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At least 19 recordsLinked to original sources
PubMed1988

Treatment of breast cancer among elderly women with segmental mastectomy or segmental mastectomy plus postoperative radiotherapy.

Elderly women with cancer are often treated non-aggressively. Between January 1972 and March 1984, 128 women greater than 60 years were treated for Stage I or II breast cancer with segmental mastectomy (SGM) plus/minus postoperative radiation at one of our four area hospitals. Whereas 82% of similar patients less than 60 years were referred for postop radiation, only 39.8% of patients greater than 60 were so referred. Referral rates progressively diminished with increasing patient age above 60. Thus, we reviewed the outcome of 77 elderly women treated with SGM and 51 treated with SGM+RT. Treatment groups were similar with regard to prognostic clinical and histologic parameters. Mean follow-up is 51.4 months. Among SGM patients, 45.5% of patients between 60-70 years, 37.9% of those greater than 70, and 20% of those greater than 80 years experienced loco/regional failure prior to death. Conversely, only two local failures occurred among all elderly women treated with SGM+RT. Distant failure was approximately 11% and was unaffected by treatment. Complications of SGM+RT were modest. These data suggest that SGM+RT can be safely and effectively applied to the elderly. Moreover, the data suggests that postop radiation may be more beneficial when extended to elderly patients post segmental mastectomy than among younger women. Referring surgeons should focus upon their patients' physiologic and not chronologic age as a basis for treatment allocation decisions.

Age Factors↗
PubMed1985

Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.

In 1976 we began a randomized trial to evaluate breast conservation by a segmental mastectomy in the treatment of Stage I and II breast tumors less than or equal to 4 cm in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total mastectomy, segmental mastectomy alone, or segmental mastectomy followed by breast irradiation. All patients had axillary dissections, and patients with positive nodes received chemotherapy. Life-table estimates based on data from 1843 women indicated that treatment by segmental mastectomy, with or without breast irradiation, resulted in disease-free, distant-disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy (P = 0.04), and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy (P = 0.07, and 0.06, respectively). A total of 92.3 per cent of women treated with radiation remained free of breast tumor at five years, as compared with 72.1 per cent of those receiving no radiation (P less than 0.001). Among patients with positive nodes 97.9 per cent of women treated with radiation and 63.8 per cent of those receiving no radiation remained tumor-free (P less than 0.001), although both groups received chemotherapy. We conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for Stage I and II breast tumors less than or equal to 4 cm, provided that margins of resected specimens are free of tumor.

Breast Neoplasms↗
PubMed1989

Treatment of breast cancer with segmental mastectomy alone or segmental mastectomy plus radiation.

A retrospective review of the outcome of treatment for primary, Stage I and II breast cancer with segmental mastectomy (SGM) alone or segmental mastectomy plus postoperative irradiation (SGM + RT) at four Rochester, New York, city hospitals is reported. Between January 1971 and March 1984, 99 women were treated with SGM and 146 with SGM + RT. Groups were similar regarding significant clinical and histologic prognostic factors; they differed, however, in that the SGM group was considerably older (means = 72) than the SGM + RT group (means = 56). Among SGM patients, local and total locoregional failure was 26.44 and 35.2%, respectively. Local and total locoregional failure (7.6 and 12.4%, respectively) was significantly reduced among patients treated with SGM + RT (p less than 0.0001). Among SGM patients, there was scant advantage in enlarging the extent of resection from local excision (29.5% local failure) to wide local excision (27.3%) to quadrantectomy (22.2%). Among women receiving SGM + RT, similar rates of local failure occurred among patients receiving local excision (15.5%) and wide local excision (12.5%). By contrast, only 2.8% of those receiving quadrantectomy failed. Results are viewed as supportive of findings of NSABP-B06. Findings suggest that SGM constitutes inadequate treatment of Stage I and II breast cancer. Locoregional failure rates of 30-40% may be reduced to around 10% with postoperative irradiation.

Adult↗
PubMed1983

Segmental mastectomy without radiotherapy. Short-term follow-up.

