Treatment and outcomes of patients with primary breast sarcoma

Background

Surgery is the main treatment for primary breast sarcoma (PBS). Here we characterize this disease and determine factors associated with use of adjuvant therapy.

Methods

Records of patients with PBS from 1986 to 2006 were reviewed. Overall survival (OS) was estimated by Kaplan-Meier. Relationships between patient variables and OS were determined using univariate Cox proportional hazard models.

Results

Thirteen patients with PBS were identified; 10 patients underwent mastectomy, and 3 underwent partial mastectomy. Six patients underwent axillary staging; none were positive. Patients with tumors >5 cm were more likely to undergo radiation therapy (P <.05). Local recurrence occurred in 7 patients. Metastatic disease was present in 2 patients at diagnosis, and 6 patients developed metastatic disease; all 8 patients died from their disease. Five patients remained disease free. Five-year OS was 67% (83% for tumors <5 cm and 42% for tumors >5 cm). Tumor size was significantly associated with OS (relative risk = 1.1/1 cm increase in size > 5 cm).

Conclusions

Treatment for PBS is excision to clear margins. Axillary staging is not indicated. Tumor size >5 cm is the only significant prognostic indicator of overall survival.     

29例乳腺肉瘤临床治疗分析

为探讨乳腺肉瘤临床最佳治疗方案,作者对１９６４年３月至１９９４年５月收治的２９例乳腺肉瘤的临床资料进行了回顾性分析。随诊４个月至２５年。７例死亡,９例复发;１５例存活１０年以上,５例存活２０年以上。作者认为,本病多需病理证实,以手术治疗为主,无论低度或高度恶性,均应采取包括肿瘤周围正常组织的广泛切除;对复发病例不应放弃再次手术机会;对临床未能触及肿大淋巴节者可不予清扫腋下淋巴节。     

Locoregional recurrence in patients with HER2 positive breast cancer

Literature shows that HER2/neu positive breast cancer cells are more sensitive to radiation-induced apoptosis by targeting the epidermal growth factor receptor family tyrosine kinase. We selected 466 patients with pT1-2 HER2/neu positive tumors who received adjuvant trastuzumab for primary invasive breast cancer. Patients were divided into three groups [Quadrantectomy followed by conventional radiotherapy vs Quadrantectomy followed by Intra-operative radiotherapy with electrons vs Mastectomy without radiotherapy]. After a median follow-up of 52 months, the 5-year cumulative incidence of locoregional recurrence (LRR) was 1.9%, 11.5% and 5.0% respectively (p < 0.01). At the multivariate analysis, extensive perivascular invasion, Luminal B HER2/Progesterone Receptor (PgR) negative status and Quadrantectomy followed by Intra-operative radiotherapy with electrons have significantly increased the risk of LRR. Our results suggest that HER2/neu positive breast cancer might have better outcomes when treated simultaneously with external radiotherapy and trastuzumab. Moreover, we underline the importance of PgR and further new stratification of risk among luminal subtypes.     

Trends in surgical treatment of breast cancer at Mayo Clinic 1980-2004

The study encompassed the time period January 1980 through December 2004. During this time 9485 women underwent mastectomy, 6847 women underwent breast conserving surgery (BCS) and 2477 women underwent breast radiotherapy (RT) for breast cancer. Linear regression modeling was used to quantify the rate of change in the proportion of women undergoing mastectomy during specific time periods. Chi-square tests were used to compare the proportion of women with a breast cancer less than 3 cm in size undergoing mastectomy the year prior to and the year after a specific event.There was a significant decrease in the number and proportion of mastectomies performed, an increase in the number of BCS procedures performed and an increase in the number of women undergoing breast RT around the times of (1) the employment of a young surgeon trained in BCS, (2) publication of the NIH Consensus Statement and (3) establishment of a multidisciplinary Breast Clinic.     

