乳腺癌保乳手术治疗的临床研究

目的：总结保乳手术治疗早期乳腺癌临床经验及观察近期疗效。方法：2000年1月至2006年12月采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫治疗临床单发的、肿瘤直径小于3．0cm、无区域淋巴结转移的女性乳腺癌患者51例，手术切缘距瘤缘2．0cm～3．0cm，术后行辅助放疗、化疗及内分泌治疗。结果：全组随访3～84个月，局部无复发或远处转移。结论：早期乳腺癌病人接受保乳手术治疗可以取得满意的临床和美容效果。     

乳腺癌保乳手术治疗的临床研究

目的:总结保乳手术治疗早期乳腺癌临床经验及观察近期疗效.方法: 2000年1月至2006年12月采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫治疗临床单发的、肿瘤直径小于3.0cm、无区域淋巴结转移的女性乳腺癌患者51例,手术切缘距瘤缘2.0cm～3.0cm,术后行辅助放疗、化疗及内分泌治疗.结果: 全组随访3～84个月,局部无复发或远处转移.结论: 早期乳腺癌病人接受保乳手术治疗可以取得满意的临床和美容效果.     

乳腺癌的保乳治疗(附76例报告)

目的 探讨乳腺癌保乳治疗的相关问题及保乳治疗成功率的影响因素.方法 总结我科2003年-2007年对76例乳腺癌采用外科保乳治疗病例及随访资料,对70例(失访6例)患者的术后乳房外形进行评估,评价乳房美容效果的影响因素.结果 Ⅰ、Ⅱ期乳腺癌保乳治疗67例,9例Ⅲ期乳腺癌经新辅助化疗2周期后,肿块缩小至3 cm以下,行保乳治疗;手术方法的选择:行肿块局部扩大切除21例,区段切除45例,象限切除10例,均行同期腋下淋巴结清扫术;其中,9例行乳腔镜下腋窝淋巴结清扫术.即时局部乳房缺损修复36例,其中胶原蛋白海绵填塞8例,带蒂背阔肌肌(皮)瓣修复缺损28例.术后乳房美容效果评价,"良好"76﹪,"一般"16﹪,"差"8﹪.所有病例术后均给予6周期的化疗、乳房术后根治性辅助放疗及内分泌治疗.随访最长58月,平均32月,2例局部复发,3例发生远处转移,其中1例死亡.结论 对于Ⅰ、Ⅱ期乳腺癌外科治疗,保乳根治术具有美观效果、提高了生活质量;对于Ⅲ期乳腺癌,采用新辅助化疗为主的综合治疗后仍可成功保乳;带蒂背阔肌肌(皮)瓣修复乳房缺损是保乳手术Ⅰ期乳房成形的理想方法;乳腔镜行腋窝淋巴结清扫术具有美观、微创的优势;加强医患沟通、提高保乳意识势在必行.     

局部广泛切除加带蒂背阔肌肌皮瓣重建乳房治疗ⅠⅡ期乳腺癌

目的:探讨乳腺癌保乳手术既能彻底切除肿瘤,又能使乳房外形完好的可行性.方法:采用局部广泛切除加带蒂背阔肌肌皮瓣重建乳房治疗Ⅰ、Ⅱ期乳腺癌.对切缘阴性患者不行术后放疗,对切缘阳性患者行术后放疗;腋窝转移淋巴结≥4枚者行区域淋巴结放疗.结果:38例乳腺癌患者实施本手术,全部病例均获随访,其中,随访＞5年者10例,1例于术后3年半局部复发;随访＞40个月以上11例,＜40个月者17例,均无复发转移.美容效果优35例占92.1%(35/38),良2例占5.26%(2/38),一般1例占2.64%(1/38).结论:该手术不仅彻底切除了肿瘤,而且乳房美容效果好,绝大多数患者不需行术后放疗.局部复发率低,适用于Ⅰ、Ⅱ期乳腺癌的治疗.本术式亦可用于乳腺肉瘤及乳房良性病变切除术后乳房缺损较大影响乳房外形者.     

保乳手术治疗乳腺癌37例分析

目的探讨保乳手术治疗乳腺癌方法的选择.方法回顾性分析2001年1月～2005年1月我院接受保乳治疗的37例乳腺癌临床资料.0期3例,Ⅰ期20例, Ⅱ期14例.手术方式为象限切除或肿瘤局部广泛切除联合腋窝淋巴结清扫.术后常规行辅助化疗,放疗和内分泌治疗. 结果手术标本石蜡病理检查各切缘均无癌侵润.经过36个月中位随访期（范围2～36月）,局部复发为5.4%（2/37）,其中腋窝1例,远处转移1例,转移部位为肺转移.对保乳综合治疗满1年的20例患者进行乳房外型的评估,优15%（3/20）,良45%（9/20）,差 40%（8/20）.结论对早期乳腺癌及部分经过新辅助化疗降期后的局部进展期乳腺癌可进行保乳手术治疗.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 .     

