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PubMed2004

Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy.

OBJECTIVE: To provide information and recommendations to assist women with breast cancer and their physicians in making decisions regarding the use of locoregional post-mastectomy radiotherapy (PMRT). OUTCOMES: Locoregional control, disease-free survival, overall survival and treatment-related toxicities. EVIDENCE: This guideline is based on a review of all meta-analyses, consensus statements and other guidelines published between 1966 and November 2002. Searches of MEDLINE and CANCERLIT for English-language randomized controlled trials published between 1995 and November 2002 were also conducted to supplement the literature previously reviewed by the American Society of Clinical Oncology (ASCO) Health Services Research Committee panel in its published guideline. A nonsystematic review of the literature was continued through June 2003. RECOMMENDATIONS: Locoregional PMRT is recommended for women with an advanced primary tumour (tumour size 5 cm or greater, or tumour invasion of the skin, pectoral muscle or chest wall). Locoregional PMRT is recommended for women with 4 or more positive axillary lymph nodes. The role of PMRT in women with 1 to 3 positive axillary lymph nodes is unclear. These women should be offered the opportunity to participate in clinical trials of PMRT. Locoregional PMRT is generally not recommended for women who have tumours that are less than 5 cm in diameter and who have negative axillary nodes. Other patient, tumour and treatment characteristics, including age, histologic grade, lymphovascular invasion, hormone receptor status, number of axillary nodes removed, axillary extracapsular extension and surgical margin status, may affect locoregional control, but their use in specifying additional indications for PMRT is currently unclear. PMRT should encompass the chest wall and the supraclavicular, infraclavicular and axillary apical lymph node areas. To reduce the risk of lymphedema, radiation of the entire axilla should not be used routinely after complete axillary dissection of level I and II lymph nodes. A definite recommendation regarding the inclusion of the internal mammary lymph nodes in PMRT cannot be made because of limited and inconsistent data. The use of modern techniques in radiotherapy planning is recommended to minimize excessive normal tissue exposure, particularly to the cardiac and pulmonary structures. Common short-term side effects of PMRT, including fatigue and skin erythema, are generally tolerable and not dose-limiting. Severe long-term side effects, including lymphedema, cardiac and pulmonary toxicities, brachial plexopathy, rib fractures and secondary neoplasms, are relatively rare. The optimal sequencing of PMRT and systemic therapy is currently unclear. Regimens containing anthracyclines or taxanes should not be administered concurrently with radiotherapy because of the potential for increased toxicity. VALIDATION: The authors' original text was submitted for review, revision and approval by the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Subsequently, feedback was provided by 11 oncologists from across Canada. The final document was approved by the steering committee. SPONSOR: The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada. COMPLETION DATE: November 2003.

Breast Neoplasms↗
PubMedDate not supplied

[Surgical wound infection--a complication of mastectomy].

The present study contains a retrospective analysis of thirty medical reports of patients that were submitted to mastectomy at a school hospital, and has the objective of knowing the frequency of surgical injury infection, relating it to predisposed factors to infection. The frequency founded was 40%, a percentage above the level pointed in the literature, suggesting that can be included in it cases of seroma, due the indicators utilized to define infection and the absence of laboratory exams registers in the consulted medical reports.

Adult↗
PubMed1976

Subtotal mastectomy and radiation therapy in the definitive management of localized breast malignancy.

Between 1961 and 1974, 51 women with primary carcinoma of the breast were treated by external radiation following surgery that was limited to diagnostic biopsy. All patients tolerated therapy well with minimal long term morbidity. While the reported follow-up periods are brief (most patients at risk for less than 3 years), 29 patients remain alive, 25 of whom show no evidence of persistent or recurring disease. These data suggest that local-regional control rates match those obtained following mastectomy. Definitive statements as to local failures and long term survival rates are not yet available.

Adult↗
PubMed2005

Axillary recurrence after modified radical mastectomy.

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.

Adult↗
PubMed1988

Low-risk breast cancer patients treated by mastectomy and lower axillary dissection. The present status of the Danish Breast Cancer Cooperative Group Trial 77-A.

