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Alberto Luini - One of the best experts on this subject based on the ideXlab platform.
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the veronesi Quadrantectomy an historical overview
Ecancermedicalscience, 2017Co-Authors: Giovanni Corso, Virgilio Sacchini, Viviana Galimberti, Paolo Veronesi, Alberto LuiniAbstract:Following a clinical trial in which the Halsted mastectomy was compared to the less invasive Quadrantectomy, no differences were reported in terms of local recurrence, disease-free or overall survival between the two. As a result, Umberto Veronesi was the first in the world to state that the radical mastectomy appeared to involve unnecessary mutilation in patients with breast cancer of less than 2 cm and no palpable axillary nodes. To date, the Veronesi Quadrantectomy is routinely considered for breast cancer treatment. This brief review, which highlights the main advances over the last 50 years, is dedicated to Professor Umberto Veronesi.
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intraoperative radiotherapy during breast conserving surgery a study on 1 822 cases treated with electrons
Breast Cancer Research and Treatment, 2010Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Roberto Orecchia, Mattia Intra, Stefano Zurrida, Paolo VeronesiAbstract:Intraoperative radiotherapy with electrons (ELIOT) after conservative surgery for breast carcinoma was introduced at the IEO in 1999 as a research programme. The results on 1,822 patients treated from January 2000 to December 2008 are reported. Women with unicentric primary breast carcinoma of less than 2.5 cm in the largest diameter were assessed by imaging. All patients were treated with breast-conserving surgery (Quadrantectomy). ELIOT was delivered by two mobile linear accelerators immediately after breast resection with a single dose of 21 Gy. Local side effects of ELIOT were mainly liponecrosis (4.2%) and fibrosis (1.8%). After a mean follow-up of 36.1 months, 42 women (2.3%) developed a local recurrence, 24 (1.3%) a new primary ipsilateral carcinomas and 26 (1.4%) distant metastases as first event. Forty-six women died (2.5%), 28 for breast carcinoma and 18 for other causes. Five- and ten-year survivals were, respectively, 97.4 and 89.7%. ELIOT appears a promising feature in early breast cancer treated with breast conserving surgery, reducing the exposure of normal tissues to radiations and shortening the radiation course from 6 weeks to one single session.
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full dose intraoperative radiotherapy with electrons during breast conserving surgery experience with 590 cases
Annals of Surgery, 2005Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Maria Cristina Leonardi, Paolo Veronesi, Roberto Orecchia, Giovanna Gatti, Mattia Intra, M Ciocca, Roberta LazzariAbstract:The 6-week postoperative course of radiotherapy is the standard approach to breast cancer patients after wide resection or Quadrantectomy. The Milan III trial evaluating the efficacy of radiotherapy after breast-conserving surgery confirmed that this treatment has an important role in the local control of breast carcinoma,1 although it does not influence survival. The results of the trial pointed out that the highest incidence of local relapse (85% of cases) occurred in the area of the breast where the primary carcinoma was excised; the remaining 15% of relapses occurred in other quadrants with a likelihood similar to the contralateral breast carcinoma. This important observation is the rationale for the partial breast irradiation, that is, reduction of radiation fields from the whole organ to the involved portion of the breast. Intraoperative radiotherapy with electrons (ELIOT) delivers a single dose of radiation directly to the tumor bed after wide resection or Quadrantectomy, using a mobile linear accelerator located in the operating theater: with this technique it is possible to treat only the involved quadrant of the breast and to shorten the radiotherapy course from 6 weeks to one session during surgery.
