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Results for “Mastectomy, Modified Radical”

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PubMed1999

Long-term outcome after postmastectomy radiation therapy for the treatment of ductal carcinoma in situ of the breast.

Postmastectomy radiation therapy may be recommended for patients with a high risk for local recurrence after mastectomy for ductal carcinoma in situ (DCIS). However, long-term outcomes after postmastectomy radiation therapy are not well described. This study was performed to determine long-term outcomes in patients treated with radiation therapy after mastectomy for DCIS. The authors reviewed the records of all patients with breast cancer treated with postmastectomy radiation therapy between 1978 and 1992. Of 287 total patients treated, three (1%) were for DCIS. These three patients had diffuse microcalcifications on screening mammography. The reason for postmastectomy radiation therapy was a potentially increased risk for local recurrence because of a positive resection margin after mastectomy for DCIS. Surgery consisted of a total mastectomy (n = 2) or a modified radical mastectomy (n = 1). Radiation therapy consisted of 4275-5000 cGy to the chest wall in 200-225 cGy fractions. The energy used was 6-MV photons (n = 2) or 15-MV photons (n = 1). No regional nodal irradiation was used. Bolus was applied to the chest wall every other day in one of the three patients. One patient was treated with a scar boost after chest wall irradiation (boost dose, 1000 cGy; total dose, 5275 cGy). The median age for the three patients was 46 years (range, 41-68 years). No patient received adjuvant chemotherapy or hormonal therapy. With a minimum follow-up of 7.1 years (median, 7.4 years; range, 7.1-19.4 years), no local-regional recurrence or evidence of metastatic disease developed in any of the patients. No long-term complication from radiation therapy was noted, and no contralateral breast cancer developed. All patients were alive and free of relapse at the last follow-up. The use of radiation therapy in this group of three patients has shown no evidence of relapse with a minimum of 7.1 years of follow-up. The authors conclude that radiation therapy may be indicated after mastectomy for DCIS to reduce the risk of recurrence for high-risk patients.

Adult↗

PubMed1992

Salvage mastectomy for local and regional recurrence after breast-conserving operation and radiation therapy.

Forty-six patients initially treated for carcinoma of the breast by tumor excision and radiation therapy who had local and regional recurrence with no evidence of distant disease and who underwent salvage mastectomy at Memorial Sloan-Kettering Cancer Center between 1970 and 1990 were reviewed retrospectively. These patients represent a recent series of patients treated with breast-conserving surgery, radiation therapy and subsequent salvage mastectomy with a median follow-up period of five years (range of one to 20 years). The mean age at initial diagnosis was 52 years (range of 31 to 75 years). All patients had excision of the primary tumor; 27 underwent local excision with axillary dissection. The median radiation therapy dose to the breast was 48 Gy. The distribution of stage of disease at the time of breast conserving treatment was stage 0 in seven patients, stage I in 13 patients, stage II in 14 and stage III in one patient. Twenty-seven patients received conservation treatment at other institutions and were referred to our institution for salvage operation. Local and regional relapse occurred at a median of 28 months (range of five months to seven years) after initial treatment. Relapses occurred only in the breast in 35 patients, in the axilla in one patient and in both sites in ten patients. Salvage operation consisted of total mastectomy in 50 per cent, modified radical mastectomy in 33 per cent and radical mastectomy in 17 per cent. Follow-up evaluation after salvage mastectomy (median 28 months, range of one month to 18 years) yielded an actuarial proportion free of disease at five years of 55 per cent (+/- 11 per cent) and an over-all five year survival rate of 76 per cent (+/- 10 per cent). The median time to relapse was 97 months (+/- eight months) and the median survival time was 103 months (+/- seven months). The local recurrence rate after salvage mastectomy was 15 per cent. These data suggest that salvage mastectomy provides local control of recurrent carcinoma of the breast and relapse-free survival time may be improved by postsalvage systemic therapy.