From 1977 to 1982 a total of 2,935 women with breast cancer fulfilled the criteria for inclusion in the low-risk protocol of the Danish Breast Cancer Cooperative Group, DBCG 77-A. The operation performed was a total mastectomy with axillary dissection slightly modified according to Cady. Postoperatively the patients were examined clinically and by chest radiography with intervals for ten years or until recurrence. With a median observation time of seven years loco-regional recurrence appeared in 409 patients (13.9%): chest wall 9.3%, axilla 3.7%. Half of the recurrences were diagnosed within two years postoperatively. Metastases appeared in 396 patients (13.5%), mainly in bones and lungs; 96 patients (23.5%) with loco-regional recurrence and 174 (43.9%) with distant metastases died from breast cancer during the observation time. Life-table analyses of recurrence-free survival (61.7%) and survival (75.4%) are presented. The results of the treatment are in accordance with reports in the literature, but a straightforward comparison is impossible on account of a huge variation in surgical and postsurgical treatment. Finally, the surgical technique in the participating departments in this nation-wide study was evaluated. A high grade of uniformity with respect to loco-regional recurrences was found.

Adult↗
PubMed1992

Flow cytometry DNA analysis and prediction of loco-regional recurrences after mastectomy in breast cancer.

The study concerns whether DNA flow cytometry and estrogen receptor analysis might help predict which breast cancer patients, particularly node-positive ones, were at the greatest risk of developing loco-regional recurrence (LRR). Such patients would best benefit from postoperative radiotherapy following modified radical mastectomy and axillary lymph node dissection. After this type of surgery, 506 patients were followed up for a median time of nearly 5 years. Among the 235 patients given postoperative radiotherapy, the loco-regional control rate was 100% in N0 cases (n = 93), 94% in cases with 1-3 positive nodes (n = 90), 93% in cases with 4-9 positive nodes (n = 43), and 67% in cases with 10 or more positive nodes (n = 9). Among the 271 non-irradiated patients, the corresponding figures for loco-regional control were 91% in N0 cases (n = 141), 71% in cases with 1-3 positive nodes (n = 84), 65% in cases with 4-9 positive nodes (n = 31), and 67% in cases with 10 or more positive nodes (n = 15). Ploidy status, level of S-phase fraction, estrogen receptor content, and primary tumor size did not, in the present material, yield significant additional information with regard to the risk of LRR in the different nodal subgroups, a finding confirmed in multivariate analysis where the only significant predictor of LRR was the number of positive nodes (p = 0.01). Adjuvant tamoxifen treatment could not replace postoperative radiotherapy for achieving loco-regional tumor control, the overall rate of which was 81% among patients treated with tamoxifen only (n = 117), as compared with 98% among those also treated with radiotherapy (n = 54) (p = 0.003).

Breast Neoplasms↗
PubMed1994

Classical prognostic factors for survival and loco-regional control in breast cancer patients treated with radical mastectomy alone.

A retrospective analysis of clinical and pathological prognostic factors was performed in 1,068 breast cancer patients treated with radical mastectomy alone in 1952-1980. Three endpoints were considered: 10-year survival, 10-year disease-free survival and 10-year loco-regional relapse-free survival. Both univariate and multivariate analyses confirmed the prognostic significance of tumour size, histological type and grade (Bloom classification) and involvement of axillary nodes for all three endpoints. Additionally, young age appeared to be a significant risk factor for loco-regional disease-free survival. Prognostic subgroups were defined by the use of 3 main indicators. In node negative patients with T1 tumours the prognosis seemed to be good regardless of histological grade (80-90% 10-year disease-free survival), in T2 tumours the survival was significantly dependent on histological type and grade. In node positive patients increasing number of involved nodes and higher histological grade had an independent adverse effect on all three endpoints. The study demonstrates that classical, commonly available prognostic factors clearly distinguish subgroups with different prognosis, which may be helpful when deciding on the use of adjuvant local and/or systemic therapies.

Adult↗
PubMed1985

A pilot study of some psychological aspects of subcutaneous mastectomy.

The report describes how the patients reacted to the information given them before the operation, their reactions following the operation, and their sexual behaviour before and after the operation. Patients who have undergone subcutaneous mastectomy with simultaneous insertion of implants have to cope with two different psychological factors: loss of the breast and sudden acquisition of an unfamiliar substitute. This study indicates that these factors may interfere with each other in a detrimental way. It may be better for patients if they are given opportunities to psychologically prepare themselves well in advance of the operation. Such preparation should include provision of full information and the opportunity to become familiar with the implants, as well as emotional counselling.

