Stewart-Treves syndrome (angiosarcoma on lyphoedema): A rare complication of lymphoedema

Stewart-Treves syndrome (SST) or former lymphangiosarcoma is a rare complication of chronic lymphoedema mainly related to the breast cancer (90% of cases). It occurs in 0.03% of patients surviving 10 or more years after radical mastectomy. The prognosis is very poor with a five-year survival close to 10% despite the various treatment modalities. The treatment of choice is a large resection, but some authors recommend radical resection in the form of shoulder disarticulation or forequarter amputation. Surgical treatment can be preceded or followed by radiation therapy. Locally advanced tumors or metastatic forms can be treated with mono or polychemotherapy, systemic or local.     

Simple mastectomy for early and advanced mammary carcinoma

Simple mastectomy was used to treat 111 women with invasive mammary carcinoma. In none of eighteen patients with cancer clinically confined to the breast did local recurrence develop after simple mastectomy, but metastases developed in the axilla in three. Adjuvant irradiation, castration, or drug therapy did not improve the survival or ultimate local control achieved by simple mastectomy.No significant difference was demonstrated in survival after simple and radical mastectomy for comparable clinical stages of disease.     

Inflammatory carcinoma of the breast. A therapeutic approach followed by improved survival.

Disappointing results of radical mastectomy for treatment of inflammatory breast carcinoma led to its abandonment and the use of alternative therapeutic methods without improvement of survival rates. Results of radical mastectomy combined with other therapeutic modalities have not been fully evaluated so far. In a series of nine patients with proven inflammatory breast carcinoma and no distant metastases, two underwent radiotherapy, oophorectomy, and adrenalectomy (group A) and seven underwent preoperative irradiation, radical mastectomy, postoperative irradiation, and chemotherapy (group B). There were no local recurrences in either group. Group A patients survived five and eight months (mean, 6.6+/-2.1) and patients of group B survived 45.5+/-26.2 months (p less than 0.05). Results show no rational basis for withholding radical mastectomy, but suggest that improved survival may be obtained when radical mastectomy is an integral part of a rational sequential therapeutic schedule.     

Radical mastectomy with parasternal node dissection or radiation to the parasternal region for breast cancer of medial or central location

In order to establish a therapeutic approach for primary breast cancer of medial and central origin, we reviewed 183 patients who had been treated by one of the following three modalities at the Second Department of Surgery, Osaka University Medical School between January, 1965 and December, 1980. Group A (n=70): standard radical mastectomy alone; Group B (n=34): standard radical mastectomy followed by postoperative irradiation to the parasternal and supraclavicular regions, and; Group C (n=62): extended radical mastectomy that included removal of the parasternal lymph nodes. The background factors of the three groups were not significantly different. The overall survival five and ten years following surgery in the three groups were 91 per cent and 79 per cent in group A, 82 per cent and 67 per cent in group B, and 82 per cent and 70 per cent in group C, respectively, showing no significant difference in overall survival among the three groups. When the patients were classified according to the extent of axillary lymph node involvement, there was no difference in survival among the three treatments in patients who had less than three lymph node metastases in the axilla. However, treatment of the parasternal lymph nodes improved survival in the patients who had more than four lymph node metastases in the axilla. Parasternal lymph node involvement definitely worsened the prognosis, showing it to be a good prognostic factor. Thus, extended radical mastectomy should be considered for patients with breast cancer of medial or central location, when extended axillary lymph node involvement is found.     

A comparison of modified radical mastectomy to radical mastectomy in the treatment of operable breast cancer.

This study compares the results of modified radical mastectomy (144 cases) to radical mastectomy (188 cases) in the treatment of operable breast cancer. Two hundred five patients had Stage I breast cancer, 60 had Stage II disease and 67 had Stage III disease (TNM System). There was no statistically significant difference in five year survival when the results of a radical mastectomy were compared to a modified radical mastectomy at any stage of disease. There was no statistically significant difference in the incidence of local recurrence in patients with Stage I and Stage II disease when the results of a radical mastectomy were compared to modified radical mastectomy. Those patients with Stage III disease who were treated by a modified radical mastectomy had a statistically significant higher incidence of local recurrence (chest wall and axilla) in comparison to patients treated by radical mastectomy. We have concluded that a modified radical mastectomy is the treatment of choice in patients with Stage I and Stage II diseases. In patients with Stage III disease, a radical mastectomy provides a better chance of local control of the disease but offers no increased chance of survival.     