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comparative study of surgical margins in oncoplastic surgery and Quadrantectomy in breast cancer
Annals of Surgical Oncology, 2005Co-Authors: Navneet Kaur, Alberto Luini, Jean Yves Petit, Mario Rietjens, Giovanna Gatti, Fausto Maffini, Pier Carlo Rey, Cicero Urban, Francesca De LorenziAbstract:Oncoplastic surgery for breast cancer is a novel concept that combines a plastic surgical procedure with breast-conserving treatment to improve the final cosmetic results. The aim of this study was to evaluate the oncological safety of oncoplastic procedures by studying the status of the surgical margins of the excised tumor specimen in comparison with standard quadrantectomies. Thirty consecutive breast cancer patients undergoing oncoplastic surgery (group 1) and 30 patients undergoing standard Quadrantectomy (group 2) were prospectively studied with regard to the stage of breast cancer, the surgical procedures performed, the volume of breast tissue excised, and the histopathology of the tumor specimen, with specific details on surgical margins. Patients who underwent oncoplastic surgery (group 1) were younger (mean age, 48.73 years) than patients who had a classic Quadrantectomy (group 2; mean age, 55.76 years; P = .022). The mean volume of the excised specimen in group 1 was 200.18 cm3, compared with 117.55 cm3 in group 2 (P = .016). Surgical margins were negative in 25 cases out of 30 in group 1 and 17 out of 30 in group 2 (P = .05). The average length of the surgical margin was 8.5 mm in group 1 and 6.5 mm in group 2, but the difference was not statistically significant (P = .074). Oncoplastic surgery adds to the oncological safety of breast-conserving treatment because a larger volume of breast tissue can be excised and a wider negative margin can be obtained. It is especially indicated for large tumors, for which standard breast-conserving treatment has a high probability of leaving positive margins.
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twenty year follow up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer
The New England Journal of Medicine, 2002Co-Authors: Umberto Veronesi, Alberto Luini, R. Saccozzi, M Greco, Luigi Mariani, Natale Cascinelli, Marisel Aguilar, Ettore MarubiniAbstract:Background We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery. Methods From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm in diameter were randomly assigned to undergo radical mastectomy (349 patients) or breast-conserving surgery (Quadrantectomy) followed by radiotherapy to the ipsilateral mammary tissue (352 patients). After 1976, patients in both groups who had positive axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. Results Thirty women in the group that underwent breast-conserving therapy had a recurrence of tumor in the same breast, whereas eight women in the radical-mastectomy group had local recurrences (P<0.001). The crude cumulative incidence of these events was 8.8 percent and 2.3 percent, respectively, after 20 years. In contrast, there was no significant difference between the two groups in th...
Umberto Veronesi - One of the best experts on this subject based on the ideXlab platform.
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intraoperative radiotherapy during breast conserving surgery a study on 1 822 cases treated with electrons
Breast Cancer Research and Treatment, 2010Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Roberto Orecchia, Mattia Intra, Stefano Zurrida, Paolo VeronesiAbstract:Intraoperative radiotherapy with electrons (ELIOT) after conservative surgery for breast carcinoma was introduced at the IEO in 1999 as a research programme. The results on 1,822 patients treated from January 2000 to December 2008 are reported. Women with unicentric primary breast carcinoma of less than 2.5 cm in the largest diameter were assessed by imaging. All patients were treated with breast-conserving surgery (Quadrantectomy). ELIOT was delivered by two mobile linear accelerators immediately after breast resection with a single dose of 21 Gy. Local side effects of ELIOT were mainly liponecrosis (4.2%) and fibrosis (1.8%). After a mean follow-up of 36.1 months, 42 women (2.3%) developed a local recurrence, 24 (1.3%) a new primary ipsilateral carcinomas and 26 (1.4%) distant metastases as first event. Forty-six women died (2.5%), 28 for breast carcinoma and 18 for other causes. Five- and ten-year survivals were, respectively, 97.4 and 89.7%. ELIOT appears a promising feature in early breast cancer treated with breast conserving surgery, reducing the exposure of normal tissues to radiations and shortening the radiation course from 6 weeks to one single session.
