乳腺癌术后局部复发的治疗及预后分析

目的 探讨乳腺癌术后局部复发的治疗方案及影响预后的相关因素.方法回顾性分析天津肿瘤医院2002年7月至2005年2月期间收治的477例乳腺癌术后复发患者的临床资料.结果 477例复发病例中,术后1年内复发占26.2%(125/477),2年内复发占61.2%(292/477).局部复发后远处转移率为65.0%(310/477),复发后5年总生存率48.4%.不同复发部位、临床分型、有无放射治疗、放射治疗范围、有无手术切除或切除活检的亚组之间局部控制率的差异有统计学意义(P<0.05).不同原发肿瘤分期、无病间期、临床分型以及治疗方式的亚组间远处转移率及5年总生存率的差异有统计学意义(P<0.05),多因素分析显示治疗方案单一、原发肿瘤分期晚、三阴型乳腺癌是影响复发性乳腺癌预后的独立危险因素(P<0.05).结论 多部位复发者和三阴型乳腺癌局部控制不佳,局部扩大野放射治疗结合手术治疗是改善局部控制率的必要模式.原发肿瘤分期晚、2年内复发、三阴型的乳腺癌复发后容易发生远处转移,对于复发性乳腺癌采取综合治疗方案可以提高患者的生存率.

Abstract：

Objective To explore an optimal treatment and to study the prognosis related factors of breast cancer patients with local recurrence after mastectomy. Methods From 2002. 7 to 2005. 2, 477female patients with loco-regional recurrence of breast cancer treated in Tianjin Cancer Hospital were analyzed retrospectively. Results In 477 cases, recurrence within 1 year after mastectomy accounted for 26. 2% , recurrence within 2 years accounted for 61. 2%. There were 310 cases with metastasis after local recurrence was diagnosed, accounting for 65.0%. 5-year total survival rate after recurrence is 48.4%.Local control rates varied in subgroups with different recurrence site, clinical subtypes, radiotherapy fields,with or without radiotherapy, surgical resection or excisional biopsy ( P<0. 05 ). There was a statistical difference in distant metastasis rate and 5-year survival rate among subgroups which had different clinical stage of primary tumor, disease-free interval, clinical subtypes or treatment methods ( P<0. 05 ). Simplistic treatment option, late clinical stage of primary tumor and triple-negative breast cancer were the independent factors predicting poor prognosis for recurrent breast cancer ( P<0.05 ). Conclusions Multi-site recurrence and triple-negative breast cancer lead to a poor local control. Local expansion of radiotherapy combined with surgery improves the local control rate. Patients with late clinical stage of primary tumor,recurrence within 2 years, triple-negative breast cancer are likely to have distant metastasis when recurrence is diagnosed. Combined treatment program improves survival rate.     

Paget’s Disease of the Breast: There Is a Role for Breast-Conserving Therapy

Background The optimal surgical management of Pagets disease of the breast remains to be defined. Mastectomy has been the standard of care, but several institutions have recently advocated breast-conserving surgery, particularly for patients with minimal disease. In an effort to develop rational treatment guidelines, we examined our institutional experience with Pagets disease of the breast.Methods Patients with Pagets disease of the breast who had surgical therapy at our institution between 1949 and 1993 were reviewed. In addition to patient and tumor characteristics, charts were reviewed for treatment modalities, locoregional recurrence patterns, and survival. Subgroups were compared for differences in survival in both univariate and multivariate analyses.Results A total of 104 patients met the study criteria. The most common presenting symptoms were nipple discharge and eczematous changes of the nipple/areola complex. Ninety-seven patients (93.2%) had an underlying invasive or noninvasive cancer associated with Pagets disease. Ninety-two patients (88.5%) underwent mastectomy, and 12 (11.5%) had a breast-conserving procedure. On univariate analysis, patients with age <60 years at diagnosis, stage II disease, positive lymph nodes, invasive disease, or a palpable mass had significantly lower 10-year disease-specific and recurrence-free survival. There were four locoregional recurrences (three after mastectomy and one after breast conservation). There were no significant differences in overall, disease-specific, or recurrence-free survival according to the type of surgery.Conclusions Pagets disease of the breast is almost always associated with an underlying breast cancer. Breast-conserving approaches result in local control and survival rates similar to those achieved with mastectomy.Presented in part at the 26th Annual San Antonio Breast Cancer Symposium, San Antonio, Texas, December 2-6, 2003.Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.     