贝伐单抗对乳腺癌皮下移植瘤放疗的增敏作用及其机制

目的 观察贝伐单抗对乳腺癌皮下移植瘤放射治疗的影响并探讨其机制.方法 将30只建立皮下移植瘤裸鼠随机分为贝伐单抗联合放射治疗组、单纯放射治疗组、正常组,相应处理后绘制生长曲线,Western blot法及免疫组织化学法检测各组缺氧诱导因子(HIF)-1α、血管内皮生长因子(VEGF)、细胞核增殖抗原(Ki-67)、CD31的表达.结果 联合组皮下移植瘤退缩更为显著(P＜0.05);免疫组织化学显示联合组Ki-67表达最弱,HIF-1 α、CD31表达也较单纯放射治疗组减弱,差异有统计学意义(P＜0.05);Western blot显示联合组HIF-1α、VEGF表达最弱.结论 贝伐单抗在乳腺癌皮下移植瘤放射治疗中发挥放射治疗增敏作用,可能是通过抑制HIF-1α、VEGF表达从而抑制肿瘤细胞增殖及肿瘤组织内血管形成来实现的.     

Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients

INTRODUCTION: There is little information on patient-driven noncompliance of adjuvant therapies and its consequences. METHODS: This retrospective study compares clinical, pathological features and outcomes of breast cancer patients who were compliant to recommended radiation, chemotherapy, and hormonal therapies to those who were noncompliant. RESULTS: Noncompliance rates for chemotherapy, radiation, and tamoxifen were 31 of 421 (7%), 30 of 855 (4%), and 294 of (37%) respectively. Old age was associated with noncompliance to chemotherapy and radiation, but younger women tend to be more often noncompliant to tamoxifen. Noncompliance with chemotherapy or radiation did not significantly affect 5-year local and distant disease-free survival rates. Noncompliance with tamoxifen was associated with decreased 5-year local and distant disease-free survivals (87% versus 96%, 76% versus 87%, respectively, P < .001). CONCLUSION: Noncompliance with tamoxifen is the most common, resulting in significantly increased risk of local and distant disease recurrence.     

乳癌放疗后放射性溃疡的治疗

目的　探讨乳癌放射性治疗 (下简称放疗 )后放射性溃疡的治疗方法 ,阐述放疗后臂丛神经损伤的广泛性和严重性。方法　 1999年以来分别应用腹直肌肌皮瓣转移、皮肤软组织扩张、局部皮瓣转移和局部延迟皮瓣转移等方法修复乳癌放疗后放射性溃疡 16例 ,并常规行肌电图检查了解臂丛神经损伤的情况。结果　除 1例患者因创口感染而皮瓣部分坏死外 ,其余皮瓣成活良好 ,创面修复满意 ;10例行肌电图检查的患者中 ,有 7例合并有臂丛神经损伤。结论　乳癌放疗后引起的放射性溃疡常伴有臂丛神经损伤 ,这些损伤呈慢性、进行性和不可逆性改变 ;应用血运良好的皮瓣可有效地修复溃疡创面。     

Immediate breast reconstruction with expander in pregnant breast cancer patients

BackgroundBreast reconstruction after mastectomy is currently considered an essential component in managing breast cancer patients, particularly those diagnosed at a young age. However, no studies have been published on the feasibility of immediate breast reconstruction in patients diagnosed and operated during the course of gestation.MethodWe retrospectively identified all breast cancer patients who were subjected to mastectomy and immediate breast reconstruction during pregnancy at the European Institute of Oncology between 2002 and 2012. Patient demographics, gestational age at surgery, tumor stage, adjuvant treatment, details of the surgical procedures, surgical outcomes and fetal outcomes were analyzed.ResultsA total of 78 patients with breast cancer diagnosed during pregnancy were subjected to a surgical procedure during the course of gestation. Twenty-two patients had mastectomy; of whom 13 were subjected to immediate breast reconstruction. Twelve out of 13 patients had a two-stage procedure with tissue expander insertion. Median gestational age at surgery was 16 weeks. No major surgical complications were encountered. Only one patient elected to have an abortion, otherwise, no spontaneous abortions or pregnancy complications were reported. Median gestational age at delivery was 35 weeks (range: 32–40 weeks). No major congenital malformations were reported. At a median follow-up of 32 months, all patients are alive with no long-term surgical complications.ConclusionsThis is the first study of immediate breast reconstruction in pregnant breast cancer patients. Tissue expander insertion appears to ensure a short operative time, and does not seem to be associated with considerable morbidity to the patient or the fetus. Hence, it could be considered in the multidisciplinary management of women diagnosed with breast cancer during pregnancy.     

