Treatment of Early Breast Cancer with Conservation of the Breast a Review

Abstract

This paper reviews the current status of conservative treatment for early breast cancer. While the first patients were treated with such techniques more than 60 years ago, it is during the last decade that randomized trials have confirmed that such treatment is comparable to mastectomy in preventing breast cancer death. Radiotherapy to the breast after local tumour excision is important to prevent local breast relapse, but it is not clear whether it has any influence on the risk of distant metastases. Several questions remain to be answered. While most investigators agree that the breast should receive a radiation dose of about 50Gy in 5 weeks, there is no general agreement about the need for a tumour bed booster dose. Considering patients with tumour infiltration at the surgical resection line for whom it is not possible for cosmetic reasons to perform re-resection, it is not clear whether an acceptable local control rate can be achieved through application of a high booster dose in the tumour bed. More trials are needed to show whether certain patients with small invasive carcinomas should be treated with wide local excision without radiotherapy. The need for radiotherapy after local excision for small intraductal (ductal carcinoma in situ) cancers is being addressed in ongoing trials.Key words: Breast cancer, breast conserving therapy, local relapse risk, review.The term 'breast-conserving treatment' includes techniques by which radical eradication of an early breast cancer (TI -2, NO-I, MO) is achieved without ablation of the mammary gland. Such treatment techniques have attracted widespread interest and recently become accepted alternatives to more radical and mutilating surgical procedures. The possibility of treating limited breast cancers, without breast ablation was suggested more than 60 years ago. Hirsch. (1) in Berlin and Keynes (2) in London published their first results in 1927 and 1929 respectively. Mustakallio (3) in Helsinki published his first series in 1945, and the Institute Curie group headed by Baclesse published their results in 1949 (4). The preliminary results achieved by these pioneers suggested that survival after breastconserving treatment could be similar to that achieved after radical mastectomy. This view gained further support when a follow-up paper from St. Bartholomew's Hospital (5) in 1953 reported long-term survival to be similar among the patients treated conservatively by Keynes and breast cancer patients treated in the same hospital with mastectomy. During the 1960s more authors reported encouraging results with breast-conserving treatment (6-9). and during the last two decades multiple reports have been published:1. The survival rate and risk of distant metastases following breastconserving therapy and mastectomy have been compared in randomized trials. 2.Long-term ( > 25 years) follow-up reports containing large numbers of patients have provided important information on long-term survival and risk of locoregional failure. These studies also give important informat...

Estudo preliminar do estado atual das pacientes submetidas ao tratamento conservador do câncer de mama do Centro de Ginecologia Luiza Gomes de Lemos - CGLGL – INCa

“…Já a análise da sobrevida de acordo com o tipo histológico mostrou, neste estudo, um pior prognóstico para os tumores histologicamente classificados como medulares. Este achado não se confirma nos dados obtidos da literatura, que o classificam como um tipo histológico de boa evolução [10,11,12], embora aqueles considerados medulares atípicos não apresentem este prognóstico mais favorável.…”