早期乳腺癌保乳手术术中放疗59例

目的 研究早期乳腺癌保乳手术术中放疗的可行性,评价术后并发症、乳房美容效果及肿瘤复发事件.方法 2007年6月至2010年12月,115例患者做保乳手术,59例(研究组)做术中放疗,同期有56例(对照组)术后做全乳放疗,在术后1个月评估切口愈合状况及并发症;术后1年比较两组乳房美容效果;术后随访肿瘤复发及死亡事件.结果 研究组切口愈合天数为13 ～22d,对照组为9 ～14d.研究组2例出现切口脂肪液化,16例有切口水肿,对照组未见切口脂肪液化、水肿;两组均未出现术后切口感染或血肿.术后1年乳房美容评价:研究组41例中优秀或好的有36例、一般或差的5例;对照组37例中优秀或好的有25例、一般或差的有12例(P=0.031).随访3～42个月(中位24个月),研究组局部复发2例(3.39％),其中1例(1.7％)死亡;对照组局部复发1例(1.8％),无死亡.结论 早期乳腺癌保乳手术术中放疗安全可靠、美容效果好、局部控制满意.     

早期乳腺癌保乳手术探讨

目的 探讨早期乳腺癌保乳手术加放疗治疗效果.方法 分析近6年76例保乳术后加放疗的乳腺癌病人临床资料.结果 76例患者3,5年生存率分别为96.05%,94.8%;3,5年局部复发率分别为5.3%,6.6%;术后3,5年乳房保留率分别为96.05%,93.3%;仅1例胸壁复发,无死亡病例.该复发病例25岁,未婚,保乳愿望强烈,复发后再次行乳房切除及化疗,现健在.术后形体美容效果满意度80.5%.结论 早期乳腺癌采用保乳手术及放射治疗可取得满意结果,规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.     

乳腺癌保乳整复手术

保乳整复手术是乳腺癌治疗中的一个基本组成部分。这种治疗方式可以切除大量的乳腺组织,提高美容效果,在使患者满意的同时保持良好的肿瘤学切除原则,减少再切除术和乳腺切除率,并有助于辅助放射治疗计划。 我们复习了近年来各种不同保乳整复手术,并描述了在切除乳腺内不同位置肿瘤的技术应用以及选择不同技术时所考虑患者相关的具体因素。最后,对于这种外科手术类型的肿瘤学安全性的证据及并发症进行了讨论。     

早期乳腺癌保乳手术175例回顾性分析

目的探讨影响乳腺癌保乳手术后局部复发的预后因素。方法对中国医学科学院肿瘤医院腹部外科2001年1月至2004年12月间收治的175例早期乳腺癌保乳手术资料进行回顾性研究,对年龄、分期、切缘、肿瘤大小、淋巴结情况等指标做单因素和多因素分析。结果中位随访时间57（18~94）个月。全组5年的总存活率和无病存活率分别为964%和911%,局部复发率17%。单因素分析显示保乳手术后局部复发危险因素包括肿瘤直径＞3cm、切缘＜2mm以及TNM分期。结论早期乳腺癌行保乳治疗是安全的,但要掌握保乳手术指征,保证术后综合治疗。     

早期老年乳腺癌的保乳治疗

目的总结早期老年乳腺癌保乳治疗的临床疗效。方法保乳手术治疗23例早期老年乳腺癌患者,其中Ⅰ期7例,ⅡA期12例,ⅡB期4例,术中切除距肿块边缘2 cm以上乳腺,术后予放疗、化疗及激素治疗。结果随访3.5（2～5）年,未见复发及远处转移。采用Harris提出的四等分类法为美容评定标准,佳4例（17.4%）,良16例（69.6%）,一般2例（8.7%）,差1例（4.3%）,总优良率87.0%。结论保乳治疗早期老年乳腺癌具有机体创伤小、组织器官破坏少、美容效果好和保存功能的优点,在严格掌握手术适应证的前提下,并不增加复发及远处转移的风险。     