Standards for follow-up care of patients with breast cancer

In the United States alone, over 200,000 women are diagnosed with invasive breast cancer each year, and another 50,000 are diagnosed with ductal carcinoma in situ. The vast majority of these women will survive for five or more years, and the majority will never experience a recurrence of their disease. Follow-up care is focused on the early identification of new primary cancer and locoregional recurrences. There is no clear evidence that early identification of distant metastases will lead to an extension in survival, and for this reason routine imaging studies such as CT and PET scans are not recommended. Comprehensive care for breast cancer survivors should also address late complications of treatment and ongoing psychosocial problems that may have arisen as a result of a breast diagnosis and treatment. Although subspecialists often provide follow-up care for breast cancer survivors, randomized trials have demonstrated that generalists can provide such care. As the number of breast cancer survivors continues to increase, guidelines and programs to provide comprehensive, compassionate, and cost-effective follow-up care will become ever more important.     

The value of latissimus dorsi flap with implant reconstruction for total mastectomy after conservative breast cancer surgery recurrence

Total mastectomy is usually indicated after breast conservative treatment cancer recurrence. Breast reconstruction in this group can be performed with many options. We did 63 latissimus dorsi flap with implants reconstructions between 2001-2007. All of them were performed in breast cancer recurrence cases after breast conservative treatment and preceded for total mastectomy. The patient age range from 31 to 71 years old (50.1 ± 7.3 years). The follow-up was 36.5 ± 14.9 months (22-141 months). Neither flap loss nor significant major donor-site complication was recorded. The capsular contraction Baker’s grade III was observed in 2 cases (3.1%). The rest were grade I-II and there was no grade IV contracture. We purpose that LD flap with implant can be performed in irradiated breast with low capsular contracture rate. It is suitable in total mastectomy reconstruction after conservative breast cancer surgery recurrence.     

早期乳腺癌保留乳房手术62例疗效评价

目的探讨早期乳腺癌保留乳房手术治疗疗效。方法回顾性分析1996～2004年经治的62例早期乳腺癌实施保乳手术治疗疗效。结果全部病人手术过程顺利,近期乳房外形保持良好。术后随访1～8年(平均2年),无局部复发、远处转移和死亡病例。无放疗后合并症。结论保乳手术治疗早期乳癌的近、远期疗效满意。术前严格掌握手术适应证,术后规范的综合治疗,是保乳手术获得良好疗效的保证。     

Defining ovarian failure in amenorrheic young breast cancer patients

At present, there is no gold standard test for the investigation of ovarian function in pre-menopausal breast cancer patients who develop amenorrhea after chemotherapy. Clinical, biochemical and biophysical investigations continue to be utilized in clinical practice, despite concerns regarding their predictive value for menopause. The resulting uncertainty about a woman’s actual menopausal status has important consequences for patient management. These include choice of appropriate endocrine therapy, assessment of residual ovarian function and its effect on breast cancer recurrence, fertility issues and the prediction of the likelihood of conception. It is hoped that the development of novel surrogates may allow clinicians to more accurately assess menopausal status and thereby facilitate tailored and individualised therapy for this common group of patients.     

Radiation-induced breast sarcoma

BACKGROUND: The purpose of this study was to examine the presentation, treatment, and prognosis of patients with radiation-induced sarcomas after adjuvant radiotherapy for breast cancer. METHODS: This was a retrospective review from 1975 to 2001 of patients who presented with a sarcoma in an irradiated field after surgical treatment for breast cancer. RESULTS: Thirty-four women were included. Six had undergone breast-conserving therapy and 28 had mastectomy for primary breast carcinoma. All patients received postoperative radiation. The mean time to diagnosis of sarcoma was 152 months (range 40 to 372). Twenty-three of 34 patients (68%) had recurrence of the sarcoma after resection, and 22 patients (65%) died of their disease. Patients with no evidence of disease at follow-up had a mean tumor size of 4.2 cm +/- 0.7 (n = 6), compared with 8.1 cm +/- 1.2 (n = 10) for patients who died of their disease (P = 0.030). CONCLUSIONS: Radiation-induced sarcoma is a late complication of definitive treatment for breast carcinoma. The prognosis of such patients is poor, with two thirds dying of their disease. In the present series, improved survival was associated with smaller tumor size at presentation.     

