Progress in local treatment of breast cancer: A narrative review / Evolução do tratamento local do câncer de mama: Revisão narrativa

Abstract The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the samemolecular subtypemay receive different individualized surgical treatments aimed atoptimizing systemic adjuvant therapy. With a view to retaining the gainsmade in diseasefree and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.

Resumo Este artigo discute o tratamento local do câncer de mama a partir de uma perspectiva histórica. Uma busca de artigos publicados em inglês foi realizada nas bases de dados Medline e EMBASE, sendo selecionados 40 artigos. Nos últimos 10 anos, vários ensaios clínicos controlados e randomizados sobre o tratamento local do câncer de mama indicaram que pacientes com o mesmo subtipo molecular podem receber diferentes tratamentos cirúrgicos individualizados como objetivo de otimizar a terapia adjuvante sistêmica. Pretendendo reter os ganhos obtidos na sobrevida livre de doença e na sobrevida global, as técnicas cirúrgicas avançaram progressivamente da cirurgia radical para mastectomias conservadoras, reduzindo sequelas, enquanto as terapias adjuvantes e neoadjuvantes contribuíram para o controle da doença, tanto em relação às metástases distantes quanto à recorrência local. Estudos atuais avaliam se a terapia futura contra o câncer de mama poderá até mesmo eliminar a cirurgia da mama e da axila por completo.

The influence of molecular classification of breast cancer on the safety of breast-conserving surgery / 中华肿瘤杂志

Objective@#To analyze the relationship between the breast cancer molecular classification and the prognosis of patients underwent breast-conserving therapy and to discuss the safety of the breast conserving surgery from the choice of operation in terms of breast cancer molecular classification.@*Methods@#Clinical data of 618 patients with breast-conserving therapy in Tianjin Medical University Cancer Institute and Hospital from August 2005 to August 2010 were analyzed retrospectively. According to the molecular classification when breast cancer was diagnosed, patients were subdivided into five groups, including Luminal A, Luminal B1, Luminal B2, HER-2-positive and Triple-negative. Clinicopathological characteristics and prognosis were compared among five groups and the influencing factors of local recurrence, distant metastasis and overall survival were analyzed.@*Results@#Among 618 patients, there were 148 cases Luminal A, 231 cases Luminal B1, 63 cases Luminal B2, 40 cases HER-2-positive and 136 cases Triple-negative. The age, family history, TNM stage, calcification, histological grade, pathological type and response to endocrine therapy of these 5 molecular types of breast cancer patients were significantly different (all P<0.05). The 5-year local regional recurrence-free survival rates of Luminal A, Luminal B1, Luminal B2, HER-2-positive and Triple-negative were 99.3%, 98.7%, 98.4%, 94.9% and 95.9%, respectively, without significant differences (P=0.104). The 5-year distant metastasis-free survival rates of these 5 types were 97.3%, 95.7%, 93.7%, 87.5% and 91.4%, respectively, with significant differences (P=0.013). Moreover, the 5-year overall survival rates of these 5 types were 98.6%, 97.8%, 98.4%, 92.5% and 95.6%, respectively, without significant differences (P=0.153). Multifactor analysis showed that radiotherapy (HR=0.036, P=0.049) and the number of lymph node metastases (HR=10.72, P=0.004) were independent factors of local recurrence of breast cancer patients underwent breast-conserving therapy. The age (HR=0.369, P=0.046), status of surgical margin (HR=5.486, P=0.007), number of lymph node metastases (HR=2.882, P=0.023) and molecular typing (HR=5.191, P=0.008) were independent factors of distant metastasis of above breast cancer patients. None of the factors were found to be independent factors of the overall survival of these breast cancer patients.@*Conclusions@#Breast conserving therapy does not increase the risks of local recurrence and death of HER-2-positive and Triple-negative breast cancer patients. Therefore, breast conserving therapy can be accepted by patients with HER-2-positive and Triple-negative breast cancer.