Adult↗
PubMed1986

A prospective study of psychiatric and psychosocial sequelae of bilateral subcutaneous mastectomy.

Short- and long-term adaptation (two months and one year respectively) to bilateral subcutaneous mastectomy was studied in twenty-five consecutive patients operated upon at the Department of Plastic and Reconstructive Surgery, Malmö, Sweden. The results were related to preoperative personality and psychosocial profiles. Postoperative difficulties in accepting the surgical result, sexual dysfunctions and mental reactions with depression and anxiety were observed. Such reactions proved to be associated with specific personality characteristics.

Adaptation, Psychological↗
PubMed1996

Breast reconstruction and tissue expansion in irradiated versus not irradiated women after mastectomy.

Thirty-five women whose breast cancer had been treated by radiation and 111 in whom it had not underwent unilateral breast reconstruction with the tissue expansion technique after modified radical mastectomy. Their records were reviewed and in a questionnaire the patients reported their own opinion on the results. The two groups differed significantly, because those patients who had been irradiated had a more painful course of expansion and a less over-expansion. Their reconstructed breasts were harder, had more deformities, and they required significantly more capsulotomies. The irradiated group also reported less satisfaction with the cosmetic results and more unfulfilled expectations. Tissue expansion cannot therefore be recommended as a routine procedure for breast reconstruction in patients after irradiation. However, our results do not show whether other methods are better for these patients.

Adult↗
PubMed2002

Effects of mastectomy on composition of peripheral blood mononuclear cell populations in periparturient dairy cows.

There is an increased incidence of infectious disease in periparturient dairy cows. During the periparturient period there is a decline in T-lymphocyte cell subsets, which parallels a reduction in functional capacities of blood lymphocytes and neutrophils. Mechanisms responsible for these changes in immune function during the periparturient period are poorly characterized. Ten mastectomized and eight intact multiparous Jersey cows were used to determine whether the periparturient changes in peripheral blood mononuclear cell populations are the result of the physiological demands associated with the onset of lactation or whether they are a result of the act of parturition. Blood mononuclear cells were phenotyped with monoclonal antibodies against T-cell subsets, B-cells, and monocytes. Blood samples were taken frequently from before 4 to 4 wk after parturition. In intact cows, all T-cell subset populations (i.e., CD3-, CD4-, CD8-, and gamma-delta positive cells) decreased at the time of parturition, while the percentage of monocytes increased. Mastectomy eliminated the changes in leukocyte subset populations (CD3-, CD4-, and gamma-delta positive cells, and monocytes) observed in intact cows around parturition. These results indicate that the mammary gland and metabolic stresses associated with lactation influence the composition of peripheral blood mononuclear cell populations in dairy cows during the periparturient period.

Animals↗
PubMedDate not supplied

Breast reconstruction after mastectomy in young women.

Young women with breast cancer differ from older women in a number of ways that may affect their experience with breast reconstruction after mastectomy. Parenting, work, or recreational activities may influence a young woman's decisions about whether or not to have reconstruction, timing of reconstruction, and type of reconstruction. Young women with breast cancer are known to experience greater psychological morbidity and poorer quality of life than older women. A young woman's breast anatomy and physiology and overall medical condition generally allow more reconstructive options. Young women can often tolerate autologous reconstruction well, and more young women are expressing interest in perforator-based free tissue transfer to reduce donor site morbidity. Although the reconstructive issues are different for younger women, outcomes of breast reconstruction appear to be the same for women of all ages.

Adult↗
PubMed2004

[Improvement of wound treatment in modified radical mastectomy of breast cancer].

OBJECTIVE: To evaluate the efficacy of Dexon continuous intracutaneous sewing (DCIS) and Redon negative pressure absorbing drainage (RNPAD) in modified radical mastectomy of breast cancer. METHODS: The clinical data of 128 patients treated with DCIS and RNPAD, and 123 cases treated with traditional sewing and negative pressure absorbing ball were analyzed retrospectively. RESULTS: There were 16 cases (12.5%) of seroma formation,1 (0.8%) of skin flay necrosis among 128 cases treated by DCIS and RNPAD, and 47 cases (38%) of seroma formation, 16 (13%) of skin flay necrosis among 123 cases treated by traditional method. The statistically significant difference was found (P <0.001). The average length of post-operation hospital stay in DCIS and RNPAD group was 8.8 days compared with 14.7 days in traditional treatment group. CONCLUSION: The use of DCIS and TNPAD could decrease the complication rate of breast cancer operation.