放射治疗在早期乳腺癌保乳术中的价值

目的：进一步证实放射治疗在早期乳腺癌保乳术中的重要性。方法：1994年12月～2001年12月本院共收治237例早期乳腺癌。其中83例做保乳手术。154例做改良根治术。保乳术后全部患者接受放疗。放疗的范围根据肿块的大小、部位、腋淋巴结是否受累而定。胸壁切线剂量予8MV—X线5000cGy。肿瘤瘤床加电子线1500cGy。改良根治术后仅3例作放疗。结果：保乳组和改良组局部复发各1人。保乳组区域淋巴结复发1例。改良组无区域淋巴结复发，有肝转移、肺转移各1人。两组各死亡1人。保乳组五年生存率96．49％，改良组98．61％。保乳组双侧乳房外形基本一致，柔软，有弹性。结论：早期乳腺癌保乳术加放射治疗，效果与改良根治术相似，并伴良好美容效果。     

早期乳腺癌保乳手术后10年局部复发与部分乳腺放疗

目的:总结早期乳腺癌保乳手术后局部复发的表现,分析全乳放疗的作用.方法:1990年4月至1995年12月保乳治疗原发性早期乳腺癌49例.行象限切除加腋窝淋巴结清扫术40例,单纯肿块局部广泛切除术9例.术后全乳切线加瘤床放疗39例,全乳切线照射整个乳房,6-MV X线,中平面剂量45GY,瘤床补加电子束剂量15GY.结果:本组10年复发3例,占6.12%(3/49),均为非浸润性癌.术后不加全乳放疗组局部复发率高(2.56%与20.00%).行象限切除加腋窝淋巴结清扫手术组局部复发率低于单纯肿块局部广泛切除术组(2.5%与22.22%).局部复发病例l00%为原位复发.结论:保乳术后放疗是必要的,只限于肿瘤邻近区域足够剂量的放疗方式应该是可行的.     

早期乳腺癌的保留乳房治疗

我院自1994年12月至1997年12月共进行乳腺癌手术150例,其中8例乳腺癌作了保留乳房手术,术后加外照射放疗。资料和方法病例选择：根据国际抗癌联盟（UICC）制定的TNM分期标准选择;临床Ⅰ、Ⅱ期女性乳腺癌作为治疗对象,原发肿瘤的最大径＜3cm,如乳房体积大,适当放宽,腋淋巴结无肿大或仅有孤立、直径＜1.0cm的肿大淋巴结,肿瘤位于乳房外上象限为佳。均为自愿选择“保乳”手术。本组中年龄40岁-75岁,平均年龄52.5岁。病变位于左、右各四例,肿瘤部位均位于乳房外上象限。Ⅰ期5例,Ⅱ期3例。单纯癌5例,浸润性导管癌2例及粘液癌1例。腋淋巴结有转…     

乳腺癌保留乳房手术的中期疗效评估

目的研究评估临床Ⅰ、Ⅱa期乳腺癌行保留乳房手术的中期疗效。方法1995年1月至2005年10月对96例早期乳腺癌行保留乳房根治术。手术适应证:肿瘤≤3cm,周围型,年龄31～55岁(44例),患者有保留乳房意愿,乳房大小适中。手术方式:肿瘤广泛切除加腋淋巴结清扫,术后常规行辅助放疗、化疗及内分泌等治疗。对照组:随访同期的248例改良根治术(Auchinclo术)乳腺癌,与保留乳房根治术比较疗效。结果①所有病例切缘均未见有肿瘤细胞残留。②病理:原位癌8例,浸润性导管癌76例,黏液腺癌8例,其他癌4例。③肿瘤部位以外上象限最多。④10例腋淋巴结阳性,1例伴有腋中群淋巴结阳性。中位腋淋巴结转移数3个。⑤随访:保乳组随访率100%,中位随访期78个月,5年生存率100%,复发率2.1%,转移率2.1%;对照组随访率90.3%(224例),中位随访期86个月,5年生存率95.5%,复发率1.8%,转移率4.9%。两组生存率、复发率比较,差异无显著性(P>0.05),两组转移率比较,差异有显著性(P<0.05)。⑥保乳组1例在37个月时再发第二源性乳腺癌,改行全乳切除术后随访至今51个月。⑦放疗后综合征以短期症状及色素沉着为主,6个月内基本消除。⑧大于12个月主观满意度99.0%,乳房美观检测数据提示,90%以上的保留乳房根治术均能获得理想的外观。结论规范的病灶广泛切除、腋淋巴结清扫加术后辅助放疗是早期乳腺癌保留乳房根治术的关键。保留乳房的乳腺癌根治术可以与改良根治术一样获得长期疗效。保留乳房的乳腺癌根治术可使患者获得良好的心理康复和满意的乳腺外观。     