Outcomes after curative or palliative surgery for locoregional recurrent breast cancer

Background

Locoregional recurrence (LRR) after breast cancer is an independent predictor for later systemic disease and poor long-term outcome. As the surgical treatment is complex and often leaves the patient with extensive defects, reconstructive procedures involving flaps, and thus plastic surgical assistance, are often required. The aim of the present study was to evaluate our institution’s approach to surgical treatment for locoregional recurrence of a breast cancer.

Methods

In the present retrospective, single-centre study, we evaluate our experience with 12 patients who underwent surgery for locally recurrent breast cancer at Aarhus University Hospital between 2006 and 2010. Nine patients underwent wide local excision. The remaining three patients underwent full thickness chest wall resection.

Results

There was no perioperative mortality and no major complications. Minor complications occurred in four (33 %) of the patients. Median overall survival was 22 months, regardless of the surgery being curative or palliative. A median disease-free survival of 18 months was achieved for patients having achieved radicality.

Conclusions

Both wide local excision and full thickness chest wall resection offer the opportunity of local control and palliation in patients with LRR. The plastic surgical reconstructive procedures are associated with a low complication rate, and thus not postponing further adjuvant therapy. However, a multidisciplinary approach with a highly careful patient selection is critical in order to ensure the best outcome for the patient. Level of Evidence: Level IV, therapeutic study.     

Ⅳ期乳腺癌局部外科治疗策略

综合治疗是Ⅳ期乳腺癌的主体治疗。尽管大多数回顾性研究提示切除原发病灶可以获得生存获益,然而,目前的指南并不推荐原发病灶的手术切除。现有有限的前瞻性临床研究并未发现总生存获益。所以,存在远处转移的原发病灶切除与否目前存在争议。然而,笔者建议应采用个体化治疗策略。对于那些需要缓解症状或即将出现并发症,如皮肤溃疡、出血和疼痛病人,如果手术能够保证肿瘤局部完全获得清除,而其他转移灶不会立即威胁生命,特别是在多学科讨论的基础上,并征询病人本人及家属的意愿,可以考虑行初始原发病灶姑息性手术切除。     

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??Locoregional surgical strategies of stage IV breast cancer ZHAO Yan??ZHENG Xin-yu. Department of Breast Surgery, the First Affiliated Hospital, China Medical University, Shenyang 110001, China
Corresponding author: ZHENG Xin-yu?? E-mail: xyzheng@mail.cmu.edu.cn
Abstract Systemic therapy is the mainstream treatment of stage IV breast cancer. Current guidelines do not recommend locoregional surgery for Stage ?? breast cancer despite most retrospective studies suggesting a survival benefit. Surgical excision of the primary breast cancer tumor in the presence of synchronous metastatic disease is debated since limited prospective, randomized studies showing that surgical treatment of primary tumors in woman presenting with stage IV disease does not produce an increase in OS. However, the author suggests the situation could be treated individually, initial surgery could be done for those women requiring palliation of symptoms or with impending complications, such as skin ulceration, bleeding and pain if complete local clearance of tumor may be obtained and if other sites of disease are not immediately threatening to life, especially when it is offered in a multimodality treatment program and with the preference of patients.     

Early Data from the First Population-Wide Breast Cancer-Specific Registry in Hong Kong

Background

Current measures for breast cancer prevention and options for treatment adopted in Hong Kong are mainly based on research data and clinical evidence from overseas. It is essential to establish a cancer-specific registry to monitor the status of breast cancer in Hong Kong.

Objectives

We summarized the current status of breast cancer in Hong Kong based on the data collected from Hong Kong Breast Cancer Registry (HKBCR).

Methods

Prevalent and newly diagnosed breast cancers (including in situ and invasive breast cancers) were registered in the HKBCR. Information on patient demographics, risk factors, medical information, and survival were analyzed and reported in this study.

Results

Data of 2,330 breast cancer patients were analyzed. We observed an earlier median age at diagnosis in Hong Kong than those reported in other countries. Distribution of cancer stage was: stage 0 (11.4%), stage I (31.4%), stage II (41%), stage III (12.5%), stage IV (0.8%), and unclassified (2.9%). The percentages of patients who received surgery, chemotherapy, radiation therapy, and endocrine therapy were 98.7, 67.9, 64.8, and 64.1%, respectively. At a median follow-up of 1.2?years, locoregional recurrence was recorded at 2%, distant recurrence at 2.8%, and breast-cancer–related mortality at 0.3%.

