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  • 1
    Electronic Resource
    Electronic Resource
    Breast Cancer in Reduction Mammaplasty Specimens: Case Reports and Guidelines (2003)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 9 (2003), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Increasing numbers of women of all ages are electing to have reduction mammaplasty for very large breasts. Breast cancer can be an incidental finding in reduction mammaplasty specimens. We report here the discovery of breast cancer in specimens from four patients who underwent elective breast reduction, three of whom had not had recent mammograms. All four patients underwent modified radical mastectomy. The role of mammography, surgical options, specimen evaluation, and practical guidelines are discussed. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2003.09216.x
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  • 2
    Electronic Resource
    Electronic Resource
    Response to Induction Chemotherapy in Black and White Patients with Locally Advanced Breast Cancer (2000)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 6 (2000), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Black women with breast cancer have significantly poorer survival rates, a more advanced stage distribution, and are diagnosed at younger ages compared to white patients in the United States. We evaluated tumor response and survival with respect to race and age after induction chemotherapy. The study population consisted of 303 patients (229 white, 74 black) registered in two prospective trials of induction chemotherapy for locally advanced breast cancer [stage II (T 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ99071:ges" location="ges.gif"/〉 4 cm), stage III (noninflammatory), and stage IV (supraclavicular lymph node involvement only)] between 1989 and 1996. Chemotherapy regimens utilized 5-fluorouracil, cyclophosphamide, and doxorubicin (FAC). Response was defined as complete (CR, no clinical/radiographic detectable disease), partial (PR, 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ99071:ges" location="ges.gif"/〉50% reduction in disease), minor (MR, 〈50% reduction), no change (NC), or progressive disease (PD). Median follow-up was 58 months; survival was calculated using the Kaplan–Meier method. There was no significant difference in age at presentation (54% of black patients compared to 58% of white patients 〈50 years of age). The black patients had significantly more advanced stages of disease at diagnosis (50% of black patients compared to 30% of white patients with stage IIIB disease; p = 0.03). For both age groups together, tumor response, 5-year overall survival (OS), and 5-year disease-free survival (DFS) rates were similar between the black and white patients. A trend was noted that the younger black patients were more likely to have a clinical CR or PR; this did not translate into a survival advantage. Despite the more advanced stage distribution for black women with breast cancer, induction chemotherapy yields high response rates (especially for younger black patients) and survival rates equivalent to white patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2000.99071.x
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  • 3
    Electronic Resource
    Electronic Resource
    Case report 532 (1989)
    Springer
    Skeletal radiology 18 (1989), S. 147-151 
    Details
    ISSN: 1432-2161
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00350667
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  • 4
    Electronic Resource
    Electronic Resource
    Management of inflammatory breast cancer (1994)
    Springer
    World journal of surgery 18 (1994), S. 87-92 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Le cancer du sein inflammatoire (CSI) est rare mais souvent fatal. Les auteurs concluent que: 1) le diagnostic du CSI est basé sur la triade clinique: érythème, phénomène de peau d'orange et début rapide. L'importance de l'envahissement ganglionnaire est controversée; 2) la chimiothérapie combinée, comportant au moins la doxorubicine, associée à une mastectomie ou à la radiothérapie, améliore le pronostic par rapport à la mastectomie ou la radiothérapie seules; 3) la mastectomie après chimiothérapie d'induction peut parfois ne pas améliorer le pronostic ni diminuer le taux de récidives locorégionales. La chirurgie fournit, cependant, des données essentielles au plan pronostic, basées aussi sur la réponse thérapeutique et permet d'utiliser des doses de radiothérapie moindres par la suite, réduisant ainsi le taux de complications à long terme; 4) le nombre de cycles et les doses de chimiothérapie optimaux ne sont pas encore bien définis dans le CSI.
