Estrogen receptor status of breast cancer in Ontario

Data from a number of studies of breast cancer have suggested that after the ages associated with the menopause the rates of estrogen-receptor-positive tumours increase with age, whereas the rates of estrogen-receptor-negative tumours do not. Previous investigators studied cases in specific treatment centres, so there was a possibility that the findings were influenced by differences in patterns of case referral by age. A review of all the cases of breast cancer diagnosed in Ontario women in 1981 and assayed for estrogen receptors, however, confirmed the earlier findings. The results showed that the incidence of estrogen-receptor-positive and estrogen-receptor-negative tumours increased at about the same rate before age 45, but thereafter an increase in incidence was seen only for estrogen-receptor-positive tumours. These differences in patterns of incidence suggest the possibility that the two types of tumour may have different etiologic factors.     

Temporal trends in breast cancer surgery in Ontario: can one randomized trial make a difference?

OBJECTIVE: To assess the effect of a single randomized clinical trial, the National Surgical Adjuvant Breast Project (NSABP) B-06, on the surgical management of breast cancer in women. DESIGN: Retrospective cohort study. SETTING: All hospitals in Ontario. PATIENTS: A consecutive sample of 37,447 women with breast cancer newly diagnosed from Jan. 1, 1980, to Dec. 31, 1989, linked to a surgical procedure record in the Ontario Cancer Registry. MAIN OUTCOME MEASURE: The most invasive surgical procedure used within 90 days of diagnosis. RESULTS: Unilateral breast-ablative surgery (BAS) was performed in 57.3% of the women and breast-conserving surgery (BCS) in 31.6%. The annual rate of BAS declined from 77.5% in 1980 to 44.2% in 1989 and the rate of BCS rose from 12.5% in 1980 to 43.5% in 1989. The decline was linear from 1980 to 1984 and then accelerated significantly in 1985 (p < 0.0001), after the results of the NSABP B-06 trial were published. CONCLUSION: One randomized clinical trial can have an immediate and profound effect on medical practice.     

Adjuvant radiotherapy for early breast cancer: patterns of practice in Ontario.

OBJECTIVE: To determine the number of different radiation schedules used in Ontario to treat women with node-negative breast cancer after lumpectomy and axillary dissection. DESIGN: Retrospective survey. SETTING: Princess Margaret Hospital, Toronto, and regional centres of the Ontario Cancer Treatment and Research Foundation (in Hamilton, London, Ottawa, Windsor and Thunder Bay). PATIENTS: A total of 551 of 1624 consecutive patients with node-negative breast cancer having undergone lumpectomy and axillary dissection who were eligible but did not participate in the Ontario Clinical Oncology Group randomized clinical trial and who received adjuvant breast irradiation between April 1984 and February 1989. OUTCOME MEASURES: Schedules of radiotherapy received. RESULTS: Forty-eight different radiotherapy schedules were identified. Total doses ranged from 4000 to 6600 cGy and the number of fractions from 15 to 30. Several different schedules were preferred: 322 patients (58.5%) received 4000 cGy in 15 or 16 fractions to the whole breast over 3 weeks plus a local boost of 1250 cGy to the primary site in 5 fractions over 1 week; 66 patients (12.0%) received 4000 cGy in 15 or 16 fractions over 3 weeks to the whole breast plus a local boost of 1000 cGy to the primary site in 4 or 5 fractions over 1 week; and 63 patients (11.5%) received 5000 cGy in 25 fractions to the whole breast in 5 weeks, without a boost. CONCLUSIONS: The practice of adjuvant radiotherapy for early breast cancer in Ontario varies. The optimal radiation regimen for patients after lumpectomy should be determined through randomized clinical trials.     

Radiotherapy after definitive surgery for breast cancer.

(1) Radiotherapy after definitive surgery for breast cancer has not been proved to have a deleterious effect on patient survival. (2) The beneficial effect of radiation therapy is to decrease significantly local recurrences (P less than .001), which are very difficult to control once they develop. (3) In the hands of experienced radiotherapists, the incidence of complications is quite low. (4) Adjuvant chemotherapy effects on the prevention of local recurrence are most encouraging but still experimental and should at this stage be used mainly in study situations. (5) Until more detailed information is obtained, radiation therapy remains the most effective, least toxic method for the control of local disease.     

保乳手术治疗乳癌概况

保乳手术包括乳房部分切除与腋淋巴结清扫两部分,笔者对其适应证、禁忌证、操作方法和术后辅助的治疗进行论述.近年的研究表明保乳手术是治疗Ⅰ、Ⅱ期乳腺癌的主要术式.     