乳腺癌患者术后预后相关因素分析

目的探讨影响乳腺癌患者术后预后的相关因素。方法对101例乳腺癌患者,进行回顾性研究。本组病例采用Log—rank单因素分析和COX多因素模型的分析方法分析乳腺癌预后的相关指标。结果Log-rank单因素分析结果提示肿瘤大小（直径〉5em）、病理分级、淋巴结转移、HER-2／neu和CD44五个因素是乳腺癌的预后因素（P均〈0．05）,ER和PR不能作为乳腺癌的预后指标;进一步采用COX多因素分析结果提示,仅有HER-2／neu、肿瘤大小、淋巴结转移和病理分级是乳腺癌预后的独立预测指标。结论肿瘤大小、病理分级、淋巴结转移、HER-2／neu是临床判断乳腺癌预后有价值的指标。     

Skin-sparing mastectomy and immediate breast reconstruction: incidence of recurrence in patients with invasive breast cancer

The aim of this study was to investigate whether skin-sparing mastectomy (SSM), which is gaining increasing importance and gives well-accepted cosmetic results, provides adequate treatment of the patients' oncologic disease. From 1995 to 2003, 60 patients diagnosed with invasive breast cancer were treated with SSM and complete axillary dissection. All patients underwent immediate breast reconstruction after primary surgery. Patients were treated either with a latissimus dorsi flap or with a transversus rectus abdominis myocutaneous flap. Depending on the intraoperative analysis of frozen sections, 14 patients were treated with preservation of the nipple-areola complex. During a median follow-up of 52 months (4-92 months), four local recurrences (6.6%) occurred. One patient was also found to have contralateral breast carcinoma. Three patients developed distant metastases, and two patients died of their disease a mean of 18 months after primary therapy. Factors associated with local recurrence were tumor size, poor tumor differentiation, and positive node involvement. SSM followed by immediate breast reconstruction is an alternative to modified radical mastectomy in a subset of patients with invasive breast cancer. The risk of local recurrence is low and is associated with such factors as tumor stage, poor tumor differentiation, and node-positive disease. This procedure does not increase the risk of distant metastases, which is comparable to that after other surgical approaches.     

输血对乳腺癌患者术后感染的影响观察

目的　观察输血对乳腺癌患者术后感染的影响。方法　选择 3 11例乳腺癌手术患者进行临床观察 ,其中 10 9例患者术中输注浓缩红细胞 ,112例输注去白细胞浓缩红细胞 ,90例未输血 ,对三组患者术后感染率进行比较。结果　浓缩红细胞输血组术后感染率为 5 .5 0 % ,去白细胞浓缩红细胞输血组术后感染率为 0 .89% ,与浓缩红细胞输血组比较差异有显著性 (P <0 .0 1) ,未输血组患者术后感染率为 1.11% ,与浓缩红细胞输血组比较差异有显著性 (P <0 .0 1) ,而与去白细胞浓缩红细胞输血组比较差异无显著性 (P >0 .0 5 )。结论　乳腺癌患者术中输注浓缩红细胞较输注去白细胞浓缩红细胞患者及未输血患者术后感染率高 ,且术后感染率与浓缩红细胞输注量密切相关。     

原发性乳腺癌患者非哨兵淋巴结转移预测因素的研究

目的探讨原发性乳腺癌患者哨兵淋巴结活检(SLNB)后，哨兵淋巴结(SN)转移者非哨兵淋巴结(NSN)转移相关的临床及组织学因素。方法252例确诊为原发性乳腺癌患者SLNB后行腋窝淋巴结清扫，所有的腋窝淋巴结(SN及NSN)均行常规组织学检查。应用X^2检验分析年龄，肿瘤大小，肿瘤位置，病理类型，受体状态和SN转移数目与NSN转移的关系。结果SLNB成功率94％，假阴性率7．4％。随着原发肿瘤的增大，NSN转移的可能性增加：T1a T1b期肿瘤NSN转移率为0；T1c期为42％；T2期为87％。只有1个SN转移的患者NSN转移率明显低于多个SN转移的患者(27％vs46％)。结论NSN转移的可能性随着原发肿瘤的增大和多个SN转移而增加，而患者的年龄，肿瘤的位置，病理类型和受体状态不影响NSN转移的可能性。