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Results for “Mastectomy, Modified Radical”

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PubMed1994

[Primary high-dose chemotherapy with hematopoietic growth factors followed by surgery and radiotherapy in stage III breast carcinoma; a Phase II study in 15 patients].

OBJECTIVE: To establish if the prognosis of a stage III breast carcinoma is improved by primary high-dose chemotherapy in combination with haemopoietic growth factors, followed by radical surgery and radiotherapy. DESIGN: Phase II study. SETTING: University Hospital Free University, Amsterdam. METHOD: Fifteen patients with a locally advanced breast carcinoma (stages IIIA or IIIB) were treated every three weeks with doxorubicin 90 mg/sq.m. and cyclophosphamide 1000 mg/sq.m., followed by granulocyte-macrophage colony-stimulating factor (GM-CSF) 250 micrograms/sq.m. from day 2 up to and including day 12. After 4-6 of these courses the treatment in principle was continued with a modified radical mastectomy, followed by radiotherapy. Median duration of follow-up was 18 months. RESULTS: All tumours were reduced by over 50%. 10/15 Patients went into clinical complete remission; in 6/9 of these, pathological examination revealed only microscopical tumour rests, in the other three the rest diameter was < or = 1 cm. The haematological toxicity was mild. Grade III-IV bone marrow suppression was followed by rapid return to normal of the numbers of neutrophil granulocytes and thrombocytes under the influence of GM-CSF. The non-haematological toxicity manifested itself with nausea and vomiting, stomatitis and mild side effects attributable to GM-CSF. CONCLUSION: It appears justified in the treatment of locally advanced breast carcinoma to start with chemotherapy. Dose escalation of efficacious chemotherapeutics resulted in a large number of complete remissions.

Adult↗

PubMed1992

Primary tumor size. Relevance to breast cancer survival.

In view of current emphasis on identifying prognostic factors for patients with early breast cancer, we studied the importance of tumor size to survival among 1392 patients with primary operable breast cancer who were followed up prospectively. All patients had modified radical mastectomies. Nine hundred seventeen patients had negative nodes and did not receive postoperative adjuvant therapy. Four hundred seventy-five patients had node involvement and received combination chemoendocrine therapy. In a Cox's proportional hazards model, tumor size was a significant predictor of disease-free and overall survival when the number of positive nodes, estrogen receptor status, menopausal status, and race were considered. Among the node-negative group, tumor size explained considerable variation in disease-free and overall survival, varying from a 10-year disease-free and overall survival of 80% and 99% for patients with estrogen receptor-positive tumors measuring 1 cm or less to a 10-year disease-free and overall survival of 51% and 59% for patients with tumors larger than 5 cm.

Aged↗

PubMed2002

Decreased axillary lymph node retrieval in patients after neoadjuvant chemotherapy.

BACKGROUND: The purpose of this study was to assess our clinical impression that fewer lymph nodes are retrieved after level I and II axillary dissection after neoadjuvant chemotherapy and whether there is a positive correlation between the total number of lymph nodes retrieved and the number of diseased lymph nodes. METHODS: Patients included those with stage IIB, IIIA, and IIIB breast cancer of whom 77 had neoadjuvant chemotherapy and 58 had initial surgery only. All had modified radical mastectomy with in continuity level I and II axillary dissection. RESULTS: Patients after neoadjuvant chemotherapy had 14.3 +/- 6.7 lymph nodes detected versus 16.9 +/- 8.8 (mean +/- SD; P <0.057) for those with initial surgery only. The number of positive nodes were 3.7 +/- 4.7 versus 6.6 +/- 8.7 (mean +/- SD; P <0.033) respectively and the number of negative nodes were 10.6 +/- 7.5 versus 10.4 +/- 8 (mean +/- SD; P <0.9). The correlation between the number of positive lymph nodes and the total number of lymph nodes was r = 0.58; P <0.001. CONCLUSIONS: It appears that fewer lymph nodes are retrieved after level I and II axillary dissection after neoadjuvant chemotherapy. The total number of lymph nodes retrieved increases directly with the number of positive lymph nodes in patients not treated with chemotherapy.

Antibiotics, Antineoplastic↗

PubMed1990

Variations in sensitivity after sectioning the intercostobrachial nerve.