Stewart-treves syndrome. A report of two cases with a review of Japanese literature

Two cases of postmastectomy lymphangiosarcoma seen at our department are reported. One case, treated by amputation, died 1 year 4 months later and the other case, treated by local excision followed by amputation, died 7 months later. Twenty cases from the Japanese literature, including our 2 cases, are reviewed herein. The initial treatment for the other 18 cases was as follows: amputation in 8 cases, local excision in 2, radiotherapy in 4 and chemotherapy in 4. Fifteen of 16 cases eligible for follow up were dead within 20 months after treatment. Although the knowledge available as to the results of the treatment of postmastectomy lymphangiosarcoma is still insufficient to indicate the optimal therapeutic approach, early recognition of the lesion and prompt radical ablative surgery seem to offer the best chance for survival.     

Intraoperative implantation radiation therapy plus lumpectomy for carcinoma of the breast

The preponderance of evidence indicates that lumpectomy plus radiation therapy produces the same survival as modified radical mastectomy in patients with early breast cancer and further suggests that the local failure rate may be lower in the patients who undergo irradiation. In this series, patients were treated with immediate implantation of the tumor bed with iridium Ir 192. There have been two recurrences in the breast from 110 breast cancers (44% had a clinical stage greater than T1, and 41% had axillary-node involvement) in 107 patients followed up for four to 52 months (25.8 +/- 13.3 months [mean +/- SD]). These preliminary data suggest that local treatment failure can be minimized by aggressive, immediate intraoperative implantation of the tumor bed with iridium Ir 192.     

Results of conservative treatment of breast cancer at ten and 15 years.

The ten-year survival of patients at the Cleveland Clinic treated by operations less than radical mastectomy was 45% compared with 43% in identically staged patients of the "National Cancer Registry" treated predominantly by radical mastectomy. The five and ten-year survival rates of patients treated by simple operations was higher than that of a similar group of patients treated by radical operations, but at 15 years there was no difference. The late deaths from cancer in the patients treated conservatively occurred in patients with favorably staged cancers who never had local recurrences and most of whom had no involvement of nodes. The incidence of local recurrence was no higher after simple operations than after the radical procedure. The ten-year incidences of local recurrence and of death from cancer were the same after partial mastectomy as after total mastectomy. It is pointed out that differences in staging the cancers and in reporting the survival rates invalidate comparisons of results from different institutions. The figures presented suggest that conservative operations and radical operations give the same survival rates at ten and at 15 years.     

Secondary lymphedema of the arm following primary therapy of breast carcinoma]

1107 cases of lymphedema of the ipsilateral arm (27%) were found in 4011 female breast cancer patients suffered from 4101 breast cancer, seen in the Bad Trissl hospital between 1972 and 1990. The right arm was affected in 47.5%, the left in 52.5%. Primary treatment had consisted of operation alone in 1630 patients with a consecutive rate of edema of 20.3%. Additional irradiation increased this rate up to 31.4% (n = 2471). The rate of edema after radical mastectomy (n = 731), modified radical mastectomy (n = 3149) and breast preserving operation (n = 221) were 39.2% and 9.5% respectively. Adjuvant radiotherapy increased the edema rate of each the surgical procedures (radical mastectomy alone 22.7%, with irradiation 44.7%, modified radical mastectomy alone 19.9%, with irradiation 29.3%, breast preserving operation alone 6.9%, with irradiation 10.4%). During the observation time from 1972 to 1990, the edema rate was reduced from 38% to 18%, reflecting the change of the chosen therapy modalities (radical surgery and conventional irradiation from the 50th's to the early 70th's, breast preserving techniques with modern megavoltage irradiation in the late 80th's). A further reduction of the lymphedema rates by minimization of the aggressiveness of the treatment seems to be possible and should be taken into account for preserving an optimal quality of life.     

Trend towards conservative surgery for intraductal carcinomas of the breast. (Retrospective study of 165 cases)]

One hundred and sixty-five intraductal, non invasive breast carcinomas in 162 patients were reviewed. The mean follow-up was 75 months. Recurrence rates seem to be influenced by the therapeutic approach: 4.8% following mastectomy (4 cases out of 83); 16% following breast conserving surgery associated with radiotherapy (4 cases of 25); 22.8% following subcutaneous mastectomy (8 cases out of 35); 50% following breast conserving surgery alone (11 cases out of 35). When considering the clinical and radiological sizes of the tumor in the group of tumor excision and breast irradiation, additional information is gained. When the size is less than 25 mm the recurrence rate drops to 6.6% (1 case out of 15). When the lesions are extensive a subcutaneous mastectomy followed by irradiation (with or without a breast implant) might be an interesting alternative to modified radical mastectomy.     