Conclusions

The HKBCR serves as a surveillance program to monitor disease and treatment patterns. It is pivotal to support research for more effective breast cancer prevention and treatment strategies in Hong Kong.     

Meta-Analysis to Determine if Surgical Resection of the Primary Tumour in the Setting of Stage IV Breast Cancer Impacts on Survival

Introduction

The role of primary tumor excision in patients with stage IV breast cancer is unclear. Therefore, a meta-analysis of relevant studies was performed to determine whether surgical excision of the primary tumor enhances oncological outcome in the setting of stage IV breast cancer.

Methods

A comprehensive search for relevant published trials that evaluated outcomes following excision of the primary tumor in stage IV breast cancer was performed using MEDLINE and available data were cross-referenced. Data were extracted following review of appropriate studies by authors. The primary outcome was overall survival following surgical removal of the primary tumor.

Results

Data from ten studies included 28,693 patients with stage IV disease of whom 52.8 % underwent excision of the primary carcinoma. Surgical excision of the primary tumor in the setting of stage IV breast cancer was associated with a superior survival at 3 years (40 % (surgery) versus 22 % (no surgery) (odds ratio 2.32, 95 % confidence interval 2.08–2.6, p < 0.01). Subgroup analyses for selection of patients for surgery or not, favored smaller primary tumors, less competing medical comorbidities and lower metastatic burden (p < 0.01). There was no statistical difference between the two groups regarding location of metastatic disease, grade of tumor, or receptor status.

Conclusions

Patients with stage IV disease undergoing surgical excision of the primary tumor achieve a superior survival rate then their nonsurgical counterparts. In the absence of robust evidence, this meta-analysis provides evidence base for primary resection in the setting of stage IV breast cancer for appropriately selected patients.     

Clinical outcome in women with HER2-positive de novo or recurring stage IV breast cancer receiving trastuzumab-based therapy

BackgroundFive to 10% of women with newly diagnosed breast cancer have synchronous metastases (de novo stage IV). A further 20% will develop metastases during follow-up (recurring stage IV). We compared the clinical outcomes of women with HER2-positive metastatic breast cancer (MBC) receiving first-line trastuzumab-based therapy according to type of metastatic presentation.Patients and methodsRetrospective analysis of 331 MBC patients receiving first-line trastuzumab-based treatment. Response rates (RR) were compared by the chi-square test. Time-to progression (TTP) and overall survival (OS) curves were compared by the log-rank test. Cox-proportional hazards models were used to study predictors of PFS and OS, including the type of metastatic presentation.ResultsSeventy-seven patients (23%) had de novo stage IV disease. Forty-six of these patients underwent surgery of the primary (“de novo/surgery”). Response rates to first-line trastuzumab-based therapy and median progression-free survival did not differ in patients with “recurring”, “de novo/surgery” and “de novo” without surgery (“de novo/no surgery) stage IV breast cancer. However, women with “de novo/surgery” stage IV breast cancer had the longest median OS (60 months), and those with “de novo/no surgery” stage IV breast cancer the shortest (26 months). For women with recurring metastatic breast cancer median OS was 40 months (overall log-rank test, p < 0.01). Multivariate analysis confirmed these findings.ConclusionOur analysis shows that response rates and PFS to first-line trastuzumab-based therapy do not differ significantly between de novo and recurring stage IV, HER2 positive breast cancer. The observed difference in OS favoring women with de novo stage IV disease submitted to surgery of the primary tumor could be the result of a selection bias.     

Centenarians and supercentenarians: a black swan. Emerging social,medical and surgical problems

Background

Five percent of all patients with breast cancer have distant metastatic disease at initial presentation. Because metastatic breast cancer is considered to be an incurable disease, it is generally treated with a palliative intent. Recent non-randomized studies have demonstrated that (complete) resection of the primary tumor is associated with a significant improvement of the survival of patients with primary metastatic breast cancer. However, other studies have suggested that the claimed survival benefit by surgery may be caused by selection bias. Therefore, a randomized controlled trial will be performed to assess whether breast surgery in patients with primary distant metastatic breast cancer will improve the prognosis.

