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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
    Comparison of charges related to radiotherapy for soft-tissue sarcomas treated by preoperative external-beam irradiation versus interstitial implantation (1994)
    Springer
    Annals of surgical oncology 1 (1994), S. 415-422 
    Details
    ISSN: 1534-4681
    Keywords: Soft-tissue sarcoma ; Radiotherapy ; Cost analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: We compared treatment-related charges associated with external beam irradiation and interstitial implantation for soft-tissue sarcoma of the extremity. Methods: Charges related to radiotherapy in 35 patients with soft-tissue sarcoma of the extremity were reviewed. Preoperative external beam irradiation (EB) delivering 50 Gy in 25 fractions with 6 MV photons was administered to 12 of the patients evaluated. The remaining 23 patients were treated with interstitial implantation (IR) as the only radiotherapeutic intervention. The anatomic distribution of the sarcomas treated by IR included 14 lower-extremity (LE) and nine upper-extremity (UE) lesions. The average length of iridium wire used for IR was 78 cm. Because LE lesions tend to be larger, the average length equaled 109.5 cm as compared with the 47 cm for UE implants. Results: The radiotherapeutic approach represented the only difference in treatment-related charges because the operative procedure of wide local excision was performed in each group. No difference in perioperative complications was observed between the two treatment approaches. Charges were stratified according to hospital-based and professional services. Radiotherapy-based hospital charges for the administration of EB averaged $6,515 compared with $4,050 for IR (p〈0.0001). Professional services also were significantly different, totaling $4,390 for EB and $3,240 for IR (p〈0.0001). The total of these charges for radiotherapy procedures and professional fees equaled $10,905 for EB compared with $7,290 for IR (p〈0.0001). Incorporating the necessary operating-room time for implant placement ($750) and five additional hospital days ($1,800), the costs associated with IR totaled $9,840; using chisquare analysis, the cost for IR remained significantly (p〈0.0001) less expensive than the $10,905 associated with EB. Because a large component of the radiotherapy cost for IR is related to the length of iridium 192 wire required, charges were stratified according to the location of the tumor. The total charge for IR of the UE equaled $9,345 compared with $10,335 for LE implants. Chi-square comparison for both UE and LE implants continued to show significant differences (p〈0.0001) when related to EB therapy. Conclusion: Cost-analysis comparison of brachytherapy versus external beam irradiation found lower charges for patients undergoing adjuvant irradiation with brachytherapy for soft-tissue sarcoma. To optimize the cost-benefit ratio, prospective studies are necessary to define the application of these radiotherapeutic approaches based on clinical criteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303815
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  • 4
    Electronic Resource
    Electronic Resource
    Melanoma Patients With Iliac Nodal Metastases Can Be Cured (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 230-231 
    Details
    ISSN: 1534-4681
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0230-1
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  • 5
    Electronic Resource
    Electronic Resource
    Feasibility of Breast Conservation Therapy in Metachronous or Synchronous Bilateral Breast Cancer (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 102-108 
    Details
    ISSN: 1534-4681
    Keywords: Breast conservation ; Bilateral breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The optimal management of contralateral breast cancer (CC) in patients previously treated with breast-conserving therapy (BCT) is unclear, as is whether these patients continue to choose BCT as the preferred treatment of their second breast cancer. Methods: Of 1328 patients treated with BCT at The University of Texas M. D. Anderson Cancer Center between 1958 and 1994, 63 developed a contralateral breast cancer. We reviewed the charts of these patients retrospectively, and standard demographic and treatment variables were evaluated. Survival was analyzed by the Kaplan-Meier method and subgroups by χ2 analysis. Results: Twenty-nine percent of the patients had a family history of breast cancer. First breast cancers were detected by patient or physician in 67% of cases and by mammogram in 17% of cases, compared to 59% and 36%, respectively, of CC (P = .04). Median time to development of CC was 61 months. Sixty percent of the initial tumors were AJCC stage 0 or I with a median size of 2 cm, whereas 74% of the CC were stage 0 or I (P = .02), with a median size of 1.5 cm. Eighty-seven percent of patients chose BCT for treatment of CC. There were few treatment-related complications. Recurrence rates were not significantly different from those of patients undergoing BCT for the initial cancer (P = .47), and 5- and 10-year actuarial survival rates after the first cancer were 93% and 76%, respectively. Median follow-up was 134 and 56 months from the time of diagnosis of the initial cancer and CC, respectively. Conclusions: Because contralateral breast cancer often is detected at an early stage, there are few treatment-related complications, and the risk of recurrence is no different from that for the initial cancer, BCT is an acceptable and desirable option for appropriately selected patients with metachronous or synchronous bilateral breast cancers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0102-8
