Cirurgia Conservadora e Radioterapia no Tratamento do Câncer da Mama

Authors

  • Luis Souhami Serviço de Radioterapia. Instituto Nacional de Câncer (INCA). Rio de Janeiro (RJ), Brasil.
  • Jurandir P. Carvalho Filho Serviço de Radioterapia. Instituto Nacional de Câncer (INCA). Rio de Janeiro (RJ), Brasil.
  • Miguel F. Guizzardi Serviço de Radioterapia. Instituto Nacional de Câncer (INCA). Rio de Janeiro (RJ), Brasil.

DOI:

https://doi.org/10.32635/2176-9745.RBC.1985v31n4.3358

Keywords:

Breast Cancer, Conservative Treatment, Radiotherapy

Abstract

From January of 1973 to December of 1983, 59 patients with breast cancer, treated conservatively by surgery, were refered to radiotherapy at the Instituto Nacional de Câncer. The mean age was 53 years (range: 24-83 years) and 50% of the patients were pre-menopausal. The clinical staging revealed 13 patients with T1 tumors, 34 with T2 tumors and three with T3 tumors. In nine patients this information was not available. The axilla was clinically involved in 10 cases and was surgically staged in 29 patients with a mean number of 14,2 lymphnodes removed (range: 2-36). The clinical/surgical correlation was 63%. Following tumorectomy (56% of the cases), quadrantectomy (39%) or biopsy only (3%), patients received radiotherapy to the breast with 5000 cGy being delivered. A boost dose of 1000-2000 cGy to the tumor bed followed the primary treatment. All patients were treated with cobalt therapy and electrons (boost dose). The lymphatics were irradiated in 48% of the cases. The overall survival rate at 5 years was 78% with 65% of the patients surviving free of disease (locally and distantly) at the same period. Four patients (7%) failed in the breast, three (5%) in the axiliar lymphnodes and nine (15%) distantly. The cosmetic results were considered excellent and good in 60% of the cases and this was most frequently observed in those patients treated by tumorectomy. The conservative treatment of breast cancer seems to be an acceptable option to this pathology. It offers to the patient an extremely satisfactory cosmetic result while keeping surviva! and local control similar to most mutilating treatments.

Downloads

Download data is not yet available.

References

Halsted WS: The resuits of radical operations for the cure of carcinoma of the breast. Ann Surg 1907; 46: 1-19. DOI: https://doi.org/10.1097/00000658-190707000-00001

Morris T: Psychological aspects of breast cancer: A review. Europ. J. Clin. Oncl. 1983; 19: 1725-1731. DOI: https://doi.org/10.1016/0277-5379(83)90160-8

Morris T: Psychological adjustment to mastectomy. Cancer Treat. Rev. 1979; 6: 41-61. DOI: https://doi.org/10.1016/S0305-7372(79)80058-4

Meyerowitz BF: Psychological correlates of breast cancer and its treatment. Psychol. Bull. 1980; 87: 108-131. DOI: https://doi.org/10.1037/0033-2909.87.1.108

Keynes G: Conservative treatment of cancer of the breast. Br. Med. J. 1937; 2: 643-647. DOI: https://doi.org/10.1136/bmj.2.4004.643

Peters MV: Wedge resection with or without radiation in early breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 1977; 2: 1151-1156. DOI: https://doi.org/10.1016/0360-3016(77)90124-9

Mustakallio S: Conservative treatment of breast cancer-Review of 25 years followup. Clin. Radiol. 1972; 23; 110-116. DOI: https://doi.org/10.1016/S0009-9260(72)80151-X

Amalric R, Santamaria F, Rober F, et al; Radiation therapy with or without primary limited surgery for operable breast cancer. A 20 year experience at the Maseilles Cancer Institute. Cancer 1982; 40: 30-34. DOI: https://doi.org/10.1002/1097-0142(19820101)49:1<30::AID-CNCR2820490107>3.0.CO;2-L

Bedwinek HM, Perez CA, Kramer S, et al. Irradiation as the primary management of stage I and II adenocarcinoma of the breast. Analysis of the RTOG breast registry. Cancer Clin. Trials. 1980; 3:. 11-18.