Design

Randomization will take place after the diagnosis of primary distant metastatic breast cancer. Patients will either be randomized to up front surgery of the breast tumor followed by systemic therapy or to systemic therapy, followed by delayed local treatment of the breast tumor if clinically indicated. Patients with primary distant metastatic breast cancer, with no prior treatment of the breast cancer, who are 18 years or older and fit enough to undergo surgery and systemic therapy are eligible. Important exclusion criteria are: prior invasive breast cancer, surgical treatment or radiotherapy of this breast tumor before randomization, irresectable T4 tumor and synchronous bilateral breast cancer. The primary endpoint is 2-year survival. Quality of life and local tumor control are among the secondary endpoints. Based on the results of prior research it was calculated that 258 patients are needed in each treatment arm, assuming a power of 80%. Total accrual time is expected to take 60 months. An interim analysis will be performed to assess any clinically significant safety concerns and to determine whether there is evidence that up front surgery is clinically or statistically inferior to systemic therapy with respect to the primary endpoint.

Discussion

The SUBMIT study is a randomized controlled trial that will provide evidence on whether or not surgery of the primary tumor in breast cancer patients with metastatic disease at initial presentation results in an improved survival.

Trial registration

NCT01392586.     

Postoperative Intraperitoneal 5-Fluoro-2′-Deoxyuridine Added to Chemoradiation in Patients Curatively Resected (R0) for Locally Advanced Gastric and Gastroesophageal Junction Adenocarcinoma

Purpose

Chemoradiation after surgery for locally advanced gastric cancer improves overall and relapse-free survival compared with observation. However, locoregional recurrences remain high. Accordingly, we instituted this pilot/feasibility study, including intraperitoneal 5-fluoro-2??-deoxyuridine (IP FUDR) as part of the treatment.

Methods

Gastric/gastroesophageal junction adenocarcinoma stage Ib?CIV (M0) patients who underwent R₀ resection were eligible and had IP catheters inserted at time of surgery. IP FUDR (3?g/dose/day) was given during study days 1?C3 and 15?C17 before combined 5-fluorouracil, leucovorin, and external beam radiation (45?Gy). Endpoints included toxicity, completion rate, locoregional recurrence, and survival.

Results

Twenty-eight patients (22 men) were enrolled from 2002?C2006 at two institutions; their median age was 59.5?years. After R₀ resection, a median 22 (range, 8?C102) lymph nodes were examined, and 22 patients had positive nodes. AJCC stages were IB (n?=?8), II (n?=?10), IIIA (n?=?5), IIIB (n?=?1), and IV (n?=?4). Full-dose IP FUDR and chemoradiation treatment was completed in 20 and 25 patients, respectively. At nearly 4-year median follow-up, 11 patients were disease-free, 5 were alive with disease, 7 were dead of disease, and 1 was dead from other cause; 4 have been lost to follow-up. Recurrences were local in one, intra-abdominal in six, distant in two, multiple sites in two, and unknown in one. The median relapse-free survival is 65.3?months, and the median overall survival has not yet been reached.

Conclusions

IP FUDR before chemoradiation after R₀ gastric cancer resection is well tolerated without compromising completion of postoperative adjuvant treatment. Larger randomized trials studying IP FUDR as part of gastric cancer multidisciplinary treatment are needed to prove efficacy in reducing regional recurrence and improving survival.     

Does Breast Conservation Therapy in Young Women with Breast Cancer Adversely Affect Local Disease Control and Survival Rate? The M. D. Anderson Cancer Center Experience