The authors present a prospective study of the variations in sensitivity that appear in the armpit and arm after the intercostobrachial nerve has been sectioned in a modified radical mastectomy. Of a total of 208 patients studied between 1978 and 1987, the intercostobrachial nerve was sectioned in 139 patients, whereas in 30 it remained intact; in 39 patients only peripheral branches of the nerve were sectioned. The patients were examined at regular postoperative intervals in order to evaluate their sensitivity both to touch and to pain in the axilla and arm. Four hundred thirty-three examinations were carried out and the 3 operative groups were assessed accordingly. After the nerve was sectioned, there was increasing anesthesia in the armpit and hypoesthesia on the posterointernal face of the arm, while for the patients in whom the intercostobrachial nerve remained intact, these alterations were less intense and long-lasting. Significant statistical differences between the two groups also exist. In the absence of axillary lymphatic ganglia infiltrated by the tumor, the conservation of the intercostobrachial nerve is recommended.

Arm↗

PubMed2000

Primary small cell (oat cell) carcinoma of the breast: report of a case and review of the literature.

A case of primary small cell (oat cell) carcinoma of the breast in a 41-year-old woman is presented. The patient was alive and well without disease 16 months after modified radical mastectomy and subsequent chemotherapy. The tumor cells revealed morphologic similarity to oat cell carcinoma of the lung and immunohistochemical expression of neuroendocrine markers. In ultrastructural examination, the tumor cells had neurosecretory granules. Review of nine previously reported cases and this case of primary small cell carcinoma of the breast has revealed that this type of tumor shows prominent vascular invasion, frequent lymph node metastasis, infrequent expression of estrogen receptor, and also very poor prognosis. Immunohistochemical study for the c-kit proto-oncogene product, which has been reported to be a specific marker for pulmonary small cell carcinoma, demonstrated positive reactivity in approximately 80% of the tumor cells of this case, which is the first report according to our knowledge. The expression of c-kit might be some aid to the diagnosis of primary small cell carcinoma of the breast.

Adult↗

PubMed1998

Breast cancer in Cowden's disease: a case report with review of the literature.

We report a case of invasive breast cancer in a 62-year-old female patient with Cowden's disease. A left modified radical mastectomy was performed and histopathology of the tumor showed invasive ductal carcinoma, histological grade 3, without lymph node metastasis. The patient had a past history of endometrial cancer at 55 but did not have a family history of malignant disease. Goiter was palpable but aspiration cytology revealed no malignancy. There were several papillomas on the oral mucosa and multiple papillomatous lesions on the right femur. Barium X-ray and endoscopic examination revealed multiple, small, hyperplastic polypoid lesions on the esophagus, stomach and rectum. Histopathology of the biopsy specimens from the esophagus and stomach showed acanthotic squamous epithelium and foveolar hyperplastic polyps. The patient was followed up closely to monitor the thyroid lesions and polyposis of the digestive tract. A total of 12 breast cancer patients who also had Cowden's disease have been reported in Japan and these cases are reviewed in this report.

Breast Neoplasms↗

PubMed1989

Breast cancer survival and perioperative blood transfusion.

The effect of perioperative blood transfusion on disease-free and overall survival was studied in 812 patients with stages I and II breast cancer, followed up prospectively in a multicenter study. All patients initially underwent a modified radical mastectomy. Patients with axillary node-negative, stage I cancer were followed up without additional therapy. Patients with axillary node-positive, stage II cancer were randomized to receive adjuvant chemoendocrine therapy. Transfusion was done in 35.8% of the patients with stage I and in 37.3% of the patients with stage II cancer. For the patients with stage II cancer, perioperative blood transfusion did not affect disease-free or overall survival. For the patients with stage I cancer, perioperative blood transfusion resulted in a worse disease-free and overall survival (p = 0.05 and 0.02, respectively), which was particularly evident for those patients who received more than 1 unit. This study suggests that stage of disease, adjuvant therapy, number of transfusions, and duration of follow-up must be considered in further analyses.

Actuarial Analysis↗

PubMed2002

Outcome with postmastectomy radiation with transverse rectus abdominis musculocutaneous flap breast reconstruction.

The effects of radiation on the outcome of patients undergoing transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction have not been extensively studied. Concern still exists of a possible negative impact secondary to irradiation as related to control of disease, cosmetic outcome, and flap viability. Thirty-six patients underwent both a modified radical mastectomy (MRM) with TRAM flap reconstruction and irradiation to the chest wall to include the TRAM flap and/or regional nodes either before reconstruction or after TRAM flap reconstruction. Fifteen patients had all of their treatment and follow-up at our institution and were retrospectively reviewed to assess treatment and outcome. During a median follow-up of 36 months there were no local-regional failures. One patient at Stage IIIA failed with distant metastases 3 years after treatment. One patient had a flap loss from a nonhealing wound after reconstruction performed 2 years after MRM and radiotherapy. Only one patient expressed dissatisfaction with the cosmetic outcome. Patients undergoing MRM with TRAM flap reconstruction and irradiation before or after reconstruction can achieve excellent local-regional control and satisfactory cosmesis. Risk of flap loss is low. Further follow-up is needed for assessing longer-term outomes in this patient group. Larger prospective studies are necessary for more definitive conclusions.