Hellman S, Harris JR, Levene MB: Radiation therapy of early carcinoma of the breast without mastectomy. Cancer 1980; 46; 988-994. DOI: https://doi.org/10.1002/1097-0142(19800815)46:4+<988::AID-CNCR2820461323>3.0.CO;2-O

Danoff BF, Pajak TF. Solin LJ, et al: Excisional biopsy, axiliary node dissection and definitive radiotherapy for stages I and II breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 1985; 11: 479-483. DOI: https://doi.org/10.1016/0360-3016(85)90178-6

Harris JR, Botnick L, Bloomer WD.et al: Primary radiation therapy for early breast cancer: the experience at the Joint Center for Radiation Therapy. Int. J. Radiat. Oncol. Biol. Phys. 1981; 7: 1549-1552. DOI: https://doi.org/10.1016/0360-3016(81)90087-0

Ghossein NA, Vilcoq JR, Stacey P. et al; Conservation surgery and radiotherapy in the treatment of localized breast Cancer. A restropective analysis. Front. Radiat. Ther. One. 1983; 17: 102-109. DOI: https://doi.org/10.1159/000407283

Clark RM: Conservative surgery and radiation therapy in the treatment of operable breast cancer. Front Radiat. Ther. One. 1983; 17: 91-101. DOI: https://doi.org/10.1159/000407282

Montague ED, Schell SR, Romsdahl MD, et al: Conservation surgery and irradiation in the treatment of breast cancer. Front. Radiat. Ther. One. 1 983; 1 7: 76-83. DOI: https://doi.org/10.1159/000407280

Veronesi U, Saccozzi R, Del Veicchio M, et al; Comparing radical mastectomy with quadrantectomy, axiliary dissection and radiotherapy in patients with small cancers of the breast. N. Engl. J. Med. 1981; 305: 6-11. DOI: https://doi.org/10.1056/NEJM198107023050102

Sarrazin D, Le M, Fontaine F, et al; Conservative treatment versus mastectomy in T1 or small T2 breast cancer. A randomized clinicai trial. In Conservative Management of Breast Cancer. Harris JR. Hellman S, Silen W (Eds). J. B. Lippincott Co. 1983; 101 -111.

Fisher B, Bauer M, Margolese R, et al: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N. Engl. J. Med. 1985; 312: 665-673. DOI: https://doi.org/10.1056/NEJM198503143121101

Fisher B, Redmond C, Fisher ER, et al: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N. Engl. J. Med. 1985; 312: 674-681. DOI: https://doi.org/10.1056/NEJM198503143121102

Union Internationale Contre le Cancer. TNM. Classification of Malignant Tumors. Edited by M.H. Harmer. Third Edition. 1978.

Fletcher GH: Textbook of radiotherapy 3rd ed. Lea & Febiger, Philadelphia, 1980.

Kaplan EL, Meier P: Non parametric estimation for incomplete observations. J. Am. Stat. Assoe. 1958; 53: 457-481. DOI: https://doi.org/10.1080/01621459.1958.10501452

Souhami L: O tratamento conservador do câncer da mama. Uma nova era. Rev. Bras. Cancerol. 1982; 29: 36-41. DOI: https://doi.org/10.32635/2176-9745.RBC.1982v29n1.3513

Faria SL. Chiminazao HRr: Radioterapia no tratamento conservador do câncer da mama — técnica, complicações e resultados cosméticos. Radiol. Bras. 1985; 18:216-220.