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  • 6
    Electronic Resource
    Electronic Resource
    Adjuvant radiation therapy after axillary lymphadenectomy for metastatic melanoma: Toxicity and local control (1995)
    Springer
    Annals of surgical oncology 2 (1995), S. 445-449 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Axilla ; Lymphadenectomy ; Radiation therapy ; Locoregional control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Certain patients with locally advanced melanoma have a high risk of regional recurrence after surgical excision and lymphadenectomy alone. Growing evidence suggests that radiation therapy may improve local control with acceptable morbidity for patients with melanoma in some sites. There is no information regarding the safety or efficacy of this treatment when applied to the axilla for regional metastasis of cutaneous melanoma. Methods: We conducted a retrospective evaluation of patients who received postoperative radiation therapy to the axillary lymphatics for malignant melanoma at the M. D. Anderson Cancer Center between 1980 and 1992. Twenty-eight patients were identified who had undergone a formal axillary lymph node dissection followed by postoperative irradiation to the full axilla and supraclavicular fossa. Twenty-two patients were irradiated using a hypofractionated treatment regimen (4–7 Gy/fraction), generally to 30 Gy in five fractions. Results: Sixteen patients are currently alive. Actuarial survival at 5 years is 50.1%. Local tumor recurred or persisted in five patients, four of whom had clinically palpable tumor when they were irradiated. Conclusions: Postoperative irradiation of the axilla for malignant melanoma has acceptable toxicity, even in those with extensive axillary dissection. In this group, patients treated for subclinical disease had a low rate of recurrence (1 of 21, [5%]).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02306379
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  • 7
    Electronic Resource
    Electronic Resource
    Recent Advances in Melanoma Staging and Therapy (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 467-475 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Sentinel lymph node ; Adjuvant therapy ; Immunotherapy ; Gene therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Recent advances in the staging and treatment of melanoma were reviewed. Methods: A literature-based review was performed. Results: The current American Joint Committee on Cancer (AJCC) Staging system for melanoma has several drawbacks. Proposed changes in the staging system to take into account simplified tumor thickness categories, tumor ulceration, and the number (rather than size) of nodal metastases will allow stage groups with more uniform prognosis. The widespread application of sentinel lymph node biopsy for nodal staging allows accurate nodal staging with minimal morbidity. Reverse transcriptase-polymerase chain reaction (RT-PCR) is a very sensitive molecular staging test that may prove useful for identifying early metastatic disease. There is finally an effective adjuvant therapy for melanoma—interferon alfa-2b. Other adjuvant therapies, including melanoma vaccines, may provide effective and less toxic alternatives. New immunotherapy and gene therapy strategies are under investigation. Conclusions: Ongoing and future adjuvant therapy trials will benefit from improved melanoma staging by accrual of homogeneous groups of patients. New approaches for adjuvant therapy await completion of clinical trials. Innovative new therapies offer hope for patients with advanced disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0467-8
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  • 8
    Electronic Resource
    Electronic Resource
    Significance of Multiple Nodal Basin Drainage in Truncal Melanoma Patients Undergoing Sentinel Lymph Node Biopsy (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 256-261 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Lymphoscintigraphy ; Sentinel lymph node