Adult↗

PubMed2001

Association of breast cancer with meningioma: report of a case and review of the literature.

We report a case of meningioma subsequently developed in a patient with primary breast carcinoma. A 53-year-old woman received a left modified radical mastectomy because of stage IIA breast carcinoma. Histologically, the tumor was a predominantly intraductal carcinoma with negative lymph node metastasis. Estrogen receptor (ER) was negative but progesterone receptor (PR) of the left tumor was positive by immunohistochemistry. Four years later, cranial bone and/or brain metastasis was suspected from a routine follow-up bone scintigram. The patient showed no symptoms or signs at that time. Magnetic resonance imaging (MRI) and angiography revealed that the right parasagittal mass was suspicious of meningioma. A complete tumor removal was performed. On histological examination, this brain tumor was a transitional-type meningioma (meningotheliomatous and fibrous type) without malignant findings. ER was negative but PR was positive also in this tumor. She is currently well 6 years after the initial surgery. A review of the literature is presented with emphasis on the association between breast cancer and meningioma, which indicates a possible hormonal relationship. The knowledge of this association is important in the differential diagnosis of patients with breast cancer who develop central nervous manifestations.

Breast Neoplasms↗

PubMed2000

A case of metastatic breast cancer achieving complete response by combination therapy with 5'-deoxy-5-fluorouridine and cyclophosphamide.

Recently there have been several reports on the effectiveness of combination chemotherapy with 5'-deoxy-5-fluorouridine (5'-DFUR) and cyclophosphamide (CPA) for treating recurrent breast cancer. We report a case in which treatment of local recurrence and lung metastases responded was remarkably effective by this combination chemotherapy. A 45-year-old woman underwent modified radical mastectomy for left breast cancer (T2N0M0) three years previously. Involvement of a left supraclavicular lymph node (ScLN) and multiple lung metastases were revealed 2 years and 6 months after the operation. First, we opted for systemic endocrine therapy with local irradiation for the lung metastases and ScLN. However the lung metastases were found to have increased on chest x-ray 2 months after treatment, showing progressive disease (PD). A locally recurrent new lesion sized 2 x 2 cm had also developed. Thus, we changed the treatment to combination chemotherapy with 5'-DFUR 800 mg/body and oral CPA 100 mg/body once a day. The lung metastases had disappeared on chest x-ray and the local recurrence was not palpable after 7 weeks of the new treatment. Thymidine phosphorylase (dThdPase) immunostaining of the primary tumor was strongly positive in almost all cancer cells. We discuss the mechanism of the increased efficacy of combination chemotherapy with 5'-DFUR and CPA.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1989

Endocrine versus endocrine plus five-drug chemotherapy in postmenopausal women with stage II estrogen receptor-positive breast cancer.

Postmenopausal women who underwent modified radical mastectomy for Stage II, estrogen receptor (ER)-positive breast cancer were randomized to receive endocrine treatment (tamoxifen [T], 40 mg daily for 3 years) alone versus endocrine treatment plus five-drug chemotherapy (Cytoxan [cyclophosphamide, C], methotrexate [M], 5-fluorouracil [F], vincristine [V], and prednisone [P], CMFVP, for 1 year). Chemotherapy consisted of oral P (1 month), oral C (12 months), and intravenous MFV weekly for the first 3 months, biweekly for 3 months, and triweekly for 6 months. Patients were entered into the study from October 1979, to October 1985, and the median follow-up is 55 months. Results show that with 94 postmenopausal women, disease-free survival (DFS) is significantly greater (P = 0.04, log-rank test; P = 0.03, multivariate analysis) in patients receiving CMFVPT as compared to those receiving T alone. These results suggest that intensive chemotherapy combined with T is more effective in delaying recurrence than T alone in postmenopausal patients.

Aged↗

PubMed1990

Evaluation of the predictive power of progesterone receptor levels in primary breast cancer: a comparison with other criteria in 559 cases with a mean follow-up of 74.8 months. The Breast Cancer Prognostic Study Associates.