    Abstract: Resumen El cáncer inflamatorio del seno (CIS) es una enfermedad rara pero generamente letal. La presente revisión se refiere a las siguientes conclusiones: (1) El diagnóstico del CIS se fundamenta en la tríada de eritema, “piel de naranja” y un comienzo rápido de la enfermedad. La importancia de la evidencia histológica de invasión de los linfáticos dérmicos, como criterio diagnóstico, es motivo de controversia. (2) La combinación de un régimen quimioterápico que contenga doxorrubicina con mastectomía o radioterapia mejora la sobrevida, en comparación con lo que logran la mastectomía o la irradiación solas. (3) Aunque es posible que con la mastectomía que se practica luego de la quimioterapia de inducción no se logre mejoría de la sobrevida ne disminuir las tasas de recurrencial local-regional, la cirugía provee importante información de carácter pronóstico en relación a la respuesta al tratamiento y permite, ulteriormente, el uso de dosis más bajas de irradicación, lo cual resulta en una reducción de las complicaciones a largo plazo. (4) El número óptimo de ciclos y la intensidad de las dosis de quimioterapia en el CIS todavía no han sido definidas.
    Notes: Abstract Inflammatory breast cancer (IBC) is a rare but often fatal disease. This review discusses the following conclusions: (1) The diagnosis IBC is based on the clinical triad of erythema, ridging with peau d'orange, and rapid onset. The importance of histologic evidence of dermal lymphatic involvement is controversial. (2) Combining doxorubicin-containing chemotherapy with mastectomy or radiation therapy improves survival over that achieved with mastectomy or irradiation alone. (3) Mastectomy after induction chemotherapy may not improve survival or decrease locoregional recurrence rates, but the surgery does provide important prognostic information on treatment response and enables use of a lower radiation dose afterward, which results in reduced long-term complications. (4) The optimal number of cycles and dose intensity of chemotherapy for IBC remain undefined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00348197
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  • 5
    Electronic Resource
    Electronic Resource
    Combined-modality treatment of inflammatory breast carcinoma: twenty years of experience at M. D. Anderson Cancer Center (1997)
    Springer
    Cancer chemotherapy and pharmacology 40 (1997), S. 321-329 
    Details
    ISSN: 1432-0843
    Keywords: Key words Combined-modality treatment  ;  Inflammatory breast carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To review the 20 years of experience at M. D. Anderson Cancer Center with a combined-modality approach against inflammatory breast carcinoma. Patients and methods: A total of 178 patients with inflammatory breast carcinoma were treated in the past 20 years at M. D. Anderson Cancer Center by a combined-modality approach under four different protocols. Each protocol included induction chemotherapy, then local therapy (radiotherapy or mastectomy), then adjuvant chemotherapy, and, if mastectomy was performed, adjuvant radiotherapy. Chemotherapy consisted of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) with or without vincristine and prednisone (VP). In protocol D, patients received an alternate adjuvant chemotherapy regimen, methotrexate and vinblastine (MV), if they did not have a complete response (CR) to induction chemotherapy. Results: The median follow-up of live patients in group A was 215 months, in group B 186 months, in group C 116 months, and in group D 45 months. An estimated 28% of patients were currently free of disease beyond 15 years. At the time of analysis, 50 patients were alive without any evidence of disease. A further 12 patients died of intercurrent illness, and 15 patients were followed beyond 10 years without recurrence of disease. Among initial recurrence, 20% of patients had local failure, 39% systemic failure, and 9% CNS recurrence. Initial response to induction chemotherapy was an important prognostic factor. Disease-free survival (DFS) at 15 years was 44% in patients who had a CR to induction chemotherapy, 31% in those who had a partial response (PR), and 7% in those who had less than a PR. There was no improvement in overall survival (OS) or DFS among patients who underwent alternate chemotherapy (MV) compared with those who did not. Using surgery and radiotherapy as opposed to radiotherapy alone as local therapy did not have an impact on the DFS or OS rate. Conclusion: These long-term follow-up data show that with a combined-modality approach a significant fraction of patients (28%) remained free of disease beyond 15 years. In contrast, single-modality treatments yielded a DFS of less than 5%. Thus, using combined-modality treatment (chemotherapy, then mastectomy, then chemotherapy and radiotherapy) is recommended as a standard of care for inflammatory breast carcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002800050664