早期乳腺癌的保乳手术治疗25例分析

目的：对早期乳腺癌采用保瘤乳房的手术治疗配以术后放疗，以探讨其手术适应证和疗效。方法：对25例早期乳腺癌进行保乳手术并与传统根治术进行比较，保乳手术指征包括：肿瘤直径小于3cm，腋窝淋巴结N0或N1a肿瘤距乳头距离大于3cm，手术前乳腺照相排除多发癌灶，手术时肿瘤周围边界至少2cm(冰冻切片证实），腋窝淋纠结解剖到第2站，术后2周内做放疗，从生存质量（Quality of life,QOL)的观点出发，分析保乳手术的适应证及存在的问题。结果：两组术后均获随访，平均随访时间64．1个月，保乳手术和传统根治术在5年生存率和复发率的比较差异无显著意义（P＞05），结论：早期乳腺癌采用保乳手术治疗效果满意。     

整形外科技术在乳腺癌保乳手术中的应用

目的 总结整形外科技术在乳腺癌保乳手术中应用的临床经验和术后美容效果.方法 回顾性分析2009年10月至2011年8月间采用整形外科技术完成的50例乳腺癌保乳手术的患者的临床资料.分析整形外科技术应用的条件、方法、并发症以及效果.结果 50例患者均为乳腺单发肿瘤,其中12例患者接受术前新辅助治疗,38例患者直接手术.肿瘤位于外上象限、内下象限、外下象限、乳头乳晕下方、乳头乳晕上方以及乳头乳晕附近与乳头乳晕深方的患者分别为20例、4例、7例、3例、7例以及6例与3例.采用的切口分别为放射状/水平状切口、V形切口、J形切口、倒T形切口、蝙蝠翼样切口以及双环切口与J形切口.术后出现2例乳腺内血肿,3例出现伤口裂开并继发感染,1例出现皮肤缺血坏死.35例患者完成辅助放化疗,有1例患者出现乳头位置偏移,2例患者出现切口处皮肤凹陷.其余患者的乳房外形均良好,患者对乳房外形的评分均较高.随访期限为4～27个月,2例患者出现局部复发,重新接受手术；其余患者均未出现复发.结论 乳腺癌保乳手术中应用整形外科技术可使部分特殊位置的肿瘤获得保乳机会,术后乳房外形保持满意.     

早期乳腺癌保乳手术与改良根治术远期疗效的比较

为探讨乳腺癌保乳手术与改良根治术远期疗效的差别。笔者回顾性分析了43例行保乳手术以及57例行改良根治术的乳腺癌患者的临床资料，对其5年疗效的差别作出评估。结果示保乳手术组5年生存率为 95.2%,根治术组为94.3%，差异无显著性（P>0.05）。提示保乳手术与改良根治术对于治疗早期乳腺癌的远期疗效相当，而保乳手术使患者保持良好的乳腺外观，可在早期乳腺癌的治疗中予以推广。     

早期乳腺癌保乳手术52例分析

目的评估早期乳腺癌保乳综合治疗的疗效。方法2000年3月～2005年9月，我院对52例Ⅰ期及部分Ⅱ期（肿瘤≤3cm，单发病灶）乳腺癌行局部广泛切除术，全腋窝淋巴结清扫术联合术后放疗，并辅以化疗（CMF或CEF方案）、内分泌治疗（口服三苯氧胺）。结果术后病理提示个切缘无癌细胞浸润。美容效果优良率达86．5％（45／52）。50例随访10～36个月（中位时间16个月），未见局部复发与远处转移。结论选择部分Ⅰ～Ⅱ期乳腺癌病例行保乳手术治疗，乳房外形及临床疗效满意，而且可以提高生活质量。     