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full dose intraoperative radiotherapy with electrons during breast conserving surgery experience with 590 cases
Annals of Surgery, 2005Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Maria Cristina Leonardi, Paolo Veronesi, Roberto Orecchia, Giovanna Gatti, Mattia Intra, M Ciocca, Roberta LazzariAbstract:The 6-week postoperative course of radiotherapy is the standard approach to breast cancer patients after wide resection or Quadrantectomy. The Milan III trial evaluating the efficacy of radiotherapy after breast-conserving surgery confirmed that this treatment has an important role in the local control of breast carcinoma,1 although it does not influence survival. The results of the trial pointed out that the highest incidence of local relapse (85% of cases) occurred in the area of the breast where the primary carcinoma was excised; the remaining 15% of relapses occurred in other quadrants with a likelihood similar to the contralateral breast carcinoma. This important observation is the rationale for the partial breast irradiation, that is, reduction of radiation fields from the whole organ to the involved portion of the breast. Intraoperative radiotherapy with electrons (ELIOT) delivers a single dose of radiation directly to the tumor bed after wide resection or Quadrantectomy, using a mobile linear accelerator located in the operating theater: with this technique it is possible to treat only the involved quadrant of the breast and to shorten the radiotherapy course from 6 weeks to one session during surgery.
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twenty year follow up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer
The New England Journal of Medicine, 2002Co-Authors: Umberto Veronesi, Alberto Luini, R. Saccozzi, M Greco, Luigi Mariani, Natale Cascinelli, Marisel Aguilar, Ettore MarubiniAbstract:Background We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery. Methods From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm in diameter were randomly assigned to undergo radical mastectomy (349 patients) or breast-conserving surgery (Quadrantectomy) followed by radiotherapy to the ipsilateral mammary tissue (352 patients). After 1976, patients in both groups who had positive axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil. Results Thirty women in the group that underwent breast-conserving therapy had a recurrence of tumor in the same breast, whereas eight women in the radical-mastectomy group had local recurrences (P<0.001). The crude cumulative incidence of these events was 8.8 percent and 2.3 percent, respectively, after 20 years. In contrast, there was no significant difference between the two groups in th...
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radiotherapy after breast preserving surgery in women with localized cancer of the breast
The New England Journal of Medicine, 1993Co-Authors: Umberto Veronesi, Alberto Luini, R. Saccozzi, Marcella Del Vecchio, Viviana Galimberti, M Greco, M Merson, Franco Rilke, Virgilio Sacchini, Tommaso SavioAbstract:Background and Methods Conservative surgery and radiotherapy have become well-established treatments for breast cancer, and many trials in progress are attempting to define the most acceptable type of procedure. Between 1987 and 1989 we randomly assigned 567 women with small breast cancers (<2.5 cm in diameter) to Quadrantectomy followed by radiotherapy or to Quadrantectomy without radiotherapy. All patients underwent total axillary dissection. The median follow-up period was 39 months (range, 28 to 54). Results The incidence of local recurrence was 8.8 percent among the patients treated with Quadrantectomy without radiotherapy, as compared with 0.3 percent among those treated with postsurgical radiotherapy (P = 0.001). However, there was a substantial effect of age: patients more than 55 years old who did not receive radiotherapy had a low rate of local recurrence (3.8 percent). The four-year overall survival was similar in the two treatment groups. Conclusions Administering radiotherapy after quadrantec...
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the Quadrantectomy technique for small breast carcinomas
Surgical technology international, 1991Co-Authors: Umberto VeronesiAbstract:Quadrantectomy describes removal of the quadrant in which a breast neoplasm is located, by excision of skin overlying the tumour en bloc with the sub-cutaneous fatty tissue and a relatively large area of the mammary gland, including the corresponding parts of the fasciae of the major pectoralis muscle.
Peter Schrenk - One of the best experts on this subject based on the ideXlab platform.
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batwing omega Quadrantectomy
2015Co-Authors: Peter SchrenkAbstract:A 76-year-old woman was diagnosed with a 24 mm receptor-positive carcinoma in the superior quadrant of the right breast 6 cm above the nipple. The breast was of medium size and ptotic, with the right breast slightly smaller than the left breast (Fig. 8.1a, b).
