Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 446
Filtrar
1.
Int J Cancer ; 146(2): 352-362, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30861567

RESUMO

Risk of second primary malignancy (SPM) is increasing. We aimed to assess the incidence and related risk factors of SPM among breast cancer (BC) patients from this nested case-control study using the SEER database. BC patients with SPM were identified as the case group and SPM-free patients were defined as the control group. Propensity score matching of cases with controls by the year of the first primary BC diagnosis was conducted at the ratio of 1:5, and 97,242 BC patients were enrolled from 1998 to 2013 after the matching. The incidence of SPM in BC patients stratified by age groups and cancer sites was compared to the general population using the adjusted standardized incidence ratio (SIR) and the risk factors for SPM were examined using Cox proportional hazard regressions. Our study showed BC patients had excess risk for SPM than the general population (adjusted SIR for all cancer sites = 12.94, p < 0.001) and the incidence of SPM among them decreased with age. The risk of SPM was significantly related to the following demographical and clinical variables: age (40-59 vs. 18-39, HR = 1.33; 60-79 vs. 18-39, HR = 2.39; ≥80 vs. 18-39, HR = 2.84), race (black vs. white, HR = 1.12), histological type (lobular BC vs. ductal BC, HR = 1.15), radiotherapy (HR = 1.33), marital status (married vs. single, HR = 0.88) and estrogen receptor status (positive vs. negative, HR = 0.85). Consistent results were found in subgroup analysis stratified by contralateral-breast SPMs and nonbreast SPMs.


Assuntos
Neoplasias da Mama/terapia , Mastectomia Segmentar/efeitos adversos , Segunda Neoplasia Primária/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Segunda Neoplasia Primária/etiologia , Radioterapia Adjuvante/estatística & dados numéricos , Receptores Estrogênicos/metabolismo , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Adulto Jovem
2.
Lymphology ; 52(3): 126-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31874124

RESUMO

One common adverse effect following breast-conservation surgery and adjuvant radiation is lymphedema. While lymphedema of the arm has been well-characterized, there has been less investigation into lymphedema of the breast. We sought to characterize rates of breast lymphedema (BLE) in women with early-stage breast cancer and identify potential predictors in its development. Two hundred and thirty consecutive patients treated with lumpectomy and adjuvant whole breast radiation therapy (WBRT) from January 2016 - June 2017 were included. All patients were seen in our lymphedema monitoring clinic for baseline and at least one follow-up lymphedema measurement. BLE grades were assigned by trained nurses in the lymphedema clinic. Data regarding patient demographic and treatment factors were extracted from the electronic medical record. Comparisons between groups were made using Chi-Square analysis performed in SAS. The median age of the sample was 62 (range 31-90). Median follow-up from surgery was 15.3 months. Forty-three patients were diagnosed with lymphedema of the breast (18.7%). Rates of grade 1 and 2 BLE were 93% and 7%, respectively; there were no cases of severe lymphedema. Sixty-three percent of cases resolved by last follow-up with treatment recommendations. There was no association between development of BLE and patient factors investigated, including age, T stage, radiation dose and fractionation, lymph node biopsy, number of lymph nodes removed, development of arm lymphedema, and use of chemotherapy. Tumor subtype was found to be significant (P = 0.04) and there was a trend towards significance for receipt of trastuzumab (P = 0.09). BLE is a distinct entity from arm lymphedema and is a common finding in women treated with breast-conserving surgery and adjuvant WBRT. It is a generally mild and self-limiting process. There were no treatment or patient-related factors that correlated with increased risk of lymphedema development in our sample except for HER-2 positive disease and receipt of trastuzamab.


Assuntos
Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Linfedema/epidemiologia , Linfedema/etiologia , Glândulas Mamárias Humanas/patologia , Mastectomia Segmentar/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Feminino , Humanos , Incidência , Linfedema/diagnóstico , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Prevalência , Prognóstico , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
3.
Ann Surg Oncol ; 26(13): 4317-4325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31552614

