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PubMed1998

[Diagnosis and treatment of male breast carcinoma].

OBJECTIVE: To evaluate the diagnosis and treatment of male breast carcinoma. METHODS: Thirty-two male breast carcinoma cases were studied. The median age was fifty-four years old. The diagnosis, treatment and prognosis for male breast carcinoma were studied. RESULTS: Clinical stage of the patients: I, 7 patients; II, 17 patients; III, 7 patients; IV, 1 patient. Of the 32 carcinomas, 31 patients had mass in the breast. Positive lymph nodes were found in 57.1% of the patients. The 5-year survival rate was 65.6% for all patients, 68.4% for patients undergone radical mastectomy, 66.7% for those undergone modified radical mastectomy and 57.1% for the others. CONCLUSION: The optimal treatment for male breast carcinoma is modified radical mastectomy combined with radiotherapy, chemotherapy and endocrine therapy.

Adenocarcinoma↗

PubMed1990

Postmastectomy locally recurrent breast cancer.

With the popularity of breast-conserving treatment plans, the natural history of "breast recurrence" in the ipsilateral breast must be distinguished from local recurrence following modified radical mastectomy. Hence, this study considers those patients who develop skin or chest wall recurrence after modified radical mastectomy, whether as a primary procedure or for patients with "breast recurrence" after partial mastectomy. The incidence of postmastectomy locally recurrent breast cancer following modified radical mastectomy (MRM) and adjuvant immunotherapy (IT) is compared to historical controls. The risk factors and treatment of local recurrence in this program as well as in a larger group of patients who recurred after modified radical mastectomy are reported.

Breast Neoplasms↗

PubMed1989

Local-regional recurrence in breast cancer after mastectomy and adriamycin-based adjuvant chemotherapy: evaluation of the role of postoperative radiotherapy.

In an attempt to determine whether patients treated for breast cancer with radical or modified radical mastectomy and adjuvant chemotherapy benefit from postoperative radiotherapy, 400 women with Stages II-III breast cancer who received adjuvant chemotherapy based on the combination of Adriamycin and Cytoxan were analyzed retrospectively. Prognostic features which predicted a high risk of isolated local-regional relapse were identified. Thirty-eight percent of these patients were also treated with postoperative radiation in addition to adjuvant chemotherapy and were compared to those patients treated only with adjuvant chemotherapy. With a median follow-up of 60 months, 15% of the patients reviewed developed local-regional disease as the first site of relapse without concommitant systemic relapse. When examined univariately, stage of disease, tumor size, nodal status, and estrogen receptor status were strong prognostic variables. Age, cell type, location of tumor within the breast, menstrual status, radiation dose, and type of treatment were not significantly related to isolated local-regional relapse. However, patients who received postoperative radiation were significantly more advanced in their disease condition. When the factors were examined multivariately, the type of treatment along with stage of disease were found to be statistically significant prognostic indicators. About half of the patients were tested for estrogen receptor status. Multivariate analysis performed on this subset of patients showed that estrogen receptor status, type of treatment, and axillary nodal status were significant predictors of the risk of isolated local-regional relapse. This study suggests that patients treated with mastectomy and Adriamycin and Cytoxan-based adjuvant chemotherapy may benefit from postoperative radiation in reducing the risk of isolated local-regional recurrence.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

Treatment of intraductal breast cancer--noncomedo type.

The treatment of intraductal breast carcinoma, ranging from local incision alone to modified radical mastectomy, remains controversial. Seventy-nine patients were treated for intraductal breast carcinoma, noncomedo type at our institution from 1975 to 1991. There were 78 females and one male with a mean age of 58 years and a range from 32 to 90 years. Clinical presentation included a palpable mass in 25 patients, abnormal mammogram in 60 patients, and nipple discharge in 12 patients. Treatment consisted of local excision in 19 patients, simple mastectomy in 25 patients, and modified radical mastectomy in 35 patients. Twenty-five patients underwent simultaneous prophylactic contralateral mastectomy. Choice of treatment was determined by physician preference and no differences were seen in family history, parity, nipple discharge, history of fibrocystic disease, presence of palpable lymph nodes, tumor size, tumor location, patient age, or mammographic findings. Forty-five patients had multicentric tumors on final pathology. One patient demonstrated an axillary lymph node metastasis following modified radical mastectomy raising the question of undetected invasive carcinoma. All patients were free of disease at last evaluation and no differences in survival were noted between different treatment groups with a mean follow up of 5 years. We conclude that local excision is an appropriate option for treatment of intraductal breast carcinoma noncomedo type.