Feasibility of neoadjuvant chemotherapy combined with breast conserving surgery for breast cancer / 肿瘤

Objective: To investigate the feasibility of breast conserving surgery (BCS) for breast cancer after neoadjuvant chemotherapy (NAC). Methods: A retrospective analysis of 114 breast cancer patients who were confirmed by crude coreneedle histologic examination from January 2006 to December 2008 was conducted, including 21 patients of stage IIA, 69 patients of stage IIB and 24 patients of stage IIIA; 35 patients received NAC-BCS, and 79 patients received NAC-modified radical mastectomy (MRM) for breast cancer. The overall survival (OS) and progression-free survival (PFS) were followed-up. The relationships of family history of cancer, tumor size, lymph node metastasis, TNM stage, estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2, molecular type, postoperative radiotherapy, NAC and targeted therapy with PFS and OS were analyzed. Results: The median follow-up period was 78 months (range: 3-139 months). In NAC-BCS group, 10-year OS rates of stage II and stage IIIA patients were 96.8% and 100.0%, respectively, and the 10-year PFS rates were 93.5% and 75.0%, respectively. In NAC-MRM group, 10-year OS rates of stage II and stage IIIA patients were 86.4% and 70.0%, respectively, and the 10-year PFS rates were 78.0% and 60.0%, respectively. There were no significant differences in PFS (P = 0.091, P = 0.203) of stage II and stage IIIA patients. The cosmetic results showed a good rate of 85.7% (30/35) after BCS in NAC-BCS group. Univariate analysis showed that the tumor size was significantly correlated to DFS (P < 0.001). The response to NAC was significantly correlated to OS (P = 0.019). Multivariate analysis showed that tumor size was an independent prognostic factor of DFS in NAC-BCS group [hazard ratio: 2.537 (95% confidence interval: 0.916-6.485), P = 0.044]. Conclusion: NAC combined with BCS is feasible and can achieve a better cosmetic results and high quality of life in patients with breast cancer.

The clinical comprison on the influence of breast conserving operation and radical operation for the complica-tions and effective of patients with early stage breast cancer / 中国基层医药

Objective To discuss the application of breast surgery with radical surgery in the therapeutic effect and complications in patients with early breast cancer.Methods 110 early breast cancer patients with surgical treatment were randomly divided into two groups,each group in 55 cases,the control group was given radical surgical treatment,the observation group was given breast conserving operation,surgery were recorded in patients of the two groups.Results The results of the observation group showed operative incision length (4.02 ±1.15)cm,operation time (58.93 ±13.25)min,intraoperative blood loss (10.11 ±2.87)mLand length of hospital stay (10.74 ±2.17)d. The datas of control group showed surgical incision length (11.87 ±2.44)cm,operation time (95.72 ±26.78)min, intraoperative blood loss (85.27 ±14.28)mL and length of hospital stay (15.86 ±4.43)d,the differences were statistically significant (t =21.582,9.131,5.714,7.697,all P <0.05).Observation group occurred postoperative hand infection in 1 case,upper extremity edema in 2 cases,and no subcutaneous hemorrhage occurs.Control group had 6 cases of postoperative hand infection,10 cases of upper limb edema,and subcutaneous hemorrhage in 5 cases,the differences were statistically significant (χ2 =4.852,5.986,5.238,all P <0.05).3 months after operation,datas of observation group showed physiological state (54.18 ±6.28)points,psychological state (59.27 ±5.82)points,environmental conditions (68.45 ±7.68)points and social function (57.46 ±5.97)points.Physiological state of the control group after 3 month was (65.69 ±9.11)points,while psychological state was (68.31 ±7.33)points,environmental conditions was (78.17 ±10.54)points,social function was (68.77 ±7.15)points,the differences were statistically significant (t =7.714,7.163,5.527,9.004,all P <0.05).Conclusion Breast surgery application in patients with early breast cancer can shorten the operation time,reduce intraoperative bleeding and flow rate,shorten the length of hospital stay, reduce complications and improve postoperative quality of life,it is worth popularizing in clinical application.