乳腺癌骨转移相关的临床病理因素的研究

目的：研究与乳腺癌骨转移有关的临床、病理因素，探讨有助于预测乳腺癌骨转移的危险因素。方法：对本院1981年1月～2000年12月手术的3796例乳腺癌患者的随访资料进行回顾分析，根据首发转移部位分组，研究116例骨转移的临床、病理资料，并与内脏转移、淋巴结或软组织转移患者的情况作比较。结果：本组病例首次复发为骨转移者116例，占3．1％；骨转移与患者年龄轻、肿块直径大、临床体检腋淋巴结肿大、腋淋巴结转移数多、病期为Ⅱ／Ⅲ期、组织学类型为非特殊型浸润性癌相关；多因素逐步回归分析术前资料显示，肿块大小、体检腋淋巴结状况与骨转移相关；术后资料中，肿块大小、腋淋巴结转移数、病理类型与骨转移相关。本组骨转移患者均曾接受正规的局部治疗和辅助化疗；首次复发在局部、淋巴结、软组织或局部复发伴远处转移组中，特殊型浸润性癌所占比例明显高于骨转移的患者；骨转移和内脏转移的时间分布无差别，而局部复发和／或淋巴结、软组织转移组，复发时间较骨转移组早。结论：年轻的、肿块分级为T2／T3，临床体检腋淋巴结肿大者，术前有必要进行同位素骨扫描检查；非特殊型浸润性乳腺癌，肿块分级为T2／T3，腋淋巴结转移数≥4枚，为骨转移的高危因素，可在此类病例中开展双磷酸盐的辅助治疗研究。     

BREAST CONSERVING THERAPY IN STAGE T_1 & T_2 BREAST CANCER PATIENTS

There have been several well-established multi-centered clinical trails about breast conserving therapy (BCT) published their results and showed that for appropriately selected and staged patients with early invasive carcinoma of the breast, breast conservation therapy has been shown to result in survival rates and local recurrence rates comparable to those achieved with mastectomy while preserving the breast[1,2]. In 1995, our hospital began breast conserving therapy of early stage breast can…     

Expérience guinéenne de la chirurgie conservatrice du cancer du sein

Objective

To evaluate the first results of conservative breast cancer surgery in surgical oncology unit of Donka University Hospital, Conakry, Guinea.

Patients and methods

Between 2007 and 2012, 140 surgical interventions for breast cancer were performed. In the present study, we report the case of 12 patients who underwent conserving breast surgery for breast cancer stages I (4), IIA (2) and IIB (6). The indication was based on the stage and the initial diagnostic procedure. In case of correlation between clinical examination, mammography and pathological review, quadrantectomy axillary dissection (QAD) were performed. If the tripod was discordant, a QAD was indicated in the case of lymphadenopathy or a quadrantectomy in the absence of axillary lymphadenopathy. Depending on the result of the histological examination of the surgical specimen, adjuvant chemotherapy and radiotherapy were recommended. Neoadjuvant chemotherapy was administrated for tumours whose size was greater than 3 cm. Thus, the following treatments were performed: QAD (8 cases), quadrantectomy (4 cases), neoadjuvant chemotherapy (3 cases), adjuvant chemotherapy (7 cases) and radiotherapy (6 cases). Post-operative complications, local control and survival of patients were studied.

Results

Postoperative complications observed for 3 cases were as follows: seroma (3 cases), breast lymphedema (2 cases), dysesthesia in the inner face of arm (1 case) and cosmetic sequelae of breast surgery (1 case). The magnetic resonance imaging of the remaining breast showed a residual suspected tumour in only 1 out of 6 cases. This patient underwent a radical mastectomy secondarily. After a median follow up of 32.0 months, all patients were alive without recurrence.

