Mortality and relapse after conservative surgery in breast cancer patients

Authors

Javier Ángel Instituto Nacional de Cancerología
Ana Mejía Instituto Nacional de Cancerología
Luis Guzmán Instituto Nacional de Cancerología
Jenni Quevedo Instituto Nacional de Cancerología
Ricardo Sánchez Instituto Nacional de Cancerología
Oscar García Instituto Nacional de Cancerología
Carlos Duarte Instituto Nacional de Cancerología,
Sandra Díaz Instituto Nacional de Cancerología,
Mauricio García Instituto Nacional de Cancerología
Carlos Lehmman Instituto Nacional de Cancerología

Keywords:

Breast cancer, Breast neoplasm, Segmental mastectomy, Conservative surgery, Cancer recurrence

Abstract Authors References How to Cite

Abstract

Surgical treatment for breast cancer has improved from radical surgery involving the chest wall, to conservative tumor resection surgery with oncologically safe margins. This latter, when supplemented with radiotherapy, is considered an alternative to radical surgery with similar survival for both procedures.
Methodology: Retrospective observational study was performed to assess the clinical response in women older than 18 years with invasive cancer undergoing conservative surgery between 1998 and 2007.
Results: A total 358 patients, with the majority in early tumor states were included for final revision. The mean age was 53 years. During a four year follow-up there were 40 local, regional and systemic relapses, with a progression rate of 2.6 relapses per 100 patients / year. There was a higher percentage of recurrence in advanced clinical status (P=.022), tumor size greater than 2 cm (P=.02), and greater number of lymph node involvement in the axillary clearance. Mortality rate was 1.2 deaths per 100 patients / year. Positive margins were associated with advanced clinical status (P=.010), and patients who received non-surgical management had a higher relapse rate compared with patients who had surgery (P=.023). This difference was maintained when comparing surgery with non-surgical management in invasive positive margins (P=.037).
Conclusions: Advanced clinical stage was associated with positive margins and tumor relapse. Axillary lymph node involvement, and non-surgical management of surgical margins, resulted in a higher percentage of recurrence.

Author Biographies

Javier Ángel, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Ana Mejía, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Fundación Universitaria de Ciencias de la Salud FUCS, Bogotá D. C., Colombia

Luis Guzmán, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Jenni Quevedo, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Ricardo Sánchez, Instituto Nacional de Cancerología

Grupo de Investigaciones Clínicas, Subdirección de Investigaciones, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Universidad Nacional de Colombia, Facultad de Medicina, Bogotá D. C., Colombia

Oscar García, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Carlos Duarte, Instituto Nacional de Cancerología,

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Sandra Díaz, Instituto Nacional de Cancerología,

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Mauricio García, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Carlos Lehmman, Instituto Nacional de Cancerología

Clínica de Seno y Tejidos Blandos, Subdirección de Atención Médica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

References

International Agency for Research on Cancer. GLOBOCAN Proyect [internet]. IARC 2011 [citado 2011 abr 10]; Disponible en: URL: http://www-dep.iarc.fr/globocan/database.htm

Instituto Nacional de Cancerología E.S.E., Ministerio de salud y de la Proteccion Social. Anuario estadístico. Bogota, D. C., Colombia, 2010.

Smitt MC, Nowels KW, Zdeblick MJ, Jeffrey S, Carlson RW, Stockdale FE, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76(2):259-67.

https://doi.org/10.1002/1097-0142(19950715)76:2<259::AID-CNCR2820760216>3.0.CO;2-2

Doyle T, Schultz DJ, Peters C, Harris E, Solin LJ. Long-term results of local recurrence after breast conservation treatment for invasive breast cancer. Int J Radiat Oncol Biol Phys. 2001;51(1):74-80.

https://doi.org/10.1016/S0360-3016(01)01625-X

DeVita V, Hellman S, Lawrence T, Rosenberg S. Cancer principles and practice of oncology. 8 ed. Philadelfia: Lippincott Williams & Wilkins; 2008.

Lichter AS, Lippman ME, Danforth DN Jr, d'Angelo T, Steinberg SM, deMoss E, et al. Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. J Clin Oncol. 1992;10(6):976-83.

https://doi.org/10.1200/JCO.1992.10.6.976

Bland K, Copeland E. The breast: comprehensive management of benign and malignant diseases. 4 ed. Philadelphia: Elsevier; 2009. p. 823-6.

Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr. 2001;(30):96-102.

https://doi.org/10.1093/oxfordjournals.jncimonographs.a003469

Instituto Nacional de Cancerología E.S.E. - Fedesalud. Guía de Atención Integral (GAI) para la detección temprana, tratamiento integral, seguimiento y rehabilitación del cáncer de mama [internet]. 2012 - GUÍA No 01 [citado 2013 nov 30]; Disponible en: URL: http://www.cancer.gov.co/documentos/Gu%C3%ADas/CMGAIcompleta.pdf

van Dongen JA, Bartelink H, Fentiman IS, Lerut T, Mignolet F, Olthuis G, et al. Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer. EORTC 10801 trial J Natl Cancer Inst Monogr. 1992;(11):15-8.

Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol. 1996;14(5):1558-64.

https://doi.org/10.1200/JCO.1996.14.5.1558

Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al., Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707-16.

https://doi.org/10.1016/S0140-6736(11)61629-2

Harris J, Lippman M, Morrow M. Enfermedades de la mama. 4 ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 626-32.

Jatoi I, Proschan MA. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol. 2005;28(3):289-94.

https://doi.org/10.1097/01.coc.0000156922.58631.d7

Consensus Development, Panel, Consensus development confe- rence on the treatment of early-stage breast, cancer, J, Natl Cancer Inst, Monogr. 1992;(11):1-5.

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16): 1233-41.

https://doi.org/10.1056/NEJMoa022152

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16): 1227-32.

https://doi.org/10.1056/NEJMoa020989

Trivers KF, Lund MJ, Porter PL, Liff JM, Flagg EW, Coates RJ, et al. The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control. 2009;20(7):1071-82.

https://doi.org/10.1007/s10552-009-9331-1

Kuerer HM, Newman LA, Smith TL, Ames FC, Hunt KK, Dhingra K, et al. Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol. 1999;17(2):460-9.

https://doi.org/10.1200/JCO.1999.17.2.460

Mieog JS, van der Hage JA, van de Velde CJ. Preoperative chemotherapy for women with operable breast cancer. Cochrane Database Syst Rev. 2007.

https://doi.org/10.1002/14651858.CD005002.pub2

How to Cite

[1]

Javier Ángel et al. 2015. Mortality and relapse after conservative surgery in breast cancer patients. Revista Colombiana de Cancerología. 19, 1 (Mar. 2015), 18–28.

ACM
ACS

Download Citation

Downloads

Download data is not yet available.

Downloads

PDF (Español)

Published

2015-03-01

Issue

Vol. 19 No. 1 (2015)

Section

Research/original articles

License

Todos los derechos reservados.