Abstract: Historically, it was thought that young women with breast cancer had a poor prognosis and a high local disease recurrence rate after breast-conservation therapy. To determine the effect of breast-conservation therapy, the outcomes of young women with breast cancer who were treated at a single institution were retrospectively reviewed.
Between 1978 and 1993, 219 women ≤35 years of age with breast cancer were treated at the University of Texas M. D. Anderson Cancer Center and met the following criteria: no evidence of distant metastasis at the time of diagnosis, no prior treatment, and no concurrent cancers. The variables analyzed included demographics, type of surgery, TNM stage, use of adjuvant therapy, locoregional disease recurrences, distant metastases, and vital status. The median length of follow-up among surviving patients was 7.9 years (range, 1–17 years). Univariate analyses were performed using the log-rank test. Multivariate analyses were performed using the Cox proportional hazards model.
Seventy-nine patients underwent breast-conservation therapy (BCT) and 140 patients underwent modified radical mastectomy (MRM). Locoregional disease recurrences were identified in 27 cases: 12 in the BCT group and 15 in the MRM group. When patients were matched stage for stage, the type of local treatment did not correlate with the loco-regional recurrence rate (p = 0.236) or the disease-specific survival rate (p = 0.915). The five-year disease-specific survival rate was 84.2%. In the multivariate analysis, only TNM stage correlated with locoregional recurrence rate (p = 0.019) and disease-specific survival rate (p = 0.002).
This study shows no significant difference in locoregional recurrence rates or disease-specific survival rates in young women with breast cancer treated with BCT versus MRM.     

根治术前肿块局部切除对乳腺癌患者预后的影响

将我院１９８７～１９９２年施行乳腺癌根治性切除的术前肿块局部切除组１０６例和直接一次性根治术组１４３例患者的预后进行对比研究。结果发现，术前肿块局部切除组之术后复发率、远处转移率及３和５年生存率分别小于１６．０％、２６．４％及７９．２％和７１．７％，而直接一次性根治术组则分别为４．９％、１６．１％及８９．５％和８２．５％，两组患者４项预后指标比较均存在显著性差异（Ｐ值分别小于０．０１、０．０５、０．０５、０．０５）。本结果表明，术前肿块局部切除将对乳腺癌患者预后造成严重影响，故术前肿块局部切除不宜轻易施行。     

A case of long term survival with skeletal only metastatic breast cancer

IntroductionThe prognosis of patients with metastatic breast cancer is very poor. Because of this, treatment of skeletal metastasis is often palliative with limited goals rather than cure. However, there are those patients, such as presented here, who survive for an extended time.Presentation of caseThis thirty-six year old female presented with lytic lesions to one ulna and rib five years after mastectomy for breast cancer. Despite radiation and chemotherapy, the ulnar lesion expanded and resulted in an elbow dislocation. The rib lesion was resected and the arm amputated above the elbow. She developed local recurrence in both her above elbow amputation stump and chest wall and a more proximal below shoulder amputation was performed with resection of chest wall lesion. Even though she had locally aggressive disease, she has survived for 31 years after diagnosis without any evidence of disease.DiscussionReports of metastatic breast cancer survival indicate the five year survival to be 15%. There have been few reports indicating that those patients with skeletal only or oligometastatic disease have improved prognosis. It is not clear what biological properties of these tumors results in the improved survival.ConclusionThis case highlights the challenges of giving patients the optimal treatment in the light of limited ability to predict prognosis. It also highlights the need to further investigate the phenotypes of breast cancer that can, despite metastatic disease and with modern treatment go on to long survival. In addition this case demonstrates the importance of long term followup.     

男性乳腺癌临床特征及诊治：附35例报告

背景与目的 男性乳腺癌是一种非常罕见的疾病，一般确诊时分期较晚，预后差。目前其治疗上多参照女性乳腺癌。笔者通过对男性乳腺癌的病例的回顾分析，探讨该病临床特点及诊治。方法 回顾分析大连医科大学附属第二医院于2003年3月—2019年6月收治的35例男性乳腺癌患者的临床特点、病理特征、治疗及随访情况。结果 全组患者就诊时均无远处转移，中位年龄65岁，主要临床表现为无痛性乳房肿块，所有患者均接受了手术治疗，仅2例（5.7%）患者接受了部分乳腺切除术，其余均接受全乳房切除术或更大范围的手术。18例（51.4%）接受了辅助化疗，4例（11.4%）接受了辅助放疗，17例（48.6%）接受了辅助内分泌治疗。30例（85.7%）术后病理诊断为浸润性导管癌。全组均获得随访，5年总生存率83.4%。结论 加强对男性乳腺癌的认识，做到早期诊断，并进行以手术为主的综合治疗非常重要。男性乳腺癌的诊治仍有待进一步研究和规范。     

Primary tumor resection in patients with stage IV breast cancer: 10-year experience