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  • 6
    Electronic Resource
    Electronic Resource
    Inflammatory carcinoma of the breast: results of a combined-modality approach — M. D. Anderson Cancer Center experience (1990)
    Springer
    Cancer chemotherapy and pharmacology 27 (1990), S. 94-100 
    Details
    ISSN: 1432-0843
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A total of 106 patients with inflammatory carcinoma of the breast underwent combined-modality treatment consisting of doxorubincin-containing chemotherapy. All patients received three cycles of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) before local therapy. From 1974 to 1977 (group A), primary radiotherapy was the local treatment modality and chemotherapy was given for a total of 24 months. From 1978 to 1981 (group B), mastectomy became the primary local treatment modality and FAC was reinstituted within 10–14 days after surgery; after completion of FAC, consolidation radiotherapy was given. From 1982 to 1986 (group C), vincristine and prednisone were added to FAC, and doxorubicin was given by continuous infusion. The median follow-up of the three groups was 56 months. For patients alive at the time of analysis, median follow-ups were 141, 111, and 49 months in groups A, B, and C, respectively. Disease-free survival at 5 years was 35%, 22%, and 41% for groups A, B, and C, respectively, and respective overall survival at 5 years was 37%, 30%, and 48%. Mastectomy in addition to radiotherapy resulted in local control rates similar to those obtained with radiotherapy alone, but this approach would result in fewer late sequelae of high-dose irradiation and provided histologic staging for chemotherapy response. The patients treated on protocol C had slightly better disease-free and overall survival, but the differences were not statistically significant. The 5-year disease-free survival of patients achieving a clinical complete remission (CR) or partial remission (PR) was superior to that of patients whose response was less than a PR. There was no episode of doxorubicin-related cardiac toxicity in group C. Combined-modality treatment for inflammatory carcinoma of the breast resulted in improved survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00689090
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  • 7
    Electronic Resource
    Electronic Resource
    Use of Dexon Mesh® for abdominal partitioning above the peritoneal reflection (1991)
    Springer
    Diseases of the colon & rectum 34 (1991), S. 833-835 
    Details
    ISSN: 1530-0358
    Keywords: Dexon Mesh ® ; Locally advanced colonic adenocarcinoma ; Intraoperative radiotherapy ; External beam radiotherapy ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Dexon Mesh® (Davis & Geck, Sugarland, TX) was used to partition the abdomen after incomplete resection of a locally advanced left colon cancer. Following surgery, external beam radiotherapy was delivered to the left flank without the risk of radiation enteritis. The technique of abdominal partitioning using Dexon Mesh® is described.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02051081
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  • 8
    Electronic Resource
    Electronic Resource
    Presentation, treatment, and outcome of local recurrence after skin-sparing mastectomy and immediate breast reconstruction (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 620-626 
    Details
    ISSN: 1534-4681
    Keywords: Early stage breast cancer ; Immediate breast reconstruction ; Skin-sparing mastectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The local recurrence (LR) rate with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) has been reported as comparable to the LR rate after conventional mastectomy. However, limited data are available on the prognostic significance and management of LR following SSM. Methods: A prospective database maintained at the University of Texas M. D. Anderson Cancer Center identified 437 SSMs performed for 372 invasive T1/T2 breast cancers between 1986 and 1993. Results: Twenty-three LRs were identified, with a LR rate of 6.2% (23/372). Twenty-two of these (96%) presented as palpable skin-flap masses. The median time to recurrence was 25 months (range, 3 to 98 months). Fourteen patients were treated with a combination of surgery and systemic therapy. Resection of the reconstructed breast was performed in only three patients. Complete local control of the recurrent disease was achieved in 17 patients (74%). Nine patients (39%) developed distant metastatic disease. At a median follow-up of 26 months, 14 of 23 patients (61%) are alive without evidence of disease, and 7 (30%) have died from breast cancer. Conclusions: Because LR rate with SSM is low and likelihood of local control and survival is high, SSM and IBR is an acceptable treatment option for early stage breast cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303832
