RESUMO
BACKGROUND: Microinvasive breast cancer is an uncommon pathological entity. Owing to the rarity of this condition, its surgical axillary management and overall prognosis remain controversial. METHODS: A database was analysed to identify patients with microinvasive ductal carcinoma in situ (DCIS) who had surgery for invasive breast cancer at the European Institute of Oncology, Milan, between 1998 and 2010. Women who had undergone axillary staging by sentinel lymph node biopsy were included in the study. RESULTS: Of 257 women with microinvasive breast cancer who underwent sentinel lymph node biopsy (SLNB), 226 (87·9 per cent) had negative sentinel lymph nodes (SLNs) and 31 had metastatic SLNs. Twelve patients had isolated tumour cells (ITCs), 14 had micrometastases and five had macrometastases in sentinel nodes. Axillary lymph node dissection was performed in 16 of the 31 patients with positive SLNs. After a median follow-up of 11 years, only one regional first event was observed in the 15 patients with positive SLNs who did not undergo axillary lymph node dissection. There were no regional first events in the 16 patients with positive SLNs who had axillary dissection. CONCLUSION: Good disease-free and overall survival were found in women with positive SLNs and microinvasive DCIS. This study is in line with studies showing that SLNB in microinvasive DCIS may not be useful, and supports the evidence that less surgery can provide the same level of overall survival with better quality of life.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Axila/cirurgia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/cirurgia , Quimioterapia Adjuvante , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Itália , Estimativa de Kaplan-Meier , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Micrometástase de Neoplasia/patologia , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Estudos Retrospectivos , Medição de Risco , Análise de SobrevidaRESUMO
Breast-conserving surgery (BCS) followed by adjuvant whole breast radiotherapy (WBRT) is an established treatment for early-stage breast cancer. Long-term follow-up has demonstrated equivalent survival to mastectomy. However, standard WBRT to the conserved breast requires daily radiation treatment, 5 days per week, for 5-7 weeks. This schedule imposes a considerable burden on breast cancer patients and healthcare systems alike. For the last decade, there has been considerable interest in lessening the volume of breast treated with radiotherapy and reducing the number of fractions of radiation treatment. Accelerated partial breast irradiation (APBI), including intraoperative radiotherapy (IORT), delivers high-dose radiation immediately surrounding the lumpectomy cavity, with relative sparing of the majority of the ipsilateral breast. Hypofractionated WBRT delivers radiation to the entire ipsilateral breast; however, this is achieved using a smaller number of fractions and total dose of radiotherapy. The attraction of less invasive or demanding radiotherapy schedules has led to the widespread introduction of APBI before its long-term results have been established. In the past 5 years, data from prospective trials of hypofractionated WBRT and IORT compared to standard WBRT have become available. Additionally, a large, prospective randomized study of APBI versus WBRT is nearing accrual. In this review article, we will discuss these new innovative techniques in radiotherapy for breast cancer. We will also discuss the recently completed and ongoing prospective studies that will provide a robust evaluation of the safety and efficacy of these techniques.