Clinical efficacy of breast-conserving surgery combined with neoadjuvant chemotherapy for locally advanced breast cancer: A report of 81 cases / 解放军医学杂志

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with breast-conserving surgery for locally advanced breast cancer. Methods Eighty-one patients with locally advanced breast cancer were selected from those who were admitted into 309 Hospital of PLA from January 2009 to October 2013, consisting of 65 patients in stage III a and 16 in stage III b, and they were treated with neoadjuvant chemotherapy combined with breast-conserving surgery. The clinical efficacy [complete response (CR), partial response (PR), stable disease (SD) and progress disease (PD)] was observed during follow-up. Results All the patients were followed-up for 12-60 months with a median of 34 months. There were 12 CR patients (14.8%), including 4 with pathological complete response (4.9%), and 52 PR patients (64.2%), 17 SD patients (21.0%). No PD was observed. The overall response rate(ORR) was 79.0%(64/81). After follow-up for 12-60 months (median 34 months), distant metastasis to the lung, liver, meninges and bone occurred in 3 patients (3.7%, 3/81) and 1 of them died. Forty-eight patients received breastconserving surgery. The local recurrence rate was 6.3% (3/48). Assessment of cosmetic result was carried out in 48 patients who received breast-conserving surgery and comprehensive treatment for one year, and excellent results were obtained in 14.6% (7/48), good in 43.8% (21/48), and poor in 41.7% (20/48). Conclusions The therapeutic efficacy of locally advanced breast cancer is satisfactory by neoadjuvant chemotherapy and breast-conserving surgery. Standardization of excision and postoperative radiotherapy, systemic comprehensive treatment is the key to the success of the treatment.

A dosimetric study of supine and prone treatment setups for breast cancer patients after breast conserving surgery / 中华放射医学与防护杂志

Objective To compare the dosimetric differences of the targets and organs at risk (OARs) for early stage breast cancer patients receiving intensity modulated radiotherapy (IMRT) with supine or prone setups after breast conserving surgery.Methods After breast conserving surgery,15 left breast cancer patients with large and pendulous breasts were selected.Their planning CT images were acquired with supine and prone orientations respectively,based on which IMRT plans of 2 tangential fields were developed using the same optimization parameters.Treatment plans of the two setups were evaluated by comparing the target dose distribution,the doses and irradiated volumes of the heart,left lung,and right breast,and the monitor units (MUs).Results Superior conformal index (CI) was observed in the plans of prone setup than the supine cases (0.79 ± 0.05 vs.0.72 ± 0.04,W =138,P ＜ 0.01).The homogeneity index (HI) of prone positioning was also better than that of supine setup (1.09 ±0.01 vs.1.12 ± 0.02,t =-4.7,P ＜0.01).The planning target volume (PTV) receiving 95％ of prescribed dose (V95％),and the minimum doses (Dmin) of the prone cases were significantly higher than the supine patients (t =7.1,6.4,P＜0.01).Higher mean doses (D) were observed in prone cases (W=153,P＜0.01).The maximum doses (Dmax) of the supine plans were lower than the prone cases (t =-3.6,P ＜0.01).The right breast volumes receiving 5 Gy doses or higher (V5) were less in the supine cases than the prone plans (W=160,P ＜0.01).The heart volumes received no less than 30 Gy (V30),D of the heart,and the left lung volumes received higher than 20 Gy or 5 Gy (V20,V5) of the supine plans were significantly higher than the prone cases (W =133,120,120,P ＜0.01).No significant difference was observed on the MUs.Conclusions For cancer patients with large and pendulous breasts receiving IMRT after breast conserving surgery,prone setup leads to better homogeneity of target dose distribution,and reduces the doses and irradiated volumes of the heart and lungs.

Dosimetric study of tangential and multi-fields applied in the dynamic intensity modulated radiotherapy plans for breast cancer patients after breast-conserving surgery / 中华放射医学与防护杂志

Objective To compare the dosimetric differences of target and organs at risk (OAR) induced by the tangential and non-coplanar multi-fields used in the dynamic intensity modulated radiotherapy (IMRT) plans for breast cancer patients after breast-conserving surgery.Methods Forty patients with early-stage left breast cancer after breast-conserving surgery were included.Based on the CT anatomy of the same patient,dynamic IMRT treatment plans using two tangential fields,3,4 and 5 non-coplanar fields were designed respectively utilizing the same optimization objects.The plans were compared by means of target dose distribution,the doses and irradiated volumes of heat,left lung,right breast,and total monitor units (MUs).Results The conformal index (CI) and homogeneity index (HI) of planning target volume (PTV) in the plans using 4 and 5 fields were better than that using 2 fields (P ＜ 0.05).Maximum doses (Dmax) in PTV were significantly lower in the plans of 4 and 5 fields than of 2 fields (P ＜0.05).Yet the plans of 4 and 5 fields generated significant higher minimum doses (Dmin) in PTV than that of 2 fields (P ＜ 0.05).No significant difference was observed between plans of 2 or 3 fields.Across the four plans,the differences of right breast V5 (relative volume acquired at least 5 Gy of dose),heart V30,heart mean dose (D),left lung V20,V5 and D were not significant.Yet the disparities of total MUs were statistically significant (F =25.63,P ＜ 0.05).The least MUs were used by the 2 fields and the most MUs were observed in the 5-field plans.Conclusions Comparing with IMRT plans of 2 fields,using 4 or 5 non-coplanar fields can improve the target dose distribution without increasing OAR doses.As a tradeoff,more MUs are needed for multi-fields plans.

