ASPECTS EVOLUTIFS APRES TRAITEMENT CONSERVATEUR DES CANCERS DU SEIN A L’INSTITUT DU CANCER DE DAKAR. A PROPOS DE 72 CAS

Abstract

Conservative treatment has become the standard treatment for early-stage breast tumors. It accounts for more than 75% of breast cancer treatments in developed countries and in our institution 6%. We studied the evolutionary aspects of breast cancer treated in a conservative modality at the Aristide Le Dantec Hospital Cancer Institute between 2000 and 2009. Objectives Describe the epidemiological profile, their evolutionary and therapeutic aspects. Methodology This work is a descriptive retrospective study of breast cancer patients selected over a 10-year period from January 2000 to December 2009 and treated conservatively at the Joliot Curie Institute in Dakar. Results We selected 72 patients out of 1100 cases treated for histologically confirmed breast cancer who had an initial conservative treatment representing 6.54%. The average age of our patients was 44.4 years. Quadrantectomy associated with axillary dissection was performed in 64 patients, or 89% of cases. Radiotherapy was performed in 53 patients, or 73.6% of cases. Twentytwo percent had locoregional recurrence (n = 16). Of the 16 patients who had recurrence, (87.5%) (n = 14) had local recurrence and 2 (12.5%) had lymph node recurrence in the internal breast chain. The average time to onset of recurrence was 17.44 months. Twenty-six percent (n =) had developed metachronous metastasis. The average time to onset of metastases was 22.63 months. The recurrences were treated by mastectomy followed by chemotherapy and radiotherapy in 8 patients, 5 patients underwent mastectomy followed by chemotherapy, 1 patient received chemotherapy alone, 1 patient received chemotherapy and palliative radiotherapy for recurrence at the the internal mammary chain and 1 patient lost to follow-up without treatment after recurrence. Metastases were treated according to different therapeutic strategies. Overall survival was 80% at 5 years and 10 years for patients with no recurrence and 37% at 5 years and 10 years for patients with recurrence. Conclusion Conservative treatment of breast cancer is possible. The results need to be improved by the generalization of mammography to discover early stages. The choice of a conservative treatment must take into account local relapse factors and diagnostic, therapeutic and follow-up means to avoid the occurrence of recurrence in order to improve patient survival.