Conclusion

The newly introduced conserving breast surgery in Guinea is an effective alternative for the treatment for early diagnosed breast cancer. It must obey the respect resection margins and consider aesthetic imperatives.     

Local recurrence after conservative surgery for breast cancer

The advent of limited operative therapy for breast cancer has produced both good cosmetic results and local recurrence. In our department we treated 38 cases with conservation surgery for early stage breast cancers between February 1988 and October 1994, and local recurrence occurred in 2. PATIENT 1. A 56-year-old-woman had a 1 x 0.8 cm tumor in the C region of the left breast. A quadrantectomy with axillary dissection (level 2) was performed as the margin of the nipple side was negative, followed by entire breast irradiation (50 Gy). Approximately four years after the first operation she developed a local recurrence in the CD region of the breast. A salvage mastectomy with subclavicular lymph node dissection was performed. After the second operation she appears to be healthy. PATINENT 2. A 54-year-old-woman noticed a 1 cm tumor located in the EAC region of the left breast. Excisional biopsy showed solid-tubular carcinoma. The distance between the nipple and the tumor was only 0.7 cm. A wide excision with axillary dissection (level 2) was performed as the margin of the nipple side was negative on the frozen section. Neither irradiation of the entire breast nor the adjuvant chemotherapy could be performed. After a three and a half year follow up local recurrence beneath the operative scar was recognized, and an additional wide excision was performed. A half year has passed since the second operation, there have been no signs of recurrence and she appears to be healthy. In conclusion, we experienced two local recurrences in 38 cases of breast conservation surgery for early breast cancers. One patient had multicentric cancers with histologically different types: mucinous and noninvasive ductal carcinoma, and another had a very short distance between the nipple and the tumor and did not undergo chemotherapy or radiotherapy.     

单中心非转移性男性乳腺癌临床病理特征和生存分析

Heʼnan Medical Team has stationed in Lin county(now Linzhou City) of Heʼnan Province for 60 years since November 1959 to carry out prevention and treatment research on high incidence of esophageal cancer. In the past 60 years, three generations of medical experts in Heʼnan Province have made a series of remarkable scientific research achievements in the molecular mechanism and early detection of esophageal cancer, intervention and prevention methods of precancerous lesions, and benefited thousands of patients. Based on the 34-year research of esophageal cancer prevention and treatment in our research group, this paper focuses on the understanding and thinking about the epidemic characteristics, key scientific issues and important research directions of esophageal cancer in China, so as to provide a reference for the prevention and treatment of esophageal cancer. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

Breast conservation is the treatment of choice in small breast cancer: Long-term results of a randomized trial

From 1973 to 1980, 701 women with small breast cancer (less than 2 cm in diameter) were randomized into two different treatments. 349 patients received classic Halsted mastectomy and 352 patients received quadrantectomy, axillary dissection and radiotherapy on the ipsilateral breast. 24.6% of the patients in the mastectomy group and 27.0% of the patients in the conservation group had axillary metastases. Overall 10 year survival was 76% in the Halsted patients and 79% in the quadrantectomy patients; 13 year survival was 69% and 71%, respectively. No differences were observed after analysis by site and size of the primary tumour and age of the patients. Patients with positive axillary nodes had consistently better survival curves in the quadrantectomy group compared with the Halsted group (not significant). Among the quadrantectomy patients there were 11 local recurrences (with 4 deaths) while among the Halsted patients, 7 had local recurrences (5 deaths). There were 19 cases of contralateral breast carcinomas in the quadrantectomy group and 20 in the Halsted group. At 16 years from the beginning of the trial no evidence of oncogenic radiation risk was observed. In patients with small size carcinomas total mastectomy should have no role.     

Coexistence of breast cancer and tuberculosis in axillary lymph nodes: a case report and literature review