The role of surgery in the management of stage IV breast cancer is controversial. Existing studies in Stage IV breast cancer have not closely evaluated the role of patient response to induction systemic therapy (IST) in its relationship to survival outcomes. We identified all patients with a diagnosis of de novo stage IV breast cancer who underwent surgery of their primary tumor from January 2008 to December 2018. Patients were grouped according to their response in the primary disease site into progression (progressive primary disease) or no progression (nonprogressive primary; comprising complete, partial and stable response). We identified a total of 45 stage IV breast cancer patients who underwent operative intervention of their primary breast tumor. Prior to surgical intervention, progression in the primary site during IST was identified in 13/42 patients (31%), of whom four patients also had progression in the distant disease. The 5-year survival was higher in the nonprogressive primary (74%) than the progressive primary disease group (52%) which did not reach statistical significance (p = 0.08). Age, pathologic tumor size, clinical nodal status, number of positive lymph nodes, and distant disease response to systemic therapy were significantly associated with survival. In this single institution experience, select patients with stage IV breast cancer at initial diagnosis who underwent resection of the primary tumor following systemic therapy achieved favorable overall and distant progression-free survival. Surgery is reasonable to consider for local palliation or in selected patients who have excellent response to systemic therapy and good performance status.     

Role of conservation therapy for invasive lobular carcinoma of the breast

Background: Invasive lobular carcinoma (ILC) accounts for 5% to 10% of all invasive breast cancers. Although breast conservation therapy using local excision and postoperative irradiation is a standard therapy for early invasive ductal breast cancer, the result of this strategy in ILC is not well documented. We sought to determine the rate of locoregional recurrence after breast conservation therapy in patients with ILC. Methods: A retrospective review of 74 patients with ILC treated with breast conservation therapy at The University of Texas M. D. Anderson Cancer Center (n=43) or The John Wayne Cancer Institute (n=31) between 1977 and 1993 was performed. Results: The median age of patients was 60 years, and median follow-up was 56 months (range 1 to 207 months). Thirty-nine patients had American Joint Committee on Cancer stage I disease, 30 had stage IIa disease, and five had stage IIb disease. All patients underwent surgical resection and postoperative radiation therapy. Twelve patients received postoperative adjuvant chemotherapy, and 27 patients were treated with adjuvant hormonal therapy. The 5-year actuarial locoregional recurrence rate was 9.8%, and the median time to recurrence was 77 months (range 41 to 113 months). Patients with positive or close (⩽1 mm) surgical margins were at increased risk for local recurrence on univariate analysis (p=0.034). Of the nine patients with breast recurrence, six underwent salvage therapy with total mastectomy and are disease free at the time of this writing, two patients died of distant disease, and one is alive with local disease at the time of this report. The 5-year disease-specific survival rate was 93.7%. Conclusions: Breast conservation therapy for ILC achieves locoregional control in the majority of patients. However, long-term follow-up of patients is important because many local recurrences following breast conservation therapy are late events. Presented at the 50th Annual Cancer Symposium of the Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Ductal Carcinoma-In-Situ: Long-Term Results of Breast-Conserving Therapy

Background: The role of breast-conserving therapy (BCT) in the management of ductal carcinoma-in-situ (DCIS) is controversial because of reported high recurrence rates. We reviewed our experience to determine whether the rate and pattern of locoregional recurrence after BCT were similar in patients with DCIS and patients with early-stage (T1) invasive breast tumors and whether local recurrence affected survival.Methods: Between 1973 and 1994, 87 patients with DCIS alone, 22 patients with DCIS with microinvasion (DCIS-M), and 646 patients with invasive breast cancer 2 cm or smaller in diameter were treated with BCT (wide local excision with radiotherapy) at The University of Texas M. D. Anderson Cancer Center. Survival was calculated by the Kaplan-Meier method. The median follow-up times were 11 years for patients with DCIS alone, 12 years for patients with DCIS-M, and 8 years for patients with invasive breast cancer.Results: Eleven (13%) of 87 patients with DCIS and 5 (23%) of 22 patients with DCIS-M had developed locoregional recurrences at follow-up. Two patients with DCIS with locoregional recurrence died of breast cancer. Of the 646 patients with invasive breast cancer, 56 (9%) had a locoregional recurrence, and 16 (2%) died of breast cancer. The median time to locoregional recurrence was significantly longer in patients with DCIS or DCIS-M (9–10 years) than patients with invasive tumors (5 years).Conclusions: DCIS is a favorable disease with an excellent long-term survival. The locoregional recurrence rate in patients with DCIS treated with BCT is similar to that in patients with early-stage invasive breast cancer treated with BCT, but time to locoregional recurrence is significantly longer in patients with DCIS. In patients with DCIS treated with BCT, intense surveillance for locoregional recurrence needs to be maintained for the patients lifetime.Presented at the 53rd Annual Meeting of the Society of Surgical Oncology, New Orleans, Louisiana, March 16–19, 2000.     

