Breast conservation: Current results and future perspectives at the European Institute of Oncology

Abstract

In the recent 10 years breast cancer treatments' scenario is radically changed. Extraordinary new surgical approaches give more and more conservative solutions both for the breast and especially for the axilla avoiding dissection in more than 80% of early cases. Instrumental early diagnosis and clinical prediction are now able to identify very initial cases often in premalignant stage. Technology arrived in the operating theatre for the intraoperative radiotherapy treatments giving to the patients the better quality of life with the help also of the plastic surgeons. There are still near horizons to reach: modern neo-adjuvant and adjuvant treatments are going quickly from the laboratory to patient's bed. ' 2007 Wiley-Liss, Inc.Key words: breast conservation; cancer prevention; genetics; diagnosis; therapy Over the last 4 decades, profound changes have occurred in breast cancer treatment, diagnosis and prevention, and radically new ways of conducting research have developed. Prognosis for the disease has improved markedly, patient quality of life has become a central concern and researchers and senologists are caught up in a whirlwind of new findings and concepts that has swept away notions thought consolidated just a few years ago. Conservative surgeryThe revolution in breast cancer treatment began in the 1970s with the large Milan I trial. This trial randomized 701 patients to either breast-conserving surgery (quadrantectomy, complete axillary dissection plus breast radiotherapy, QUART) or Halsted mastectomy. 1 Eligible patients had infiltrating carcinoma up to 2 cm, without clinically evident axillary involvement (T1N0), and were randomized in the operating room after excisional biopsy had confirmed histology and tumor size. The results, which ushered in the era of conservative surgery for all types of cancer, showed no difference in survival between the 2 arms. The most recent analysis of the Milan I results, after more than 20 years of follow-up 2 confirmed indistinguishable survival curves for the 2 arms ( Fig. 1): 28 (7.9%) conservatively treated patients and 8 (2.3%) in the Halsted arm developed local recurrences, but these events had no impact on survival. The low rate of adverse events in the QUART arm was partly attributable to the quadrantectomy operation, which was developed with the aim of achieving local control (in contrast to lumpectomy). Earlier studies had indicated that intraductal spread was relatively frequent in breast cancer, and in quadrantectomy, the entire portion of the ductal tree (up to the nipple) involved by the carcinoma is excised. Sentinel node biopsyA second major development in the surgical treatment of breast cancer was sentinel node biopsy. The first major study in this area, conducted at the European Institute of Oncology (EIO), randomized 516 patients to compare sentinel node biopsy plus immediate axillary dissection, with sentinel node biopsy plus axillary dissection only if the sentinel node was positive. After more than 5 years of follow-up, no differences between the ...

Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients

“…13 Many other factors can influence aesthetic results after lumpectomy: age, BMI, size and location of the tumor, breast size, as well as the adjuvant treatment applied. Our findings showed an association of increased age with unsatisfactory results in the lumpectomy group, especially 28 Approximately 35 % of breast tumors are located in the lower (inner or outer) quadrants, 29 and in lumpectomy this localization is a risk one (the same for inner and central quadrants), because loss of tissue there can distort and lower the nipple and areola complex. Another relevant data in our series was in relation to the breast size, because larger breasts were related with worse aesthetic outcomes in the lumpectomy group.…”

New trends in breast cancer surgery: a therapeutic approach increasingly efficacy and respectful of the patient

“…As a result, sentinel lymph node biopsy (SLNB), a minimally invasive technique, was developed to avoid lymph node dissection in patients who have a low probability of axillary metastasis (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). The sentinel node is the first lymph node which receives lymph from the anatomic site of the primary breast tumour.…”

Quality of Life and Depression Among Female Patients Undergoing Surgical Treatment for Breast Cancer: A Prospective Study

“…Following a lumpectomy, postoperative radiation treatment is always applied (Fisger et al 2002). Since Veronesi began with breast conserving surgery in patients with diagnosed breast cancer, numerous studies have confirmed the equal oncological value of this type of surgery compared with a classic mastectomy (Veronesi & Zurrida 2007). Although this type of surgery is minimally destructive, our experience as well as experience of other authors has shown that the cosmetic result is not always satisfactory (Stanton et al 2001, Medina -Franco et al 2013) Due to this, many authors have researched the influence of the cosmetic result after breast conserving therapy and observed important factors such as postoperative complications, tumor location and volume of excised tissue (tumor removal) versus breast volume (Cardoso et al 2007).…”