A total of 559 women with primary breast cancer treated by modified radical mastectomy were followed for a mean of 74.8 months to evaluate the relationship of sex hormone receptor content in the tumor with time to first recurrence and to death due to breast cancer. The prognostic significance of progesterone receptor (PgR) status was evaluated in terms of estrogen receptor (ER) status, age (less than or equal to 49 years, greater than or equal to 50 years), extent of lymph node involvement, tumor size, and morphologic characteristics. Overall, patients with PgR positive (greater than 9 femtomoles/10 mg wet weight tissue) tumors experienced a significantly longer period to both first recurrence and death due to breast cancer, but this advantage was restricted to those whose cancer had metastasized to their axillary lymph nodes. For women with nodal involvement, the extent of this involvement and the size of the primary lesion had the greatest predictive value followed by nuclear grade and PgR status. In these node-positive patients, PgR positivity, although strongly associated with ER positivity, had a greater predictive value than that of the estrogen receptor per se.

Breast Neoplasms↗

PubMed1988

Six-year results of a multimodality treatment strategy for locally advanced breast cancer.

Between 1976 and 1982, 59 patients with locally advanced breast cancer were treated with preoperative supervoltage radiotherapy, adjuvant preoperative and postoperative hormonochemotherapy, and modified radical mastectomy. Systemic treatment, which was started simultaneously with radiotherapy, consisted of a combination of daily oral tamoxifen and a monthly alternation of Doxorubicin + vincristine and cyclophosphamide + methotrexate + 5-fluorouracil (CMF). One of each cycle was given preoperatively at half dosage and five of each were repeated postoperatively at full dosage. All patients became operable. Results of pathologic examination of the operative specimen, available in 51 patients, showed complete disappearance of tumor tissue in breast areas in eight patients, of which three still had positive axillary nodes. After a median follow-up time of 6 years locoregional failure was observed in 12 patients (20%) but in only three (5%) did it occur before distant failure. The actuarial median survival of the entire patient population is close to 4 years. Seven patients are alive without recurrence at greater than 9 years. This aggressive multidisciplinary treatment approach is associated with a projected 30% long-term survival (10 years), excellent local control, but substantial toxicity.

Adult↗

PubMed2006

The impact of axillary lymph nodes removed in staging of node-positive breast carcinoma.

PURPOSE: Number of positive lymph nodes in the axilla and pathologic lymph node status (pN) have a great impact on staging according to the current American Joint Committee on Cancer staging system of breast carcinoma. Our aim was to define whether the total number of removed axillary lymph nodes influences the pN and thus the staging. METHODS AND MATERIALS: The records of 798 consecutive invasive breast cancer patients with T1-3 tumors and positive axillary lymph nodes who underwent modified radical mastectomy between 1999 and 2005 in our hospital were reviewed. The total number of removed nodes were grouped, and compared with the patient and tumor characteristics and the influence of the number of nodes removed on the staging was analyzed. RESULTS: The proportion of patients with > or =4 positive nodes (59%), and pN3 status (51%) were the highest in the group with 21-25 nodes removed. Compared with patients with 1-20 nodes removed, the proportion of patients with > or =4 positive nodes (52%), and pN3 status (46%) were significantly higher in those with more than 20 nodes removed. Although the proportion of Stage IIA and IIB decreased, the proportion of Stage IIIA and IIIC increased in patients with >20 nodes removed compared with those with 1-20 nodes removed. CONCLUSIONS: In patients with axillary node-positive breast carcinoma, staging is highly influenced by total number of removed nodes. Levels I-III axillary dissection with more than 20 axillary lymph nodes removed could lead to more effective adjuvant chemotherapy and increases substantially the proportion of patients to receive radiotherapy.

Adult↗

PubMed1991

[Pure and primary squamous cell carcinoma of the breast].

A case of a pure squamous cell carcinoma (SCC) of the breast is a 75 y.o. white female is reported. The cancer was discovered at the clinical exam requested by the patient for a growing mass in the left breast. Mammogram and an ultrasound exam showed a big cystic mass (4 cm x 4 cm) with a liquid content and a small polypoid mass of 0.5 cm x 0.5 cm arising from the inner surface of the cyst. A fine needle aspiration was done and the cytological report was consistent with squamous cell carcinoma. A left modified radical mastectomy was carried out. The skin was not involved and the lymph nodes were negative, and no other cutaneous tumor elsewhere was found. The stage was II (T 2a N o M o). The patient did well and was discharged 10 days post-op and now she is still doing well with no signs of recurrences or metastasis. This cancer should not be confused with a much more largely manifest metaplastic changes in a usual breast cancers. The criteria to define "pure" a squamous cell Ca of the breast are: 1) that no other neoplastic element such as ductal or mesenchymal ones are present in the tumor; 2) that the tumor is independent of adjacent cutaneous structure; 3) that no other distant epidermoid tumor exists in the patient. The origin of this tumor is controversial; it has been stated as arising from dermatoid cyst of the breast, chronic abscesses, complete metaplasia of glandular breast tissue. Despite the rarity of this neoplasia it should be kept in mind that in a cystic mass of the breast in older patient could arise a squamous cell carcinoma.