Breast reconstruction in conserving breast cancer surgery

Breast conserving treatment (BCT) combined with radiotherapy have proved the test of time as a sound oncological operation regarding survival and local recurrence. Successful BCT is a balance between adequate surgery and maintaining the breast's appearance. Unsatisfactory outcome reaches 20-30% in standard techniques of BCT. Concepts described to widen the spectrum of BCT, have made an improvement of cosmetic outcome, and facilitated a liberal safety margin. Volume displacement techniques, such as glandular flap, mammoplasty, donut mastopexy, and batwing mastopexy proved useful in large breasts and volume replacement, such as latissimus dorsi flap and local flaps are of great advantage to replace defects in small and medium sized breasts. Some of these techniques are simple, but comprehensive knowledge and training are required for sophisticated ones. The objectives of this article are to shed light on different techniques adopted by surgeons to perform BCT in conjunction with various oncoplastic techniques and to discuss the factors that influence their applications to achieve best oncological and aesthetic outcome.     

乳腺癌保乳术保留肋间臂神经

目的探讨保留肋间臂神经(intercostobrachial nerve ,ICBN)在乳腺癌保乳术中的可行性和临床价值.方法总结分析我科2006年9月至2010年8月施行乳腺癌保乳术92例乳腺癌患者,随机分为两组,其中保留肋间臂神经35例(保留组),未保留肋间臂神经 ICBN 57例(未保留组).术后随访1-12个月.比较两组患者术后不同时间患侧腋窝和上臂内侧疼痛麻木等感觉异常的发生情况和淋巴结切除情况.结果术后随访100%.保留肋间臂神经组淋巴结切除数目为17.8±2.8枚,未保留肋间臂神经组淋巴结切除数目是17.5±2.5枚,两组间差异无统计学意义(P >0.05).比较两组患者术后1、3、12个月患侧上臂内侧及腋部感觉异常发生率,保留ICBN组感觉异常发生率明显低于未保留ICBN组(P <0.05).随访期间两组患者均未发现肿瘤局部复发或远处转移.结论乳腺癌保乳术行腋窝淋巴结清扫中保留肋间臂神经可明显降低了术后患侧上臂内侧及腋窝疼痛、麻木等感觉异常的发生,而且不会增加胸壁及腋窝的复发风险.     

乳腺癌保乳手术28例临床分析

目的　探讨早期乳腺癌保乳综合治疗的原则及近期疗效。方法　我院 1997年 1月至 2 0 0 2年 12月 2 8例临床Ⅰ、ⅡA 期乳腺癌患者施行保乳手术 ,即局部乳腺切除 +同侧腋淋巴结清扫 ;术后 3周辅助全乳放疗 ;病理切片腋淋巴结有转移者予CMF方案化疗 ;ER阳性者服用TAM 3～ 5年。结果　平均随访 3 6个月 ,2 6例无瘤生存、乳房外形良好 ;2例术后 18个月及 2 4个月局部复发行乳癌根治手术。结论　早期乳腺癌保乳手术与根治术效果相近且能保持乳房良好外形 ,必将成为早期乳腺癌的首选手术方法     

乳腺癌外科手术发展史

外科手术是治疗乳腺癌的主要手段。回顾乳腺癌外科手术的发展史 ,大致可分为原始局部切除、乳腺癌根治术、扩大根治术、改良根治术和保乳手术 5个阶段。其中改良根治术和保乳手术是目前治疗乳腺癌常用的术式 ,尤其是保乳手术既考虑治疗效果 ,又兼顾美观 ,是早期乳腺癌的最佳手术方式。     

保乳手术治疗早期乳腺癌的效果观察

目的 比较分析不同手术方法治疗早期乳腺癌患者的临床效果.方法 选取2017年11月至2019年4月本院收治的70例早期乳腺癌患者,随机分为对照组和研究组,每组35例.对照组患者给予改良根治术,研究组患者给予保乳手术治疗,比较分析两组患者治疗效果.结果 治疗后,研究组患者各项手术指标明显优于对照组,差异具有统计学意义(P...     

乳腺癌新辅助化疗后保乳手术32例分析

目的探讨多西他赛（docetaxel,DOC,多西紫杉醇）联合环磷酰胺（cyclophosphamid,CTX）方案（TC方案）新辅助化疗后行乳腔镜保乳手术近期疗效及美容效果。方法32例乳腺癌接受TC方案化疗2周期后行乳腔镜保乳术。结果TC方案新辅助化疗客观有效率90．6％,保乳手术后对乳腺形态满意率93．8％。结论早期乳腺癌TC方案化疗后,肿瘤分期降低,便于保乳。乳腔镜保乳美容效果好。     

The timing of breast cancer surgery within the menstrual cycle.