RESUMO

BACKGROUND: Lobular carcinoma in situ (LCIS) is a risk factor for breast cancer, but the effect of LCIS found in association with ductal carcinoma in situ (DCIS) is unknown. In this study, we compared contralateral breast cancer (CBC) and ipsilateral breast tumor recurrence (IBTR) rates among women with DCIS with or without synchronous ipsilateral LCIS treated with breast-conserving surgery (BCS). METHODS: DCIS patients undergoing BCS from 2000 to 2011 with a contralateral breast at risk were stratified by the presence or absence of synchronous ipsilateral LCIS with the index DCIS (DCIS + LCIS vs. DCIS). Those with contralateral, bilateral, or prior ipsilateral LCIS were excluded. Associations of patient, tumor, and treatment factors with CBC and IBTR were evaluated. RESULTS: Of 1888 patients identified, 1475 (78%) had DCIS and 413 (22%) had DCIS + LCIS. At median follow-up of 7.2 (range 0-17) years, 307 patients had a subsequent first breast event; 207 IBTR and 100 CBC. The 10-year cumulative incidence of IBTR was similar in both groups: 15.0% vs. 14.2% (log-rank, p = 0.8) for DCIS + LCIS vs. DCIS, respectively. The 10-year cumulative incidence of CBC was greater in the DCIS + LCIS group: 10.9% vs. 6.1% for DCIS (log-rank, p < 0.001). After adjustment for other factors, CBC risk remained higher in DCIS + LCIS compared with DCIS (hazard ratio 2.06, 95% confidence interval 1.36-3.11, p = 0.001); there was no significant difference in IBTR risk. CONCLUSIONS: Compared with DCIS alone, DCIS + LCIS is associated with similar IBTR risk but double the risk of CBC. This finding should inform treatment decisions, in particular regarding endocrine therapy for risk reduction.


Assuntos
Carcinoma de Mama in situ/cirurgia , Neoplasias da Mama/cirurgia , Carcinoma Lobular/cirurgia , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Primárias Múltiplas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Mama in situ/patologia , Neoplasias da Mama/patologia , Carcinoma Lobular/patologia , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/etiologia , Neoplasias Primárias Múltiplas/etiologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
5.
Anticancer Res ; 39(8): 4215-4218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366508

RESUMO

BACKGROUND/AIM: Targeted intraoperative radiotherapy (TARGIT IORT) is an option during breast-conserving surgery (BCS). No data have yet been published regarding the safety of TARGIT IORT with implants in situ. TARGIT IORT is an attractive option in this context because of the risk of capsular fibrosis following external beam radiotherapy (EBRT) in such patients. PATIENTS AND METHODS: We are reporting a retrospective analysis of 16 patients who received TARGIT IORT during BCS for early breast cancer after previous implant-based breast augmentation. TARGIT IORT was performed using the Intrabeam™method. RESULTS: Follow-up varied from 98 to 5 months. There were no procedure-related complications. One patient developed local recurrence after 36 months of follow-up. Among the remaining patients (15/16), no breast-cancer-related events occurred. CONCLUSION: This series of patients with TARGIT IORT during BCS after implant-based breast augmentation revealed no safety concerns and gives some confidence in discussing this option with selected patients.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/efeitos adversos , Radioterapia , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Resultado do Tratamento
6.
Anticancer Res ; 39(8): 4467-4474, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366546

RESUMO

BACKGROUND/AIM: The aim of this study was to investigate the association between lymphopenia after breast conserving therapy (BCT) and ipsilateral breast tumor recurrence (IBTR) in early breast cancer (EBC). PATIENTS AND METHODS: We examined 216 EBC patients treated with partial mastectomy followed by radiotherapy (RT), none of whom received chemotherapy. Absolute lymphocyte counts (ALCs) during the two years after RT were collected from each patient: pretreatment ALC, ALC at 3-5 months (ALC1), ALC at 9-11 months, ALC at 15-17 months, and ALC at 21-23 months. RESULTS: The 102 patients with ALC1 ≤1,479 cells/µl (defined as lymphopenia) had significantly higher 10-year IBTR rate than the 102 patients with ALC1 >1,479 cells/µl (16.2% vs. 1%, p=0.0034). The multivariate analysis showed that age, resection margins, human epidermal growth factor receptor, and lymphopenia were significant predictors of IBTR. CONCLUSION: Lymphopenia is a potential predictor for IBTR in EBC patients treated with BCT.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Linfopenia/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Terapia Combinada/efeitos adversos , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos , Linfopenia/induzido quimicamente , Linfopenia/epidemiologia , Linfopenia/patologia , Mastectomia , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia Adjuvante/efeitos adversos
7.
Breast ; 47: 93-101, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31362135

