Management of locally advanced breast cancer

Borgen, Patrick I.

doi:10.1007/bf00348196

Cited by 4 publications

(3 citation statements)

References 46 publications

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“…With the recognition that the results of surgical therapy were disappointing, radiotherapy was utilized for palliation. In the 1980s several authors reported the results of systematic study of multimodality therapy of LABC [13, 14, 15, 16, 17, 18, 19, 20, 21], and multimodality therapy has since become the norm for the management for LABC [22].…”

Section: Historical Perspectivementioning

confidence: 99%

“…Surgery in combination with radiotherapy offers superior local control rates [20, 24, 31, 40, 41, 42, 43, 44, 45, 46, 47, 48]. Improvement in local control rates can be achieved with higher radiation dosages at the expense of higher complication rates [22]. Surgical resection is an important tool in the attainment of local control, even in extensively pretreated patients [39].…”

Section: Local Therapy: Surgery and Radiotherapymentioning

confidence: 99%

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Locally Advanced Breast Cancer inDeveloping Countries: The Place of Surgery

Apffelstaedt

2003

World j. surg.

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Most breast cancer patients in developing countries still present with locally advanced breast cancer (LABC). Because surgery is the most widely available treatment modality, we examine its place in the management of LABC. Historically, single local treatment modalities have had disappointing results, and multimodality therapy has become the norm for combatting LABC. Combining surgery and radiotherapy will lead to superior local control rates. Surgery should precede radiotherapy. Preoperative systemic treatment-with the possible exception of cyclophosphamide, methotrexate, 5-fluououracil (CMF) chemotherapy-does not influence surgical complication rates. Hormonal therapy is understudied and underutilized; its benefits become apparent only in prolonged follow-up. Sequencing of local and systemic treatments does not influence oncologic outcome, but failure to respond to preoperative systemic therapy may identify patients with a poor prognosis. With multimodality management including hormonal therapy, chemotherapy, radiotherapy, and surgery, local control rates of more than 80% and 5-year survival rates of more than 50% have become the norm.

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Section: Historical Perspectivementioning

confidence: 99%

Section: Local Therapy: Surgery and Radiotherapymentioning

confidence: 99%

Locally Advanced Breast Cancer inDeveloping Countries: The Place of Surgery

Apffelstaedt

2003

World j. surg.

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“…Many authors have found an improvement in local control rates and-in some series-survival if surgery is included in the man- agement [19 -21, 25, 35-42]. Reviewers recommend its inclusion in the treatment of locally advanced breast cancer [19,[43][44][45]. The use of the LDMF for wound cover allows for wide resection of big, otherwise unresectable lesions [46].…”

Section: Discussionmentioning

confidence: 99%

Indications and Complications of Latissimus Dorsi Myocutaneous Flaps in Oncologic Breast Surgery

Apffelstaedt

2002

World j. surg.

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The use of the latissimus dorsi myocutaneous flap (LDMF) in reconstructive breast surgery is well documented. Few reports exist of its use in oncologic breast surgery. This series describes indications and complications of the LDMF in locally advanced cancer. The records of 83 patients were analysed for age and sex, menstrual status, stage, indication, margins of resection, chemotherapy, radiotherapy, complications, and survival. The indication was to cover defects caused by resection of locally advanced breast cancer (67 cases), recurrent breast cancer (13 cases), radiation damage (2 cases), and surgical complications (1 case). The mean age of the patients was 50.2 years; 52% were postmenopausal. The flaps had mean diameters of 32 by 14 cm. The donor site was skin grafted. Clear margins were achieved in 83%. At the LDMF insertion site, wound infection required drainage in 1 case; flap necrosis required reintervention in 7 cases. In 2 cases a second skin graft was done for the LDMF donor site. The proportions of wound infections and incomplete skin graft take were significantly greater in patients receiving preoperative cyclophosphamide/methotrexate/5-fluorouracil (CMF) versus cyclophosphamide/doxorubicin/5-fluorouracil (CAF) chemotherapy (p < 0.001 and p < 0.05, respectively). The late complication rate was 7.2%. The mean follow-up is 40.0 months. The complication rates for CMF versus CAF chemotherapy suggest an adverse effect of methotrexate, which warrants further investigation. The use of the LDMF made wide resection of locally advanced lesions and radionecrosis possible; major complications were rare. LDMF has its place in the armamentarium of the surgeon who regularly sees locally advanced breast cancer.

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