Efficacy and safety of breast-conserving therapy for ductal carcinoma in situ / 中华内分泌外科杂志

Objective To explore the efficacy of breast-conserving therapy of ductal carcinoma in situ (DCIS),and to evaluate its safety.Methods 54 patients with DCIS receiving breast-conserving therapy(the experimental group) and 49 patients with DCIS treated with mastectomy(the control group) in the First Affiliated Hospital of Wenzhou Medical College from Mar.2010 to Mar.2013 were retrospectively analyzed.The follow-up results of the 2 groups were analyzed in terms of the local recurrence,distant metastasis and the 3-year diseasefree survival(DFS).The efficacy and safety of breast-conserving treatment were evaluated.Results All patients were followed up for 5 months to 39 months,with the average of(22.3 ± 8.5) months.No local recurrence happened in the experimental group.There was 1 case of chest wall recurrence in the control group.One case in the experimental group and 2 cases in the control group had distant metastasis.DFS rate in the 2 groups was 100％ and 95.9％ relatively.No statistically significant difference was found between the 2 group in terms of the above items (P ＞ 0.05).Conclusion For DCIS patients,the difference between breast-conserving therapy and mastectomy surgery in the rate of local recurrence and distant metastasis was not significant.Breast-conserving therapy is safe for DCIS patients and should be further promoted.

Reconstruction of secondary breast deformity after breast conservative therapy / 中华医学美学美容杂志

Objective To explore the causes of secondary breast deformity after breast conservative therapy and its preventive methods.Methods 30 cases were selected from the patients with secondary breast deformity of more than 1 year after breast conservative therapy,and more than half a year after radiotherapy and chemotherapy,and no local recurrence and distant metastasis occurred.After cicatrectomy and contracture loose solution,different methods were used according to varying degrees of the secondary breast deformity to reconstruct and repair the deformity.Results Three reconstructive methods were conducted.Local mammary flaps were used in 7 patients,latissimus dorsi myocutaneous flap in 21 patients,and transverse rectus abdominal musculocutaneous flaps in 2 patients.The shape and feeling were satisfactory in 30 patients with reconstructive breasts,in which 23were excellent (76.7 ％),and 7 were good (23.3 ％).All the patients were followed-up for average 2.5 years,and they were survived without tumor recurrence.Conclusions The secondary breast deformity after breast conservative therapy could be effectively prevented,and successfully reconstructed and repaired with different procedure according to varying degrees of the secondary breast deformity.As a result,the shape and feeling of reconstructive breasts are satisfactory.

The clinical application of the intra-operative radiation for patients with breast cancer receiving breastconserving surgery / 肿瘤

Objective: To evaluate the safety and operablility of intra-operative radiotherapy plus post-operative whole breast radiotherapy instead of post-operative whole breast radiotherapy with a boost to the tumor bed in patients with early-stage breast cancer patients receiving breast-conserving surgery. Methods: A total of 30 patients with early-stage breast cancer were included in this study, and they received breast-conserving surgery plus intra-operative radiotherapy and post-operative whole breast radiotherapy (n = 15, study group) or breast-conserving surgery plus post-operative whole breast radiotherapy with a boost to the tumor bed (n = 15, control group). The clinical measurements including the external drainage of residual cavity in 24-48 h, first stage of wound healing, duration of hospitalization, satisfaction with breast shape and the interval between breast-conserving surgery and the chemotherapy were compared between the two groups. Results: There were no significant differences between the two groups in external drainage of residual cavity, first stage of wound healing duration of hospitalization and the interval between breast-conserving surgery and the chemotherapy (P >0.05). The short-term follow-up revealed that the patients in both two groups kept breast in good shape. Conclusion: Intra-operative radiotherapy is safe and operable in patients with early-stage breast cancer receiving breast-conserving surgery. Copyright © 2012 by TUMOR.

