Factores asociados con la recidiva de cáncer de mama en pacientes con cirugía conservadora / Factors associated with breast cancer recurrence in patients with conservative surgery

Resumen OBJETIVO: Identificar los factores asociados con la recidiva de cáncer de mama en pacientes con cirugía conservadora. MATERIALES Y MÉTODOS: Estudio observacional, de cohorte retrospectiva, efectuado a partir de expedientes de pacientes con cáncer de mama en estadios tempranos e intervenidas con cirugía conservadora. Parámetros de estudio: estadio, subtipo histológico, perfil de expresión de receptores hormonales, tiempo de seguimiento, recidiva y periodo libre de enfermedad. La tasa de recidiva, el periodo libre de enfermedad y la identificación de los factores asociados con recidiva se hicieron con análisis estadístico. RESULTADOS: Se estudiaron 53 pacientes con edad media de 51.0 ± 9.4 años. El subtipo histopatológico más frecuente fue el ductal en 49 de las 53 pacientes; en 48 de ellas los tumores fueron positivos para receptores de progesterona, en 7 de 53 para Her-2 y en 3 de 53 triple negativo. La tasa de recidiva de cáncer de mama fue de 13.2% (es decir: 7 de 53 pacientes). El tiempo libre de enfermedad en quienes recayeron fue de 30.6 ± 24.8 meses. En el análisis bivariado se asociaron significativamente con recidiva: los ganglios linfáticos positivos, la expresión de receptores de progesterona y de estrógenos, los tumores triple negativo y el tratamiento complementario con quimioterapia. En el análisis multivariado solo se asociaron con recidiva: tener un tumor triple negativo (OR = 51.8; IC95%: 4.9- 548.4; p = 0.001) y recibir quimioterapia (OR = 8.0; IC95%: 1.4-46.1; p = 0.020). CONCLUSION: Los factores asociados con la recidiva fueron los ganglios linfáticos positivos, la expresión de receptores de progesterona y de estrógenos, tumores triple negativo y recibir quimioterapia.

Abstract OBJECTIVE: To identify factors associated with breast cancer recurrence in patients undergoing conservative surgery. MATERIALS AND METHODS: Observational, retrospective cohort study conducted on the records of patients with early-stage breast cancer who underwent conservative surgery. Study parameters: stage, histologic subtype, hormone receptor expression profile, follow-up time, recurrence and disease-free period. Statistical analysis was performed to estimate recurrence rate and disease-free period and to identify factors associated with recurrence. RESULTS: Fifty-three patients with a mean age of 51.0 ± 9.4 years were evaluated. The most common histopathologic subtype was ductal in 49 of 53 patients; tumors were progesterone receptor positive in 48, Her-2 positive in 7 of 53, and triple negative in 3 of 53. The breast cancer recurrence rate was 13.2% (i.e., 7 of 53 patients). Disease-free time in those who relapsed was 30.6 ± 24.8 months. In bivariate analysis, positive lymph nodes, progesterone and estrogen receptor expression, triple-negative tumors, and adjuvant chemotherapy were significantly associated with recurrence. In multivariate analysis, only having a triple-negative tumor (OR = 51.8; 95%CI: 4.9-548.4; p = 0.001) and receiving chemotherapy (OR = 8.0; 95%CI: 1.4-58.4; p = 0.001) were associated with recurrence. CONCLUSION: Factors associated with recurrence were positive lymph nodes, expression of progesterone and estrogen receptors, triple-negative tumors, and receipt of chemotherapy.

Preliminary observation of superficial brachytherapy for the upper arm skin invasion of breast cancer / 中华放射肿瘤学杂志

Objective To investigate the application of superficial brachytherapy in the treatment of the upper arm skin invasion of breast cancer. Methods This study was conducted on a female patient with ipsilateral chest wall, axillary, and clavicle recurrence, and circumferential skin and subcutaneous soft tissue invasion in the ipsilateral upper arm after modified radical mastectomy for breast cancer. The upper arm lesions were treated with 192Ir high-dose-rate superficial brachytherapy at a dose of 50 Gy in 25 fractions. Dosimetric parameters were compared between superficial brachytherapy and electron irradiation plan. Treatment outcomes and adverse reactions were observed during and after treatment. Results The heterogeneity index(HI)for target volume was 1.62 and 1.94 in superficial brachytherapy and electron irradiation plan, respectively. The D90,D100, and V150%for clinical target volume were higher in superficial brachytherapy than in electron irradiation plan(205 vs. 189 cGy;163 vs. 110 cGy;6.3% vs. 3.23%). The D0.1,D1, and D2for the humerus were also higher in superficial brachytherapy than in electron irradiation plan(155 vs. 80 cGy;147 vs. 55 cGy;145 vs. 36 cGy)and much lower than the bone tolerance dose in both treatments. The lesions partially subsided after superficial brachytherapy. The main adverse reaction was grade 2 radiation dermatitis. Conclusions Compared with electron irradiation plan, superficial brachytherapy is a simple and effective approach for irradiation of shallow target volume with a large curvature, such as circumferential upper arm skin invasion of breast cancer. Superficial brachytherapy achieves satisfactory homogeneity and dose distribution.

Secondary Partial Mastectomy with Contralateral Sentinel Lymph Node Biopsy for Ipsilateral Breast Cancer Recurrence after Conservative Surgery: Report of 2 Cases / 한국유방암학회지

Mastectomy has been known to be the best strategy for treating in patients with ipsilateral breast cancer recurrence (IBCR) after conservative surgery. For the cases with a small recurrent cancer which is found in the majority of cases on the regular check-up, the patients' desire for breast conserving surgery is increasing. Some recent studies have reported patients with IBCR might receive a second partial mastectomy, when a good local control can be predicted. It is not obvious that sentinel lymph node biopsy (SLNB) in the treated breast is feasible because the previous axillary dissection and/or irradiation may affected the pattern of lymphatic flow. Because of its high accuracy, SLNB may be safely performed for the patients with IBCR in the treated breast. Interestingly, there are reports that SLNB in this condition has revealed that the sentinel lymph node(s) can be found in the opposite side. We reported two cases in which contralateral SLNB were performed during the secondary partial mastectomy for the IBCR after breast conserving surgery.

A Case of Breast Cancer Recurrence Presenting as Dermatomyositis / 대한류마티스학회지

Dermatomyositis (DM) is an autoimmune disorder characterized by inflammatory muscular and cutaneous disease. DM may present before, during, or after the appearance of malignancies. There have been two reported cases of DM associated with breast cancer in Korea. But there is no reported case of DM associated primary cancer recurrence. We describe the first case of DM associated with breast cancer recurrence in Korea.A 50-year-old woman was admitted to our hospital because of proximal muscle weakness and multiple skin rashes. She had undergone a mastectomy, adjuvant chemotherapy and radiotherapy for left breast cancer 25 months ago and thereafter no physical or radiology evidence of recurrent breast cancer appeared clinically. She was finally diagnosed as having recurrent breast cancer with DM. This case emphasizes the importance of evaluation for recurrence of previous malignancy with newly developed DM patient.