Adult↗

PubMedDate not supplied

An overview of surgical management of stage I and stage II breast cancer for the primary care provider.

Breast cancer is the most common cancer affecting women. With early detection and treatment, most patients survive cancer and lead full, active lives. Two principal treatments for stage I and stage II breast cancer are total mastectomy with axillary node dissection (modified radical mastectomy) and lumpectomy with axillary node dissection (breast conservation). Preoperative evaluation is aimed at the patient's ability to withstand the stress of anesthesia and surgery. Lumpectomy is a low-risk procedure; however, more serious complications may result from axillary node dissection, and wound infection occurs in 4-18% of mastectomy patients. Patient and family education is aimed at the operative experience as well as home care to promote physiological and psychologic adjustment postoperatively. Following mastectomy, the breast cancer patient may be fitted with a prosthesis or consider breast reconstruction with a saline implant, expander, or flap procedure. The primary care provider has the opportunity to establish a therapeutic alliance with the patient by providing coping strategies, support, and education throughout the process.

Breast Neoplasms↗

PubMed1998

Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG).

In 1980 the EORTC-BCCG initiated a multicentre randomised clinical trial comparing modified radical mastectomy (MRM) with breast-conserving therapy (BCT) in stage I and II breast cancer. The main endpoint of the trial was survival. A brief quality of life (QoL) questionnaire consisting of two multi-item scales (body image and fear of recurrence) and two single items (satisfaction with treatment and cosmetic result) was included in the trial. A cosmetic evaluation of the breast after conservative surgery was also performed. This report concentrates on the results of the QoL study and the cosmetic evaluation. Multitrait scaling analysis was employed to verify the hypothesised scale structure of the questionnaire. Treatment comparison of the QoL scores at 2 years post-treatment was performed using a stratified Wilcoxon rank sum test. Both patients' and doctors' ratings of the cosmetic result were documented on the clinical follow-up form. A multivariate analysis was performed to identify which factors influenced the cosmetic outcome. In total, 127 patients in the MRM arm and 151 in the BCT arm completed a QoL questionnaire at approximately 2 years after randomisation (months 25-36). The Cronbach's alpha coefficients were 0.79 and 0.73 for the body image and fear of recurrence scales, respectively. Significant benefit in body image and satisfaction with treatment was observed in the BCT patients. No significant difference was observed in fear of recurrence between the two groups. Ratings of cosmetic results decreased with time, in line with clinical observations of long-term side-effects of radiotherapy. Wide excision appeared to be the most important predictive factor for poor cosmetic result. In this multicentre randomised study, BCT helped to maintain the patients' body image, resulted in higher satisfaction with treatment and yielded no significant difference from MRM with respect to fear of recurrence.

Adult↗

PubMed1990

Steroid receptors in benign mastectomy tissue.

Estrogen and progesterone receptors (ERs and PRs, respectively) were measured in both cancerous and noncancerous components of 104 modified radical mastectomy specimens. In addition, ER and PR levels were determined for 14 benign breast specimens obtained by reduction mammoplasty. The receptor levels were measured by scatchard method. Each of these groups--cancerous, corresponding noncancerous, and mammoplasty specimens--were divided into subgroups according to their receptor levels. Fourteen of the 104 noncancerous specimens were found to be ER positive (ER+). Most cases of ER+ noncancerous tissue (13 of 14 cases) were associated with ER+ tumors. The reverse was not true because only 13 of 64 cases of the ER+ tumors were associated with positive ER in their noncancerous counterparts. Comparable results were obtained for PR. The average ER-PR level of the noncancerous mastectomy tissue was significantly higher than that of the mammoplasty specimens despite the similar histologic findings in both groups.

Breast Diseases↗

PubMed1989

Rehabilitation of the mastectomy patient: a randomized, blind, prospective study.