The effect of age on local recurrence of patients with breast cancer undergoing breast-conserving therapy / 肿瘤

Objective: This study was designed to evaluate the effect of age on local recurrence after BCT (breast-conserving therapy) in patients with breast cancer. Methods: The clinical records of 548 female patients with breast cancer undergoing BCT between January 2000 and December 2007 were analyzed retrospectively, and the follow-up of these patients was performed. The univariable and multivariabe analyses were conducted to evaluate the potiential factors related to local recuurence after BCT. Results: For 548 patients, the recurrence rate within 5 years after BCT accounted for 4.01% (22/548). There were statistical differences in local recurrence rate among different ages (< 45 years vs ≥ 45 years, P = 0.041), tumor sizes (T1 vs T 2 vs T3, P = 0.014) and histologic grades (grades I-II vs grade III, P = 0.003). The multivariable analysis displayed that the factors of younger age (< 45 years, P = 0.013) and higher histologic grade (grade III, P = 0.046) were independent factors in prediction of poor prognosis of breast cancer after BCT. Conclusion: Younger age (< 45 years) is a reasonable justification to consider more aggressive treatment to prevent local recurrence in patients with breast cancer after BCT. Copyright © 2012 by TUMOR.

Clinical observation of early breast cancer after breastconserving surgery and radiotherapy / 国际肿瘤学杂志

Objective To observe the oncololigcal and cosmetic outcomes and complication of breastconserving surgery and radiotherapy for early breast cancer. Methods A total of 78 early breast cancer patients, who were treated in the First People's Hospital of Pingdingshan between January 2001 and September 2008, were identified and followed. Among them, 36 were in stage Ⅰ and 42 in stage Ⅱ. Tangential irradiation was used with a dose of 50 Gy. Tumor bed received a boost dose of 10 Gy electron beam. For axillary lymph node-positive patients, ipsilateral supraclavicular field was hybrid irradiated with 50 Gy X and electron beam.Results The total follow-up ranged from 6 to 98 months. Local recurrence was observed among 4.9% of the patients. The 3-year and 5-year overall survival rate were 96.6% and 92.7% ,respectively. The breast cosmetic satisfaction rate was 94.9%. The main complications reported were acute skin reaction and upper limb edema.Conclusion Breast-conserving surgery and post-operative radiotherapy in early breast cancer patients can lead to satisfactory survival rates and cosmetic effects and hence improved life quality.

Factors Affecting the Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy in Patients with T1 and T2 Tumors / 한국유방암학회지

PURPOSE: Nearly half of all breast cancers are treated with breast conserving therapy (BCT). The purpose of this study was to identify the risk factors for ipsilateral breast tumor recurrence (IBTR) after BCT in T1 and T2 breast cancer patients. METHODS: The medical records of 294 T1 or T2 breast cancer patients who underwent BCT at Seoul National University Hospital between January 1998 and December 2002 were retrospectively reviewed. Kaplan-Meier curves and Cox proportional regression analysis were used to identify the significant clinicopathologic factors that influence IBTR. RESULTS: Among the 294 patients, 12 patients (4.8%) developed IBTR after a median follow-up of 82 months. Univariate analysis demonstrated that younger age (< or =35 year) had significant associations with IBTR (p=0.006). Tumor size, lymph node status, histologic grade, extensive intraductal component, lymphovascular invasion, and close resection margins were not significant factor associated with IBTR. The triple negative breast cancer subtype also did not have significant association with IBTR. Multivariate analysis showed that the younger age at diagnosis was a significant predictor of IBTR with a HR of 3.86 (p=0.036; 95% CI, 1.09-13.60). CONCLUSION: Younger age at diagnosis (< or =35) may be associated with an increased risk of IBTR in patients who underwent BCT.