Patey's radical mastectomy in combined treatment of breast cancer

The late results of treatment of operable patients with breast carcinoma are analysed. The frequency of local recurrences and metastases in the subclavicular lymph nodes and distal organs are compared according to the method of operative intervention. It is emphasized that purposeful exposure to radiation makes it possible to achieve similar results in Patey's, Halsted's, and Urban-Holdin's operations. From the functional standpoint, however, conservative radical mastectomy surpasses radical and extended radical mastectomy considerably. All this allows Patey's operation in combination with irradiation to be recommended for wide introduction into therapeutic practice at oncological institutions of the Soviet Union.     

Male breast carcinoma

Fifty men with primary breast carcinoma were seen between the years 1938 and 1983 at the University of Iowa Hospitals and Clinics. In most patients, there was a significant delay between the onset of symptoms and seeking medical advice (mean, 21 months; range, 1-156). The vast majority of patients were treated by simple, modified radical, or radical mastectomy. Ten patients underwent incisional or excisional biopsy with or without radiation because of locally advanced disease or distant metastases. Survival was comparable in the groups of patients treated with simple mastectomy (mean, 70 months), modified radical mastectomy (mean, 61 months), and radical mastectomy (mean, 78 months). Local recurrence occurred in 25 per cent of all patients, and this rate was not dependent on the operation performed. The data suggest that modified radical mastectomy is adequate therapy for local control and staging of the disease without reducing survival from that observed after radical mastectomy.     

Postirradiation fibrosarcoma following radical mastectomy

A case of fibrosarcoma arising in the scar of the radical mastectomy with postoperative irradiation of breast carcinoma is reported. The tumors arose five times in spite of the extirpations including surrounding tissue since 11 years after radical mastectomy and postoperative irradiation. All of arisen tumors were diagnosed fibrosarcoma histologically and with every recurrence the aggrevation of malignancy of tumors was shown. In this case, the primary tumor of the breast was infiltrating carcinoma and no sign of fibrosarcoma was noted histologically. The mastectomy scar was indicated the irradiation therapy postoperatively and fibrosarcoma developed 11 years after postoperative irradiation. Namely, this case agreed to the strict criteria of the postirradiation sarcoma proposed by Cahan et al. In this paper, a case of postirradiation fibrosarcoma arising in the scar of radical mastectomy for carcinoma is presented.     

乳腺癌改良根治术中保留肋间臂神经的临床意义

目的探讨乳腺癌改良根治术中保留肋间臂神经（ICBN）的可行性及临床意义。方法分析105例Ⅰ、Ⅱ期乳腺癌患者,分为2组：实验组56例,行乳腺癌改良根治术时保留ICBN,对照组49例,行常规乳腺癌改良根治术,术中不保留ICBN,随访观察术后患者腋窝、上臂内侧感觉功能。结果实验组患者上臂感觉障碍发生率10.7%,而对照组为69%,差异有统计学意义（P〈0.01）,全部病例随访3 a无局部复发。结论Ⅰ、Ⅱ期乳腺癌行改良根治术时保留ICBN可明显减少术后患侧腋窝上臂内侧感觉障碍和疼痛,提高生活质量,而且不增加复发风险。     

乳腺癌保留皮肤改良根治并即刻假体再造与传统改良根治术的疗效比较

目的 比较乳腺癌保留皮肤改良根治并即刻假体再造和传统改良根治术的治疗效果.方法 对2004年1月至2008年12月手术治疗的530例0～Ⅲa期女性乳腺癌患者病例资料进行回顾性分析.530例中,91例行乳腺癌保留皮肤改良根治并即刻假体再造,439例行传统改良根治术.通过比较两组患者术后并发症、局部复发率、远处转移率、病死率的差异,评价乳腺癌保留皮肤改良根治并即刻假体重建与传统改良根治术的疗效.结果 即刻假体再造组随访患者84例,中位随访时间35个月,局部复发率2.4%,远处转移率8.3%,病死率6.0%;改良根治组随访患者439例,中位随访时间36个月,局部复发率3.3%,远处转移率9.5%,病死率6.5%.随访期间两组复发率、转移率、病死率的差异均无统计学意义(P＞0.05).即刻假体再造组术后美观效果随访12个月,医生和患者评估的良好率分别为93%、87%.结论 乳腺癌保留皮肤改良根治并即刻假体再造可以达到和传统改良根治术相当的疗效,并可显著改善患者术后乳房外形美观及生活质量.