After biopsy confirmation of breast carcinoma, women who were scheduled to undergo a modified radical mastectomy had demographic data collected, goniometric measurements of shoulder flexion and abduction, and functional evaluation of the ipsilateral shoulder performed, and upper extremity circumferential measurements at five levels determined. Patients were then randomly assigned either to a group that received immediate postoperative physical therapy or to one that did not. Results represent the combination of data from a pilot study and this subsequent study following appropriate statistical analysis. Sixty-four women in the treatment group showed a statistically significant increase in shoulder range of motion in both abduction and flexion as compared to 51 women who received no physical therapy. The treated group also had fewer problems with five of the six upper extremity functional tasks that were assessed. There were no significant differences between the groups for length of hospital stay, postoperative complications, or upper extremity edema. The authors conclude that early physical therapy intervention makes a significant contribution to return to normal function without increasing the incidence of postoperative complications or prolonging hospital stay.

Activities of Daily Living↗

PubMed1994

The CO 2 laser in mastectomy: a ten-year follow-up.

We compared the healing process, postoperative course, and follow-up of patients who underwent modified radical mastectomy in the conventional way with those who underwent a laser procedure. Sixty women, aged 33 to 77 years, who suffered from carcinoma of the breast were randomly divided into two groups: Group 1: surgery was performed using scalpel and electrosurgery; Group 2: surgery was performed with a CO 2 Sharplan laser, skin-to-skin including the axilla dissection; maximal power, 40-60 W. The postoperative course was uneventful in both groups. Wound healing was normal. Sutures were removed on the tenth day. Patients were followed at the Outpatient Clinic for 10 years. The circumference of the arm and forearm was measured at fixed points before surgery and at follow-up. Mammography and liver and bone scans were performed every year. Four Group 1 patients developed swelling and edema of 2 to 3 cm at 6 to 8 months after surgery. Also two patients from subgroup A developed local recurrence. No edema or swelling or local recurrence could be detected in patients operated by laser. Surgery with laser is preferable to the conventional approach.

Adult↗

PubMedDate not supplied

[Metaplastic carcinoma of the breast: case report of a sarcomatoid type and literature review].

OBJECTIVE: Metaplastic changes are a rare entity that occurs in fewer than 5% of breast carcinomas. Their sarcomatoid variant is the rarest primary malignancy of the breast. We report a case of sarcomatoid breast cancer and insist on the diagnosis and treatment of this rare tumor. CASE REPORT: A 71-year-old female patient presented for a right breast mass above the nipple, between the upper inner and upper outer quadrants, of 20 mm of diameter, highly dense on mammography with cystic and solid components on ultrasound. Core biopsy showed a probable sarcoma whereas the partial mastectomy revealed the sarcomatoid metaplastic breast carcinoma. The workout for distant metastasis was negative and the treatment was completed by a modified radical mastectomy and adjuvant CMF chemotherapy. Six months after treatment there was no evidence of locoregional recurrence nor distant metastases. CONCLUSION: Although metaplastic carcinoma is a rare breast malignancy, with no specific clinical or radiologic features, it should be considered as an independent entity and included in the differential diagnosis of breast tumors.

Aged↗

PubMed1988

The importance of volumetry, lymphscintigraphy and computer tomography in the diagnosis of brachial edema after mastectomy.

Arm volumes of 360 patients with breast cancer were determined by a new optoelectronic technique. About 42% developed swelling of the arm after modified radical mastectomy which varied from mild (edema-volume 150-400 ml), moderate (400-800 ml), to severe (more than 800 ml) lymphatic edema. Lymphscintigraphy and computer tomography of the arms was also studied in different grades of lymphatic edema. Two years after operation and telecobalt-irradiation, one half of the patients without arm edema showed marked signs of a decreased capacity of lymphatic transport. In patients with severe lymphatic edema, the dynamic as well as the static evaluation of the lymphscintigrams revealed delayed transport, lack of radioisotope accumulation in the axillary region and notable congestion in the upper arm and forearm. Computerized tomography displayed a shift of fluid volume in the epifascial and subfascial tissue compartments and detected progressive structural changes in the soft tissue. Moderate edema not only increased the epifascial but also the subfascial compartments. In severe postmastectomy arm lymphedema, however, expansion of the epifascial space was paradoxically sometimes associated with a decrease in the subfascial compartment.