RESUMO

OBJECTIVES: The aim of this retrospective study is to compare surgical margins, reoperation rates and local recurrences after breast conserving surgery (BCS) using radioguided occult lesion localization (ROLL) or radioactive seed localization (RSL). MATERIALS AND METHODS: We reviewed 744 consecutive patients with impalpable primary invasive breast cancer who underwent BCS at Helsinki University Hospital between 2010 and 2012. ROLL was used in our unit until October 31st, 2011; from November 1st we changed localization method to RSL. RESULTS: 318 patients underwent ROLL and 426 RSL. Patients in the RSL group had more often multifocal (p = 0.013) tumours. No statistically significant differences were found regarding tumour size, specimen weight, histology or grade of tumours or lymph node status. 42 (5.6%) patients were reoperated because of insufficient margins, 13 (4.1%) in the ROLL group and 29 (6.8%) in the RSL group. The reoperation rate was not different between the groups either in the univariable analysis (p = 0.112) or in the multivariable binary logistic regression analysis (p = 0.204). Risk factors for reoperations were multifocality of the tumour (p < 0.001), extensive intraductal component (p < 0.001), larger tumour size (p = 0.011), and smaller specimen weight (p = 0.014). The median follow-up time in the ROLL group was 81 (8-94) months and 64 (3-73) months in the RSL group. The five-year local recurrence-free survival (LRFS) estimates for ROLL and RSL groups were 98.0% and 99.4%, respectively (log-rank test, p = 0.323). CONCLUSION: Reoperation rates and LRFS were comparable for ROLL and RSL in patients with impalpable breast cancer treated with BCS.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Margens de Excisão , Mastectomia Segmentar/métodos , Recidiva Local de Neoplasia/patologia , Ultrassonografia Mamária/métodos , Adulto , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Finlândia , Hospitais Universitários , Humanos , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Palpação , Prognóstico , Cintilografia/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
8.
Breast J ; 25(6): 1071-1078, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31264293

RESUMO

Salvage mastectomy (SM) is the standard of care for patients with local recurrence (LR) after breast conservation therapy (BCT), often with immediate reconstruction. Complications of reconstruction are a concern for these patients, and long-term data are limited. We sought to compare rates of complications requiring re-operation (CRR) and reconstruction failure (RF) between autologous reconstruction (AR) and tissue expander/implant reconstruction (TE/I). Patients with locally recurrent breast cancer after BCT, treated with SM and immediate AR or TE/I between 2000 and 2008, were identified. CRR was defined as unplanned return to operating room for wound infection, dehiscence, necrosis (including flap, skin, or fat), hematoma, or hernia (for AR) and extrusion, leak, or capsular contracture (for TE/I). RF was defined as conversion to another reconstruction technique or to flat chest wall. This study included 103 patients with 107 reconstructions. Median follow-up was 6.6 years. CRR and RF were significantly higher with TE/I (n = 34) compared to AR (n = 73) at 5 years (50.9% vs 25.5%; P = 0.02) and (42.1% vs 5.8%; P < 0.001). On univariate analysis (UVA), TE/I (HR = 2.14; P = 0.02) and diabetes (HR = 5.10; P = 0.007) were significant predictors for CRR. On UVA, TE/I (HR = 7.30; P < 0.001) and older age at reconstruction (HR = 1.03; P = 0.003) were significant predictors for RF. In this population of previously irradiated patients, TE/I was associated with significantly higher CRR and RF. Complications continue to occur up to 10 years after TE/I. AR should be considered in appropriately selected patients, though TE/I may remain a reasonable option in patients without high-risk factors for surgical complications.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Retalhos de Tecido Biológico/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Expansão de Tecido/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/radioterapia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação
9.
Breast ; 47: 16-21, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31265973