早期乳腺癌保乳手术与改良根治术的疗效对比

目的：探讨乳腺癌保乳手术与改良根治术治疗早期乳腺癌疗效及临床应用价值。 方法：早期84例乳腺癌患者,按照手术方法分为观察组和对照组,对照组给予乳腺癌改良根治术治疗,观察组给予保乳手术治疗,观察两组治疗效果。 结果：观察组在手术时间、术中出血量、住院时间均短于对照组,差异具有统计学意义（P<0.05）;观察组患者的乳房美容效果明显好于对照组（P<0.05）;两组并发症发生率、局部复发率、远处转移发生情况,组间差异无统计学意义（P>0.05）。 结论：早期乳腺癌患者实施保乳手术具有创伤小、恢复快等特点,术后乳房美容效果好,是治疗早期乳腺癌的发展趋势,值得在临床上大力推广使用。     

早期乳腺癌的保乳综合治疗疗效分析

目的　评价早期乳腺癌保乳综合治疗的疗效。方法　保乳组 92例 ,行保留乳房的肿瘤切除加腋窝淋巴结清扫术 ;对照组 60例 ,行乳癌改良根治术。术后给予放疗、全身化疗和 /或内分泌治疗。结果　平均随访 5 7个月 ,保乳组中无局部复发病例 ,3年生存率为 97.2 % ,5年生存率为 89.3 % ,远隔脏器转移率为 6.5 % ;对照组局部复发 2例 ,3年生存率为 97.5 % ,5年生存率为90 .1% ,远隔脏器转移率为 5 .0 % ,两组各指标对比无明显差异 (P >0 .0 5 )。结论　早期乳腺癌采用保乳综合疗法 ,可以达到与根治术相似的治疗效果 ,可作为首选方法     

Omission of radiotherapy in elderly women with early stage metaplastic breast cancer

PurposeMultiple studies have evaluated the omission of radiation therapy (RT) in elderly women with invasive carcinoma; no studies to date have assessed this question for metaplastic breast cancer (MBC). This study is the only known study describing national practice patterns and addressing the impact of RT versus observation on survival in elderly women with T1-2N0 MBC.MethodsThe National Cancer Data Base was queried (2004–2013) for women aged ≥70 years with T1-T2N0 MBC that underwent lumpectomy. Multivariable logistic regression ascertained factors associated with RT administration. Kaplan-Meier analysis evaluated overall survival (OS) between patients treated with or without postoperative RT. Cox proportional hazards modeling determined variables associated with OS. Propensity matching was performed in order to address indication bias.ResultsOf 547 total patients, 176 (32%) underwent observation, and 371 (68%) received postoperative RT. Temporal trends revealed that withholding RT steadily declined over the studied time period. RT delivery was less likely in patients not undergoing hormonal therapy or those ≥80 years old. In both the overall population and following propensity matching, delivery of RT was associated with higher OS (p < 0.001 for both). On Cox multivariate analysis, poorer OS was independently associated with advancing age, higher T stage, high-grade disease, and omitting postoperative RT (p < 0.05 for all).ConclusionsAlthough level I evidence exists to omit RT in select elderly women, this is the only study evaluating this notion for MBC. These results do not support the routine withholding of RT in T1-2N0 MBC owing to the independent association with worse survival.     

Concurrent versus sequential adjuvant chemo-endocrine therapy in hormone-receptor positive early stage breast cancer patients: a systematic review and meta-analysis

BackgroundAlthough in clinical practice adjuvant chemotherapy (CT) and endocrine therapy (ET) are administered sequentially in patients with hormone-receptor positive breast cancer, the optimal timing, i.e. concurrent or sequential administration, of these treatments has been scarcely investigated. To better clarify this issue we conducted a systematic review and meta-analysis of randomized studies comparing these two modalities of administrations in terms of disease-free survival (DFS) and overall survival (OS).MethodsRelevant studies were identified by searching PubMed, Web of Knowledge and the proceedings of the major conferences with no date restriction up to March 2016.The summary risk estimates (pooled hazard ratio [HR] and 95% confidence intervals [CI]) for DFS and OS were calculated using random effect models (DerSimonian and Laird method).ResultsA total of three randomized studies were eligible including 2021 breast cancer patients. Overall, 755 DFS events were observed, 365 in the sequential arm and 390 in the concomitant arm, with a pooled HR of 0.95 (95% CI = 0.76 to 1.18, P = 0.643).No association between timing of treatment and OS was observed (HR = 0.95; 95% CI = 0.80 to 1.12, P = 0.529).ConclusionOur pooled analysis showed no association between the timing of administration of adjuvant CT and ET and DFS and OS in breast cancer patients candidates for both adjuvant treatments. Because of the small number of published trials, the lack of data on the timing with modern adjuvant treatments, i.e. taxane-containing CT and aromatase inhibitors, this topic remain still controversial and requires further studies to be clarified.     