The effects of the timing of surgery, fine needle aspiration cytology (FNAC) and mammography within the menstrual cycle were investigated retrospectively in 211 premenopausal breast cancer patients. The day of surgery within the menstrual cycle was known for 157 women whose menstrual cycles were regular. Recurrence and survival were closely similar whether surgery was performed during days 3-12 or at other times (days 0-2 or 13-32) in the cycle. Outcome was also unrelated to the timing of mammography which was known in 101 cases. There were no significant differences in recurrence or survival associated with the timing of FNAC when all patients were considered. In the subset of lymph node negative patients (n = 32), however, FNAC outside days 3-12 was associated with a significantly decreased rate of relapse (RR = 0.25, 95% CI = 0.07-0.9) and death (RR = 0.10, 95% CI = 0.02-0.9). These patients, however, also had significantly smaller tumours (median = 2 cm, interquartile range = 2-3 cm) than patients having FNAC on days 3-12 of the cycle (median = 3, interquartile range = 2-4) (Mann-Whitney: z = 2.11, P = 0.04). We have not confirmed that surgery or FNAC during days 3-12 of the cycle is associated with a poorer outcome than interventions during other parts of the cycle.     

改良乳腺癌手术与传统乳腺癌手术的临床对比研究

目的 研究改良乳腺癌手术与传统乳腺癌手术的效果差异.方法 选取乳腺癌患者98例为研究对象,随机将患者分成对照组和观察组,各49例.对照组患者给予传统乳腺癌手术治疗,观察组患者给予改良乳腺癌手术治疗,对比两组患者的手术时间、术中出血量、并发症发生率、住院时间等指标值.结果 观察组患者的术中出血量少于对照组,且手术时间、引流时间和住院时间比对照组短,两组比较差异具有统计学意义(P<0.05);观察组患者的并发症发生率6.12%低于对照组22.45%,两组比较差异具有统计学意义(P<0.05).结论 改良乳腺癌手术比传统乳腺癌手术更具优势,手术创伤小,患者术后恢复快,值得在临床上推广应用.     

乳腺癌术后皮下积液的预防及护理

目的 探讨乳腺癌患者术后皮下积液的预防及护理.方法 回顾性分析我院2004年6月～2006年10月间103例乳腺癌患者术后皮下积液情况.结果 103例乳腺癌患者术后出现皮下积液20例（19.4%）,最短半月,最长4月.经对症处理,皮下积液均消失.结论 乳腺癌术后皮下积液是常见并发症,护理人员的水平对预防乳腺癌术后皮下积液的发生有重要作用.     

Evaluation of surgical outcomes following oncoplastic breast surgery in early breast cancer and comparison with conventional breast conservation surgery

Background

The aim of this study was to determine whether oncoplastic breast surgery (OBS) ensures better tumour resection than conventional breast conservation surgery (BCS).

Methods

A prospective comparative study, conducted over a 3-year period, enrolled patients with early breast cancer who underwent OBS. The total volume of glandular resection, tumour volume resection and width of the margins obtained were noted. The incidence of complications, requirement of revision surgery and locoregional recurrence during follow-up period were also noted. The data were compared with matched controls who had undergone convention BCS in the past.

Results

Thirty-three patients underwent oncoplastic surgery and the data was compared with 46 patients of conventional breast conservation. The mean volume of specimen was higher in the oncoplastic group (173.5 cm³ vs 101.4 cm³, p = 0.03) though the tumour volume excised was similar (43.2 cm³ vs 36.4 cm³, p = 0.14). The mean margin widths were larger in the oncoplastic group (14 mm vs 6 mm, p = 0.01). There were more instances of close and positive margins seen in conventional BCS groups. The incidence of complication rate was similar. Median follow-up 18 months for oncoplasty group showed no cases of locoregional recurrence while in median follow-up of 38 months for conventional BCS group, six cases of locoregional relapse were noted.

Conclusions

Oncoplastic surgery results in excision of larger volume of breast tissue and correspondingly obtain wider surgical margins as compared to conventional BCS. Longer follow-up is required to determine if wider resection translates into better locoregional control.     

早期乳腺癌保乳手术的疗效评价

目的 探讨乳腺癌保乳手术治疗的适应证，手术方法及术后放化疗方案。方法 回顾性分析20例早期乳腺癌实施保乳手术及综合治疗的资料。结果 保乳术后病侧乳房外形较好，两侧乳房基本对称，术后3年复发率为5％，3年生存率为100％。结论 早期乳腺癌保乳手术治疗安全，疗效确切，但必须严格掌握手术指征及合理的切除范围，同时要保证术后的综合治疗及严格的随访制度。