Conservative Surgery and Radiation Therapy for Early Breast Cancer

Rose, Mary Ann; Olivotto, Ivo A.; Cady, Blake; Koufman, Clinton; Osteen, Robert T.; Silver, Barbara; Recht, Abram; Harris, Jay R.

doi:10.1001/archsurg.1989.01410020023002

Cited by 293 publications

(117 citation statements)

References 14 publications

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“…The general consensus of these and other studies is that 80% of patients develop a good to excellent result following BCT. [10][11][12] Despite the high level of cosmetic outcome following BCT, several factors found in these and other studies negatively influence outcome.…”

Section: Abstract: Reconstruction Breast Conservation Deformitymentioning

confidence: 76%

Reconstruction of the Breast Conservation Deformity

Slavin

Halperin

2004

Seminars in Plastic Surgery

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The era of breast conserving treatment of early-stage breast carcinoma has created reconstructive challenges for the plastic surgeon. Although good to excellent cosmetic outcomes occur in the majority of patients, a significant number could benefit from additional reconstructive measures. Because of the need for continuing surveillance following breast-conserving therapy, estimated at 5-10% after fifteen years, plastic surgeons should choose techniques that do not interfere with the detection of recurrent breast carcinoma. Myocutaneous flaps-in particular, the latissimus dorsi and transverse rectus abdominishave fulfilled the reconstructive needs of these patients by providing well-vascularized soft tissue. Postoperative radiological evaluation has demonstrated that these flaps are radiolucent, unlike breast implants that can obscure accurate mammographic interpretation.Myocutaneous flaps have been used for both immediate and delayed reconstruction of post-breast conservation deformities. The delayed approach offers the benefit of an established contour deformity that usually involves cutaneous, parenchymal, and nippleareolar components. Moderate overcorrection of the defect has been advocated in anticipation of ongoing postradiation wound contraction and fibrosis. Immediate reconstruction of lumpectomy and partial mastectomy defects permits wider initial excision of the breast lesion, but can be compromised by positive histological margins. Long-term results suggest stability of the aesthetic outcome following reconstruction of delayed deformities.

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Section: Abstract: Reconstruction Breast Conservation Deformitymentioning

confidence: 76%

Reconstruction of the Breast Conservation Deformity

Slavin

Halperin

2004

Seminars in Plastic Surgery

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“…When cosmetic results are evaluated, it is of importance to know that certain complications, such as telangiectasias and breast retraction, develop slowly over the years ( 132,133). Breast retraction has been reported to be the most disturbing cosmetic problem in the long run (134). The risk of a poor cosmetic result depends on the radiation dose delivered, and whole breast radiation doses of 60 Gy or more or skin doses above 50 Gy have both been related to a poor cosmetic result (132,135).…”

Section: Cosmetic Results After Breast-conserving Therapymentioning

confidence: 99%

“…Radiation treatment of adjacent fields (axilla, supraclavicular fossa) ( 133) may also impair longterm cosmetic results, due to tissue retraction. Simultaneous radiotherapy and adjuvant chemotherapy seem to have a negative impact on the cosmetic result while sequential application of the same treatment modalities seems to have little influence (134).…”

Section: Cosmetic Results After Breast-conserving Therapymentioning

confidence: 99%

Treatment of Early Breast Cancer with Conservation of the Breast a Review

1991

Acta Oncologica

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This paper reviews the current status of conservative treatment for early breast cancer. While the first patients were treated with such techniques more than 60 years ago, it is during the last decade that randomized trials have confirmed that such treatment is comparable to mastectomy in preventing breast cancer death. Radiotherapy to the breast after local tumour excision is important to prevent local breast relapse, but it is not clear whether it has any influence on the risk of distant metastases. Several questions remain to be answered. While most investigators agree that the breast should receive a radiation dose of about 50Gy in 5 weeks, there is no general agreement about the need for a tumour bed booster dose. Considering patients with tumour infiltration at the surgical resection line for whom it is not possible for cosmetic reasons to perform re-resection, it is not clear whether an acceptable local control rate can be achieved through application of a high booster dose in the tumour bed. More trials are needed to show whether certain patients with small invasive carcinomas should be treated with wide local excision without radiotherapy. The need for radiotherapy after local excision for small intraductal (ductal carcinoma in situ) cancers is being addressed in ongoing trials.Key words: Breast cancer, breast conserving therapy, local relapse risk, review.The term 'breast-conserving treatment' includes techniques by which radical eradication of an early breast cancer (TI -2, NO-I, MO) is achieved without ablation of the mammary gland. Such treatment techniques have attracted widespread interest and recently become accepted alternatives to more radical and mutilating surgical procedures. The possibility of treating limited breast cancers, without breast ablation was suggested more than 60 years ago. Hirsch. (1) in Berlin and Keynes (2) in London published their first results in 1927 and 1929 respectively. Mustakallio (3) in Helsinki published his first series in 1945, and the Institute Curie group headed by Baclesse published their results in 1949 (4). The preliminary results achieved by these pioneers suggested that survival after breastconserving treatment could be similar to that achieved after radical mastectomy. This view gained further support when a follow-up paper from St. Bartholomew's Hospital (5) in 1953 reported long-term survival to be similar among the patients treated conservatively by Keynes and breast cancer patients treated in the same hospital with mastectomy. During the 1960s more authors reported encouraging results with breast-conserving treatment (6-9). and during the last two decades multiple reports have been published:1. The survival rate and risk of distant metastases following breastconserving therapy and mastectomy have been compared in randomized trials. 2.Long-term ( > 25 years) follow-up reports containing large numbers of patients have provided important information on long-term survival and risk of locoregional failure. These studies also give important informat...

