Mastectomy

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H Bartelink - One of the best experts on this subject based on the ideXlab platform.

  • long term results of a randomized trial comparing breast conserving therapy with Mastectomy european organization for research and treatment of cancer 10801 trial
    Journal of the National Cancer Institute, 2000
    Co-Authors: Joop A Van Dongen, Adri C Voogd, I S Fentiman, Catherine Legrand, Richard Sylvester, D Tong, Emmanuel Van Der Schueren, Peter A Helle, Kobus Van Zijl, H Bartelink
    Abstract:

    Background: Breast-conserving therapy (BCT) has been shown to be as effective as Mastectomy in the treatment of tumors 2 cm or smaller. However, evidence of its efficacy, over the long term, in patients with tumors larger than 2 cm is limited. From May 1980 to May 1986, the European Organization for Research and Treatment of Cancer carried out a randomized, multicenter trial comparing BCT with modified radical Mastectomy for patients with tumors up to 5 cm. In this analysis, we investigated whether the treatments resulted in different overall survival, time to distant metastasis, or time to locoregional recurrence. Methods: Of 868 eligible breast cancer patients randomly assigned to the BCT arm or to the modified radical Mastectomy arm, 80% had a tumor of 2.1–5 cm. BCT comprised lumpectomy with an attempted margin of 1 cm of healthy tissue and complete axillary clearance, followed by radiotherapy to the breast and a supplementary dose to the tumor bed. The median follow-up was 13.4 years. All P values are two-sided. Results: At 10 years, there was no difference between the two groups in overall survival (66% for the Mastectomy patients and 65% for the BCT patients; P = .11) or in their distant metastasis-free rates (66% for the Mastectomy patients and 61% for the BCT patients; P = .24). The rate of locoregional recurrence (occurring before or at the same time as distant metastasis) at 10 years did show a statistically significant difference (12% of the Mastectomy and 20% of the BCT patients; P = .01). Conclusions: BCT and Mastectomy demonstrate similar survival rates in a trial in which the great majority of the patients had stage II breast cancer.

Deborah Baynes - One of the best experts on this subject based on the ideXlab platform.

  • nipple sparing Mastectomy technique and results of 54 procedures
    Archives of Surgery, 2004
    Co-Authors: Joseph P Crowe, Randall J Yetman, Jillian Banbury, Rebecca J Patrick, Deborah Baynes
    Abstract:

    HYPOTHESIS: The rationale for removal of the nipple-areolar complex (NAC) during total Mastectomy centers on long-standing concerns about possible neoplastic involvement of the NAC and its postoperative viability. Nipple-sparing Mastectomy (NSM) combines a skin-sparing Mastectomy with preservation of the NAC, intraoperative pathological assessment of the nipple tissue core, and immediate reconstruction, thereby permitting better cosmesis for patients undergoing total Mastectomy. Neoplastic involvement of the NAC can be predicted before surgery and assessed during the operation, and sustained postoperative viability of the NAC is likely with appropriate surgical technique. RESULTS: Fifty-four NSMs with immediate reconstruction were attempted among 44 patients. Six NAC core specimens revealed neoplastic involvement on frozen section analysis, resulting in conversion to total mastectomies. Forty-five of the 48 completed NSMs maintained postoperative viability of the NAC; 3 NACs had partial loss. CONCLUSION: Nipple-sparing Mastectomy is a reasonable option for carefully screened patients.

Norman Wolmark - One of the best experts on this subject based on the ideXlab platform.

  • twenty five year follow up of a randomized trial comparing radical Mastectomy total Mastectomy and total Mastectomy followed by irradiation
    The New England Journal of Medicine, 2002
    Co-Authors: Bernard Fisher, Edwin R Fisher, Jonghyeon Jeong, Stewart J Anderson, John Bryant, Norman Wolmark
    Abstract:

    Background In women with breast cancer, the role of radical Mastectomy, as compared with less extensive surgery, has been a matter of debate. We report 25-year findings of a randomized trial initiated in 1971 to determine whether less extensive surgery with or without radiation therapy was as effective as the Halsted radical Mastectomy. Methods A total of 1079 women with clinically negative axillary nodes underwent radical Mastectomy, total Mastectomy without axillary dissection but with postoperative irradiation, or total Mastectomy plus axillary dissection only if their nodes became positive. A total of 586 women with clinically positive axillary nodes either underwent radical Mastectomy or underwent total Mastectomy without axillary dissection but with postoperative irradiation. Kaplan–Meier and cumulative-incidence estimates of outcome were obtained. Results No significant differences were observed among the three groups of women with negative nodes or between the two groups of women with positive nodes with respect to disease-free survival, relapse-free survival, distant-disease–free survival, or overall survival. Among women with negative nodes, the hazard ratio for death among those who were treated with total Mastectomy and radiation as compared with those who underwent radical Mastectomy was 1.08 (95 percent confidence interval, 0.91 to 1.28; P=0.38), and the hazard ratio for death among those who had total Mastectomy without radiation as compared with those who underwent radical Mastectomy was 1.03 (95 percent confidence interval, 0.87 to 1.23; P=0.72). Among women with positive nodes, the hazard ratio for death among those who underwent total Mastectomy and radiation as compared with those who underwent radical Mastectomy was 1.06 (95 percent confidence interval, 0.89 to 1.27; P=0.49). Conclusions The findings validate earlier results showing no advantage from radical Mastectomy. Although differences of a few percentage points cannot be excluded, the findings fail to show a significant survival advantage from removing occult positive nodes at the time of initial surgery or from radiation therapy. (N Engl J Med 2002;347:567-75.)

Paul Okunieff - One of the best experts on this subject based on the ideXlab platform.

  • ten year results of a comparison of conservation with Mastectomy in the treatment of stage i and ii breast cancer
    The New England Journal of Medicine, 1995
    Co-Authors: Joan Jacobson, David N Danforth, Kenneth H Cowan, T Dangelo, Seth M Steinberg, Lori J Pierce, Marc E Lippman, Allen S Lichter, E Glatstein, Paul Okunieff
    Abstract:

    Background Breast-conservation therapy for early-stage breast cancer is now an accepted treatment, but there is still controversy about its comparability with Mastectomy. Between 1979 and 1987, the National Cancer Institute conducted a randomized, single-institution trial comparing lumpectomy, axillary dissection, and radiation with Mastectomy and axillary dissection for stage I and II breast cancer. We update the results of that trial after a median potential follow-up of 10.1 years. Methods Two hundred forty-seven patients with clinical stage I and II breast cancer were randomly assigned to undergo either modified radical Mastectomy or lumpectomy, axillary dissection, and radiation therapy. The 237 patients who actually underwent randomization have been followed for a median of 10.1 years. The primary end points were overall survival and disease-free survival. Results At 10 years overall survival was 75 percent for the patients assigned to Mastectomy and 77 percent for those assigned to lumpectomy plus ...

Amy S Colwell - One of the best experts on this subject based on the ideXlab platform.

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