Conservative Treatment Of Breast Carcinoma Research Articles

Stewart-Treves syndrome: Pathogenesis and management

Stewart-Treves syndrome is a malignancy that arises within chronic lymphedema. Although classically described as a consequence of radical mastectomy, this lymphangiosarcoma has been documented to occur in cases of congenital and other causes of chronic secondary lymphedema. The development of this aggressive lymphangiosarcoma at sites of chronic lymphedema renders it a possible model for Kaposi sarcoma. Because of the increase in conservative treatment for breast carcinoma and improvement of operative and radiation therapy techniques, the prevalence of Stewart-Treves syndrome has decreased. Regardless, this malignancy significantly worsens patients' outcomes and needs to be diagnosed and treated early. Chemotherapy and radiation therapy have not improved survivorship significantly. Early amputation or wide local excision offers the best chance for long-term survival. Yet, overall prognosis remains dismal. Untreated patients usually live 5 to 8 months after diagnosis.

Invited commentary

Lindford and colleagues 1 Lindford A. Böhling T.L. Vaalavirta L. Tenhunen M. Jahkola T. Tukiainen E. Surgical management of radiation-associated cutaneous breast angiosarcoma. J Plast Reconstruct Aesthet Surg. 2011; Google Scholar have detailed their experience of radiation-induced angiosarcoma of the breast over a 10-year period, demonstrating good local control rates with surgical margins of greater than 3 cm. This is a rare but well recognised complication of breast conserving therapy and the authors should be commended for bringing it to the attention of this journal’s readership. Its incidence is likely to increase due to a shift towards more conservative breast cancer surgery and physicians must be vigilant of any vascular changes within previously irradiated tissue. Few case series exist 2 Marchal C. Weber B. de Lafontain B. et al. Nine breast angiosarcomas after conservative treatment for breast carcinoma: a survey from French comprehensive cancer centres. Int J Radiat Oncol Biol Phys. 1999; 44: 113-119 Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar , 3 Williams E.V. Banarjee D. Dallimore N. Monypenny I.J. Angiosarcoma of the breast following radiation therapy. Eur J Surg Oncol. 1999; 25: 221-227 Crossref PubMed Google Scholar , 4 Billings S.D. McKenney J.K. Folpe A.L. Hardacre M.C. Weiss S.W. Cutaneous angiosarcoma following breast-conserving surgery and radiation: an analysis of 27 cases. Am J Surg Pathol. 2004; 28: 781-788 Crossref PubMed Scopus (186) Google Scholar , 5 Hodgson N.C. Bowen-Wells C. Moffat F. Franceschi D. Avisar E. Angiosarcomas of the breast: a review of 70 cases. Am J Clin Oncol. 2007; 30: 570-573 Crossref PubMed Scopus (89) Google Scholar and thus the natural history and management of this condition are yet to be fully understood and defined.

Isolated skin recurrence following salvage mastectomy for intramammary recurrence (after initial breast conservation therapy): Is it a fatal event?

Aims The authors analyzed the outcome of patients with Isolated Skin Recurrence After Salvage Mastectomy (ISRASM) performed after conservative treatment for breast carcinoma, taking into account initial tumor characteristics, intramammary recurrence (first recurrence) characteristics, local skin recurrence (second recurrence) characteristics, and the type of treatment at each stage of the breast cancer continuum. Methods Forty-two patients who had ISRASM between 1976 and 2007 were included in this retrospective study. Twenty-six factors were studied in univariate and multivariate analyses. Results Mean Overall Survival (OS) was 70.3 (±4.1) months. The 5-year OS rate was 66.6%. 31% of patients did not present any recurrence, 52% had locoregional recurrence and 14% metastatic recurrence following ISRASM. Univariate analysis showed that 4 prognostic factors were significantly related to OS and/or Disease-Free Survival (DFS): (1) initial chemotherapy after primary breast cancer ( P = 0.09 and 0.01 respectively), (2) presence of emboli at the site of intramammary recurrence (first recurrence) ( P = 0.02 and 0.03), (3) interval between first and second surgery of less than 3 years ( P = 0.09 and 0.0003), and (4) inflammatory skin involvement at ISRASM ( P = 0.005 and 0.17). Multivariate analysis showed that presence of emboli at the site of intramammary recurrence was significantly related to OS and that an interval between first and second recurrence of less than 3 years was significantly related to DFS. Conclusion Our results show that ISRASM affects a group of breast cancer patients with predominantly local rather than metastatic disease. Prognostic factors depend on characteristics at initial breast cancer, first recurrence and second recurrence. Evidence-based guidelines are still required for ISRASM management.