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superior pedicle Quadrantectomy and defect reconstruction with an inferior based pedicle secondary mastectomy and immediate reconstruction with a latissimus dorsi flap
2015Co-Authors: Peter SchrenkAbstract:A 44-year-old patient underwent Quadrantectomy for high-grade intraductal carcinoma in situ of the left breast at another hospital. The final histology showed involved margins in all directions, and the patient was scheduled for further surgery at our department.
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superior based pedicle Quadrantectomy and reconstruction of the Quadrantectomy defect with an inferior pedicle flap
2015Co-Authors: Peter SchrenkAbstract:The 43-year-old woman was diagnosed with a 15 mm receptor positive cancer in the upper outer quadrant of the right breast. The tumor was close to the skin, which required resection of the skin over the tumor. The patient had a small size symmetric breast with moderate ptosis (Fig. 25.1a–c).
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mastectomy and immediate expander reconstruction for local breast recurrence after previous Quadrantectomy and radiation
2015Co-Authors: Peter SchrenkAbstract:A 51-year-old patient had a history of prior Quadrantectomy for a 16 mm triple-negative invasive cancer of the left breast in the upper outer quadrant at another hospital. The patient underwent axillary clearance for a positive sentinel node biopsy (2 positive nodes out of 14 nodes removed). Postoperatively the patient received chemotherapy and whole breast radiation.
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local recurrence after Quadrantectomy and radiation treated by oncoplastic reduction mammoplasty
2015Co-Authors: Peter SchrenkAbstract:The 67-year-old patient had a history of prior Quadrantectomy and radiation for invasive cancer in the upper outer quadrant of the left breast. Surgery was performed at another hospital. Postoperative endocrine treatment was given for 5 years. Routine follow-up mammography 8 years after surgery found a mass suspicious for local recurrence, which was histologically confirmed by core needle biopsy as invasive cancer recurrence.
Paolo Veronesi - One of the best experts on this subject based on the ideXlab platform.
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the veronesi Quadrantectomy an historical overview
Ecancermedicalscience, 2017Co-Authors: Giovanni Corso, Virgilio Sacchini, Viviana Galimberti, Paolo Veronesi, Alberto LuiniAbstract:Following a clinical trial in which the Halsted mastectomy was compared to the less invasive Quadrantectomy, no differences were reported in terms of local recurrence, disease-free or overall survival between the two. As a result, Umberto Veronesi was the first in the world to state that the radical mastectomy appeared to involve unnecessary mutilation in patients with breast cancer of less than 2 cm and no palpable axillary nodes. To date, the Veronesi Quadrantectomy is routinely considered for breast cancer treatment. This brief review, which highlights the main advances over the last 50 years, is dedicated to Professor Umberto Veronesi.
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intraoperative radiotherapy during breast conserving surgery a study on 1 822 cases treated with electrons
Breast Cancer Research and Treatment, 2010Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Roberto Orecchia, Mattia Intra, Stefano Zurrida, Paolo VeronesiAbstract:Intraoperative radiotherapy with electrons (ELIOT) after conservative surgery for breast carcinoma was introduced at the IEO in 1999 as a research programme. The results on 1,822 patients treated from January 2000 to December 2008 are reported. Women with unicentric primary breast carcinoma of less than 2.5 cm in the largest diameter were assessed by imaging. All patients were treated with breast-conserving surgery (Quadrantectomy). ELIOT was delivered by two mobile linear accelerators immediately after breast resection with a single dose of 21 Gy. Local side effects of ELIOT were mainly liponecrosis (4.2%) and fibrosis (1.8%). After a mean follow-up of 36.1 months, 42 women (2.3%) developed a local recurrence, 24 (1.3%) a new primary ipsilateral carcinomas and 26 (1.4%) distant metastases as first event. Forty-six women died (2.5%), 28 for breast carcinoma and 18 for other causes. Five- and ten-year survivals were, respectively, 97.4 and 89.7%. ELIOT appears a promising feature in early breast cancer treated with breast conserving surgery, reducing the exposure of normal tissues to radiations and shortening the radiation course from 6 weeks to one single session.
