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

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.

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.

Clinical analysis of chemoradiation sequence for early breast cancer patients with conserving surgery / 中华放射医学与防护杂志

Objective To investigate the prognostic factors affecting early breast cancer patients with conserving surgery and discuss the influences of chemoradiation sequence on treatment efficacy.Methods We retrospectively analyzed 191 cases of early breast cancer after breast conservation surgery in the second hospital of Dalian medical university,from January 1,2006 to December 31,2015.According to the treatment order,they were divided into radiotherapy group,chemotherapy group and sandwich group.There were 32 patients in the radiotherapy group,107 patients in the chemotherapy group,and 52 patients in the sandwich group.The sandwich group was treated with chemotherapy-radiotherapy-chemotherapy.The factors were analyzed independently from the patients' age,menopausal status,pathology type,tumor size (T1,T2),axillary lymph node,molecular type of breast cancer,the interval between surgery and radiation,vascular tumor emboli.Regression model was used to find the risk factors of early stage breast cancer patients with conserving surgery.The 5-year LRR and 5-year OS was compared among radiotherapy-first group,chemotherapy-first group,the sandwich group in patients with high risk factors,and the factors associated with the prognosis of patients were analysed.Results The Multivariate Cox Regression model showed that tumor size,axillary lymph node,vascular tumor emboli,the interval between surgery and radiation were independent risk factors associated with 5-year OS.Among patients with T1 and T2 stage in radiotherapy-first group,chemotherapy-first group,sandwich group,there was no statistical difference in 5-year LRR or 5-year OS (P ＞ 0.05).Among patients with N0 stage in radiotherapy first group,chemotherapy first group,sandwich group,5-year LRR were not statistically different (P ＞ 0.05).For patients with N1 stage in chemotherapy-first group and the sandwich group 5-year LRR were with statistical difference(x2 =4.813,P =0.028).OS were without statistical difference (P ＞ 0.05).In patients with vascular tumor emboli in radiotherapy-first group,chemotherapy-first group,the sandwich group,5-year LRR were without statistical difference (5.3％,9.2％,vs.18.1％,P ＞ 0.05),OS were statistically different (61.5％,90.1％ vs.87.2％,x2 =6.282,P =0.043).For patients without vascular tumor emboli,there was no statistical difference in 5-year LRR (P ＞ 0.05).For patients started radiation within 6 months after surgery in radiotherapy-first group,chemotherapy-first group,the sandwich group,5-year LRR were without statistical difference (P ＞ 0.05).However,patients in chemotherapy-first group the time interval surgery and radiation ≤6 months vs.＞6 months 5-year LRR was 5.2％ and 14.1％ (x2 =4.886,P=0.027),5-year OS were 96.9％ and 85.7％ (x2 =5.758,P =0.038).Conclusions Clinical treatment is based on individualized options.For patients with negative axillary lymph nodes,but high risk factors for local recurrence,radiotherapy may be performed firstly.For high-risk patients with axillary lymph node metastasis or vascular tumor embolus,chemotherapy should be started early and radiotherapy may be followed,but not more than 6 months.

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.

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.

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.

Early stage squamous cell carcinoma of the pyriform sinus: A review of treatment options.

The purpose of this review of the literature was to present treatment options for early stage pyriform sinus cancer. Squamous cell carcinoma of the pyriform sinus, as the most frequent cancer arising from the hypopharynx, is rarely diagnosed in its early stage. Based on evidence from retrospective studies, conservation surgery and definitive radiotherapy are considered the available treatment modalities for patients presenting with stage T1 and T2 pyriform sinus carcinomas without clinical evidence of neck lymph node metastases, offering similar results with respect to disease control and functional organ preservation. Also, the high risk of occult metastatic nodal disease even in the earliest stage of pyriform sinus cancer entails elective neck dissection or elective neck irradiation to be considered mandatory. However, for patients with early stage pyriform sinus cancer, no level 1 study exists in which conservation surgery is compared with radiotherapy alone for the evaluation of local control or survival. Randomized multicenter controlled trials evaluating efficacy of conservation surgery and definitive radiotherapy, and correctly interpreting functional outcome for each of the treatment procedures examined are necessary to obtain sufficient evidence to influence the decision in the choice of the most effective treatment for early pyriform sinus cancer.

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.

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.

Conservation Surgery for Hypopharyngeal Cancer / 한양의대학술지

Hypopharyngeal carcinoma is a very aggressive cancer that is generally diagnosed at advanced stages and consequently has a poor prognosis and low survival rate. The treatment of these tumors is designed to cure the patient with the cancer and to preserve or restore physiologic function of the laryngo-pharyngeal complex as well. However, the need for extensive ablative surgery often coupled with radiation therapy renders many patients incapable of performing the basic human functions of swallowing and speech. Loss of such integral functions has a dramatically negative influence on the patients' quality of life, which has already been threatened by the aggressive nature of this disease. Therefore, it is imperative to use a reliable surgical strategy with low morbidity that will allow expedient restoration of speech and swallowing. Consequently, conservation surgery for hypopharynx carcinoma offers a wider resection with promising functional results in hypopharyngeal cancer patients. Recently several procedures were introduced for this purpose and we review the introduction and indications of those conservation methods in hypopharyngeal cancer surgery.

