The importance of the lumpectomy surgical margin status in long term results of breast conservation

Smitt, Melanie C.; Nowels, Kent W.; Zdeblick, Mark J.; Jeffrey, Stefanie S.; Carlson, R. W.; Stockdale, Frank E.; Gfinet, Don R.

doi:10.1002/1097-0142(19950715)76:2<259::aid-cncr2820760216>3.0.co;2-2

Cited by 374 publications

(144 citation statements)

References 41 publications

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“…11,[42][43][44] Consistent with these reports, in the study reported here, the presence of negative margins was associated with improved IBTR-free survival in both univariate and multivariate analyses. Therefore, our multidisciplinary emphasis on improving margin status may have contributed to the declining IBTR rates in our study.…”

Section: Discussionmentioning

confidence: 99%

Improving local control with breast‐conserving therapy

Cabıoğlu

Hunt

Buchholz

et al. 2005

Cancer

101

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BACKGROUNDThe risk of ipsilateral breast tumor recurrence (IBTR) after breast‐conserving therapy (BCT) is associated with treatment and tumor‐related variables, such as surgical margin status and the use of systemic therapy, and these variables have changed over time. Correspondingly, the authors of the current study hypothesized that the contemporary multidisciplinary management of breast carcinoma would lead to an improvement in IBTR rates after BCT.METHODSBetween 1970 and 1996, 1355 patients with pathologic Stage I‐II invasive breast carcinoma underwent BCT (breast‐conserving surgery and adjuvant radiation therapy) at The University of Texas M. D. Anderson Cancer Center. Contemporary methods of analyzing surgical margins were in routine use by 1994. To analyze the effect of this variable and others, patient and tumor characteristics and IBTR rates in patients treated during 1994–1996 were compared with those in patients treated from 1970 to 1993.RESULTSCharacteristics were similar in patients treated during 1994–1996 (n = 381) and those treated before 1994 (n = 974) except for patients aged >50 years (63.3% vs. 51.7%, P < 0.001), and patients who had a family history of breast carcinoma (37.9% vs. 30.8%, P = 0.017). Patients treated after 1994 were less likely to have positive or unknown margins (2.9 % vs. 24.1 %, P = 0.0001), more likely to receive chemotherapy (40.5% vs. 26%, P < 0.001), and more likely to receive hormonal therapy (33.3% vs. 19.4%, P < 0.001), but less likely to receive radiation boosts to the primary tumor bed (59.8% vs. 89%, P < 0.001). The 5‐year cumulative IBTR rate was significantly lower among patients treated in 1994–1996 than among patients treated before 1994 (1.3% vs. 5.7%, P = 0.001) largely because of the drop in IBTR rates among patients aged ≤ 50 years (1.4 % vs. 9.1 %, P = 0.0001). On multivariate analysis, age > 50 (hazards ratio [HR] = 0.401; P = 0.0001), presence of negative surgical margins (HR = 0.574; P = 0.017), and use of adjuvant hormonal therapy (HR = 0.402; P = 0.05) were independent predictors of improved 5‐year IBTR‐free survival. On subgroup analysis, use of chemotherapy was associated with increased IBTR‐free survival among women aged ≤ 50 years (HR = 0.383; P = 0.001). Although 5‐year cumulative IBTR rates were lower among women aged > 50 years than among younger women before 1994 (2.6 % vs. 9.1%, P < 0.0001), no such difference was found in the group treated in 1994–1996 (1.2 % for age > 50 yrs vs. 1.4 % for ≤ 50 yrs, P = 0.999).CONCLUSIONSThe IBTR rate after BCT appears to be declining, especially among patients < 50 years of age. However, long‐term follow‐up is necessary to confirm this finding. This finding may reflect changes in surgical approaches and pathologic evaluation as well as an increased use of systemic therapy. The current low incidence of IBTR with multidisciplinary management of breast carcinoma may result in more patients choosing BCT over mastectomy. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Improving local control with breast‐conserving therapy

Cabıoğlu

Hunt

Buchholz

et al. 2005

Cancer

101

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“…In the majority of the reported series, positive margins of resection have been associated with an increased risk of breast recurrence, although the magnitude has varied considerably (Table 10). 48,[53][54][55][56][57][58][59][60][61] The variation in these results may be related to the extent of the surgical resection for the primary tumor, the presence or absence of an EIC, the definition of a positive margin, the number of margins that are positive, and the extent of the margin positivity.…”

Section: Elements Of the Breast Physical Exammentioning

confidence: 99%

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

301

165

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Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

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“…The local-recurrence rate is, however, approximately twice as large in patients with incompletely excised tumors and in patients 40 years of age or younger [2][3][4][5]. Results from major trials with long-term follow-up demonstrated that improvement of local control results in better survival, and complete gross excision of the primary tumor has been shown to maximize local control [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%