RESUMO

BACKGROUND: A positive resection margin after breast-conserving surgery (BCS) usually requires re-excision, which impairs cosmetic outcomes and causes considerable distress. This study aimed to evaluate the prognosis of patients with positive resection margin after BCS and the role of radiation therapy (RT) in these patients. MATERIALS AND METHODS: We analyzed 297 patients who underwent BCS for breast cancer and had invasive carcinoma or ductal carcinoma in situ (DCIS) within less than 1 mm from the resection margin in Samsung Medical Center from January 2000 to June 2012. The association between RT dose and the incidence rate of ipsilateral breast tumor recurrence (IBTR) was examined. RESULTS: After a median follow-up of 78 months, the incidence rate of IBTR in all patients was 4.6% after 5 years. In the multivariate analysis, the unfavorable factors associated with IBTR were age < 40 years (p = 0.019), RT dose (<60 Gy vs. > 66 Gy, p = 0.012; 60-66 Gy vs. > 66 Gy, p = 0.017), and discontinuation of hormone therapy (p = 0.001). CONCLUSIONS: Among the patients with invasive carcinoma or DCIS within less than 1 mm from the resection margin, adjuvant RT with higher dose > 66Gy EQD2 might improve local control. Further prospective studies are warranted to validate the benefit and risk of a high dose boost after BCS in patients with a positive resection margin.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/radioterapia , Carcinoma Intraductal não Infiltrante/cirurgia , Margens de Excisão , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/patologia , Estudos de Coortes , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/cirurgia , Modelos de Riscos Proporcionais , Dosagem Radioterapêutica , Radioterapia Adjuvante , Reoperação/métodos , República da Coreia , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
10.
Radiat Oncol ; 14(1): 121, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291997

RESUMO

BACKGROUND: The boost irradiation to the tumor bed following whole-breast irradiation (WBI) reduced the risk of ipsilateral breast tumor recurrence (IBTR). However, in Japan, almost all patients with a margin ≤5 mm receive boost irradiation to the tumor bed, but the decision to perform boost irradiation for those with a margin > 5 mm is dependent on the institution. Thus, institutional guidelines on utilizing boost irradiation for patients aged ≤40 or ≤ 50 years vary. We investigated the IBTR rate to assess the appropriate age for boost irradiation to the tumor bed with a margin > 5 mm. METHODS: From January 1993 to December 2010, 419 patients with early-stage breast cancer and negative margins (> 5 mm) after breast-conserving surgery received WBI without boost irradiation. The Gray test was used to compare the cumulative incidence of IBTR among patients aged ≤40, 41-50, and ≥ 51 years. Hazard ratios were estimated using the Fine and Gray models. Furthermore, as a subgroup analysis, we investigated whether IBTR depended on the use of systemic therapy, such as anthracycline or taxane regimens. RESULTS: The median follow-up time was 9.3 years. In multivariate analysis, only age predicted IBTR (p = 0.047). The 10-year IBTR rate was 15.7% in patients aged ≤40, 3.8% in those aged 41-50, and 2.0% in patients aged ≥51 years. The difference between patients aged ≤40 and 41-50 years was statistically significant (p = 0.045), whereas the difference between patients aged 41-50 and ≥ 51 years was not significant (p = 0.21). CONCLUSIONS: In our institutional surgical setting, when boost irradiation is performed only for patients with a margin ≤5 mm, the IBTR rate after WBI without boost irradiation was significantly higher in patients aged ≤40 years, suggesting that boost irradiation should be used for patients in this age group.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/cirurgia , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Radioterapia Adjuvante/estatística & dados numéricos , Adulto , Fatores Etários , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Lobular/patologia , Carcinoma Lobular/radioterapia , Feminino , Humanos , Incidência , Japão/epidemiologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/etiologia , Prognóstico , Taxa de Sobrevida
11.
Ann Surg Oncol ; 26(10): 3282-3288, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342373

RESUMO

BACKGROUND: A ductal carcinoma in situ (DCIS) Nomogram integrating 10 clinicopathologic/treatment factors and a Refined DCIS Score (RDS) that incorporates a genomic assay and three clinicopathologic factors (Oncotype DX DCIS Score) are available to estimate DCIS 10-year local recurrence risk (LRR). This study compared these estimates. METHODS: Patients 50 years of age or older with DCIS size 2.5 cm or smaller and a genomic assay available were identified. An RDS within 1-2% of the range of Nomogram LRR estimates obtained by assuming use and non-use of endocrine therapy (Nomogram ± ET) was defined as concordant. Assuming a 10-year risk threshold of 10% for recommending radiation, Nomogram ± ET and RDS estimates were compared, and threshold concordance was determined. RESULTS: For 54 (92%) of 59 patients, the RDS and Nomogram ± ET LRR estimates were concordant. For the remaining 5 (8%) of the 59 patients, the RDS LRR estimates were lower than the Nomogram + ET estimates, with an absolute difference of 3-8%, and thus were discordant. For these five patients, the RDS estimates of 10-year LRR were lower than 10% (range 5-8%) and the Nomogram + ET estimates were 10% or higher (range 11-14%). These five patients with both discordant and threshold-discordant estimates all had close margins (≤ 2 mm). CONCLUSIONS: Among 92% of women 50 years of age or older with DCIS size 2.5 cm or smaller, free-of-charge online Nomogram 10-year LRR estimates were concordant with those obtained using the commercially available RDS (> $4600). Among the 8% with discordant risk estimates, the RDS appeared to underestimate the LRR and may lead to inappropriate omission of radiotherapy. Unless other data show a clinically significant advantage of the RDS (Oncotype DX DCIS Score), the study data suggest that for women 50 years of age or older with DCIS size 2.5 cm or smaller, its use is not warranted.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/diagnóstico , Nomogramas , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Feminino , Seguimentos , Perfilação da Expressão Gênica , Humanos , Incidência , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/etiologia , New York/epidemiologia , Prognóstico , Taxa de Sobrevida
12.
J Surg Oncol ; 120(3): 518-526, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31168844