Clinical Analysis of Breast Cancer Patients Treated with Surgery / 한국유방암학회지

purpose: In Korea, the incidence of breast cancer is continuously increasing. Since 2001, breast cancer is the most common cancer in females.(1) Methods: We analyzed the clinical data of 323 breast cancer patients who were treated in department of surgery at Pusan National University Hospital between January 2001 and December 2002. Results: A total of 323 patients, 322 patients are female and 1 patient is male. The most common prevalent age was the fifth decades. The most common sign and symptom was a painless palpable mass. The most common tumor location was the left upper outer quadrant. The main preoperative histologic diagnostic methods were core needle biopsy (48.3%) and Fine Needle Aspiration (35.6%). Breast conservation surgeries were performed in 259 cases (80.2%), a modified radical mastectomy in 35 cases (10.9%), a radical mastectomy in 3 cases (0.9%), a simple mastectomy in 3 cases (0.9%) and other procedures in 23 cases (7.1%). According to the TNM staging system, the most common stage was stage IIA (121 cases, 37.4%). The most common pathologic type was invasive ductal carcinoma (273 cases, 84.6%). Axillary lymph node metastasis was present in 109 cases (33.7%). The most common distant metastasis site was the bone (12 cases, 3.7%). The average follow-up period was 22.3 months. 19 cases (5.9%) were recurred between 15 to 28 months after surgery. Their mean disease- free interval was 21.2months. During the follow-up, 4 patients died. Conclusion: In spite of the short follow-up period, this study shows that breast conservation surgery is a recommendable modality in breast cancer, in terms of recurrence rate, disease free survival, patient's satisfaction and cosmetics.

Clinical analysis on breast conservative therapy for 304 cases of breast cancer / 解放军医学杂志

Objective To analyze the clinical results and risk factors according to cause-specific survival and local recurrence rates for the patients with Ⅰ-Ⅱstage breast cancer after breast conservative therapy(BCT).Methods During Jun.1988 to Jun.2005,304 patients with Ⅰ-Ⅱstage breast cancer in the General Hospital of PLA underwent lumpectomy,axillary lymph node dissection and definitive irradiation.All patients received adjuvant chemotherapy.The patients with positive estrogen hormone receptors received orally tamoxifen administration.The median follow up was 8.1 years.Results For all the patients,the total 5-year survival rate,cause-specific survival rate and local recurrence-free survival rate were 92.58%,93.46% and 86.26%,respectively.And the total 10-year overall survival rate,cause-specific survival rate and local recurrence-free survival rate were 85.29%,88.27% and 77.75%,respectively.The 5-year and 10-year local recurrence rates were 5.5% and 11.7%,respectively.The univariate and mutivariate analyses revealed that the age(4)were the risk factors according to cause-specific survival rates.The age(

Characteristics of Clinically Occult Breast Carcinoma

BACKGROUND: Early detection of breast cancer is important because it can reduce morbidity and mortality. Mammography is widely used for clinical and screening purposes and was contributed to the early detection of breast cancer, even tumors less than 1 cm in size and microcalcifications without lumps. METHODS: We retrospectively analyzed the clinical records of 340 patients with clinically evident breast cancer and 55 patients with clinically occult breast cancer who were treated at the Department of Surgery, Samsung Medical Center. Preoperative mammography, ultrasonography, and cytology, as well as operative method and postoperative pathology, were compared to evaluate the clinical features of clinically occult cancer. Preoperative marking was performed in suspected lesions by means of hookwire insertion or, in case of breast conservation surgery, by means of tattooing. RESULTS: Based on mammography, malignancy was suspected in 39 out of 42 cases (92.8%). Micro calcifications were seen on the mammography in 19 patients (45.2%), a mass in 17 (40.5%), a mass with microcalcifications in 4 (9.5%), and an asymmetric increased density in 2 (4.8%). Microcalcifications were major findings in comparing with clinically evident cases (16.9%) (p=0.001). Ultrasonography detected a malignancy in 10 patients (76.9%) and a core biopsy under ultrasonography was performed in 9 of them. Among the 39 patients with a mammographically suspected malignancy, a stereotactic core biopsy was performed in 12 patients, an ultrasonography-guided core biopsy in 9, fine needle aspiration cytology in 10, and localization & excisional biopsy in 3; the remaining 5 cases underwent surgery without additional evaluation. Breast conservation surgery was performed in 23 patients (41.8%) and modified radical mastectomy in 31 (56.4%). In the breast conservation surgery, 19 patients were localized by using mammographic needle localization and 4 patients by using ultrasonographically tattooing preoperatively. A ductal carcinoma in situ (DCIS) was more frequently found in the group with clinically occult breast cancer (10 patients, 18.2%) than in the group with clinically evident breast cancer (2.6%, p<0.001). Postoperative staging was earlier in patient with clinically occult cancers than in those with clinically presenting masses (p<0.001). CONCLUSION: By using mammography and ultrasonography, breast cancer can be diagnosed before it becomes palpable, and thus it can be treated with conservative surgical procedures.

