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Breast-conserving surgery for T3/T4 breast cancer: an analysis of 196 patients

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Abstract

Introduction

Breast conservation therapy (BCT) increases quality of life and self-esteem of breast cancer patients. In special cancer centers up to 90% of patients are treated with BCT. T3/T4 breast cancer is one of the few contraindications for BCT. However, retrospective data suggest that BCT may be eligible in selected cases of T3/T4 breast cancer.

Method

We analyzed retrospectively 196 breast cancer patients (operated between 1995 and 2004) suffering from T3/T4 tumors and compared BCT and radiotherapy with mastectomy in these patients in terms of overall survival (OS), local recurrence free-survival (LRFS) and breast cancer-related death (BCRD).

Result

Demographic data showed no significant differences in prognostic factors between patients treated with mastectomy compared with BCT. Kaplan-Meier curves demonstrated no significant difference for OS, LRFS and BCRD between the two groups.

Discussion

Our data strongly suggest that BCT with R0 resection followed by radiotherapy is feasible in patients with T3/T4 breast cancer. Prospective studies have to be performed to further investigate this issue.

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References

  1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241

    Article  PubMed  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232

    Article  PubMed  Google Scholar 

  3. Morrow M, Bucci C, Rademaker A (1998) Medical contraindications are not a major factor in the underutilization of breast-conserving therapy. J Am Coll Surg 186(3):269–274

    Article  PubMed  CAS  Google Scholar 

  4. Jakesz R, Samonigg H, Gnant M, Kubista E, Depisch D, Kolb R, Mlineritsch B, Mischinger HJ, Menzel RC, Steindorfer P et al (2003) Significant increase in breast conservation in 16 years of trials conducted by the Austrian Breast & Colorectal Cancer Study Group. Ann Surg 237(4):556–564

    Article  PubMed  Google Scholar 

  5. Fitzal F, Gnant M (2006) Breast conservation: history, surgical strategy and specific considerations. Breast J (in press)

  6. Morrow M (2005) Limiting breast surgery to the proper minimum. Breast 14(6):523–526

    Article  PubMed  Google Scholar 

  7. Bartelink H, Borger JH, van Dongen JA, Peterse JL (1988)␣The impact of tumor size and histology on local control after breast-conserving therapy. Radiother Oncol 11(4):297–303

    Article  PubMed  CAS  Google Scholar 

  8. van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, van der Schueren E, Helle PA, van␣Zijl K, Bartelink H (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst 92(14):1143–1150

    Article  PubMed  Google Scholar 

  9. Asgeirsson KS, McCulley SJ, Pinder SE, Macmillan RD (2003) Size of invasive breast cancer and risk of local recurrence after breast-conservation therapy. Eur J Cancer 39(17):2462–2469

    Article  PubMed  CAS  Google Scholar 

  10. Khanna MM, Mark RJ, Silverstein MJ, Juillard G, Lewinsky B, Giuliano AE (1992) Breast conservation management of breast tumors 4 cm or larger. Arch Surg 127(9):1038–1041; discussion 1041–1033

    Google Scholar 

  11. Bjurstam N, Bjorneld L, Warwick J, Sala E, Duffy SW, Nystrom L, Walker N, Cahlin E, Eriksson O, Hafstrom LO et al (2003) The Gothenburg breast screening trial. Cancer 97(10):2387–2396

    Article  PubMed  Google Scholar 

  12. Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE (2002) Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 359(9310):909–919

    Article  PubMed  Google Scholar 

  13. Steger G, Kubista E, Hausmaninger H, Gnant M, Tausch C, Lang A, Samonigg H, Galid A, Jakesz R (2004) 6 vs. 3 Cycles of epirubicin/docetaxel + G-CSF in operable breast cancer: Results of ABCSG-14. J Clin Oncol 22(14S):553

    Google Scholar 

  14. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349(6):546–553

    Article  PubMed  Google Scholar 

  15. Fitzal F, Mader N, Rudas M, Draxler W, Mittlbock M, Riedl O, Taucher S, Jakesz R, Gnant M (2006) Intra-operative frozen section analyses during breast cancer operations: feasibility and advantages from 1.559 cases. Ann Surg Oncol epub ahead print

  16. Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW, Mouridsen HT (1992) Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis, Danish breast cancer cooperative group. J Natl Cancer Inst Monogr (11):19–25

    PubMed  Google Scholar 

  17. Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, Lippman ME, Lichter AS, Glatstein E, Okunieff P (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332(14):907–911

    Article  PubMed  CAS  Google Scholar 

  18. Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Harnett AN, Smith DC, George WD (1996) Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish cancer trials breast group. Lancet 348(9029):708–713

    Article  PubMed  CAS  Google Scholar 

  19. Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, Menard C, Lippman ME, Lichter AS, Altemus RM (2003) Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the national cancer institute randomized trial. Cancer 98(4):697–702

    Article  PubMed  Google Scholar 

  20. Holland R, Veling SH, Mravunac M, Hendriks JH (1985) Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990

    Article  PubMed  CAS  Google Scholar 

  21. Vaidya JS, Vyas JJ, Chinoy RF, Merchant N, Sharma OP, Mittra I (1996) Multicentricity of breast cancer: whole-organ analysis and clinical implications. Br J Cancer 74(5):820–824

    PubMed  CAS  Google Scholar 

  22. Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, Fourquet A, Borger J, Jager J, Hoogenraad W et al (2001) Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 345(19):1378–1387

    Article  PubMed  CAS  Google Scholar 

  23. Veronesi U, Marubini E, Del Vecchio M, Manzari A, Andreola S, Greco M, Luini A, Merson M, Saccozzi R, Rilke F et al (1995) Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst 87(1):19–27

    Article  PubMed  CAS  Google Scholar 

  24. Woerdeman LA, Hage JJ, Thio EA, Zoetmulder FA, Rutgers EJ (2004) Breast-conserving therapy in patients with a relatively large (T2 or T3) breast cancer: long-term local control and cosmetic outcome of a feasibility study. Plast Reconstr Surg 113(6):1607–1616

    Article  PubMed  Google Scholar 

  25. Horst KC, Smitt MC, Goffinet DR, Carlson RW (2005) Predictors of local recurrence after breast-conservation therapy. Clin Breast Cancer 5(6):425–438

    Article  PubMed  Google Scholar 

  26. Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H (1998) Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC trial 10801. The European organization for research and treatment of cancer (EORTC), breast cancer co-operative group (BCCG). Eur J Cancer 34(3):307–314

    Article  PubMed  CAS  Google Scholar 

  27. Salvesen GS, Dixit VM (1997) Caspases: intracellular signaling by proteolysis. Cell 91(4):443–446

    Article  PubMed  CAS  Google Scholar 

  28. Meikrantz W, Schlegel R (1995) Apoptosis and the cell cycle. J Cell Biochem 58(2):160–174

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

We have to thank Mr. Mtomanek for helping to prepare the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1080 , Vienna, Austria

    Florian Fitzal, Otto Riedl, Lisa Wutzl, Peter Dubsky, Thomas Bachleitner-Hofmann, Raimund Jakesz & Michael Gnant

  2. Department of Bioinformatics and Statistics, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria

    Wolfgang Draxler

  3. Department of Pathology, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria

    Margaretha Rudas

  4. Department of Oncology, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria

    Ursula Pluschnig & Günther Steger

  5. Department of Radiotherapy, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria

    Leonore Handl-Zeller

Authors
  1. Florian Fitzal
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  2. Otto Riedl
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  3. Lisa Wutzl
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  4. Wolfgang Draxler
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  5. Margaretha Rudas
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  6. Ursula Pluschnig
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  7. Leonore Handl-Zeller
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  8. Peter Dubsky
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  9. Thomas Bachleitner-Hofmann
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  10. Günther Steger
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  11. Raimund Jakesz
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  12. Michael Gnant
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Correspondence to Florian Fitzal.

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Fitzal, F., Riedl, O., Wutzl, L. et al. Breast-conserving surgery for T3/T4 breast cancer: an analysis of 196 patients. Breast Cancer Res Treat 103, 45–52 (2007). https://doi.org/10.1007/s10549-006-9325-6

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  • DOI: https://doi.org/10.1007/s10549-006-9325-6

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