RESUMO

BACKGROUND: The axillary-approach pedicled descending branch latissimus dorsi (LD) mini-flap presents clear benefits in repairing partial mastectomy defects. This study assessed the functional and esthetic outcomes of this flap compared with conventional breast-conserving surgery (BCS). METHODS: From October of 2015 to March of 2017, patients with early breast cancer were enrolled and assigned to the LD group or conventional BCS (CCS) group according to the need of using the pedicled descending branch LD mini-flap for volume replacement. Muscle strength and range of motion (ROMs) of bilateral shoulders, a disabilities of the arm, shoulder and hand (DASH) questionnaire, and an esthetic evaluation were conducted in all patients at 1 year after surgery. RESULTS: Thirty-two patients were assigned in the LD group, and 28 in the CCS group. There was no significant difference in muscle strength, ROMs of the shoulder or DASH scores between LD and CCS groups. The results of esthetic survey also revealed a similarly high level of esthetics in both groups. Donor-site seroma occurred in three patients in the LD group, and no other complication was observed. CONCLUSIONS: The pedicled descending branch LD mini-flap enabled larger excision with favorable esthetics, minimal functional impairment, low rate of complications, and high level of satisfaction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia Segmentar/métodos , Retalhos Cirúrgicos , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/fisiopatologia , Feminino , Humanos , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Ombro/fisiologia , Adulto Jovem
13.
J Gynecol Obstet Hum Reprod ; 48(7): 467-472, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207391

RESUMO

INTRODUCTION: This study sought to identify predictive factors of involved surgical margins in breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) to help guide the surgical procedure. MATERIALS AND METHODS: Retrospective study of patients who had BCS after NAC between January 2008 and December 2013. OUTCOME MEASURE: tumor-involved margin, defined by tumor cells on ink for invasive cancer and tumor-free margin < 2 mm for DCIS. RESULTS: Ninety-seven patients were included. The median age of patients was 46 years old [28-71]. The initial average tumor size was 47.8 mm [+/- 18.6]. Twelve patients (12.4%) had involved tumor margins on final histology after BCS and NAC. According to the multivariate model including only preoperative variables of positive margins, initial ultrasound tumor size ≤ 27 mm (p = 0.045) and low SBR grade (p = 0.009) were independently associated with tumor-involved margins. According to the multivariate model including pre- and postoperative variables of positive margins, ductal carcinomain situ was also independently associated with tumor-involved margins (p = 0.021). CONCLUSION: Initial ultrasound tumor size ≤ 27 mm and low SBR grade were independently associated with tumor-involved margins. These preoperative data were very helpful to guide the surgical procedure in breast cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/cirurgia , Margens de Excisão , Mastectomia Segmentar/efeitos adversos , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patologia , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasia Residual , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Brachytherapy ; 18(5): 645-650, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31200994

