Breast-conserving therapy for breast carcinoma: Margins, re-excision and recurrence rates

Abstract

IntroductionBreast cancer affects 1 million women in the developed world every year. 1 The burden of breast cancer is also on the rise in the developing world. According to Jones, 2 it is estimated that 70% of new cancer cases will occur in the developing world by the year 2020.Until the 1970s, the Halsted radical mastectomy had been the surgical procedure in the management of breast cancer irrespective of size. It was described and performed by William Stewart Halsted in 1882.3 It included the excision of the skin, the breast and underlying pectoralis muscles. Patients also underwent an axillary lymph node dissection. A skin graft was often used to close the wound defect. Patients were left with morbid disfiguring appearances.Modified radical mastectomy was shown to be as effectual as radical mastectomy and less mutilating. Modified radical mastectomy remains to be applicable to certain patients. However, breast-conserving therapy (BCT) has become the adopted procedure for the surgical management of early breast cancer. BCT refers to the surgical excision of the primary breast cancer tumour with a rim of normal breast tissue, followed by radiation therapy. It is also referred to in the literature as lumpectomy, partial mastectomy or segmental mastectomy. 4 Over the past 40 years, prospective large multicentre randomised controlled trials (RCTs) in Europe and United States have provided level 1 evidence that there is no statistically significant difference in the overall long-term survival between mastectomy and BCT in appropriately selected patients treated for early breast cancer.5 Although the overall long-term survival is similar between the two procedures, patients undergoing BCT are at a recognised risk of ipsilateral breast tumour recurrence. 6 The success rate of BCT relies upon appropriate patient selection, surgical technique and postoperative radiotherapy to eliminate microscopic tumour cells in the ipsilateral breast. The goals of BCT are therefore to resect the tumour with clear microscopic margins and to achieve acceptable cosmetic outcomes without compromising patient survival.Background: Breast-conserving therapy (BCT) is a wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer. There has not been a formal audit to review BCT outcomes in our unit.

Outcomes of breast conserving therapy: Recurrence, imaging findings and histological correlation

“… 3 , 38 This study determined a relative IBTR of 6.5% with a mean time to recurrence time of 34.4 months and is comparable to local and international recurrence rates which are reported as acceptable if between the 5% – 15% range. 1 , 11 , 14 , 16 , 19 …”

“…The recurrence rates post-BCT vary with an acceptable range of 5% – 15%, although some studies have reported higher and lower incidences. 8 , 9 , 10 , 11 , 12 , 13 Local studies performed at Groote Schuur Hospital in Cape Town showed a 5-year recurrence of 6.8% (median follow-up of 60 months) 14 with a smaller study conducted in Johannesburg reporting a 5.5% recurrence (median follow-up of 65 months). 15 Newer studies report significantly lower recurrence rates.…”

Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review

“…In eight of the 16 studies that reported oncoplastic breast surgery (OPBS) procedures, with a total of 764 patients, latissimus dorsi myocutaneous flap was specified as one of the techniques used, with a total of 112 (15%) patients receiving this procedure. 12,16,18,19,21,32,33 Only one study documented the Wise pattern mastopexy surgery, which was performed on 136 (18%) patients. 15 The level 1 oncoplastic surgery approach was performed on 91 (12%) patients, making it the third most prevalent procedure that was mentioned in the review.…”