Bedwinek J: Treatment of stage I and II adenocarcinoma of the breast by tumor excision and irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1981; 7: 1553-1559. DOI: https://doi.org/10.1016/0360-3016(81)90088-2

Harris JR, Levene MB, Svensson G,et al: Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int. J. Radiat. Oncol. Biol. Phys. 1979; 5: 257-261. DOI: https://doi.org/10.1016/0360-3016(79)90729-6

Ray GR, Fish VJ: Biopsy and definitive radiation therapy in stage I and II adenocarcinoma of the female breast: Analysis of cosmesis and the role of electron beam suppiementation. Int. J. Radiat. Oncol. Phys. 1983; 9: 813-818. DOI: https://doi.org/10.1016/0360-3016(83)90006-8

Clarke D, Martinez A, Cox RS: Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1983; 9: 1807-1813. DOI: https://doi.org/10.1016/0360-3016(83)90348-6

Haagensen CC, Miller E, Handiey RS, et al: Treatment of early breast cancer; A cooperativa International study. Ann surg 1969; 170: 875-899. DOI: https://doi.org/10.1097/00000658-196912000-00001

Nobler MP, Vinet L: Prognostic factors in patients undergoing curative irradiation for breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 1985; 11: 1323-1331. DOI: https://doi.org/10.1016/0360-3016(85)90248-2

Recht A, Silver S, Schnitt S, et al: Breast relapse following primary radiation therapy for early breast cancer. I. Classification, frequency and salvage. Int. J. Radiat. Oncol. Biol, Phys. 1985; 11: 127M276. DOI: https://doi.org/10.1016/0360-3016(85)90241-X

Arriagada R, Mourlesse H, Sarrazin D, et al: Radiotherapy alone in breast cancer. I Analysis of tumor parameters, tumor dose and local control: The experience of the Gustave-Roussy Institute and the Princess Margaret Hospital. Int. J. Radiat. Oncol. Biol. Phys. 1985; 11: 1751-1757. DOI: https://doi.org/10.1016/0360-3016(85)90027-6

Fisher B, Wolmark N, Redmond C, et al; Findings from NSABP Protocol n° B-04: comparison of radical mastectomy with alternative treatments. II. The clinical and biologic signifícance of medial-central breast cancers. Cancer 1981; 48: 1863-1872. DOI: https://doi.org/10.1002/1097-0142(19811015)48:8<1863::AID-CNCR2820480825>3.0.CO;2-U

Fisher ER, Gregorio R, Redmond C, et al: Pathologic findings from the NSABP (Protocol n° 4). I: Observations concerning the multicentricity of mammary cancer. Cancer 1975; 35: 247-254. DOI: https://doi.org/10.1002/1097-0142(197501)35:1<247::AID-CNCR2820350130>3.0.CO;2-S

Gallagher HS: Multicentricity in breast cancer. In Conservative Management of Breast Cancer. Harris JR, Hellman S.Silen W, Editors. Philadelphia, J .B., Lippincott 1983; pp 117-122.

Rosen PP, Fracchia AA, Urban JA, et al: "Residual” mammary carcinoma following simulated partial mastectomy. Cancer 1975; 35: 739-747. DOI: https://doi.org/10.1002/1097-0142(197503)35:3<739::AID-CNCR2820350329>3.0.CO;2-5

Urban JA: Surgical management of palpable breast cancer. Cancer 1980; 46: 983-987. DOI: https://doi.org/10.1002/1097-0142(19800815)46:4+<983::AID-CNCR2820461322>3.0.CO;2-5

Fletcher GH: Clinical dose-response curves of human malignant epithelial tumors. Br. J. Radiol. 1973; 46; 1-12. DOI: https://doi.org/10.1259/0007-1285-46-541-1

Published

2023-08-07

How to Cite

1.
Souhami L, Carvalho Filho JP, Guizzardi MF. Cirurgia Conservadora e Radioterapia no Tratamento do Câncer da Mama. Rev. Bras. Cancerol. [Internet]. 2023 Aug. 7 [cited 2024 Dec. 23];31(4):243-8. Available from: https://rbc.inca.gov.br/index.php/revista/article/view/3358

Issue

Section

ORIGINAL ARTICLE

Most read articles by the same author(s)