Short-term treatment failures following 43 segmental mastectomies without radiation therapy and 157 total mastectomies for primary operable breast cancer Stages I and II (T1-2, N0-1, M0) are compared. Although not randomized by design, the patients in the two treatment groups were of similar age and had tumors of comparable histologic type, size, grade, and stage. The overall recurrence rates in an average follow-up of 24 months (range, 6-48 months) were 5% for patients treated by standard mastectomy and 19% for those treated by segmental mastectomy. Recurrence rates in patients with the more commonly encountered carcinomas of 11 to 50 mm in size treated by surgery alone were 7.5% for total mastectomy and 28.0% for segmental mastectomy. Nearly all of this difference relates to a higher frequency of local recurrence in the segmental mastectomy group (P = less than 0.005). Recurrent disease in both groups developed at comparable intervals, averaging 17 months for segmental mastectomy and 16 months for total mastectomy. Using a serial subgross technique, which permitted detection of clinically unsuspected involvement of resection margin by microscopic foci of carcinoma, it was noted that such involvement was an important prognostic indicator for local recurrence. Five of eleven breast resections with this feature developed local recurrence, compared with only 3 of 32 without such involvement of the resection margin.

Breast Neoplasms↗
PubMed1990

Segmental mastectomy without radiotherapy for T1 and small T2 breast carcinomas.

We describe 111 patients with invasive breast cancer treated by segmental mastectomy at the University of Miami (Fla) since 1975. Postoperative adjuvant radiotherapy was recommended as optional rather than mandatory to 64 of these patients based on small (2.5 cm or less) primary tumor size, adequate resection margins, no lymphatic or vascular invasion within the segmental mastectomy specimen, and minimal associated in situ cancer. Fifty-one of these patients elected to forego postoperative adjuvant radiotherapy. At 72 months median follow-up, relapse occurred in the ipsilateral breast in three patients who elected to forego postoperative adjuvant radiotherapy (6% by Kaplan-Meier analysis). Retrospective pathologic review revealed that tumor grade may also be important in determining whether postoperative adjuvant radiotherapy is necessary following segmental mastectomy. These data suggest that postoperative adjuvant radiotherapy may not be required in every patient treated by segmental mastectomy. Further studies to define which patients can be spared the inconvenience, expense, and potential morbidity of postoperative adjuvant radiotherapy are warranted.

Adenocarcinoma↗
PubMed2001

Does intraductal breast cancer spread in a segmental distribution? An analysis of residual tumour burden following segmental mastectomy using tumour bed biopsies.

INTRODUCTION: Breast-conserving surgery for early breast cancer is now routinely used as an alternative to mastectomy. Despite post-operative radiotherapy, early local recurrence of tumour remains a concern. It has been reported that invasive and in-situ ductal carcinoma spread locally through the ductal tree in a segmental distribution, however, there is no consensus as to the best surgical method to maximize tumour clearance whilst leaving a good cosmetic result. AIM: We aimed to measure the effectiveness of segmental mastectomy (excision of tumour plus associated segmental ductal tissue) in the clearance of different tumour types. Bed biopsy of the excision cavity was employed to assess the rate of incomplete excision or the multifocality of certain breast cancers. METHODS: One hundred and one patients with breast cancers underwent segmental mastectomy and cavity bed biopsies. Specimens were assessed for tumour type and completeness of excision. An excision of the cancer was considered incomplete if the margins were involved or if any of the bed biopsies showed residual or multifocal tumour. RESULTS: A total of 24 patients had incomplete tumour excision. Invasive ductal carcinoma was more likely to be completely excised by segmental mastectomy than invasive lobular carcinoma (P<0.05). Incomplete excision was associated with multifocality and the presence of extensive DCIS. The report of clear pathological margins was significantly more likely to be accurate, as measured by negative bed biopsies, in invasive ductal carcinoma when compared to invasive lobular carcinoma (P<0.05). CONCLUSION: These results support the concept that ductal carcinomas spread locally in a segmental fashion. Patients with invasive ductal carcinomas are more likely to benefit from breast conserving surgery that is tailored to include the associated ductal tissue, in a segmental fashioned excision.

Adult↗
PubMed2000

Long-term results of wide-field brachytherapy as the sole method of radiation therapy after segmental mastectomy for T(is,1,2) breast cancer.