Arm↗

PubMed2000

Delayed infection of a lymphocele following mastectomy with immediate breast reconstruction: report of a case.

We report herein a rare case of delayed infection of a lymphocele following mastectomy with immediate breast reconstruction. A 38-year-old woman presented to our hospital 7 months after undergoing a left-modified radical mastectomy with an immediate breast reconstruction, following the sudden development of a giant mass in the left thoracoabdominal region as well as a high fever and shivering. Ultrasonography and a computed tomographic scan revealed massive fluid retention extending from the left axilla to the lower abdominal region. Puncture drainage was performed three times and the injection of an antibiotic directly into the cyst resulted in resolution of the fluid. This massive retraction of fluid was considered to have resulted from a delayed infection of an axillary lymphocele.

Adenocarcinoma↗

PubMed1993

Partial mastectomy without radiation is adequate treatment for patients with stages 0 and I carcinoma of the breast.

The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.

Breast Neoplasms↗

PubMed1992

Achieving local control for inflammatory carcinoma of the breast.

A single institution, retrospective study of 28 patients with inflammatory carcinoma of the breast treated from 1984 to 1990 was performed. Patients received two to four cycles of cyclophosphamide, doxorubicin and 5-fluorouracil (CDF) and were then evaluated for mastectomy. Mastectomy was accomplished in 26 patients after CDF. In 21 patients, the breast was resectable after the initial doses of chemotherapy and modified radical mastectomy was done. Radiation therapy was given to 16 of the 21 patients after six to nine cycles of postoperative chemotherapy. The remaining five of 26 patients had a marginal response to CDF and underwent preoperative radiation therapy. Local recurrence occurred in four of five patients receiving preoperative radiation, in three of 16 receiving postoperative radiation and in one of five receiving mastectomy without radiation therapy. The overall observed five year survival rate was 18 percent, with a median of 34 months. Neither dermal lymphatic invasion nor estrogen receptor status were statistically significant variables when analyzing patients for local recurrence or survival. Despite poor long term survival results, the combination of induction CDF, mastectomy and postoperative radiation achieved local control in 81 percent of patients.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1996

Breast reconstruction and tissue expansion in irradiated versus not irradiated women after mastectomy.

Thirty-five women whose breast cancer had been treated by radiation and 111 in whom it had not underwent unilateral breast reconstruction with the tissue expansion technique after modified radical mastectomy. Their records were reviewed and in a questionnaire the patients reported their own opinion on the results. The two groups differed significantly, because those patients who had been irradiated had a more painful course of expansion and a less over-expansion. Their reconstructed breasts were harder, had more deformities, and they required significantly more capsulotomies. The irradiated group also reported less satisfaction with the cosmetic results and more unfulfilled expectations. Tissue expansion cannot therefore be recommended as a routine procedure for breast reconstruction in patients after irradiation. However, our results do not show whether other methods are better for these patients.

Adult↗

PubMed2001

Radiation after mastectomy in high-risk patients: is it necessary?

A retrospective review of cases from 1988 through 1992 was performed examining high-risk breast cancer patients treated with modified radical mastectomy without postoperative radiation at a single institution. Locoregional recurrence, distant metastases, overall survival, and number of lymph nodes removed were examined. This was compared with recent Danish and Canadian studies. Thirty-three premenopausal node-positive breast cancer patients had a 9 per cent locoregional recurrence rate. In the Danish and Canadian studies the locoregional recurrence rates were 32 and 21 per cent. These were reduced to 9 per cent and 10 per cent respectively in the radiated arms. Our locoregional recurrence in nonradiated patients was similar to that in the radiated arms of the studies and improved when compared with recurrence in their non-radiated controls. The adequacy of the axillary lymph node dissection was examined. In the current study a median of 18 lymph nodes were recovered with only 3 per cent containing less than 12 nodes. In the Danish study a median of seven lymph nodes were removed. Similarly in the Canadian trial a median of 11 nodes were removed. With complete axillary dissection results equivalent to those of postoperative adjuvant radiation is achieved. Further randomized controlled studies with standard axillary dissections are needed before the recommendation of routine postoperative radiotherapy.