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  • 9
    Electronic Resource
    Electronic Resource
    Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction (1997)
    Springer
    Annals of surgical oncology 4 (1997), S. 377-384 
    Details
    ISSN: 1534-4681
    Keywords: Breast reconstruction ; Postmastectomy radiation therapy ; Chest wall recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Postoperative radiotherapy (PORT) has been shown to decrease locoregional failure rates in high-risk breast cancer patients following modified radical mastectomy. However, there had not been a study evaluating the effect of PORT in patients after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. Therefore, we evaluated flap viability, cosmetic results, and locoregional recurrence in patients who underwent TRAM flap reconstruction and PORT. Methods: The charts of patients who had undergone modified radical mastectomy with TRAM flap reconstruction and PORT at our institution were reviewed. Patients were examined in the clinic and interviewed by telephone to evaluate their perceptions of the cosmetic result. Results: PORT was delivered to 19 patients with TRAM flaps (3 pedicled and 16 free flaps) between 1988 and 1994. There were no TRAM flap losses as a result of either surgical or radiotherapy complications. Two patients developed fat necrosis, one with a pedicled and one with a free TRAM flap. Patients with pedicled TRAM flaps noted more volume loss in the breast after radiation therapy. Eighty-four percent of patients felt their overall cosmetic result was excellent or good; only one patient reported a poor cosmetic result. Local control was achieved in three of the four patients who received PORT for local recurrence. There was only one local recurrence among the 14 patients who received PORT because they were at high risk of local recurrence. Conclusions: These results suggest that PORT can be given safely to high-risk patients following TRAM flap breast reconstruction with excellent cosmetic results and good locoregional control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02305549
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  • 10
    Electronic Resource
    Electronic Resource
    Effectiveness of mastectomy by response to induction chemotherapy for control in inflammatory breast carcinoma (1997)
    Springer
    Annals of surgical oncology 4 (1997), S. 452-461 
    Details
    ISSN: 1534-4681
    Keywords: Inflammatory breast carcinoma ; Local recurrence ; Chemotherapy ; Mastectomy ; Radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Controversy exists as to the treatment regimen necessary to best provide optimal local control for inflammatory breast carcinoma (IBC). This study was conducted to determine if mastectomy combined with radiotherapy offered any advantages over radiotherapy alone in patients with IBC who had been treated with doxorubicin-based combination chemotherapy. Methods: A retrospective review of 178 women treated for IBC on doxorubicin-based multimodality therapy protocols between January 1974 and September 1993 was performed. Clinical and histologic response to treatment, time to local recurrence, survival, and ultimate control of local disease were analyzed. Kaplan-Meier analysis was used to examine survival and relapse times, and Fisher's exact test was used to test differences in treatment outcomes. Significance was determined at p≤0.05. Results: Median follow-up was 89 months (range 22 to 223 months). Locoregional disease persisted in seven patients and recurred in 44 patients who had been rendered disease free at a median time of 10 months. The mortality rate after a local recurrence (LR) was 98%, and all patients but one with LR developed systemic metastases. Response to induction chemotherapy influenced the incidence of LR, and the amount of residual disease found on histologic examination of mastectomy specimens was highly prognostic for local failure. Patients who underwent mastectomy in addition to radiotherapy had a lower incidence of LR than did patients who received radiotherapy alone (16.3% vs. 35.7%, p=0.015). Conclusions: The addition of mastectomy to combination chemotherapy plus radiotherapy improved local control in patients with IBC. The addition of mastectomy to chemotherapy plus radiotherapy improved distant disease-free and overall survival in patients with a clinical complete or partial response to induction chemotherapy. Patients who had no significant response to induction chemotherapy received no survival or local disease-control benefit from the addition of mastectomy to their treatment regimen. These patients should be considered for entry into clinical trials of new treatment regimens.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303668
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