormone receptor positive. Median follow-up was 49 months. Two patients developed isolated local recurrences which were salvaged surgically. Seven patients had systemic disease of which 5 had simultaneously failed locally. Overall 5-year DFS was 89 %. Conclusions: When given an option, patients with breast cancer do desire to conserve their breast.

The Impact of Local and Regional Recurrence on Distant Metastasis and Survival in Patients Treated with Breast Conservation Therapy / 한국유방암학회지

PURPOSE: We evaluated the effect of local recurrence (LR) and regional recurrence (RR) on distant metastasis and survival in patients treated with breast conservation therapy (BCT). METHODS: We analyzed 907 patients who were treated for invasive breast cancer between 1993 and 2006. With 53 months of follow-up, 28 patients (3.1%) developed LR in the breast and 12 patients (1.3%) developed RR before distant metastasis. LR and RR were separated into four patterns to determine the prognostic relevance of recurrence site and time to recurrence: LR within 3 years (early LR), LR after 3 years (late LR), RR within 3 years (early RR), and RR after 3 years (late RR). RESULTS: Early LR (hazard ratio [HR], 4.76; p=0.003) and early RR (HR, 18.16; p<0.001) were independent predictors of distant metastasis. In terms of overall survival, early LR (HR, 5.24; p=0.002), and early RR (HR, 18.80; p<0.001) were significantly related with poor survival. Patients with late LR/RR had a similar favorable prognosis compared with patients who never experienced LR/RR. CONCLUSION: The result suggests that time to LR/RR following BCT is a significant predictor developing a distant metastasis and surviving.

Cosmetic assessment of radiofrequency ablation combined with endoscopic breast conservation surgerv for treatment of early breast cancer / 中华医学美学美容杂志

Objective Radiofrequency ablation (RFA) and endoscopic breast conserving surgery (EBCS) has been developed as a potential means for treating breast tumors with minimal disruption to adjacent soft tissues.The purpose of this study was to evaluate the cosmetic outcomes of RFA assisted by EBCS on patients with early breast carcinoma (T1 -2 N0-1 M0).Methods Twenty-three patients with biopsy proven invasive breast carcinoma ( ≤3 cm in diameter),were treated with ultrasound (US)guided percutaneous-RFA for the local tumors followed by sentinel lymph node biopsy and endoscopic auxiliary node dissection and lumpectomy.The reactions to breast cosmetics were observed and compared to the conventional approaches using the breast asymmetry score for EBCS and a self -assessment questionnaire targeting objective and subjective data about treatment related breast change.Results Twenty-three patients were successfully treated with RFA.Complete coagulation necrosis of the tumor was visualized at US and mammography in 22 of 23 patients (95.6 ％).22 patients being per formed RFA and EBCS presented little scars and the breasts preserved more cosmetically acceptable than the reported results of traditional protocols.Self-assessment acceptable rate was 100 ％,aesthetic outcome as good or excellent rated in 95.5 ％(21/22).Within the follow-up of above 36 months,there were no local recurrence,metastasis,wound infection or necrosis,nerve damage,haematoma,as well as upper limb swelling or lymphoedema,no reduced upper limb mobility and tumor seeding.Conclusions RFA with endoscopic breast conservation therapy for the treatment of early breast carcinoma is more effective and cosmetically acceptable than the traditional approaches.

Quality of life among young women with breast cancer: Study from a tertiary cancer institute in south India.

Background : The incidence of breast cancer in young patients less than 35 years is less than 1%. The physical and psychosocial morbidity may affect their ability to successfully function in their social roles. Hence we studied the quality of life (QOL) issues in this subset. Materials and Methods :Younger women with age less than 35 years, diagnosed with non-metastatic breast cancer at our Institute, from 1995 to 2005, were included in the study. Quality of life issues were studied during the follow-up using EORTC QOL C30 and BR23. Descriptive and inferential statistics were used in order to analyze the data. Results : A total of 51 patients were included for the study. The mean age at diagnosis was 30 years. The effect of breast cancer on the occupation and marital status was minimal. The global health status and the functional scores were high, while the overall sexual function was lower. The global health status was higher in the mastectomy group. The arm symptoms (P = 0.027) and pain were higher in the Breast conservation surgery (BCS) group. The sexual symptoms appeared to be higher in the ovary ablated group when compared to the ovary preserved group. The sexual functional scores (P = 0.02) and sexual enjoyment scores (P = 0.003) were better in the mastectomy group. Conclusion : The overall QOL in younger patients with breast cancer appeared to be good. The QOL and sexual function were marginally worse in the breast conservation group when compared to mastectomy group.

APPLICATION OF PRE-OPERATIVE CHEMOTHERAPY COMBINED WITH BREAST CONSERVATION SURGERY FOR THE TREATMENT OF MIDDLE-ADVANCED BREAST CANCER / 现代医院

Objective To study the value of pre-operative chemotherapy combined with breast conservation surgery for the treatment of middle-advanced breast cancer.Methods The clinical efficacy and outcomes of breast conservation therapy in 100 patients with middle-advanced breast cancer received pre-operative chemotherapy were analyzed.Restuls Total efficacy, stadge decrease rate and breast conservation rate were 64%, 53% and 42% respectively. 31 patients received breast conservation therapy and there was no recurrence in following 3 years.Conclusion Breast conservation therapy after pre-operative chemotherapy in patients with middle-advanced breast cancer is safe and it can significantly improve the life quality of patients.