Breast Neoplasms↗

PubMed1975

Lobular carcinoma of the breast in situ. Are we too radical in its treatment?

Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammorgraphy and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contraleteral bipsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process.

Adult↗

PubMed1987

Does radical mastectomy still have a place in the treatment of primary operable breast cancer?

This study (Alabama Breast Cancer Project) reports the ten-year surgical results of a prospective randomized trial comparing Halsted radical mastectomy (RM) with modified radical mastectomy (MRM) for breast cancer. We entered 311 patients in the study between 1975 and 1978. Patients with histologically positive axillary lymph nodes were randomized after operation to receive melphalan or intermittent intravenous cyclophosphamide, methotrexate, and fluorouracil for one year. After a median follow-up of ten years, there was no significant difference in the survival of the two groups (RM, 71%; MRM, 64%). Local recurrence after RM was significantly lower than after MRM. A subset of patients with more advanced cancers (T3 and T2 with clinically positive axillary nodes) experienced significantly better survival at ten years following RM compared with MRM (59% vs 38%, respectively). These results indicate that overall survival is similar for patients treated by either RM or MRM. However, there is subset of patients with more advanced cancers whose ultimate survival can be favorably influenced by RM.

Breast Neoplasms↗

PubMed1991

Long-term risk of sarcoma following radiation treatment for breast cancer.

Between 1954 and 1983, 7620 patients were treated for breast carcinoma at Institut Gustave Roussy (France). Of these patients, 6919 were followed for at least 1 year. Out of these, 11 presented with sarcomas thought to be induced by irradiation, 2 of which were Steward-Treves Syndrome, and 9 of which were sarcomas within the irradiated fields. All histological slides were reviewed and a comparison with those of breast cancer was done. The sites of these sarcomas were: parietal wall, 1 case; second costal cartilage, 1 case; infraclavicular region, 1 case; supraclavicular region, 2 cases; internal third of the clavicle, 2 cases; axillary region 2 cases; and the internal side of the upper arm (Stewart-Treves syndrome), 2 cases. The median age of these 11 patients at the diagnosis of sarcomas was 65.8 (49-83). The mean latent period was 9.5 years (4-24). Three patients underwent radical mastectomy and nine modified radical mastectomy. Only one patient received chemotherapy. The radiation doses received at the site of the sarcoma were 45 Gy/18 fr. for 10 cases and 90-100 Gy for 1 case (due to overlapping between two fields). The histology was as follows: malignant fibrous histiocytoma, 5 cases; fibrosarcoma, 3 cases; lymphangiosarcoma, 2 cases; and osteochondrosarcoma, 1 case. The median survival following diagnosis of sarcoma was 2.4 years (4 months-9 years). Two patients are still alive: one with recurrence of her breast cancer, the other in complete remission, with 7 and 3 years follow-up, respectively. All other patients died from their sarcomas. The cumulative incidence of sarcoma following irradiation of breast cancer was 0.2% (0.09-0.47) at 10 years. The standardized incidence ratio (SIR) of sarcoma (observed n# of cases (Obs)/expected n# of cases (Exp) computed from the Danish Cancer Registry for the same period) was 1.81 (CI 0.91-3.23). This is significantly higher than one, with a p = 0.03 (One Tailed Exact Test). The mean annual excess (Obs-Exp)/100.000 person-years at risk during the same period/(100,000) was 9.92. This study suggests that patients treated by radiation for breast cancer have a risk of subsequent sarcomas that is higher than the general population. However, the benefit from adjuvant radiation therapy in the treatment of breast cancer exceeds the risk of second cancer; therefore, the potential of radiation-induced sarcomas should not be a factor in the selection of treatment for patients with breast cancer.