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“…Theoretically, withholding WBRT after BCS should be an option only for selected elderly patients with favorable clinical and biological prognostic factors (node negative, hormone sensitive, low-grade disease) and relevant comorbid conditions potentially affecting the life expectancy (5). Historically, WBRT has been delivered using conventional fractionation (1.8-2 Gy daily), up to a total dose of 50 Gy over 5 weeks with a subsequent boost dose of [10][11][12][13][14][15][16] Gy to the tumor bed for a 6-to 7-week overall treatment time (1). The addition of a boost dose to the site of surgical excision was shown to further raise local control (6).…”

Section: Original Research Articlementioning

confidence: 99%

“…We considered as skin toxicity events the following clinical cutaneous and subcutaneous conditions: erythema, edema, desquamation, ulceration, hemorrhage, necrosis, telangiectasia, fibrosis-induration, hyperpigmentation, retraction and atrophy. Cosmetic results were assessed at the end of WBRT and thereafter at every follow-up time point, using a physicianrated scale consisting of different categories (excellent, good, fair or poor) in the comparison between the treated and untreated breast, as set by the Harvard criteria (13). Basically, at each follow-up examination, physicians were asked to judge the cosmetic results as follows: an ''excellent'' score was assigned when the treated breast looked essentially the same as the contralateral breast; a ''good'' score was assigned for minimal but identifiable radiation effects; a ''fair'' score meant that significant radiation effects were readily observable; a ''poor'' score was used for radiation-induced severe late effects on the breast tissue (13).…”

Section: Follow-up Toxicity and Cosmesismentioning

confidence: 99%

Hypofractionated Whole-Breast Radiotherapy and Concomitant Boost after Breast Conservation in Elderly Patients

Cante

Franco

Sciacero

et al. 2015

Tumori

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Aims To report the 5- and 10-year results of accelerated hypofractionated whole-breast radiotherapy (WBRT) with concomitant boost to the tumor bed in 83 consecutive patients with early breast cancer aged >70 years. Methods All patients were treated with breast conservation and hypofractionated WBRT. The prescription dose to the whole breast was 45 Gy (2.25 Gy/20 fractions) with an additional daily concomitant boost of 0.25 Gy to the surgical cavity (2.5 Gy/20 fractions up to 50 Gy). The maximum detected toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. We considered as skin toxicity: erythema, edema, desquamation, ulceration, hemorrhage, necrosis, telangiectasia, fibrosis-induration, hyperpigmentation, retraction and atrophy. Cosmetic results were assessed as set by the Harvard criteria. Results With a median follow-up of 60 months (range 36-88), no local recurrence was observed. The maximum detected acute skin toxicity was G0 in 57% of patients, G1 in 40% and G2 in 3%. Late skin and subcutaneous toxicity was generally mild with no ≥G3 events. The cosmetic results were excellent in 69% of patients, good in 22%, fair in 5%, and poor in 4%. Conclusions The present results support the use of hypofractionation employing a concomitant boost to the lumpectomy cavity in women aged >70 years. This is a convenient treatment option for both this type of population and health-care providers.

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Conservative Surgery and Radiation Therapy for Early Breast Cancer

Cited by 293 publications

References 14 publications

Reconstruction of the Breast Conservation Deformity

Reconstruction of the Breast Conservation Deformity

Treatment of Early Breast Cancer with Conservation of the Breast a Review

Hypofractionated Whole-Breast Radiotherapy and Concomitant Boost after Breast Conservation in Elderly Patients

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