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2002, Number 1

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Cir Gen 2002; 24 (1)

Conservative surgery, milestone in breast cancer treatment. Analysis of 105 patients

Torres TR, Basurto KE, Olmos RG, Labastida AS

Language: Spanish
References: 61
Page: 11-21
PDF size: 161.75 Kb.


ABSTRACT

Objective: To inform our experience with the conservative surgical treatment of breast cancer.
Setting: Third level health care hospital (private institution).
Design: Retrospective, longitudinal study, without control group.
Patients and methods: We present a group of 105 breast cancer patients T1 T2 NO MO, version TNM of 1978, studied at the “Hospital de Mexico” between 1982 and 1998, subjected to conservative surgical treatment (CST). Breast cancer was confirmed microscopically through excision biopsy with transoperative study. A three-dimensional spindle of skin similar to the tumor’s volume, which included the anterior leaf of the major pectoral muscle’s aponeurosis, was performed, as well as total axillary dissection, through incision of one of the medial folds of the axilla. The postoperative radiotherapy scheme used was Co60. In the last cases, a linear accelerator was used at a 50 Gy-dose to two tangential fields to the rest of the breast tissue and overdose of 10 Gy to the tumoral bed, with protraction of five weeks. Adjuvant therapy with 6 cycles of FAC or FEC were initially indicated for those patients with four or more positive ganglia and negative receptors or premenopausal and Tamoxifen at a dose of 20 mg daily for 3 at 5 years to postmenopausal women with positive hormonal receptors. Afterwards, those women with negative ganglia but with risk factors of subclinical dissemination were subjected to this therapy scheme, receiving simultaneously radiation therapy with 6 cycles of cyclophosphamide-methotrexate-5-fluoracil (CMF).
Results: Average age of presentation was 48.7 years, range 24 to 77 years, 62 patients were menopausal and 43 were menstruating women. Mean evolution time was 3.7 months, range 1 to 36 months. Follow-up of patients was performed by the same group with a median of 56 months, range 6 to 144 months. The mean age of presentation (48.7 years) coincides with the reports of the National Histopathological Registry of Neoplasias; however, 41.5% of the cases in this series occurred between the age of 20 and 44 years, in contrast to the 28.7% reported in the mentioned registry for the same age group. Eighty-six cases of ducts infiltrating carcinoma without a specific pattern were recorded, three of medullary carcinoma and three of colloidal character, ten cases of infiltrating lobular carcinoma, and three cases of intraductal carcinoma with micro-invasive areas. The surgical pieces showed an average of 22.8 dissected ganglia; in 85 cases (81%) these were negative and in 20 cases (19%) they were positive; 9 cases with 1 to 3 ganglia and 11 cases with more than 3 positive ganglia. Six cases (5.7%) of local recurrence were recorded, three of them coincided with the presence of extra-regional metastases and three cases were of new primary tumors in the same breast. They were treated with total mastectomy, except those presenting systemic failure and one in which the local recurrence was of minimal dimension that was treated with a new ample local excision. All received systemic therapy. Four patients subjected to rescue mastectomy are alive without tumoral activity, as well as the patient subjected to re-excision, the other two died due to dissemination of the disease. There were 16 cases of extra-regional metastases that received diverse combinations of first and second line, depending on the case, systemic therapy. Fourteen of these patients died due to tumoral activity and three are alive with tumoral activity. Global survival at five years was of 88.2% and at 10 years of 73.7%. A statistically significant difference was observed when comparing the survival index at 5 years between patients with 1-3 cm tumors to those with larger ones (p‹ 0.03). Survival in patients with positive ganglia compared to those with negative ganglia revealed no statistically significant difference (p‹ 0.83). At present 87 patients (82.8%) are alive and without tumoral activity, three (2.8%) are alive with tumoral activity, 14 (13.3%) died due to tumoral activity, and one (0.9%) died without tumoral activity.
Conclusion: Conservative surgical treatment is an alternative for the early stages of breast cancer, and is now starting to be used in more advanced stages of the disease.


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