RESUMO

PURPOSE: Brachytherapy-based partial-breast irradiation (PBI) is a treatment option for breast-conserving therapy. Although intraoperative catheter implantation has been introduced, early wound complications are a concern. Covert operations with a moving incision are widely performed to hide surgical scars and may reduce the incision-site radiation dose. This study aimed to compare complication rates for moving incision and conventional incision in covert breast-conserving surgery. METHODS AND MATERIALS: Between October 2008 and December 2018, the medical records of all patients who underwent PBI using multicatheter interstitial brachytherapy after breast-conserving surgery were examined. Since July 2016, to hide the scar, we have performed a moving incision from above the tumor to an invisible site at our institution. The planning target volume included 1.0-1.5 cm of tissue surrounding the surgical cavity. High-dose-rate interstitial brachytherapy with a dose of 32 Gy in eight fractions was performed. The cumulative incidences of surgical site infections and symptomatic seromas ≤90 days were analyzed. RESULTS: The study included 516 consecutive patients with 526 lesions. Overall, 40 (7.6%) early wound complications were observed, in which 4 (2.6%) involved 152 moving incisions and 36 (9.6%) involved 374 conventional incisions (p = 0.01). On univariate analysis, age, tumor diameter, re-excision, planning target volume, numbers of catheters and planes, and incision type were risk factors for complications. On multivariate analysis, only incision type was a risk factor. Moving incision reduced the early complication rate by 75% (p = 0.01). CONCLUSION: Moving incision in covert breast-conserving surgery reduced the risk of early wound complications.


Assuntos
Braquiterapia/métodos , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/métodos , Adulto , Idoso , Braquiterapia/efeitos adversos , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Feminino , Humanos , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Fatores de Risco , Seroma/etiologia , Seroma/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle
15.
Brachytherapy ; 18(4): 510-520, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31109871

RESUMO

PURPOSE: Adjuvant partial breast radiotherapy is the standard of care for early-stage favorable breast cancer. We report dosimetry, acute and late tolerance for 67 permanent breast seed implants. MATERIALS AND METHODS: From July 2012 to October 2018, 67 postmenopausal women with unifocal pT1pN0 invasive ductal or ductal carcinoma in situ received partial breast radiotherapy using stranded Pd-103 seeds after breast-conserving surgery, delivering 90 Gy to the seroma + margin (1.25-1.5 cm), planned with computed tomography simulation and performed as an ultrasound-guided outpatient procedure. The planning and postimplant computed tomography images were fused for seroma delineation for postimplant dosimetry. Evaluations were performed at 1, 2, 6, and 12 months and then annually. RESULTS: Although patient acceptance is high, only 40% met technical requirements of seroma volume, location, and visibility. For 67 patients, the median seroma volume was 6.6 cc, PTV 61 cc, and number of needles 18. In day 0 dosimetry, median seroma D90 dose was 132 Gy; seroma + 5 mm, 106 Gy; and seroma + 10 mm, 80 Gy. Peak reaction at 6 weeks is limited to the implant site: 51% grade 1 erythema and 12% focal desquamation. Late reactions (>2 years) are generally minimal: 35% no sequelae, 43% localized fibrosis, 20% mild telangiectasia (6% moderate but asymptomatic), 22% contour change. At minimum 6-month follow-up, 94% were "very or totally satisfied." Recurrences (median follow-up: 3.3 years) were one in breast (different quadrant) and 2 contralateral. Three patients have had biopsies of fibrosis, all negative for malignancy. CONCLUSIONS: Our experience with permanent breast seed implant is favorable with a high patient acceptance and satisfaction, excellent early efficacy, and very satisfactory cosmesis.


Assuntos
Braquiterapia/métodos , Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Carcinoma Intraductal não Infiltrante/radioterapia , Recidiva Local de Neoplasia , Seroma/etiologia , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Mastectomia Segmentar/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Paládio/uso terapêutico , Satisfação do Paciente , Radioisótopos/uso terapêutico , Dosagem Radioterapêutica , Radioterapia Adjuvante , Seroma/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Zhonghua Wai Ke Za Zhi ; 57(5): 366-372, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31091592