Coexistence of breast cancer and tuberculosis (TB) of the breast and/or axillary lymph nodes is uncommon. In this article, we present a case of tuberculous axillary lymphadenitis existing simultaneously with invasive ductal carcinoma of the left breast. We also conducted an extensive literature review of English language studies published on the coexistence of breast cancer and TB of the breast and/or axillary lymph nodes from 1899 to 2011 using the PubMed and Google Scholar databases. Twenty-nine cases of coexisting breast cancer and TB of the breast and/or axillary lymph nodes have been published to date, including a 74-year-old female diagnosed with left breast cancer and TB of the axillary lymph nodes. A tumor in the right breast was detected in 14 patients and in the left breast in 12 patients between the ages of 28 and 81 years, but no data were available regarding the side on which the tumor occurred in three patients. Eighteen patients underwent a modified radical mastectomy, five patients underwent a radical mastectomy, two a lumpectomy and an axillary lymph node dissection (ANLD), two a quadrantectomy (Q) and an ALND, and two an applied excision. TB was detected at the axilla in all 21 patients in patients with no TB of the breast, and TB was also detected in the axilla in five of eight patients with breast TB. Both a tumor and TB lymphadenitis were detected following an axillary dissection in 14 patients, and both cancer metastasis and TB lymphadenitis were detected at the same lymph nodes in six of these patients. The simultaneous occurrence of these two major illnesses in the breast and/or axillary lymph nodes can produce many problems with respect to diagnosis and treatment. Accurate diagnoses are necessary for down-staging carcinoma of the breast and for identifying curable disease.     

Local control and survival in early breast cancer: the Milan trial

From 1973 to 1980, 701 patients with breast cancer measuring less than 2 cm in pathological diameter and with no palpable axillary lymph nodes were randomized to Halsted mastectomy (349) or to "quadrantectomy" with axillary dissection and radiotherapy to the ipsilateral breast tissue (QUART) (352). The two groups were comparable in age distribution, size and site of primary tumor; menopausal status; and frequency of axillary metastases. At 8 years, the disease-free survival was 77% for the Halsted patients and 80% for the "quadrantectomy" patients, while overall survival was 83% and 85%, respectively. Disease-free and overall survival curves show no difference between the two groups. Breast cancer of small size (less than 2 cm) may be safely treated with conservative treatment. Mutilating operations are not justified.     

Results of Breast-Conserving Therapy for Ductal Carcinomain situ: The Kyoto University Experiences

BACKGROUND: The purpose of this study was to evaluate the results of breast-conserving therapy (BCT), defined as the combination of breast-conserving surgery with axillary dissection and definitive radiation therapy for ductal carcinoma in situ (DCIS). METHODS: Between November 1987 and March 1998, 33 patients with DCIS undergoing BCT at our hospital were examined. The mean age was 48. All patients underwent quadrantectomy or wide excision as well as axillary dissection. Radiation therapy consisted of 50 Gy to the ipsilateral whole breast. Boost irradiation of 10 Gy was given to 15 patients with close or positive margins. Nearly all patients received adjuvant chemotherapy with 5-fluorouracil or its derivatives and adjuvant endocrine therapy with tamoxifen for 2 years. RESULTS: The minimum and median follow-up periods were 32 and 80 months, respectively. All patients but one were followed. Only one patient had a non-invasive local recurrence, 23 months after her operation. This patient was salvaged with simple mastectomy. Her prognostic index score was 8. The five-year local control rate was 97%. No serious acute or late complications were noted. CONCLUSION: The results of this retrospective study substantiate favorable data and appear to confirm the efficacy and reasonable local recurrence rate of BCT for the treatment of DCIS.     

Local recurrence after conservative surgery without postoperative radiation for pure tubular carcinoma of the breast: A case report with reference to multifocality of tubular carcinoma

A 49-year-old premenopausal woman with stage 1 breast carcinoma underwent left quadrantectomy with axillary dissection in 1992. The tumor was 0.7×0.5 cm. Histopathologically, this was a pure tubular carcinoma without lymph node metastasis or lymphatic or vascular invasion. Although the surgical margin was pathologically negative, atypical ductal hyperplasia was present close to the cut margin’s edge. Neither adjuvant chemotherapy nor radiotherapy had been given after the operation. Approximately 5 years after the first surgery, she had a local recurrence in the vicinity of the operative wound. There was no clinical evidence of distant metastasis. A salvage mastectomy was performed. Histopathological examination revealed that the second tumor was an invasive ductal carcinoma, histological grade 2, with extensive intraductal component. It was difficult to determine whether this was a true in-breast recurrence or a second primary cancer. Overexpression of p53 and c-erbB-2 was observed in the second tumor. Estrogen receptor and progesterone receptor were both negative. No postoperative chemotherapy was given. Multifocality and atypical ductal hyperplasia were observed in 7 (87.5%) and 6 75% of 8 patients, respectively, with tubular carcinoma between 1991 and 1997 at the National Cancer Center Hospital. Coexisting disease associated with tubular carcinoma suggests that radiotherapy may be an important component of breast conservation treatment to prevent local recurrence in this type of tumor.     

BREAST CONSERVING THERAPY IN STAGE T1 ＆ T2 BREAST CANCER PATIENTS

Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.