Adult↗

PubMedDate not supplied

The surgical management of primary invasive breast cancer.

The treatment of operable primary breast cancer has evolved dramatically in the past few decades. The standard operative procedure has changed from the radical mastectomy to the modified radical mastectomy, and the use of breast-conserving treatment is increasing. This article reviews trends in treatment of early-stage breast cancer, factors associated with increased risk for local recurrence after breast-conserving treatment, and the use of axillary lymph node dissection.

Adult↗

PubMed1987

[A case report of inflammatory breast cancer effectively treated with cis-platinum].

A 50-year-old woman with bilateral inflammatory breast cancer (T4, N1b, M1, Stage IV) underwent right extended radical mastectomy and left modified radical mastectomy following pre-operative administration of carcinostatics (ADM, 5-FU) and irradiation. However, tumor recurrence was observed at the skin and right pleural cavity after the operation. Adriamycin-containing combination chemotherapy and radiation therapy were performed, but no significant response was obtained. CDDP was then administered intravenously at a daily dose of 62.5 mg/m2 at intervals of 60 days. The pleural effusion disappeared and the extent of skin metastasis was reduced, resulting in partial response which lasted for 90 days. The serum CEA level decreased from 13.1 ng/ml to 2.3 ng/ml. As the side effects of this therapy, slight nausea, vomiting and general fatigue were observed. This result suggested that CDDP is an effective drug for inflammatory breast cancer.

Breast Neoplasms↗

PubMed2004

Primary malignant lymphoma of the breast: clinicopathological study of nine cases.

Primary lymphoma of the breast is rare, accounting for 1.7-2.2% of extranodal lymphomas and 0.38-0.7% of non-Hodgkin's lymphomas (NHL). The aim of this study was to evaluate the clinicopathological features and treatment outcomes of patients with primary breast lymphomas (PBL). We conducted a retrospective review of the NHL cases diagnosed at Korea Cancer Center Hospital between 1989 and 2002. Nine (0.9%) of the 1,050 cases fulfilled the criteria for PBL. All patients were women (median age, 45 years) and usually presented with breast masses that had recently become enlarged. Six cases involved the breast alone (stage IE), whereas 3 cases also involved the ipsilateral axillary lymph nodes (stage IIE). Histopathologic studies revealed a diffuse large B cell lymphoma in 7 cases, marginal zone B cell lymphoma in 1 case, and small lymphocytic lymphoma in 1 case. Immunohistochemical analysis revealed a B-cell phenotype in all cases. There was no uniform approach to the treatment of PBL. Modified radical mastectomy and chemotherapy was performed in 4 cases, modified radical mastectomy and chemoradiotherapy was performed in 1 case, chemoradiotherapy alone, modified radical mastectomy alone, chemotherapy alone, and radiotherapy alone were performed in 1 case each. All cases achieved complete remission, but median overall survival was 12 months, showing very poor prognosis irrespective of the type of treatment modality.

Adult↗

PubMed1999

An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.

BACKGROUND: Male breast cancer is rare, and there are no large comparative studies to guide treatment. We used National Cancer Data Base data on 4755 men and 624,174 women who had breast cancer (1985-1994) to identify equivalent groups of male and female breast cancer patients. METHODS: For each man with breast cancer, the next woman treated at the same hospital was sought who matched the man's age (within 5 years), ethnicity, income category, and stage. We identified 3627 closely matched pairs of male and female patients with breast cancer. RESULTS: Men were more likely to be treated with mastectomy (modified radical, 65% of men versus 55.1% of women; radical, 2.5% of men versus 0.9% of women; simple, 7.6% of men versus 3.4% of women; P <.001), and more likely to receive radiation therapy after mastectomy (men, 29%; women, 11%; P <.001). Men treated with lumpectomy were less likely to receive radiation therapy (men, 54%; women, 68%; P <. 001). Men were also less likely to receive chemotherapy (26.7% of men versus 40.6% of women; P <. 001) after any surgical treatment. CONCLUSIONS: This large comparative study is the first to detail stage-specific differences in contemporary treatment strategies for highly comparable groups of men and women treated for breast cancer. Further studies of male breast cancer should focus on identifying prognostic factors and defining optimal therapy.