RESUMO

Objective: To analyze the association between clinicopathological factors and clinical diagnosis, treatment and surgery of local regional recurrence (LRR) in breast cancer. Methods: A retrospective study was done to evaluate consecutive 7 823 breast cancer LRR cases between January 2009 and August 2018 at Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine. A total of 108 LRR patients were enrolled: 35 cases (32.4%) with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery, 40 cases (37.0%) of chest wall recurrence (CR), and 33 cases (30.6%) with regional lymph node recurrence (LNR). All patients were female, aged from 26 to 83 years with a mean of 49 years. Clinicopathological factor and its relationship with different sites of LRR and following surgical choice were analyzed by χ(2) test, rank-sum test and Logistic regression. Survival analysis were performed between different LRR patterns and whether undergoing second surgery. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of overall survival. Results: Both univariate analysis and multivariate analysis found that axillary lymph nodes (ALN) status (OR=7.27, 95% CI: 1.30 to 40.53, P=0.042) and disease-free interval (OR=0.18, 95% CI: 0.06 to 0.60, P=0.013) were related to different site of LRR. Compared with patients with IBTR, LNR and CR patients had a higher rate of ALN metastasis and a shorter disease-free interval. A total of 36 LRR patients underwent following surgery. In univariate analysis, initial ALN surgery (χ(2)=16.705, P=0.001), pathological type (χ(2)=7.047, P=0.03), ALN status (χ(2)=10.812, P=0.002), disease-free interval (χ(2)=6.118, P=0.023) and LRR site(χ(2)=19.328, P=0.000) were associated with surgical treatment for LRR patients. Multivariate analysis demonstrated that only site of LRR was independently associated with surgery (OR=0.17, 95% CI: 0.05 to 0.65, P=0.024). The 5-year overall survival was 100% and 60.1% (P=0.018) for LRR patients treated with surgery or not. Furthermore, CR patients had significantly worse overall survival than LNR and IBTR patients, with 5-year overall survival 53.1%, 73.5%, and 100% respectively (P=0.021). Conclusions: Initial lymph nodes metastasis and disease-free interval are associated with different site of LRR. LRR site significantly influenced following surgery choice after LRR, which are both related with overall survival after LRR.


Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , China , Intervalo Livre de Doença , Análise Fatorial , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Parede Torácica/patologia
17.
Pract Radiat Oncol ; 9(5): e457-e464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978468

RESUMO

PURPOSE: To report 1-year cosmesis and toxicity outcomes of a prospective, phase II trial of accelerated partial breast irradiation using intensity-modulated radiation therapy (RT) to deliver 27 Gy in 5 daily fractions. METHODS AND MATERIALS: Node-negative breast cancer patients after breast conserving surgery with clear excision margins, with physician-assessed excellent or good baseline cosmesis were invited to participate in a prospective clinical trial to receive 27 Gy in 5 daily fractions to the expanded primary site. Clinical photographs and European Organisation for Research and Treatment of Cancer cosmetic score were collected at baseline prior to RT and 1-year after radiation therapy. A protocol-specified, interim analysis was scheduled when 50 patients had completed 1-year follow-up. A panel of 6 physicians provided a consensus global cosmetic score (termed panel-assessed score) based on clinical photographs at baseline and 1-year. Fibrosis and telangiectasia were prospectively assessed by clinical research staff at clinic visits. RESULTS: At the interim analysis, 55 patients had baseline and 1-year post-RT images available. Most patients had either an improvement (53%) or no change (40%) in cosmesis from baseline to 1-year. Among 49 patients with excellent or good panel-assessed score at baseline, only 2 (4%) patients had a fair score at 1-year post-RT, indicating cosmetic deterioration. No patients had evidence of telangiectasia or grade 2 or higher fibrosis. There were no recurrences. CONCLUSIONS: APBI using 27 Gy in 5 daily fractions achieved acceptable 1-year cosmesis and no grade 2 fibrosis. A preplanned stopping rule of 5% grade 2+ fibrosis was not observed. The trial will continue to the planned target accrual of 274 patients.


Assuntos
Neoplasias da Mama/radioterapia , Fibrose/etiologia , Mastectomia Segmentar/efeitos adversos , Neoplasias da Mama/patologia , Estudos de Coortes , Feminino , Humanos , Mastectomia Segmentar/métodos , Resultado do Tratamento
18.
Breast J ; 25(3): 461-464, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30945388

RESUMO

To compare the clinical efficacy and aesthetic perspectives between single-port gasless laparoscopic breast-conserving surgery (SGL-BCS) and traditional breast-conserving surgery (T-BCS) in early-stage breast cancer. A total of 70 patients who were diagnosed with stage I or stage II breast cancer participated in this study, which 35 patients underwent SGL-BCS, while others underwent T-BCS. There were no death or severe intraoperative complications, and none of the patients exhibited regional recurrence, distant metastases, or any critical complications after 2 years follow-up. SGL-BCS is feasible and safe surgery, and has advantages in terms of a single, shorter, hidden incision, high-satisficed aesthetic outcome and less intraoperative blood loss.