Aggressive therapy for locoregional recurrence after mastectomy in stage II and III breast cancer patients

Background: To determine if aggressive treatment of locoregional recurrence affects survival, we retrospectively analyzed the clinical outcome of 69 breast cancer patients who developed locoregional disease as their first episode of recurrence following mastectomy and adjuvant chemotherapy. Methods: Patients were identified from among 1,707 stage II and III breast cancer patients who enrolled in five different doxorubicin-based adjuvant chemotherapy protocols at The University of Texas M. D. Anderson Cancer Center from 1975 to 1986. Sixty-nine evaluable patients who had a locoregional recurrence as the first site of relapse after mastectomy formed the study group. Multifactorial analysis of clinical and histopathological characteristics of both the primary tumor and the subsequent recurrence was performed using a logistic regression method. Survival analysis was performed using an actuarial life-table method calculated from the date of registration into the adjuvant therapy protocols. Results: Median follow-up was 6.6 years. Two factors significantly affected survival: recurrence of disease during or after adjuvant treatment of the primary and whether the patient was rendered disease free after recurrence. Conclusions: Stage II and III breast cancer patients who have locoregional recurrence after adjuvant chemotherapy and can be rendered disease free may have a better survival rate. Aggressive treatment of locoregional recurrence including complete surgical excision should be considered in this subgroup of patients.     

Patient and Tumor Characteristics Associated with Primary Tumor Resection in Women with Stage IV Breast Cancer: Analysis of 1988–2003 SEER Data

Abstract: Surgery is the cornerstone of treatment for women with nonmetastatic breast cancer. In contrast, standard treatment for patients with Stage IV disease includes chemotherapy and radiation, with surgery usually reserved for local tumor‐related complications. Little is known about the predictive factors associated with primary tumor resection for Stage IV breast cancer. We conducted a retrospective, population‐based, case–control study using the 1988–2003 Surveillance Epidemiology and End Results (SEER) data. Using multiple logistic regression, we identified patient and tumor characteristics from among SEER region, age at diagnosis, year of diagnosis, marital status, race, Hispanic ethnicity, tumor grade, and size that were associated with surgical resection of the primary breast tumor (compared with no surgical resection) among women with stage IV breast cancer. Adjusted odds ratios and 95% confidence intervals are reported. Of 10,017 patients, 4,836 (48%) underwent surgical resection of the primary breast tumor. Patients in the Northeast and Midwest and patients presenting with two or more primary breast tumors were more likely to have surgical resection. Patients who were older, diagnosed after 1992, unmarried, black, and whose tumors were >5 cm, inflammatory, of unknown size, indeterminate grade, or unknown progesterone status were less likely to have had surgical resection of the primary tumor. Several patient and tumor characteristics were significantly associated with surgical resection of the primary breast tumor in Stage IV disease. Further study of the surgery decision‐making process is recommended.     

Surgical treatment of oral cavity carcinoma

Ninety-four squamous cell carcinomas of the oral cavity, treated on the author's service between 1969 and 1981, were evaluated. The series included squamous cell carcinomas of various intraoral sites excluding the lips and hard palate. Survival of 60 mo was 70% for stage I, 65% for stage II, 45% for stage III, and 27% for stage IV carcinoma. Twenty-four of 34 patients with "early" cancer (stages I and II) were treated by operation alone. Too few patients with "early" cancer were treated by combined irradiation and surgery to draw conclusions regarding relative efficacy of combination therapy. Sixty patients had "advanced" cancer (stages III and IV). Five-year survival was 37% for patients treated by operation alone, 18% after salvage surgery after failed irradiation, and 60% for patients treated by operation combined with planned perioperative irradiation. Combination therapy appeared to improve control of locoregional disease as well as survival in patients with "advanced" cancer.