Adult↗

PubMed2002

[Clinical analysis of seven patients with occult breast cancer and literature reviews].

BACKGROUND AND OBJECTIVE: Occult breast cancer is a kind of specific seldom clinically seen breast cancer. This study was designed to investigate the diagnosis and treatment of the patients with breast cancer. METHODS: Retrospective study was conducted in 7 cases of occult breast cancer from May 1990 to May 2001. RESULTS: All cases were female and account for 0.59% of the total breast cancer treated in the same period. Axillary node enlargement was presented as first sign and no breast mass was palpable in physical examination. Fine needle aspiration or excisional biopsy revealed metastatic adenocarcinoma before surgery. All cases were taken mammography and 1 case was suspicious of malignancy. 3 cases were taken ultrasonography and 1 case was suspicious of malignancy. 5 cases underwent radical mastectomy and 2 cases underwent modified radical mastectomy. Pathological examination of the removed specimen found the primary breast cancer leison in 4 case and showed infiltrative carcinoma in 3 cases and intraductal carcinoma in 1 case. After surgery, 2 cases received radiotherapy plus chemotherapy, 5 case received chemotherapy and 4 case received tamoxifen therapy. All case were still alive and 3 cases survived over 54 months and 1 case survived for 7 years. CONCLUSION: Occult breast cancer should be considered when axillary lymph node is enlarged in female. Fine needle aspiration and excisional biopsy are helpful in pathologic diagnosis preoperatively. Mammography and ultrasonography have low sensitivity in identifying primary tumor. Radical or modified radical mastectomy with adjuvant radiotherapy and chemotherapy is a suitable choice for the patients with occult breast cancer and the prognosis is superior or similar to those patients who with palpable mass both in breast and axillary.

Adult↗

PubMed1989

Long-range results for breast cancer patients treated by radical mastectomy and postoperative radiation without adjuvant chemotherapy: an update.

Between 1963 and 1977, 941 patients with carcinoma of the breast received, at the University of Texas M.D. Anderson Cancer Center, peripheral lymphatic irradiation alone or with chest wall irradiation after a radical or modified radical mastectomy. None of the patients received adjuvant chemotherapy. The incidence of patients with histologically involved axillary nodes was 70%. The lymphatics of the apex of the axilla, of the supraclavicular area, and of the internal mammary chain were irradiated in patients with histologically positive axillary nodes and/or in patients with central or inner quadrant primaries regardless of the axillary status. When in 1963 an electron beam became available, chest wall irradiation has been added to the peripheral lymphatics irradiation, primarily when there was a heavy infestation of the axillary nodes. The disease-free survival curves tend to flatten out at 10 years. At 10 and 20 years, the disease-free survival rates are respectively 55% and 50% for all patients, 44% and 40% for all patients with positive nodes, 56% and 48% for the patients with one to three positive nodes, and 33% and 30% for the patients with four or more positive nodes. The comparison of the mortality curves between the general population and the breast cancer patients seems to indicate a cured fraction, since the curves become parallel at 17 years. The highest incidence of failures is between 0 and 5 years, still a significant incidence between 5 and 10 years, but after 10 years the incidence of failures is relatively small.

Breast Neoplasms↗

PubMedDate not supplied

[Coping with illness and body image following different surgical techniques in breast cancer].