Assuntos
Neoplasias da Mama/cirurgia , Laparoscopia/métodos , Mastectomia Segmentar/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica , Neoplasias da Mama/patologia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Margens de Excisão , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/instrumentação , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do Tratamento
19.
Lasers Med Sci ; 34(9): 1881-1887, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31025209

RESUMO

Light-based modalities appear to be effective for ameliorating surgical scar appearance; however, protocols for achieving such outcomes have yet to be established. We studied the safety and efficacy of a combination of pulsed dye laser (PDL) and fractional ablative CO2 laser (FACL) for the attenuation of post-lumpectomy scarring. We conducted a prospective, evaluator-blinded, comparative split-scar study in post-lumpectomy patients. One-half of the scar was treated with three sessions of 595-nm PDL and FACL at 1-month intervals, starting within 6 weeks after suture removal. The entire scar was also treated with standard moisturizers and silicone gels. Six months after the last treatment, the two halves of the scar were assessed by three uninvolved physicians who used the Observer Scar Assessment Scale as well as by the patients who used the Patient and Observer Scar Assessment Scale. Eighteen female patients (mean age, 51.3 years) with a mean scar length of 7.8 cm completed the treatment and follow-up. Six months after the last treatment, both the physician evaluators and the patients noted significant improvements for all assessed scar parameters in the laser-treated scar area compared with the untreated scar area. The treatment was well tolerated, and no remarkable adverse events were reported. All 18 participants were satisfied with the treated scar areas. A combination PDL and FACL protocol starting up to 6 weeks after suture removal is a safe and effective method for the attenuation of post-lumpectomy scar formation.


Assuntos
Cicatriz/etiologia , Cicatriz/cirurgia , Lasers de Corante/uso terapêutico , Lasers de Gás/uso terapêutico , Mastectomia Segmentar/efeitos adversos , Cicatriz/patologia , Feminino , Humanos , Lasers de Corante/efeitos adversos , Lasers de Gás/efeitos adversos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Resultado do Tratamento
20.
Plast Reconstr Surg ; 143(5): 927e-935e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033814

RESUMO

BACKGROUND: Reconstruction of partial breast defects in low-volume, nonptotic breasts can be challenging. The authors hypothesized that use of the latissimus dorsi flap in partial breast reconstruction is safe and associated with low complication and high patient satisfaction rates. METHODS: All patients who underwent breast-conserving therapy and latissimus dorsi flap reconstruction from January 1, 2006, to December 31, 2016, were identified in a prospectively maintained database. Patient demographics, tumor characteristics, and complications were recorded. Patient-reported outcomes were assessed with the BREAST-Q breast-conserving therapy module. A group of plastic surgeons and laypersons used a five-point Likert scale to evaluate aesthetic outcomes in representative patients. RESULTS: Forty-seven patients met the inclusion criteria. Median follow-up was 5.4 years. Most patients (93.6 percent) underwent immediate reconstruction. The mean resection volume was 219.5 cc (range, 70 to 877 cc). The overall complication rate was 8.5 percent. Grade 2 or 3 ptosis (OR, 1.21; 95 percent CI, 1.0 to 1.46; p = 0.03), smoking (OR, 13.1; 95 percent CI, 1.2 to 143.2; p = 0.03), and multicentric tumor (OR, 1.23; 95 percent CI, 1.04 to 1.64; p = 0.02) were associated with a higher complication rate. Ductal carcinoma in situ was associated with reoperation for positive margins (OR, 14.4; 95 percent CI, 2.1 to 100; p = 0.009). Of particular interest, patient-reported outcomes were favorable, with the highest rated domains being Satisfaction with Breasts (61; interquartile range, 37 to 77), Psychosocial Well-being (87; interquartile range, 63 to 100), and Physical Well-being (87; interquartile range, 81 to 100). The median aesthetic score was 4 (of 5). CONCLUSIONS: This is the first study to date using the BREAST-Q to assess patient-reported outcomes associated with the latissimus dorsi flap for partial breast reconstruction. The flap is safe and effective for reconstruction in the setting of breast-conserving therapy, providing aesthetically pleasing results with high patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias da Mama/terapia , Carcinoma Intraductal não Infiltrante/terapia , Mamoplastia/métodos , Medidas de Resultados Relatados pelo Paciente , Músculos Superficiais do Dorso/transplante , Adulto , Estética , Feminino , Seguimentos , Humanos , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/métodos , Pessoa de Meia-Idade , Retalho Miocutâneo/transplante , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Satisfação do Paciente/estatística & dados numéricos , Radioterapia Adjuvante , Reoperação/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA