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E Obedian

Publications and source records attributed to E Obedian.

5 recordsLinked to original sources
PubMed2000

Breast conserving therapy in breast cancer patients presenting with nipple discharge.

PURPOSE: To retrospectively review the outcome of conservatively treated breast cancer patients who present with nipple discharge at initial diagnosis. METHODS AND MATERIALS: The charts of 1097 patients undergoing conservative surgery and radiation therapy between January 1970 and December 1990 were reviewed. All patient data, including clinical, pathologic, treatment, and outcome variables were entered onto a computerized database. For the current study, specific attention was directed to the initial presenting symptoms and patients were divided into two groups: those presenting at initial diagnosis with nipple discharge (D/C-YES, n = 17), and those presenting without nipple discharge (D/C-NO, n = 1080). RESULTS: As of August 1998, with a median follow-up of 12 years, the 10-year actuarial survival, distant metastasis-free survival, and breast relapse-free survival rates for the overall population were 73%, 78%, and 83%, respectively. Although the D/C-YES and D/C-NO groups were well balanced with respect to the majority of clinical factors, the D/C-YES patients had a higher percentage of DCIS histology (7.3% vs 1.2%, p < 0.01), were less likely to undergo reexcision (12% vs 35%), and were more frequently under age 40 (35% vs 12%) than the D/C-NO patients. Over the time span of this study, status of the final surgical margin was indeterminate in the majority of cases. Local relapses occurred in 6 of the 17 patients in the D/C-YES group, resulting in a 10-year actuarial breast relapse-free survival rate of 50%, which was signifcantly lower than the 10-year breast relapse-free survival rate of 86% in the D/C-NO population. Among the patients presenting with nipple discharge, those with sacrifice of the nipple areolar complex had a lower local relapse rate than those patients who had conservation of the nipple areolar complex (20% vs 42%), although this difference did not reach statistical significance. CONCLUSIONS: Although patients presenting with nipple discharge may be suitable candidates for radiation therapy, local relapse rates were higher than those presenting without nipple discharge. The limitations of the study and implications regarding breast conserving management in patients presenting with nipple discharge are discussed.

Adult↗
PubMed2000

Second malignancies after treatment of early-stage breast cancer: lumpectomy and radiation therapy versus mastectomy.

PURPOSE: To determine the risk of second malignancies after lumpectomy and radiation therapy (LRT), and to compare it with that in a similar cohort of early-stage breast cancer patients undergoing mastectomy without radiation (MAST). PATIENTS AND METHODS: Between January 1970 and December 1990, 1,029 breast cancer patients at our institution underwent LRT. A cohort of 1,387 breast cancer patients who underwent surgical treatment by mastectomy (MAST), and who did not receive postoperative radiation during the same time period, served as a comparison group. Second malignancies were categorized as contralateral breast versus nonbreast. In the cohort of patients undergoing LRT, a detailed analysis was carried out with respect to age, disease stage, smoking history, radiation therapy technique, dose, the use of chemotherapy or hormone therapy, and other clinical and/or pathologic characteristics. RESULTS: As of March 1999, the median follow-up was 14.6 years for the LRT group and 16 years for the MAST group. The 15-year risk of any second malignancy was nearly identical for both cohorts (17.5% v 19%, respectively). The second breast malignancy rate at 15 years was 10% for both the MAST and LRT groups. The 15-year risk of a second nonbreast malignancy was 11% for the LRT and 10% for the MAST group. In the subset of patients 45 years of age or younger at the time of treatment, the second breast and nonbreast malignancy rates at 15 years were 10% and 5% for patients undergoing LRT versus 7% and 4% for patients undergoing mastectomy (P, not statistically significant). In the detailed analysis of LRT patients, second lung malignancies were associated with a history of tobacco use. There were fewer contralateral breast tumors in patients undergoing adjuvant hormone therapy, although this did not reach statistical significance. The adjuvant use of chemotherapy did not significantly affect the risk of second malignancies. CONCLUSION: There seems to be no increased risk of second malignancies in patients undergoing LRT using modern techniques, compared with MAST. Continued monitoring of these patient cohorts will be required in order to document that these findings are maintained with even longer follow-up periods. With nearly 15 years median follow-up periods, however, these data should be reassuring to women who are considering LRT as a treatment option.

Adult↗
PubMed1999

Internal mammary nodal irradiation in conservatively-managed breast cancer patients: is there a benefit?

PURPOSE: Recent randomized trials have demonstrated a significant benefit to postmastectomy radiation in node-positive breast cancer patients. The contribution of internal mammary nodal radiation (IMNR) to this benefit remains controversial, and in conservatively-treated patients (CS + RT), may compromise cosmesis and contribute to morbidity. The purpose of this retrospective analysis is to evaluate outcome as a function of IMNR in a cohort of breast cancer patients treated with CS + RT. PATIENTS AND METHODS: Between January 1970 and December 1990, 984 patients with invasive breast cancer were treated at our facility with CS + RT, and serve as the base for this study. Of these patients, 399 patients had pathologically-negative lymph nodes, 167 (17%) had pathologically-involved lymph nodes, and 381 did not undergo lymph node dissection. The majority of node-positive patients received adjuvant systemic therapy (94%) and were treated with tangential fields matched to a separate supraclavicular field (95%) with or without IMNR. For this analysis, patients were divided into two groups: those treated by intentionally targeting the internal mammary nodes (IM-yes, n = 535) and without intentionally targeting the internal mammary nodes (IM-no, n = 411). In the IM-no group, the medial border was typically placed at midline. The decision not to use a separate internal mammary field was a result of a change in treatment policy over time, and generally not based on number of nodes or tumor location. RESULTS: As of August 1998, with a median follow-up of 13 years, the overall survival at 10 years is 76%, the distant disease-free survival is 81%, and the breast relapse-free survival is 88%. There were no significant differences between the IM-yes and IM-no groups with respect to age, ER/PR status, or use of adjuvant chemotherapy or hormone therapy. There were more patients with T2 tumors, positive nodes, medial lesions, indeterminate margins, and slightly longer follow-up in the IM-yes group compared to the IM-no group. Although there was a trend toward better outcome in the IM-no group, there were no significant differences between the IM-yes and IM-no groups with respect to overall survival (72% IM-yes vs. 84% IM-no, p = NS) or distant metastasis-free survival (64% IM-yes vs. 82% IM-no, p = NS). Subset analysis showed no benefit in the IM-yes group regardless of age, number of nodes, or location. CONCLUSION: In this retrospective analysis, no benefit could be attributed to IMNR in conservatively-treated breast cancer patients, even if node-positive or medial in location. Until results of an ongoing EORTC randomized trial addressing this issue are available, these data suggest that it is acceptable to continue to treat node-positive conservatively-managed patients to tangential fields usually matched to a supraclavicular field, but without a separate internal mammary field.

Adult↗
PubMedDate not supplied

Negative margin status improves local control in conservatively managed breast cancer patients.

OBJECTIVE: The purpose of this study was to determine the impact of final pathologic margin status on breast relapse-free survival, distant metastasis-free survival, and overall survival in patients undergoing conservative surgery and radiation therapy for invasive breast cancer. MATERIALS AND METHODS: Between January 1970 and December 1990, 984 patients underwent conservative surgery and radiation therapy at our institution as treatment for invasive breast cancer. After lumpectomy, patients were given radiation therapy to the intact breast with or without treatment to regional nodes with the routine use of electron boost to a total median tumor bed dose of 64 Gy. Pathology reports were available for review in 871 patients. Re-excision was carried out in 294 of these patients. For this analysis, patients were divided into four groups based on final pathologic margin status: negative (n = 278), dose (typically within 2 mm, n = 47), positive (n = 55), or indeterminate (n = 491). RESULTS: There were no significant differences between the groups with respect to age, histology, estrogen and progesterone receptor status, tumor location, or total radiation dose. Patients with negative margins were more likely than those with positive margins to have T1 mammographically detected lesions, to have negative nodal status, and to have undergone re-excision. Patients with positive margins were more likely to receive adjuvant chemotherapy or hormone therapy (P = 0.001). As of July 1998, with a median follow-up of 13 years, the median breast relapse-free survival, distant metastasis-free survival, and overall survival rates at 10 years for the entire cohort of patients were 86%, 81%, and 76%, respectively. Breast relapse-free survival at 10 years was 98% for patients with negative margins versus 98% for those with close margins versus 83% for those with positive margins versus 82% for those with indeterminate margins. There were no significant differences in breast relapse-free survival between patients with negative and dose margins or between patients with positive and indeterminate margins. Although the negative margin status also conferred an overall survival and distant metastasis-free survival advantage, this difference is confounded by the earlier stage of disease in these patients, and margin status did not influence overall survival in multivariate analysis. CONCLUSION: In patients undergoing conservative management of breast cancer, negative margin status significantly improves breast relapse-free survival. Close margins appear equivalent to negative margins, and indeterminate margins appear equivalent to positive margins. Adjuvant chemotherapy or hormone therapy did not counteract the adverse impact of positive margin status. Re-excision to obtain dear surgical margins is recommended, even if a radiation boost or adjuvant systemic therapy is planned.

Breast Neoplasms↗