Angiosarcoma Developing after Conservative Treatment for Breast Carcinoma

Angiosarcoma Developing after Conservative Treatment for Breast Carcinoma

Angiosarcoma Developing after Conservative Treatment for Breast Carcinoma: Case Report with Review of the Current Literature

Angiosarcoma Developing after Conservative Treatment for Breast Carcinoma: Case Report with Review of the Current Literature

Oncoplastic surgery allows extensive resections for conservative treatment of breast carcinoma

Oncoplastic surgery allows extensive resections for conservative treatment of breast carcinoma

Traitement conservateur des cancers du sein : zonectomie vs oncoplastie. Étude prospective à propos de 99 patientes

The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. Aim of the study. – This prospective study was undertaken to compare the accuracy of breast resection, between standard narrow lumpectomy and oncoplastic surgery. Patients and methods. – Ninety-nine consecutive women undergoing breast cancer resection were enrolled in a prospective study comparing oncoplastic surgery (42 women) and standard lumpectomy (57 women). The size of the glandular resection, the width of the nearest margins, the ratio of clear margins and the need for further surgery were recorded. Results. – The oncoplastic approach resulted in significantly greater glandular resection and wider free histological margins than did standard lumpectomy. The need for re-exicsional surgery was significantly lower in the oncoplastic group than in the lumpectomy group. Furthermore, a trend towards fewer secondary mastectomies was seen for the oncoplastic approach versus standard lumpectomy. Conclusions. – The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma achieves accurate tumour resection and reduces the need for further surgery.

Conservative Treatment of Breast Cancer: Its Evolution

Over recent decades, breast carcinoma surgery has witnessed a considerable evolution. The extent of surgery undertaken has progressively reduced, leading to less disfigurement and a significant improvement in quality of life, thereby offering women considerable motivation to seek early diagnosis. From an oncological perspective, outcome was found to be equally effective, and this key observation provided us with significant impetus to investigate the effects of reducing the radiotherapy field. We present the achievements made so far in the conservative treatment of breast carcinoma, based on experiences at the European Institute of Oncology in Milan and, prior to 1994, at the Milan Cancer Institute. Conservative surgery of breast carcinoma, both in the breast and in the axillary nodes, has yielded very good results in terms of overall survival and impact on quality of life. The reduction of the radiation field, conducted in our Institute by means of electron intraoperative radiotherapy (ELIOT), is currently the subject of evaluation via a randomised trial.

Single fraction boost with high dose rate interstitial brachytherapy in conservative treatment of breast carcinoma

Introduccion Evaluamos la eficacia de la sobreimpresion del lecho quirurgico con braquiterapia intersticial de alta tasa de dosis, en fraccion unica en pacientes con cancer de mama, tratadas con tratamiento conservador, como alternativa a la sobreimpresion con electrones.

The Pilot Trial on Intraoperative Radiotherapy with Electrons (ELIOT): Update on the Results

Intraoperative radiotherapy with electrons (ELIOT) is under evaluation in the conservative treatment of breast carcinoma. At the European Institute of Oncology we started our study on ELIOT in 1999; the first step has been a phase I-II trial to test feasibility and tolerance of ELIOT in patients candidate to breast conserving surgery. From July 1999 to September 2000, 101 patients affected by unifocal breast carcinoma up to a diameter of 2.5 cm received wide resection of the breast followed by ELIOT. The trial was based on a dose-escalation starting from 10 Gy: we tested the dose-levels of 10, 15, 17, 19 and 21 Gy. The dose-levels of 10 and 15 Gy were followed by a reduced course of external fractionated radiotherapy. Most patients received 21 Gy intraoperatively. Patients were evaluated 1, 3, 6 and 12 months after surgery, and thereafter every 6 months, to look for early, intermediate, late complications, and other events. After a mean follow-up of 42 months, 16 patients (16%) developed breast fibrosis, mild in 15, severe in one, which resolved within 24 months. Two patients suffered of postoperative infection, and four developed a lyponecrosis in the treated area. The first group of patients treated with ELIOT in the phase I-II trial are confirming the good impact of the procedure in terms of tolerance and quality of life.

Early versus late local recurrences after conservative treatment of breast carcinoma. Are there differences in primary tumor characteristics

Early versus late local recurrences after conservative treatment of breast carcinoma. Are there differences in primary tumor characteristics

Early versus late local recurrences after conservative treatment of breast carcinoma. Are there differences in primary tumor characteristics

To investigate whether some aspects of patient or tumor characteristics influence the timing of local recurrence in breast cancer treated conservatively. A retrospective analysis was conducted on patients treated with conservative breast surgery followed by radiotherapy for breast carcinoma, and who developed local recurrence. Out of 2037 cases treated in our Institute, 59 local recurrences were observed within 36 months after treatment, called early local recurrence (ELR), and 87 local recurrences occurred after 60 months, called late local recurrence (LLR). Patient and tumor characteristics were analyzed in the 2 groups and compared. In patients with ELR, the mean age was 53, versus 54 in patients with LLR (ns). Likewise, the menopausal status was evenly distributed in the 2 groups. Primary tumors greater than 20 mm were more frequently found in patients with ELR: 35% vs. 19% in patients with LLR (p = 0.03). Grade 3 tumors were more encountered in patients with ELR: 35% vs. 8% in patients with LLR (p < 0.0001). Tumor ploidy was evenly distributed within the 2 groups. Patients with ELR had tumors with negative estrogen receptors more frequently than patients with LLR: 42% vs. 19% (p = 0.006), and negative progesterone receptors more frequently than patients with LLR: 54% vs. 22% (p = 0.0003). There was no statistically significant difference in the axillary lymph node (LN) status between patients with ELR and those with LLR: respectively 37% and 27% of positive LN (p = 0.18). The specific mortality was higher in patients with ELR: 63% vs. 24% for patients with LLR (p < 0.0001). Unfavorable tumor characteristics as big size, high grade, lack of hormone receptors, but not lymph node status were associated with ELR. The first 3 factors are often linked to tumor cell kinetics. These findings suggest that patients with such aggressive tumor characteristics who do not recur early will have a lower risk of LLR than patients with more favorable factors

Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas.

To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving therapy using oncoplastic techniques with concomitant symmetrization of the contralateral breast. Although breast-conserving therapy is the standard form of treatment for invasive breast tumors up to 4 cm, in patients with large, ill-defined, or poorly situated tumors, cosmetic results can be poor and clear resection margins difficult to obtain. The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. This is a prospective study of 101 patients who were operated on for breast carcinoma between July 1985 and June 1999 at the Institut Curie. The procedure was proposed for patients in whom conservative treatment was possible on oncologic grounds but where a standard lumpectomy would have led to poor cosmesis. Standard institutional treatment protocols were followed. All patients received either pre- or postoperative radiotherapy. Seventeen patients received preoperative chemotherapy to downsize their tumors. Mean follow-up was 3.8 years. Results were analyzed statistically using Kaplan-Meier estimates. Mean weight of excised material on the tumor side was 222 g. The actuarial 5-year local recurrence rate was 9.4%, the overall survival rate was 95.7%, and the metastasis-free survival rate was 82.8%. Cosmesis was favorable in 82% of cases. Preoperative radiotherapy resulted in worse cosmesis than when given postoperatively. The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma and results in favorable oncologic and esthetic outcomes. This approach might be useful in extending the indications for conservative therapy.

Angiosarcoma radioinducido de aparición precoz tras tratamiento conservador en cáncer de mama. Papel de la cirugía radical

One of the risks of radiotherapy is the development of secondary malignant tumors, mostyly sarcomas. Radiation-induced angiosarcoma after conserving therapy for breast cancer is a extremely rare tumor and diagnosis may be difficult. Early diagnosis is essential and it appears that radical mastectomy gives the highest chance of cure and the best long-term survival. A new case of breast angiosarcoma after conservative treatment for breast carcinoma is reported.

Nine breast angiosarcomas after conservative treatment for breast carcinoma: a survey from French Comprehensive Cancer Centers

Objectives: To conduct a survey of the angiosarcomas developing after breast conservation for carcinoma in the French Cancer Centers, to study the evolution of these cases in detail, and to review literature in an attempt to propose an optimal treatment scheme. Material and Methods: Eleven of the 20 French Cancer Centers agreed to research and retrospectively analyze all angiosarcomas discovered in patients previously treated by conservative treatment. The majority of the patients were node negative, T1N0M0. The mean age of the patients at the time of primary breast cancer treatment was 62.5 years, and 69 years at the diagnosis of the angiosarcoma. Results: During the last two decades, nearly 20,000 patients have been treated conservatively in these 11 centers, and only 9 cases of angiosarcoma were found. The median latency period between the treatment of the breast carcinoma and the diagnosis of the breast angiosarcoma was approximately 74 months, with a range of 57–108 months. Mastectomy was performed as the main treatment of this angiosarcoma. All recurrences after mastectomy for the angiosarcoma appeared within 16 months after the mastectomy. A median time of recurrence was found to be 7.5 months, regardless of the treatment. The angiosarcomas appeared to be very aggressive, and chemotherapy, radiotherapy, and sometimes hyperthermia could only palliate the condition for a short time. After the diagnosis of angiosarcoma, the median survival was 15.5 months, showing a particularly poor prognosis. Only 1 patient of 9 is alive without progressive disease at 32 months after salvage mastectomy for the recurrence of the angiosarcoma. Precise data obtained from 11 centers show that, of 18115 breast carcinomas treated conservatively, only 9 breast angiosarcomas are reported, which represents a prevalence of 5 cases of angiosarcoma per 10,000, which is the same prevalence for primary breast angiosarcomas occurring in healthy breasts. Conclusion: Angiosarcoma developing after breast conserving therapy for carcinoma is a rare event, and induction of it by treatment is controversial. However, early diagnosis is essential and it appears that radical mastectomy gives the highest chance of cure and the best long-term survival.

Case report: MR imaging of fat necrosis of the breast associated with lipid cyst formation following conservative treatment for breast carcinoma

Case report: MR imaging of fat necrosis of the breast associated with lipid cyst formation following conservative treatment for breast carcinoma