A UK national survey of breast surgeons on primary endocrine therapy of early operable breast cancer

Introduction

A significant proportion of elderly breast cancer patients in the UK have no surgical treatment recorded and appear to be treated with primary endocrine therapy (PET) only. Despite this, PET remains one of the poorly studied areas in breast cancer therapy and very little is known about the practice of PET in the UK.

Methods

A questionnaire comprising 14 questions relevant to PET was sent to 489 breast surgeons who were members of the UK Association of Breast Surgery and returned questionnaires were analysed.

Results

Overall, 228 questionnaires (47%) were returned. The vast majority (93%) of surgeons who responded use PET in early operable breast cancer in elderly women unfit for surgery or owing to patient preference but 7% would recommend PET to fit elderly patients. Most (76%) use letrozole. The percentage of elderly patients treated with PET varied from <10% to 70% between surgeons. The majority (77%) of respondents had not formally audited the outcome of their PET patients and over 70% underestimated the expected survival of an 80-year-old woman.

Conclusions

Most UK breast surgeons use PET in elderly patients with surgically resectable breast cancer. While most use it in unfit, frail patients, a minority would treat even fit elderly women with PET. Most surgeons have not formally audited the outcome of their patients treated with PET and underestimate the expected survival of elderly patients, which might have an impact on their decision to offer PET rather than surgery.     

Determinants of early distant metastatic disease in elderly patients with breast cancer

BACKGROUND: The purpose of this analysis was to determine predictors of early distant metastasis in elderly breast cancer patients receiving hormonal therapy. METHODS: We analyzed data from 938 patients in the North American Fareston Tamoxifen Adjuvant Trial>or=65 years old to determine predictors of early metastatic disease. RESULTS: The median patient age was 73 (range 65 to 100). With a median follow-up of 34 months, 17 patients (1.8%) developed distant metastases. The median time to distant metastasis was 21 months. On univariate analysis, significant predictors of distant metastatic disease were as follows: progesterone receptor status (P=.032), lymphovascular invasion (P=.020), tumor grade (P=.007), tumor size (P<.01), and number of metastatic nodes (P<.01). On multivariate analysis, only the number of positive nodes (P=.029) remained significant. Patients with >or=4 positive nodes were more likely to develop early metastases than those with 0 to 3 positive nodes (odds ration 20.304; 95% confidence interval 2.777-148.456, P=.003). CONCLUSIONS: Lymph node status in the elderly breast cancer patient treated with hormonal therapy alone is a strong predictor of early distant recurrence.     

Assessment of compliance with hormonal therapy in early breast cancer patients with positive hormone receptor phenotype: A single institution study