Preliminary Result of Concurrent Chemotherapy and Radiotherapy in Stage I and II Breast Cancer Patients Treated with Breast Conservation Surgery

PURPOSE: Breast conserving surgery is increasingly performed in early stage breast cancer patients. A certain propotion of these patients are at substantial risk for systemic metastasis. However, there is no valid consensus about optimal sequencing of chemotherapy and radiation therapy. METHODS: We conducted a randomized prospective study to investigate whether concurrent chemotherapy and radiation therapy after breast conserving surgery are associated with increased toxicity. Fifty-seven patients with stage I or II breast cancer were randomly assigned to receive CMF chemotherpy either simultaneously with (n=37) or before (n=20) radiation therapy. RESULTS: Moist desquamation was the most common adverse effect which occurred in 46% (16/37) of the patients treated with concurrent chemotherapy and radiation therapy and 40% (8/20) of those treated with the sequential regimen. This difference between two groups was not statistically significant. Also the incidence of severe neutropenia (WBC<1,800) or abnormal elevation of liver enzymes was not influenced by the sequencing of the adjuvant therapies. Arm edema was observed in 2 patients of the concurrent group and in 2 patients of the sequential regimen. Two patients treated with the concurrent regimen did not complete 6 cycles of chemotherapy while only one patient treated with sequential regimen did not. The incidence of toxicity during chemotherapy was not altered by the timing of radiation therapy. CONCLUSION: Chemotherapy and radiation therapy can be given concurrently after breast conserving surgery in stage I or II breast cancer patients without increase in serious toxicity.

A Clinical Study of Extended-Conservation Surgery in Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The surgical goals of laryngeal cancer should not only be to preserve life but also to preserve laryngeal functions such as airway, aspiration prevention, and voice production. Classic, standard conservation laryngectomy such as horizontal supraglottic laryngectomy and vertical hemilaryngectomy has served well to those purposes but has the limits of resection. And so extended conservation laryngeal surgery was developed to extend surgical resection margin if we carefully select surgical indication. Our study was to determine the best surgical method according to the extent of tumor and evaluate the surgical outcome oncologically and physiologically in extended conservation laryngectomy. MATERIALS AND METHODS: Forty patients were treated with extended conservation surgery in laryngeal cancer at Department of Otorhinolaryngology, Head and Neck Surgery, at the Hallym university hospitals according to surgical algorithm invented by author (Young Min Kim, MD)from 1992 to 1998. They were reviewed retrospectively with respect to age, sex, endoscopic and radiologic evaluation, primary site, extended site, postoperative complications and results. RESULTS: Thirteen patients had glottic cancer, and were treated with extended vertical laryngectomy. Two patients showed recurrence at the primary site or neck nodes, one patient died due to other disease. Ten patients (76.9%)are alive without disease. Twenty-seven patients were supraglottic cancer. They treated with extended horizontal laryngectomy. Twenty patients (74.1%)are alive without disease. Three patients recurred at primary site or neck nodes. CONCLUSION: Extended conservation surgery was oncologically safe in both glottic and supraglottic cancer. Functional outcome was relatively satisfactory and so we could avoid total or near-total laryngectomy with careful evaluation of tumor extent.

Preliminary Result of Concurrent Chemotherapy and Rediotherapy in Stage I and II Breast Cancer Patients Treated with Breast Conservation Surgery / 한국유방암학회지

Breast conserving surgery is increasingly performed in early stage breast cancer patients. A certain propotion of these patients are at substantial risk for systemic metastasis. However, there is no valid consensus about optimal sequencing of chemotherapy and radiation therapy. We conducted a randomized prospective study to investigate whether concurrent chemotherapy and radiation therapy after breast conservation surgery are associated with increased toxicity. Fifty-seven patients with stage I or II breast cancer were randomly assigned to receive CMF chemotherapy either simultaneously (n=37) or before (n=20) radiation therapy. Moist desquamation was the most common adverse effect which occurred in 46% (16/37) treated with concurrent chemotherapy and radiation therapy while 8 patients (38%) treated with sequential regimen had the finding. Difference between two groups was not statistically significant. Incidence of severe neutropenia (WBC>1,800) or abnormal elevation of liver enzymes was also not influenced by sequencing of adjuvant therapies. Arm edema was observed in 2 patients of concurrent group and was observed in 2 patients treated with sequential regimen. Two patients treated with concurrent regimen did not complete 6 cycles of chemotherapy while one patient with sequential regimen did not complete. Incidence of toxicity during chemotherapy was not altered by timing of radiation therapy. In conclusion, chemotherapy and radiation therapy can be given concurrently after breast conservation surgery in stage I or II breast cancer patients without increase of serious toxicity.