Abstract：

Objective To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. Methods The data of 530 female patients with early of stage 0 to Ⅲ a breast cancer was retrospectively analyzed, from January 2004 to Decembet 2008. Among the patients,91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction ( Group of immediate implanting reconstruction), and 439 patients were with modified radical mastectomy (Group of modified radical mastectomy ). By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. Results In the group of immediate implanting reconstruction,84 patients completed follow-up with the median follow-up time of 35 months ( 14-72 months) while the local recurring rate was 2. 4%, distant metastasis rate was 8. 3% and mortality rate was 6. 0%. In the group of modified radical mastectomy, 398 patients completed follow-up with the median follow-up time of 36 months ( 12-74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9. 5% and mortality rate was 6. 5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P ＞ 0. 05 ). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. Conclusions For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.     

保留乳房的乳腺癌改良根治术治疗早期乳腺癌的临床观察

目的探讨保留乳房的乳腺癌根治术治疗早期乳腺癌的疗效。方法对22例早期乳腺癌患者行保乳手术治疗，术后并行辅助放疗、化疗等综合治疗。结果全组随访6～48个月，无局部复发和远处转移，3年生存率100％（17／17）。结论对早期乳腺癌行保乳手术疗效满意，严格掌握手术指征，规范的切除和术后放疗、化疗等综合治疗是保乳手术治疗成功的关键。     

Juvenile secretory carcinoma of the breast

Juvenile secretory carcinoma of the breast, a rare tumor in infants and children, has an unusual histological appearance and clinical behavior. Isolated case reports and small series have appeared since this lesion was first described by McDivitt and Stewart in 1966. Our case of a 3-year-old boy with axillary metastasis and 17 cases in children, from the literature, provide the basis of this review. Of the 18 patients, there were three boys and 15 girls. Their ages ranged from 3 to 17 years (mean 9.8 years). All patients presented with an asymptomatic mass in the breast. None had nodes which were clinically involved. Eight patients had excisional biopsy only. Two patients had quadrantectomy. Four had simple mastectomy; one of whom received postoperative axillary irradiation, and one of whom had axillary nodal sampling (our patient). One patient had a modified radical mastectomy and three had radical mastectomy. Two of eight children who had excisional biopsy alone developed local recurrences. In the first patient, the recurrences occurred at 2 and 8 years following initial therapy. In the second, they occurred at 4 and 21 years. Axillary nodal metastases were found in three of the six patients in whom nodal biopsies were performed. In only one patient were estrogen receptors measured and they were negative. No deaths have been reported in children during a follow-up period ranging from 0 to 22 years (mean 6.5 years). Secretory carcinoma of the breast in this group of patients appears to be a slow growing, locally recurring malignancy. Adults with histologically similar tumors also have a good prognosis. Excisional biopsy is probably inadequate therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Limited surgical excision as the basis of a comprehensive therapy for cancer of the breast.

A comprehensive program of therapy has evolved with collaborating roles for surgery, pathology, radiotherapy, and chemotherapy. Our experience includes 131 patients with breast cancer treated at the Massachusetts General Hospital since 1956 by limited excision of the cancer. The tumors of 10 patients were noninvasive or sluggishly so; the patients received no further therapy. Because of the invasive character of their tumor, 121 patients received heavy postoperative irradiation. In 12 of these 121, the irradiation has been followed by immediate and prolonged chemotherapy. It is too soon to judge the effect of the chemotherapy, but survival rates of those treated by limited excision and primary irradiation compare favorably with those of patients treated by radical mastectomy.     

The treatment of breast cancer: II. A 20-year follow-up and reappraisal of the en bloc principle

This retrospective study of the extended Oregon Series (1940 to 1965) of patients with breast cancer, first reported in 1961, compares the now long-term results of treatment of pathologic stage T2/3 NO breast cancers with intent to cure by the following two en bloc ablative operative procedures of variable extent and completeness: standard radical mastectomy vs ultraradical mastectomy. The extent and completeness of the en bloc procedure are shown again to be critical determinants of local control and survival. The local recurrence rate for standard radical mastectomy is 12.4% (8/70) and for ultraradical mastectomy it is 0% (0/78). Proportionate survival at 20 years for standard radical mastectomy was 59.8% (95% confidence limits, 0.598 +/- 0.14) and for ultraradical mastectomy it was 98.1% (95% confidence limits, 0.981 +/- 0.04).