Coping and body image were studied in 80 patients with breast cancer. We compared three groups, who had undergone different operative strategies: temporary expander prothesis (n = 19), excisional biopsy (n = 20) and modified radical mastectomy (n = 40). Instruments were: the Herschbach coping questionnaire, the Strauss and Appelt body image questionnaire and a semi-structured interview. Patients after excisional biopsy showed significantly less illness-related stress than the other two groups, both in the number of all items named (p less than 0.02) and in the weighted total (p less than 0.05). Patients after modified mastectomy had chosen a different, "unfavourable" pattern of coping mechanisms than patients after expander prothesis or excisional biopsy: more resignation (p less than 0.05), less fighting and talking (p less than 0.05, respectively). In the body image questionnaire, no significant difference was found. However, in the semi-structured interview, patients after mastectomy mentioned more frequently that they avoided looking at the scar (p less than 0.05). These results underline the importance of preoperative counselling.

Adaptation, Psychological↗

PubMed1989

[Breast saving therapy in the small breast cancer].

According to the satisfying results reported by Fisher, Veronesi and other authors who used a breast-conserving operation modality in the treatment of breast cancer since 1980 109 patients with a carcinoma up to 2.5 cm underwent this kind of operation at the surgical department of the Hanusch-Hospital, Vienna. Although the median follow-up-time (29 months) is too short for conclusive statements, results of recurrence and survival compared to 162 cases of modified radical mastectomy were satisfying. Therefore--following certain indications--breast conserving operation is offered to our patients as a possible method.

Adult↗

PubMed1994

[Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous flap (TRAM-flap)].

The surgical treatment of breast cancer shows a recent trend toward breast-saving procedures, in consideration of quality and body image. Surgeons who performed mastectomy, however, have not taken aggressive approaches to reconstructive surgery, leaving this to plastic surgeons. We adopted the transverse rectus abdominis musculocutaneous flap (TRAM-flap) for breast reconstruction in 1988 and performed immediate breast reconstructions in 37 cases. There were no major complications, and good cosmetic results were obtained. For general surgeons, this excellent technique can safely cope with tissue defects in radical mastectomy, as well as modified radical mastectomy. Immediate breast reconstruction with this technique will be an integral part of breast cancer surgery in company with breast-saving surgery.

Adult↗

PubMedDate not supplied

[Mammary reconstruction after resection (author's transl)].

The authors present 44 cases of mammary reconstruction after sub-cutaneous mastectomies (16 cases), modified radical mastectomies (20 cases) and total radical mastectomies (8 cases). The implantation of a prosthesis is always performed a few months after sub-cutaneous mastectomy to avoid the numerous complications. Implantation of a prosthesis after a modified radical mastectomy (conservation of the pectoral muscles) yields excellent results. The authors graft the areola-nipple complex of the mastectomised breast on the abdominal skin, each time that they are sure of its integrity. At the later implantation of the mammary prosthesis, they perform a reduction or remodeling of the controlateral breast, if indicated. The total radical mastectomy without radiation generally allows implantation of a prosthesis without additional use of skin flaps or musculo-cutaneous skin flaps. Sequellea of radiodystrophy may impose preliminary cutaneous or musculo-cutaneous skinflaps with inferior esthetic results.

Breast↗

PubMed1997

[Development of breast surgery including plastic-reconstructive surgery results of the Universitätsfrauenklinik Leipzig].

The previous retrospective analysis surveys the introduction and development of breast surgery between 1992 and 1996 where a total of 741 procedures have been performed at our department. Recently, these operations represent about 10% of all gynecological procedures including small and extended operations. The total of breast surgical procedures have increased fivefold within the early introduction period of two years. Surgery of the breast was performed because of cancer in 335 cases (45%). Breast preserving procedures such as "wide excision" or segment resection with axillary nodal dissection (level I and II) respectively, have advanced from initially 46% in 1993 to 52% at present. 36% of women undergoing modified radical mastectomy receive an immediate breast reconstruction. So far, severe intraoperative complications were not encountered. The rate of postoperative and early complications needing therapy including cases with reoperation for postoperative haematoma formation (0.6%) or cases with impaired wound healing (3.1%) is assessed to be minor.

Axilla↗