BackgroundAdherence to long-term adjuvant hormonal therapy in hormonal receptors (HR)-positive breast cancer is really challenging and can affect the survival outcome. The present study aims to assess rate of compliance with hormonal therapy and possible predictive factors in a single institute in Saudi Arabia.Patients &methodsWe recruited patients with HR-positive breast cancer who presented to oncology outpatient clinics. Patients were assessed for compliance using a study questionnaire. Compliance was defined as taking ≥80% of prescribed doses of oral hormonal therapy. Different epidemiological, clinical, pathological and treatment data were checked in patients’ medical records and correlated with compliance/interruption of hormonal therapy.ResultsAmong the 203 recruited patients, 95.1% were compliant with hormonal therapy, while it was interrupted in 16.7% of patients, and 58.1% reported missing intake of hormonal pills. Age >50 years, having permanent job and higher education level were significantly associated with non-compliance in univariate analysis. On multivariate analysis, job status was the only independent predictor of non-compliance. The following parameters were significantly related to hormonal therapy interruption: marital status (single: 28.8% vs married patients: 12.6%, p = 0.01) and residence location (Makkah: 11.7% vs. outside Makkah: 25.3%, p = 0.019), lymphovascular invasion (LVI) (No: 20.9%, Yes: 7.8%, p = 0.025) and N0 tumours (compared to node-positive patients, p = 0.008). On multivariate analysis, marital status, residence location and N-stage, maintained significance relation with hormonal therapy interruption.ConclusionCompliance with hormonal therapy was high in the study cohort. Marital status, residence location, job status and N-stage may be related to interruption/compliance with hormonal therapy.     

Impact of extensive intraductal component on recurrence and survival in patients with stage I or II breast cancer treated with breast conservation therapy

Background: The relationship between an extensive intraductal component (EIC) and recurrence and survival in patients with stage I or II breast cancer treated with breast conservation therapy has not been clearly defined. Methods: 133 patients with stage I or II breast cancer who underwent breast conservation therapy between 1978 and 1990 at The University of Texas M. D. Anderson Cancer Center were retrospectively studied. All pathology slides were reviewed to determine tumor size, nuclear grade, extent of intraductal component, number of positive lymph nodes, and histologic margins. EIC was defined as ductal carcinoma in situ (DCIS) occupying 25% or more of the area encompassed by the infiltrating tumor and DCIS present in grossly normal adjacent breast tissue. Results: 110 patients are alive, and 23 have died, with a median follow-up of 7 years; 85 of 133 patients had an intraductal component, but only 18 had an EIC. Locoregional control and disease-free and overall survival were not adversely affected by the presence of an EIC. Five of 133 patients had a locoregional recurrence, but only one had an EIC. Conclusions: EIC, if negative margins can be achieved, does not adversely affect disease-free or overall survival or local control rates.     

乳腺癌患者综合治疗后肺部早期放射性反应

作者总结了经过手术、放疗和化疗等综合治疗的６２例乳腺癌病例。化疗用ＣＭＦ或ＣＡＭＦ方案。肺部早期放射性反应的发生率为１１．３％（７例），而且早期肺放射性反应发生率均发生于含阿霉素的ＣＡＭＦ化疗方案病例中，说明阿霉素与放射治疗合并使用会增加早期肺放射性反应的发生率。因此，综合治疗中，为了既得到好的治疗效果又减少肺部早期放射性反应的发生，对于用阿霉素化疗的病例，我们应该适当控制总照射剂量，精确设计放射野。     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

Risk factors for brain metastasis as a first site of disease recurrence in patients with HER2 positive early stage breast cancer treated with adjuvant trastuzumab

PurposeThe aim of this study was to determine risk factors for brain metastasis as the first site of disease recurrence in patients with HER2-positive early-stage breast cancer (EBC) who received adjuvant trastuzumab.MethodsMedical records of 588 female patients who received 52-week adjuvant trastuzumab from 14 centers were evaluated. Cumulative incidence functions for brain metastasis as the first site of disease recurrence and the effect of covariates on brain metastasis were evaluated in a competing risk analysis and competing risks regression, respectively.ResultsMedian follow-up time was 36 months. Cumulative incidence of brain metastasis at 12 months and 24 months was 0.6% and 2%, respectively. HER2-enriched subtype (ER− and PR−) tumor (p = 0.001, RR: 3.4, 95% CI: 1.33–8.71) and stage 3 disease (p = 0.0032, RR: 9.39, 95% CI: 1.33–8.71) were significant risk factors for development of brain metastasis as the first site of recurrence.ConclusionsIn patients with HER2 positive EBC who received adjuvant trastuzumab, HER2-enriched subtype (ER− and PR−) tumor and stage 3 disease were associated with increased risk of brain metastasis as the first site of disease recurrence.