Summary
Background
The conservative treatment of operable breast cancer has gradually become well-established during the last 20 years as it offers adequate loco-regional control of the disease and saves the brest. Moreover, larger, demolishing operations have not shown to decrease the risk of distant metastases.
Methods
Four prospective, randomized trials (Milan Trials I to IV) have been conducted at the Department of Surgical Oncology of the Istituto Nazionale Tumori Milan since 1973 comparing the radical Halsted approach in operable breast cancer to conservative treatments combining extensive breast resection and various radiotherapies.
Results
Data analysis lends force to the conservative treatment concept, showing that an extensive breast resection, defined as quadrantectomy, together with radiotherapy are a safe procedure that results in a long term survival comparable to that after Halsted's mastectomy. Furthermore, the studies reveal that too limited a resection (lumpectomy) and withdrawal of radiotherapy increase the risk of local recurrence. In women older than 55 years, however, quadrantectomy without radiotherapy yields good results. Young age and the presence of an extensive intraductal component are further, signficant and important risk factors of local recurrence.
Conclusions
If attention is paid to the defined risk factors and adjuvant therapeutic regimes the conservative surgical treatment of breast cancer yields excellent long term results.
Zusammenfassung
Grundlagen
In den letzten 20 Jahren wurde die konservative Therapie des operablen Mammakarzinoms eingeführt. Sie ermöglicht eine adäquate lokoregionale Kontrolle der Erkrankung bei weitgehender Brusterhaltung, und ausgedehntere, verstümmelnde Eingriffe können letzlich das Risiko einer Fernmetastasierung auch nicht verhindern.
Methodik
Von 1973 bis heute sind vier prospektive, randomisierte Studien (Milan Trials I bis IV) an der Abteilung für Chirurgische Onkologie des Istituto Nazionale Tumori, Milan, durchgeführt worden, wobei die radikale Halsted Operation des operablen Mammakarzinoms mit der brusterhaltenden Quandrantenresektion und verschiedenen Radiotherapien verglichen wurde.
Ergebnisse
Die Ergebnisse aller Studien unterstreichen die Überlegungen zugunsten einer konservativen Therapie des operablen Mammakarzinoms. Es konnte gezeigt werden, daß nach ausgedehnter Brustresektion, definiert als Quadrantenresektion, mit nachfolgender Radiotherapie, Langzeitergebnisse erzielt werden, die denen nach einer radikalen Mastektomie nachHalsted vergleichbar sind. Die Untersuchungen erbrachten, daß sich bei zu sparsamer Resektion (lumpectomy) das Risiko eines Lokalrezidivs erhöht. Dies zeigte sich auch bei Weglassen der Radiotherapie. Bei Frauen über 55 Jahre hingegen brachte die alleinige Quadrantenresketion (ohne Radiotherapie) ähnlich gute Ergebnisse. Ferner sind ein jugendliches Alter sowie eine ausgedehnte intraduktale Tumorkomponente signifikante, wichtige Risikofaktoren für ein Lokalrezidiv.
Schlußfolgerungen
Unter Beachtung von definierten Risikofaktoren und aduvanten Therapieregimen erbringt ein konservatives chirurgisches Therapievorgehen beim Mammakarzinom sehr gute Langzeitergebnisse.
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References
Meeting of Investigators on the Evaluation of Methods of Diagnosis and Treatment of Breast Cancer: Final Report. Geneva, WHO, December 1969, pp 8–12.
Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, Gallus G, Greco M, Luini A, Marubini E, Muscolino G, Rilke F, Salvadori B, Zecchini A, Zucali R: Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl J Med 1981;305:6–11.
Veronesi U, Banfi A, Salvadori B, Luini A, Saccozzi R, Zucali R, Marubini E, Del Vecchio M, Boracchi P, Marchini S, Merson M, Sacchini V, Riboldi G, Santoro G: Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 1990;26:668–670.
Zucali R, Luini A, Del Vecchio M, Sacchini V, Sverzellati E, Stucchi C, Banfi A, Veronesi U: Contralateral breast cancer after limited surgery plus radiotherapy of early mammary tumors. Eur J Surg Oncol 1987;13:413–416.
Sarrazin D, Le M, Fontaine MF: Conservative treatment versus mastectomy in T1 and small T2 breast cancer: a randomized trial, in Harris JR, Hellman S, Silen W (eds): Conservative Management of Breast Cancer. Philadelphia, Lippincott, 1981. pp 101–103.
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wallmark N, Deutsch M, Montague E, Saffer E, Wickerham L, Lerner H, Glass A, Shibata H, Deckers P, Ketgham A, Hoisi R, Russell I: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665–673.
Van Dongen J: Randomized clinical trial to assess the value of breast conserving therapy in stage I and II breast cancer: EORTC trial 10801. Proc NIH Consensus Development Conf 1990, pp 25–27 (abstr).
Lichter AS, Lippman M, Danforth DN, D'Angelo T, Steinberg S, deMoss E, Donald H, Reichert CM, Merino M, Swain SM, Cowan K, Gerber LH, Bader JL, Findlai PA, Scain W, Gorrell CR, Strauss K, Rosenberg SA, Glastein E: Mastectomy vs. breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. J Clin Oncol 1992;10:976–983.
Veronesi U, Volterrani F, Luini A, Saccozzi R, Del Vecchio M, Zucali R, Galimberti V, Rasponi A, Di Re E, Squicciarini P, Salvadori B: Quadrantectomy vs. lumpectomy for small size breast cancer. Eur J Cancer 1990;6:671–673.
Sacchini V, Luini A, Lozza L, Galimberti V, Merson M, Agresti R, Veronesi P, Greco M: Quantitative and qualitative cosmetic evaluation after conservative treatment for breast cancer. Eur J Cancer 1991;27:1395–1400.
Veronesi U, Luini A, Del Vecchio M, Greco M, Galimberti V, Merson M, Rilke F, Sacchini V, Saccozzi R, Savio T, Zucali R, Zurrida S, Salvadori B: Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Eng J Med 1993;328:1587–1591.
Fisher B, Redmond C, Fisher ER, Bauer M, Walmark N, Wicherham L, Deutsch M, Montague E, Margolese R, Foster R: Teh year result of a randomized trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 1985;312:674–681.
Veronesi U, Luini A, Galimberti V, Marchini S, Sacchini V, Rilke F: Extent of axillary involvement in 1446 cases of breast cancer. Eur J Surg Oncol 1990;16:127–133.
Veronesi U, Rilke F, Luini A, Sacchini V, Galimberti V, Campa T, Dei Bei E, Greco M, Magni A, Merson M, Quagliuolo V: Distribution of axillary node metastases by level of invasion. An analysis of 539 cases. Cancer 1987:59:682–687.
Banodonna G, Veronesi U, Brambilla C, Veronesi U, Brambilla C, Ferrari L, Luini A, Greco M, Bartoli C, Coopmans de Yoldi G, Zucali R, Rilke F, Andreola S, Silvestrini R, Di Fronzo G, Valagussa P: Primary chemotherapy to avoid mastectomy in tumors with diameters of three centimeters of more. J Natl Cancer Inst 1990:82:1539–1545.
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Greco, M., Agresti, R. & Raselli, R. Conservative treatment of breast cancer: Milan experience. Acta Chir Austriaca 27, 238–242 (1995). https://doi.org/10.1007/BF02625969
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DOI: https://doi.org/10.1007/BF02625969