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Outcome of breast-conserving therapy in the Tokyo women’s medical university breast cancer society experience

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Abstract

Background

The results of BCT in Japanese women have not been fully evaluated. The Tokyo Women’s Medical University Breast Cancer Society initiated BCT protocols in 1987. Here, we present a retrospective analysis of BCT outcomes and identify prognostic factors.

Methods

The study population comprised 348 patients (353 breasts) with UICC clinical stage 0, I or II breast cancer, for whom wide excision (n = 294), quadrantectomy (n = 56) and tumorectomy (n = 3) were performed. The final pathological margin states were positive in 102 breasts (cancer cells remained within 5 mm of the surgical margin). The whole breast was irradiated to a total dose with 44 Gy/20 fractions or 46 Gy/23 fractions in the patients with negative surgical margins. The patients with positive or close margins received 48.4 Gy/22 fractions or 50 Gy/25 fractions irradiation to the whole breast. All but 2 patients received a radiation boost to the tumor bed and all tumor beds were irradiated to more than 53 Gy. Adjuvant therapy was administered in 240 cases. The median follow-up time was 4.3 years.

Results

The 5-year overall, cause-specific and disease-free survival rates were 95.8%, 97.3% and 92.5%, respectively. Recurrence was observed in 29 patients including 11 patients with loco-regional recurrence. Local recurrence was observed in 6 patients, 5 of whom were premenopausal. The 5-year local control and loco-regional control rates were 98.9% and 96.6%, respectively. T status (T1 to T2) was the only significant prognostic factor for disease-free survival. No severe morbidity has been observed. Cosmetic results were excellent or good in 73% of patients.

Conclusion

Our BCT protocols provide a high rate of local control and good cosmetic outcome. Pathologic margin status was not a major prognostic factor for local recurrence. Long term follow-up is required to reach a definite conclusion on optimal BCT protocols.

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Abbreviations

BCT:

Breast-conserving therapy

UICC:

Union Internationale Contre 1e Cancer

ECOG:

Eastern Cooperative Oncology Group

ER:

Estrogen receptor

PgR:

Progesterone receptor

DCC:

Dextrancoated charcoal

EIA:

Enzyme immunoassay

LH-RH:

Luteinizing hormone-releasing hormone

LENT SOMA scale:

Late Effects Normal Tissues, Subjective, Objective, Management and Analysis scale

EORTC:

the European Organization for Research and Treatment of Cancer

We:

Wide excision

Bq:

Quadrantectomy

Tm:

Tumorectomy

inf:

Inflammatory type

Bp:

Partial mastectomy

WB:

Whole breast irradiation

LO:

Local boost irradiation

NSABP:

National Surgical Adjuvant Breast and Bowel Project

Osaka MCCCD:

Osaka Medical Center for Cancer and Cardiovascular Diseases

TWMU:

Tokyo Women’s Medical University

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Author information

Authors and Affiliations

  1. Department of Radiology School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan

    Kumiko Karasawa & Norio Mitsuhashi

  2. Department of Endocrine, School of Medicine Tokyo Women’s Medical University, Japan

    Takao Obara, Takahiro Okamoto & Yukio Ito

  3. Department of Surgery, Tokyo Women’s Medical University Daini Hospital, Japan

    Tadao Shimizu & Shunsuke Haga

  4. Department of Surgery II, School of Medicine Tokyo Women’s Medical University, Japan

    Takako Kamio, Tsunehito Kimura & Shingo Kameoka

  5. Department of Surgical Pathology, School of Medicine Tokyo Women’s Medical University, Japan

    Toshio Nishikawa

  6. Department of Surgical Pathology, Tokyo Women’s Medical University Daini Hospital, Japan

    Motohiko Aiba

  7. Department of Breast Surgery, Syorakudo Hospital, Japan

    Masaru Izuo

Authors
  1. Kumiko Karasawa
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  2. Takao Obara
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  3. Tadao Shimizu
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  4. Shunsuke Haga
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  5. Takahiro Okamoto
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  6. Yukio Ito
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  7. Takako Kamio
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  8. Tsunehito Kimura
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  9. Shingo Kameoka
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  10. Norio Mitsuhashi
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  11. Toshio Nishikawa
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  12. Motohiko Aiba
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  13. Masaru Izuo
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Corresponding author

Correspondence to Kumiko Karasawa.

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Karasawa, K., Obara, T., Shimizu, T. et al. Outcome of breast-conserving therapy in the Tokyo women’s medical university breast cancer society experience. Breast Cancer 10, 341–348 (2003). https://doi.org/10.1007/BF02967655

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  • DOI: https://doi.org/10.1007/BF02967655

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