BACKGROUND: We hypothesized that wide-field brachytherapy (BRT) after margin negative excision would result in complication rates, local recurrence rates, and cosmesis scores equivalent to external beam radiotherapy (ERT). METHODS: Patients with T(is,1,2) tumors less than or equal to 4 cm, 0 to 3 positive axillary nodes, and negative inked surgical margins were entered prospectively into BRT phase I/II trial. Patients who met the eligibility criteria for BRT but were treated with ERT during the same time period were retrospectively identified as controls. A blinded panel of healthcare professionals graded cosmetic outcome. RESULTS: Fifty patients with 51 breast cancers received BRT from January 1992 to October 1993. We identified 94 patients eligible for BRT but concurrently treated with ERT. At a median follow-up of 75 months, the two groups were similar for grade III treatment toxicities, local/regional recurrence rates, and cosmesis scores. CONCLUSIONS: For selected breast cancer patients undergoing breast-conserving therapy, BRT is an attractive alternative to ERT.

Brachytherapy↗
PubMed1997

Segmental mastectomy and tamoxifen alone provide adequate locoregional control of breast cancer in elderly women.

We wished to determine whether tamoxifen and local excision without breast radiation or axillary lymph node dissection provides adequate local and regional control of breast cancer in elderly women. The records of 36 women with breast cancer who were more than 70 years old and were treated only with tamoxifen and local excision from January 1985 to July 1996 were retrospectively reviewed. These patients had refused, or were considered too ill for, standard therapy. The mean follow-up was 44.1 months. Twenty-two (61%) were alive without disease, and six (17%) died of unrelated causes, without recurrence. Two (6%) were alive with metastasis, and five (14%) died with metastasis. One patient developed a breast recurrence, which was reexcised. A second patient developed metastasis and axillary recurrence, which was treated with modified radical mastectomy. Pathologic grade, tumor size, and estrogen receptor and margin status were not predictive of recurrence. In conclusion, despite the omission of breast radiation and axillary dissection, there were only two locoregional recurrences, and both were easily treated surgically. In this select group of patients, local excision and tamoxifen provided adequate locoregional control of breast cancer in elderly women.

Aged↗
PubMed1992

Cutaneous angiosarcoma of the breast after segmental mastectomy and radiation therapy.

Angiosarcoma of the breast is an uncommon entity, and the development of cutaneous angiosarcoma of the breast after segmental mastectomy and irradiation therapy is even less common. We report a case of cutaneous angiosarcoma that developed 4 1/2 years after segmental mastectomy (lumpectomy) with axillary dissection and irradiation therapy for infiltrating ductal carcinoma of the breast.

Aged↗
PubMedDate not supplied

Preemptive analgesia with bupivacaine for segmental mastectomy.

BACKGROUND AND OBJECTIVES: Preemptive analgesia is the concept of providing analgesia before surgical incision, resulting in less postoperative pain. The purpose of this study is to determine if preemptive and/or postoperative local anesthetic infiltration of bupivacaine in patients undergoing segmental mastectomy results in less postoperative pain compared with patients receiving placebo. METHODS: In this prospective, double-blinded study, 120 patients were randomized into 4 groups: group 1, preincisional (10 mL) and postoperative (10 mL) wound infiltration of 0.5% bupivicaine, (+Pre+Post); group 2, preincisional bupivacaine (10 mL) and postoperative infiltration (10 mL) of placebo (normal saline solution), (+Pre-Post); group 3, preincisional placebo (10 mL) and postoperative bupivacaine (10 mL), (-Pre+Post); or group 4, preincisional (10 mL) and postoperative infiltration of placebo (10 mL), (-Pre-Post). All patients received a standardized laryngeal mask general anesthetic. Data were recorded at the following time intervals: preoperative admission, postanesthesia care unit (PACU) admission, PACU stay, stepdown-unit admission, stepdown-unit stay, hospital discharge, and 24 hours post operation. RESULTS: No difference was noted with respect to preoperative pain visual analog scale (VAS, 0-100 mm), surgical duration, PACU stay time, stepdown-unit stay time, incidence of postoperative nausea, or treatment for nausea in all measured time periods. The placebo group (group 4) had significantly higher mean pain VAS scores during the early postoperative period (PACU admission and PACU stay) compared to the other groups (PACU admission: group 1 = 2 +/- 8, group 2 = 4 +/- 11, group 3 = 3 +/- 15, group 4 = 17 +/- 21, P < .01; PACU stay: group 1 = 6 +/- 13, group 2 = 6 +/- 10, group 3 = 10 +/- 21, group 4 = 20 +/- 18, P < .01). Likewise, the number of patients who reported pain (pain frequency) was significantly higher in group 4 (placebo) compared with all other groups at PACU admission, PACU stay, stepdown-unit admission, and stepdown-unit stay (P < or = .01). CONCLUSION: Preincisional and/or postoperative wound bupivacaine infiltration lacks preemptive analgesic effects for segmental mastectomy.