Adult↗

PubMed1987

Male breast carcinoma. II. A study of the total material reported to the Swedish Cancer Registry 1958-1967 with respect to treatment, prognostic factors and survival.

The complete material of male breast cancer, 166 cases, reported to the Swedish Cancer Registry in 1958-1967 is described and analyzed concerning different prognostic parameters, treatment methods and survival. Age at diagnosis, axillary lymph node status and tumour size all had significant prognostic importance in a multivariate analysis with axillary lymph node status as the strongest factor. Histologic malignancy grade was strongly correlated to axillary lymph node status and tumour size and thus to prognosis, but did not seem to be an independent prognostic factor. The primary treatment methods were quite heterogeneous and were obviously influenced by both age of the patient and clinical tumour status. No significant correlation was found between type of primary treatment and survival, but due to the retrospective nature of the study no definite conclusion could be drawn. Radical mastectomy seemed, however, to give fewer loco-regional recurrences than both modified radical mastectomy and simple mastectomy. Very few patients in the present series had received radiation therapy in adequate doses. The material gave some indications that orchiectomy might prolong survival in patients with recurrent or generalized disease.

Age Factors↗

PubMed1975

[The treatment of carcinoma in situ of the breast (author's transl)].

The management of 63 carcinomas in situ of the breast is reviewed. These 63 carcinomas in situ occurred among 575 carcinomas of the breast from 1969 to 1973. The treatment consisted of simple mastectomy. In cases of early invasion the axilla was explored by palpation of the adipose tissue for enlarged lymph nodes. None were found and no extirpation of the axillary nodes was carried out. Of 59 patients with carcinoma in situ of the breast, 3 later had a local recurrence. Two patients later died of distant metastases. In view of these inadequate results of simple mastectomy it is recommended that a modified radical mastectomy should also be done in all cases of carcinoma in situ of the breast.

Axilla↗

PubMed2005

The left sternalis muscle variation detected during mastectomy.

The sternalis muscle variation is a well-known anatomical situation. It is present in 8.7% of women and 6.4% of men, although the incidence varies according to sex, race and ethnicity. During a left modified radical mastectomy operation on a 46-year-old female patient a sternalis muscle was detected on the pectoralis major muscle in the superficial fascia. It was in craniocaudal position and was parallel to the body of the sternum. The cylindrical muscle was approximately 8 cm in length and 2 cm in diameter. Such variations are considered to have their origin in embryological development. Awareness of muscular variations and their identification is important both for procedure through the proper dissection planes during breast surgery and in radiological examination and follow-up.

Breast Neoplasms↗

PubMed2002

Debilitating lymphedema of the upper extremity after treatment of breast cancer.

Lymphedema after mastectomy occurs with a frequency as high as 30%. The incidence increases with more radical surgical dissection, as was often seen with radical mastectomies in the late 1800s. This is one aspect of breast surgery that has been greatly neglected. Surgery has often been deemed a success if the malignancy is eradicated. Patients may complain of symptoms as minor as arm heaviness to major ones such as massive chronic swelling, as was the case with our patient. The patient presented here had increasing lymphedema during a 14-year period after modified radical mastectomy and radiation therapy for advanced breast cancer. This condition had progressed to incapacitation of the extremity and a patient who as a result had become an invalid. The massively edematous extremity revealed no signs of recurrent disease or malignant degeneration. She underwent surgical intervention and physical therapy as procedures of choice to restore function.

Aged↗