Locoregional therapy of breast cancer: maximizing control, minimizing morbidity

Abstract

The goal of locoregional therapy in breast cancer has remained unchanged for a century: the eradication of all malignant cells from the breast and draining lymph nodes, hopefully prior to them having spread to distant organs. However, how we accomplish this goal has changed dramatically over this time period and our success in achieving this goal has been greatly enhanced by improvements in breast imaging and systemic therapies. The therapeutic importance of surgery and radiation has been underestimated in recent years and is thought to have minimal impact on long-term outcome. More recent data have reputed this contention and the relationship between local control and survival in breast cancer is becoming increasingly apparent. This article will review the importance of attaining optimum local control with minimum morbidity and examine where the future of locoregional therapy of breast cancer may lie.

Intraoperative Cryosurgical Freezing Assists with Local Drug Delivery and Targeting of Tumor Fluids in VX2 Model, which Translates in Locoregional Drug Targeting of Tumor Fluids during Cryoprobe-Assisted Surgical Resection of Breast Cancer

“…The tracer entrapment within tumor core during and after the thaw process as seen in the VX2 study suggests the use of Freezethaw assisted injection of active drug not only during the resection but also in the resection cavity margins. The local injection of cytotoxic would help priming residual tumor cells to adjuvant systemic therapies 49,50 , and/or radiotherapy 6 .…”

“…Margin assessment, sentinel lymph node mapping and biopsy (SLNB), resection cavity shaving (RCS), partial breast irradiation (PBI), or photodynamic therapy (PDT) is common procedure 4,5 . During breast conserving surgery (BCS), most local recurrences in the conserved breast appear close to the tumorectomy cavity [6][7][8] ; pathologic studies of mastectomy specimens have shown that tumor cells rarely extend 4 cm beyond the index lesion 8 . These clinicopathological facts have spurred the development of techniques that target the tumor bed 9 , such as routine circumferential resection cavity shaving 5 or partial breast irradiation (PBI).…”

The Role of Pelvic Lymphadenectomy in the Management of Prostate and Bladder Cancer

“…Regional lymphadenectomy in addition to primary tumor excision has been incorporated into the routine treatment of many malignancies [1,2,3]. In genitourinary surgery this is clearly seen in the management of testis and penile cancer.…”

Cryoablation for breast cancer: No need to turn a cold shoulder

“…The importance of local recurrence in the management of breast cancer, and its potential impact on survival, is increasingly clear [15][16][17]. But the present limitations or concerns regarding cryoablation do not argue against further evaluation, but rather the importance of well-designed clinical trials to optimize patient selection and identify patients who may not have had a complete response.…”