Adult↗
PubMedDate not supplied

Perioperative blood transfusion and survival of breast cancer patients after modified radical mastectomy.

To investigate the effect of perioperative blood transfusion on the survival of patients with breast cancer, the authors reviewed the clinical records of 455 patients who underwent modified radical mastectomy between 1960 and 1979. Thirty-eight patients (8.4%) received blood transfusions. For stage I patients who received perioperative transfusions, 5- and 10-year survival rates were 53% and 47%; for the no-transfusion group, the rates were 93% and 85%. There was also a significant difference in disease-free survival for stage I patients: for the transfusion group, 5- and 10-year survival rates were 47%; for the group not receiving a transfusion, the rates were 89% and 84%. For stage II patients, there was no difference in total or disease-free survival between those who received transfusions and those who did not, and both groups had comparable distribution of nodes.

Blood Transfusion↗
PubMed2005

[Effects of abdominal breathing training using biofeedback on stress, immune response and quality of life in patients with a mastectomy for breast cancer].

PURPOSE: This study was to determine the effects of abdominal breathing training using biofeedback on stress, immune response, and quality of life. METHOD: The study design was a nonequivalent control group pretest- posttest, quasi-experimental design. Twenty-five breast cancer patients who had completed adjuvant chemotherapy were enrolled. The experimental group (n=12) was provided with abdominal breathing training using biofeedback once a week for 4 weeks. State anxiety, cancer physical symptoms, serum cortisol, T cell subsets (T3, T4, T8), NK cell and quality of life were measured both before and after the intervention. RESULT: Though state anxiety, cancer physical symptoms, and serum cortisol were reduced after 4 weeks of abdominal breathing training using biofeedback, there was no statistical significance. It showed, however, improvement in quality of life (p=.02), and T3 (p=.04). CONCLUSION: Abdominal breathing training using biofeedback improves quality of life in breast cancer patients after a mastectomy. However, the mechanism of this beneficial effect and stress response requires further investigation with special consideration in subject selection and frequency of measurement. Nurses should consider this strategy as a standard nursing intervention for people living with cancer.

Adult↗
PubMed2004

Multiple bilateral fibroadenomas of the breasts requiring mastectomy in a renal transplant patient.

Fibroadenomas of the breast have been reported in female renal graft recipients and associated with the use of cyclosporin A (CsA). We report the case of a young patient given CsA who developed multiple bilateral fibroadenomas of the breasts 3 years after renal transplantation, leading to bilateral mastectomy. We discuss the association of CsA with fibroadenomas, the mechanisms by which the drug can act and review the literature. Based on these observations, an early conversion from CsA to tacrolimus should be considered; further observations are needed to assess the reversibility of the breast(s) lesions after such immunosuppressive regimen switch.

Adolescent↗
PubMed1983

External breast prostheses. A survey of their use by women after mastectomy.

Women who have had a mastectomy for breast cancer have to cope with two major problems: first, that they have cancer, and second, that they have lost their physical appearance. The provision of an appropriate prosthesis can reduce the sense of disfigurement. If women were to obtain the full psychological benefit of wearing a breast prosthesis, they need to be informed about the available breast forms, have an opportunity to choose between them, and to be satisfied with their choice. In this study of 49 women, only 44% had had the opportunity to choose a prosthesis, 28% were dissatisfied with their prostheses, and 17% were still using temporary prostheses.

Aged↗
PubMed1999

[Locoregional radiotherapy after mastectomy and chemotherapy for breast cancer: prolonged survival and better local tumor control].

In two recent randomized clinical trials from Denmark and Canada the usefulness of radiotherapy was evaluated in premenopausal patients with breast cancer who had been operated and in whom the findings indicated a poor prognosis. Over 2000 patients participated. After follow-up periods of 10 and 15 years, respectively, addition of locoregional therapy to mastectomy and chemotherapy with cyclophosphamide, methotrexate and fluorouracil (CMF) was found to result in better locoregional control and a better disease-free survival. These studies also demonstrated, for the first time, that the overall survival was increased after postoperative radiotherapy. In view of these findings, the indication for postoperative locoregional radiotherapy in breast cancer in the Netherlands should be reconsidered.

Adult↗