Analgesics↗
PubMed1990

Nipple centralization for the correction of breast deformity from segmental mastectomy.

A breast deformed by lateral tissue deficiency and severe lateral displacement of the nipple, caused by the treatment of an early breast cancer with segmental mastectomy and radiotherapy, was corrected by a modification of techniques used commonly for mastopexy. The nipple and areola were moved medially on a central pedicle to create the illusion that the missing lateral tissues had been restored. Simultaneously, the opposite breast was reduced to improve symmetry. The result was a normalization of breast appearance without the need for distant tissue. It is possible that modifications of this approach could be used to treat similar deformities in other quadrants of the breast as well.

Adult↗
PubMed1975

Segmental mastectomy plus radiation therapy for stage I cancer of the breast.

Segmental mastectomy (surgical removal of the palpable tumor mass with a shell of normal tissue) plus irradiation to the entire remaining breast and regional lymph nodes is commonly used in other countries as a treatment for Stage I cancer of the breast. It is not, however, generally practiced or accepted in the United States. Adequate postoperative irradiation consisting of 4,500-5,000 rads to regional lymph nodes and a slightly higher dose to the breast itself will eliminate more than 90% of remaining subclinical tumor, as evidence by very low local recurrence rates. Many patients having local recurrence may then be salvaged by mastectomy or axillary node dissection. Equal five- and ten-year survival rates are obtained compared with radical mastectomy with less physical and psychological morbidity for the patient. While this treatment is not suitable for all Stage I cases, its efficacy should be more widely recognized.

Breast Neoplasms↗
PubMed1987

Angiosarcoma of the breast following segmental mastectomy complicated by lymphedema.

A patient is discussed who had angiosarcoma of her lymphedematous right breast develop four years after segmental mastectomy for infiltrating ductal carcinoma. The lymphedema developed and persisted after an indolent and recurrent postoperative infection. The possibility that the second malignancy is a consequence of the chronic lymphedema, similar to the angiosarcomas of lymphedematous extremities after radical mastectomy, is cautiously entertained. This hypothesis is worthy of consideration as more breast conservation surgery is being done, with or without adjuvant radiation therapy, and accumulating evidence suggests that lymphedema of the breast is a common complication of surgery followed by radiation.

Aged↗
PubMed1988

The patient's appraisal of the cosmetic result of segmental mastectomy in benign and malignant breast disease.

Women's appraisal of the cosmetic result and their psychosocial adjustment after a standardized segmental mastectomy for benign or malignant breast disease was analyzed on the basis of a mailed questionnaire, which was satisfactorily answered by 263 (92%) of 285 women operated on consecutively. The overall result was favorable: 96.5% of the patients found the new appearance of their breast very good (30.7%), good (44.0%), or acceptable (21.8%). Women with a benign diagnosis ran a two-fold higher risk of being discontented with the new appearance of the breast than those with breast cancer. Complications of radiation therapy, preoperative concern that the breasts are important for the appearance, and anxiousness about the cosmetic result were associated with a significantly elevated risk of being less satisfied with the outcome. The main finding that it is possible to perform a locally radical operation that is highly acceptable to the woman is relevant to the surgical management of potentially malignant mammographic lesions and also to the scientific strategies for future evaluation of breast-conserving treatment modes in malignant disease.

Aged↗