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full dose intraoperative radiotherapy with electrons during breast conserving surgery experience with 590 cases
Annals of Surgery, 2005Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Maria Cristina Leonardi, Paolo Veronesi, Roberto Orecchia, Giovanna Gatti, Mattia Intra, M Ciocca, Roberta LazzariAbstract:The 6-week postoperative course of radiotherapy is the standard approach to breast cancer patients after wide resection or Quadrantectomy. The Milan III trial evaluating the efficacy of radiotherapy after breast-conserving surgery confirmed that this treatment has an important role in the local control of breast carcinoma,1 although it does not influence survival. The results of the trial pointed out that the highest incidence of local relapse (85% of cases) occurred in the area of the breast where the primary carcinoma was excised; the remaining 15% of relapses occurred in other quadrants with a likelihood similar to the contralateral breast carcinoma. This important observation is the rationale for the partial breast irradiation, that is, reduction of radiation fields from the whole organ to the involved portion of the breast. Intraoperative radiotherapy with electrons (ELIOT) delivers a single dose of radiation directly to the tumor bed after wide resection or Quadrantectomy, using a mobile linear accelerator located in the operating theater: with this technique it is possible to treat only the involved quadrant of the breast and to shorten the radiotherapy course from 6 weeks to one session during surgery.
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radiotherapy after breast conserving surgery in small breast carcinoma long term results of a randomized trial
Annals of Oncology, 2001Co-Authors: U Veronesi, Ettore Marubini, Paolo Veronesi, Luigi Mariani, V Galimberti, A Luini, Bruno Salvadori, Roberto ZucaliAbstract:Summary Background Breast-conserving surgery followed by radiotherapy is a widely accepted form of treatment in patients with breast cancer of limited extent. Many attempts have been made to identify subgroups of patients who might avoid radiotherapy. Patients and methods Between 1987 and 1989, 579 women with carcinoma of the breast were randomly assigned to Quadrantectomy, axillary dissection and radiotherapy (299) and to Quadrantectomy with axillary dissection without radiotherapy (280). Eligible patients were women with a breast carcinoma less than 2.5 cm in maximum diameter up to 70 years of age. Primary endpoints were intra-breast tumour reappearance (IBTR) and all-cause mortality. Results The number of IBTRs was significantly higher in patients treated with surgery alone (59 cases out of 273; 10-year crude cumulative incidence of 23.5%) than in patients treated with surgery plus radiotherapy (16 cases out of 294; 10-year crude cumulative incidence of 5.8%). The difference in IBTR frequency between the two treatments appeared to be particularly high in women up to 45 years of age, tending to decrease with increasing age up to no apparent difference in women older than 65 years. Overall survival curves for the two groups, did not differ significantly (P = 0.326). However, a limited survival advantage was evident after radiotherapy for nodepositive women. Conclusions After breast-conserving surgery radiotherapy appears indicated in all patients up to 55 years of age, in patients with positive axillary nodes, and in patients with extensive intraductal component at histology. The data suggest that radiotherapy may be avoided in patients older than 65, and may be optional in women aged 56–65 years with negative nodes.
Maria Cristina Leonardi - One of the best experts on this subject based on the ideXlab platform.
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local failure after accelerated partial breast irradiation with intraoperative radiotherapy with electrons an insight into management and outcome from an italian multicentric study
Annals of Surgical Oncology, 2020Co-Authors: Maria Cristina Leonardi, M. Alessandro, A Ciabattoni, Luigi Tomio, Davide Radice, Silvia Takanen, Elisabetta Bonzano, Giovanni Battista Ivaldi, Vincenzo Bagnardi, Ombretta AlessandroAbstract:Background The aim of this work is to evaluate pattern of care and clinical outcome in a large series of patients with in-breast recurrence (IBR), after Quadrantectomy and intraoperative radiation therapy with electrons (IOERT) as partial breast irradiation.