Resultados preliminares da oncoplástica no tratamento conservador do câncer de mama / Preliminary results of oncoplastic surgery in breast conserving-therapy

A oncoplástica (OP) associa as técnicas de cirurgia plástica à cirurgia conservadora no tratamento do câncer de mama. O seu emprego na Europa tem sido cada vez mais difundido, mas ainda existem poucos trabalhos demonstrando seus resultados em nosso meio. Assim, o objetivo deste estudo foi avaliar os resultados oncológicos e estéticos preliminares da OP em 33 pacientes consecutivas submetidas à cirurgia conservadora de mama com remodelamento bilateral por meio de técnicas de OP no ano de 2004, no Serviço de Oncologia do Hospital Nossa Senhora das Graças, em Curitiba/PR. A média de idade das pacientes foi de 51 anos. O local da mama mais freqüentemente envolvido foi a união dos quadrantes superiores (30%), e a média do tamanho tumoral foi de 15 mm. O peso médio da ressecção cirúrgica foi de 89 g, e as margens foram negativas em 85% dos casos. A maioria das pacientes foi submetida à reconstrução empregando a técnica de mamoplastia baseada no pedículo inferior (36,4%). Os resultados estéticos foram considerados bons ou excelentes em 80% dos casos. Este estudo demonstrou que a OP é segura como procedimento oncológico e com resultados estéticos satisfatórios.

Oncoplastic (OP) surgery combines breast conserving-therapy (BCT) and plastic surgery techniques. This surgery is being diffused in Europe but there are few data concerning their results in Brazil. The aim of this study was to assess the oncological and aesthetical outcomes of a consecutive series of 33 early breast cancer patients who underwent to BCT and concomitantly bilateral plastic remodeling at Surgical Oncology Division, Hospital Nossa Senhora das Graças in Curitiba in 2004. The median age of the patients was 51 years. Superior quadrants were the most frequent involved local of the breast (30%), and the medium tumor size was 15mm. The mean volume of excised specimen was 89cc. Assessment of excision margins showed complete excision in 85% of the cases. The inferior pedicle was performed for the majority of breast reconstructions (36,4%). This study confirms that OP surgery is oncologically safe and aesthetically suitable.

Breast-Conserving Therapy of Early-Stage Breast Cancer(a Report of 31 Cases) / 中国医师杂志

Objective To investigate the principle and method of breast-concerving therapy of early-stage breast cancer.Methods The clinical data of 31 cases of early-stage breast cancer who were conserved breast were analysed retrospectively from January 1992 to April 2002. 14 cases performed wide lumpectomy plus axillary nodes dissection,5 cases performed wide lumpectomy, 11 cases performed lumpectomy and 1 case did not perform operation. After operation 17 cases received radiotherapy and chemotherapy,8 cases received only radiotherapy,3 cases received only chemotherapy and 3 cases did not receive radio-chemotherapy.Results Surviving time of all patients was 6 to 122 months.Mean surviving time was 32?5 months.Median of survival time was 22 months.Among 31 patients 1 case died of metastasis due to refusing chemotherapy,the other were alive now and 10 cases of all patients have survival over 3 years. Local recurrence was found in 1 case after 5 years,but he did not take chemotherapy and radiotherapy. Fairly good cosmetic outcome was obtained in 29 patients(93 5%).Conclusions It probably is ideal method that the wide lumpectomy plus axillary nodes dissection combines rationally with radiotherapy and chemotherapy in breast-conserving treatment of early- stage breast cancer.

Breast-conserving therapy of early stage breast cancer / 中国癌症杂志

To introduce the advances of breast-conserving therapy(BCT) of early stage breast cancer.Discussion of pathological and biological feature of breast cancer,equivalence between breast-conserving therapy and radical operation,skills in BCT,sentinel lymph node biopsy,relative factors of ipsilateral breast tumor recurrence(IBTR),postoperative radiotherapy,were emphasized.Usage of BCT will spread widely because of the increasing ratio of early stage breast and evolution of opinions of both the physicians and patients.