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Although previous studies have demonstrated that truncal site is associated with an adverse prognosis, explanations for such risk are lacking. In addition, the number of nodal basins as well as the number of lymph nodes containing regional metastases are important prognostic factors in these patients. Because the lymphatic drainage pattern of truncal melanoma often includes more than one basin, we designed a study to evaluate (1) whether patients with multiple nodal basin drainage (MNBD) were at an increased risk of lymph node metastases identified by sentinel lymph node (SLN) biopsy, and (2) whether the histological status of an individual basin reliably predicted the status of the other draining basins in patients with MNBD. Methods: The records of 295 consecutive truncal melanoma patients who were managed primarily with intraoperative lymphatic mapping and SLN biopsy, between 1991 and 1997, were reviewed. All patients underwent preoperative lymphoscintigraphy, which established the number and location of draining nodal basins. Univariate and multivariate analyses of relevant clinicopathological factors were performed to assess which factors may predict the presence of a pathologically positive SLN. Results: At least one SLN was identified in 281 patients. MNBD was present in 86 (31%) patients, and a pathologically positive SLN was found in 56 (20%) patients. By multivariate analysis, the presence of MNBD (relative risk = 1.9; P = .03), tumor thickness (P = .007), and tumor ulceration (relative risk = 2.4; P = .01) were significant independent risk factors for the presence of at least one pathologically positive SLN. SLN pathology in one basin did not predict the histology of other basins in 19 (22%) of 86 patients with MNBD. Conclusions: MNBD is independently associated with an increased risk of nodal metastases in truncal melanoma patients. Because the histological status of an individual basin did not reliably predict the status of the other draining basins in patients with MNBD, it is important to adequately identify and completely assess all nodal basins at risk, as defined by lymphoscintigraphy, in truncal melanoma patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0256-x
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  • 9
    Electronic Resource
    Electronic Resource
    Feasibility of Immediate Breast Reconstruction for Locally Advanced Breast Cancer (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 671-675 
    Details
    ISSN: 1534-4681
    Keywords: Locally advanced breast cancer ; Immediate breast reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Immediate breast reconstruction (IBR) has been considered contraindicated for patients with locally advanced breast cancer (LABC). Our goal was to determine whether IBR resulted in delayed postoperative chemotherapy, increased postoperative complications, or increased risk of recurrent disease. Methods: A prospective database of 540 modified radical mastectomies performed with IBR between 1990 and 1993 identified 50 patients with LABC. Postoperative management and outcome were compared to that of 72 patients undergoing modified radical mastectomy without IBR treated on a standardized LABC protocol using preoperative chemotherapy, postoperative chemotherapy, and radiotherapy during the same time period. Results: Results were evaluated by χ2 analysis. The median ages for the patients with IBR versus those not undergoing IBR were 44 and 46 years, respectively. The stage distribution for the IBR patients versus patients not undergoing IBR was as follows: IIB, 46% versus 17%; IIIA, 44% versus 39%; and IIIB, 10% versus 44%. The types of IBR were transverse rectus abdominis myocutaneous (TRAM) flap (68%), latissimus dorsi flap (2%), and implants (30%). Chemotherapy was given to all IBR patients: 24% preoperatively and 96% postoperatively. Radiotherapy was used in 40%. Four postoperative complications (8%) necessitated prolongation of hospitalization, including two patients requiring surgical debridement for partial flap loss; there were no complete flap losses. The incidences of major and minor wound complications in the group not undergoing IBR were 7% and 4%, respectively. Of the 15 patients receiving implant reconstruction, 7 (47%) required subsequent implant removal because of contractures or infections. The median interval between surgery and postoperative chemotherapy was 35 days for the IBR patients and 21 days for the patients not undergoing IBR. This difference was marginally significant (P 5.05). With a median follow-up of 58.4 months, no significant differences in local or distant relapse rates were detected. Conclusions: IBR can be performed with low morbidity in patients with LABC. Use of autogenous tissue is preferable because of poor results with implants. IBR is associated with somewhat longer intervals to resumption of postoperative chemotherapy, but this does not appear to be clinically significant—the local and distant relapse rates are similar for LABC patients undergoing modified radical mastectomy with or without IBR.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0671-6
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  • 10
    Electronic Resource
    Electronic Resource
    Sentinel Lymphadenectomy for Melanoma—Is It a Substitute for Elective Lymphadenectomy? (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 416-417 
    Details
    ISSN: 1534-4681
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0416-6
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