Aged↗

PubMed1995

Adequate locoregional treatment for early breast cancer may prevent secondary dissemination.

PURPOSE: To analyze different events that determine event-free survival (EFS) in a randomized trial on adjuvant radiotherapy in early breast cancer patients with more than 15 years of follow-up evaluation. PATIENTS AND METHODS: The trial included 960 patients with a unilateral, operable breast cancer. Surgery consisted of a modified radical mastectomy. The trial compared three arms, as follows: preoperative radiotherapy, postoperative radiotherapy, and no adjuvant treatment. Events were analyzed by a competing-risk approach. A proportional hazards multiple regression model was used to analyze the effects of radiotherapy on the risk of distant metastasis. Similar analyses were performed separately for node-negative [N(-)] and node-positive [N(+)] patients in the two groups that did not include preoperative radiotherapy. RESULTS: Radiotherapy produced a fivefold decrease of the risk of local recurrence (P < .0001). In N(+) patients, postoperative radiotherapy decreased the risk of distant dissemination (relative risk, 0.63). When local recurrence was introduced in the model as a time-dependent covariate, this factor was predictive of distant dissemination (P < .0001) and nullified the effect of postoperative radiotherapy. This finding suggests that the decrease of distant metastases was related to the prevention of local recurrence. A similar effect was found in models that used overall survival as an end point. CONCLUSION: This study shows that postmastectomy radiotherapy in N(+) breast cancer patients may decrease the distant metastasis rate by preventing local recurrences and thus avoiding secondary dissemination.

Breast Neoplasms↗

PubMed1989

Multicentric primaries and residual tumor masses following wide excision in breast cancer: a basis for irradiation.

In the Department of Gynecology and Obstetrics 131 modified radical mastectomies were carried out in patients with invasive breast cancer eligible for breast conserving therapy between 1978 and 1981. The technique of plastination was used for the first time in a complete histological investigation of the breast specimens. In all cases segmental resections with a rim of crossly normal tissue around the primary of at least 2 cm were simulated. Residuals of the primary in vicinity of the resection margin were found in 19.1% and multicentric tumor foci in 24.4% of all cases in the remaining breast. In 8.4% of the patients the residuals extended more than 3 cm beyond the resection margin. The volumes of the residuals were significantly larger than the volumes of the multicentric foci (p = 0.004). According to these results a 2 cm rim of grossly normal tissue should be resected with the primary tumor. A reexcision is to be recommended in cases with resection margins that are histologically not free of tumors. Considering the difficulty of a total histologic examination of the whole resection margin a boost dose should be supplemented. The extension of the residuals requires a boost field covering one third up to one half of the normal sized breast.

Breast Neoplasms↗

PubMed1989

[Axillary lymph node excision in breast cancer].

We report on 264 patients with operable breast cancer, treated between 1980 and 1984 at the First Clinic of Obstetrics and Gynecology in Vienna. The operation was in all cases a modified radical mastectomy. The patients were randomized in two groups. In one group of 140 patients, the lymphatic tissue of the axilla was marked by technetium-99 antimonsulfide and these patients were operated on a gammacamera. The other group of 124 patients was not marked. This unspecific imaging of lymph nodes enabled us to increase the average number of removed lymph nodes by 25% in the marked group. In this group the amount of lymph-node-positive cases was 50.7% compared to 37.4% in the unmarked group. This difference may find its explanation in the higher number of lymph nodes removed. All other prognostic parameters in both groups showed no significant difference. After an observation period of 5 years or longer no difference in survival rate, disease-free interval, local and regional recurrence or distant metastases was found. This seems surprising because the number of lymp-node-positive cases was higher in the marked group, which according to oncological principles should result in a lower prognostic score. The explanation may be that a higher number of identified and removed lymph node metastases may bring those patients the advantage of modern adjuvant therapy and therefore a better prognosis.

Austria↗