Advances in breast cancer clinical research / 中国癌症杂志

New theory, technology and drugs have stinulated clinical research of breast cancer. The typical method for early detection of breast cancer consisted of self examination, clinical breast examination by a health professional and mammography, both fiberoptic ductoscopy and ductal lavage cytology could be effective supplements. Sentinel lymph node biopsy is a potential means of avoiding axillary dissection in women with clinically negative axillary patients without influencing the survival. New drugs and regimes had improved complete response in neoadjuvant setting so as to further treatment. Breast conserving therapy with local excision and radiation is well established as an option in the treatment of localized breast cancer, but social and economic factors of the patients should be considered aside from pathological and clinical factors. It is evident that emphasis on early detection, systemic treatment as well as more limited surgery are the trend of breast cancer treatment today.

Treatment of locally advanced breast cancer with breast-conserving therapy after neoadjuvant chemotherapy: Report of 31 cases / 中国微创外科杂志

12 months postoperatively,and excellent results were obtained in 16.0% of the patients((4/25)),good in 40.0%(10/25),and poor in 44.0%(11/25). Conclusions For patients with locally advanced breast cancer previously treated with downstaging neoadjuvant chemotherapy,breast-conserving therapy offers satisfactory results.Strict adherence to technique and use of postoperative irradiation and systemic therapy are crucial to breast-conserving therapy.

Preliminary Results of Postoperative Radiotherapy after Breast Conserving Surgery in Early Breast Cancer / 대한암학회지

PURPOSE: To evaluate treatment results of breast conserving surgery and radiation therapy including survival rates, patterns of failure, and complication and to analyze prognostic factors. MATERIALS AND METHODS: Retrospective analysis was carried out for 111 (112 cases) consecutive patients with breast cancer treated by radiation therapy after breast conserving surgery from October 1994 to April 1997. The median follow up was 45 months (range 10~66). AJCC staging was as follows: 16 cases (14%) for ductal carcinoma in situ, 46 cases (41%) for stage I, 33 cases (30%) for stage IIa, and 17 cases (15%) for stage IIb. Radiation therapy after breast conserving surgery was delivered to whole breast with 50.4 Gy and additional 10 Gy electron beam boost to tumor bed. Adjuvant CMF or CAF chemotherapy was performed in 61 patients. RESULTS: Overall three- and five-year survivals were 99% and 95%, and progression-free survival were 93%, 87%, respectively. Treatment failure occurred in 11 cases (10%); loco-regional recur rence in six; distant metastasis in five. Univariate analysis showed prognostic factor affecting survival was only T-stage. Acute radiation dermatitis were found in five cases (4%), and chronic complications were found in five (4%); one case with amputation of nipple, two cases with lymphedema requiring rehabilitation therapy and two cases with symptomatic radiation pneu monitis requiring steroid therapy. CONCLUSION: Breast conserving therapy of early breast cancer including ductal carcinoma in situ showed high survival rates and low complications, and T stage was prognostic factor for survival. But further follow-up should be needed.

Experience with 132 Cases of Breast Conservation Surgery

Recently, "Breast Conserving Therapy" (BCT) in the early-stage breast cancer has spread rapidly in Korea, as is in western world. For the evaluation and the standardization of BCT in Korea, a randomized study of 132 patients with breast cancer who received BCT was performed. Of the 401 patients with breast cancer who were admitted to Yongdong Severance Hospital from Feb. 1991 to Jan. 1996, 116 patients with stage I/II breast cancer and 15 patients with ductal carcinoma in situ (DCIS) had BCT and 173 patients with stage I/II breast cancer received modified radical mastectomy (MRM). In order to evaluate the BCT, the clinicopathologic features, locoregional recurrence, distant metastasis, actuarial overall survival rate and disease-free survival rate were analyzed during the follow-up period (a minimum of 1 month, a maximum of 58 months and a mean of 32 months). The results are as follows : 1) Three out of the 116 BCT patients with stage I/II and 5 out of 173 MRM patients with stage I/II had locoregional recurrence. 2) For BCT, the actuarial overall survival rate was 94.9% and disease-free survival rate was 87.6%; however, for MRM, the actuarial overall survival rate was 96.6% and the disease-free survival rate was 83.9%. Hence, there was no statistically significant difference between BCT and MRM. 3) Patient with DCIS who had BCT experienced neither locoregional recurrence nor distant metastasis. 4) All patients were good to excellent in their cosmetic appearance. In conclusion, BCT can be a good alternative surgical treatment modality and can substitute for MRM with the patients with early-stage breast cancer, including DCIS, in Korea. However, further follow up study will be needed to assess the long term results.