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Local Failure After Accelerated Partial Breast Irradiation with Intraoperative Radiotherapy with Electrons : An Insight into Management and Outcome from an Italian Multicentric Study
'Springer Science and Business Media LLC', 2020Co-Authors: Maria Cristina Leonardi, M. Alessandro, A Ciabattoni, Luigi Tomio, Davide Radice, Silvia Takanen, Elisabetta Bonzano, Giovanni Battista Ivaldi, Vincenzo Bagnardi, Ombretta AlessandroAbstract:Background: The aim of this work is to evaluate pattern of care and clinical outcome in a large series of patients with in-breast recurrence (IBR), after Quadrantectomy and intraoperative radiation therapy with electrons (IOERT) as partial breast irradiation. Patients and Methods: Patients with IBR after IOERT, treated with salvage surgery \ub1 adjuvant reirradiation (re-RT), were selected from a multiinstitution database. Disease-free survival (DFS), overall survival (OS), cumulative incidence of second IBR, and distant metastases (DM) were estimated. Results: A total of 224/267 patients from seven institutions were included. Primary tumors received 21 Gy. Median time to first IBR was 4.3 years (range 2.6\u20136.1 years). Salvage mastectomy and repeat Quadrantectomy were performed in 135 (60.3%) and 89 (39.7%) patients, followed by adjuvant re-RT in 21/135 (15.5%) and 63/89 (70.8%), respectively. Median follow-up after salvage treatment was 4.1 years. Overall, 5- and 8-year outcomes were as follows: cumulative incidence of second IBR: 8.4% and 14.8%; cumulative incidence of DM: 17.1% and 22.5%; DFS: 67.4% and 52.5%; OS: 89.3% and 74.7%. The risk of second IBR was similar in the salvage mastectomy and repeat Quadrantectomy + RT groups [hazard ratio (HR) 1.41, p = 0.566], while salvage mastectomy patients had greater risk of DM (HR 3.15, p = 0.019), as well as poorer DFS (HR 2.13, p = 0.016) and a trend towards worse OS (HR 3.27, p = 0.059). Patients who underwent repeat Quadrantectomy alone had worse outcomes (second IBR, HR 5.63, p = 0.006; DFS, HR 3.21, p = 0.003; OS, HR 4.38, p = 0.044) than those adding re-RT. Conclusions: Repeat Quadrantectomy + RT represents an effective salvage approach and achieved local control comparable to that of salvage mastectomy
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full dose intraoperative radiotherapy with electrons during breast conserving surgery experience with 590 cases
Annals of Surgery, 2005Co-Authors: Umberto Veronesi, Alberto Luini, Viviana Galimberti, Maria Cristina Leonardi, Paolo Veronesi, Roberto Orecchia, Giovanna Gatti, Mattia Intra, M Ciocca, Roberta LazzariAbstract:The 6-week postoperative course of radiotherapy is the standard approach to breast cancer patients after wide resection or Quadrantectomy. The Milan III trial evaluating the efficacy of radiotherapy after breast-conserving surgery confirmed that this treatment has an important role in the local control of breast carcinoma,1 although it does not influence survival. The results of the trial pointed out that the highest incidence of local relapse (85% of cases) occurred in the area of the breast where the primary carcinoma was excised; the remaining 15% of relapses occurred in other quadrants with a likelihood similar to the contralateral breast carcinoma. This important observation is the rationale for the partial breast irradiation, that is, reduction of radiation fields from the whole organ to the involved portion of the breast. Intraoperative radiotherapy with electrons (ELIOT) delivers a single dose of radiation directly to the tumor bed after wide resection or Quadrantectomy, using a mobile linear accelerator located in the operating theater: with this technique it is possible to treat only the involved quadrant of the breast and to shorten the radiotherapy course from 6 weeks to one session during surgery.
