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World Journal of Surgery

Published in:

01-10-2006

Effect of Prevailing Local Treatment Options of Breast Cancer on Survival Outside Controlled Clinical Trials: Experience of a Specialist Breast Unit in North India

Authors: Mallika Tewari, MS, MRCSEd, S. Pradhan, MD, M. Kumar, MD, H. S. Shukla, MS, PhD, FRCSEd

Published in: World Journal of Surgery | Issue 10/2006

Abstract

Background

This study aimed at analyzing different treatments of breast cancer (BC) prevalent in the region, their effect on patients’ survival, and discusses the most suitable method within available resources.

Methods

The study was set up at a tertiary care hospital in north India. We retrospectively reviewed data of 473 female BC patients who attended the departments of Surgical Oncology and Radiotherapy from January 1997 to December 1999. Patients with cTNM stage IV and inoperable stage III were included; those who defaulted or were lost to follow-up were excluded. Out of 473 patients, 372 were selected. The selected patients were divided into groups on the basis of place and type of local treatment they received: (1) local excision only, (2) standard breast conservation therapy (BCT), (3) total mastectomy (TM) + axillary lymph node dissection + radiotherapy (RT), and (4) modified radical mastectomy (MRM) + RT. Data regarding recurrence and survival were analyzed in December 2005. Minimum follow-up was 6 years.

Results

Overall recurrence rates were significantly higher in patients operated elsewhere (P <0.0001). Of 194 operated at our Breast Unit, 25 (14.6%) of 171 MRM patients and none of 23 BCT had recurrence. Of 178 patients operated elsewhere, 44 (100%), 6 (42.9%), 41 (41%), and 8 (40%) developed recurrence in groups 1, 2, 3, and 4 respectively. Overall survival was significantly better in patients with MRM at our unit versus TM outside (93.6% vs. 80%).

Conclusions

Several types of treatment from improper local excision alone, BCT, TM, to a carefully done MRM are prevalent here. Properly done, MRM yields significant local control with survival benefit and appears to remain the gold standard in management of our BC patients.

Mittra I, Badwe RA. Breast cancer In: Badellino F, Gipponi, editors Flow charts for diagnosis and staging of cancer in developed and developing countries. Geneva, UICC Publications, 1998

Halsted WS. The results of operations for the cure of cancer of the breast performed at Johns Hopkins Hospital from June 1889 to January 1894. Ann Surg 1894;20:497.CrossRefPubMed

Fisher B. Breast cancer management: alternative to radical mastectomy. N Engl J Med 1979;301:326–328.PubMedCrossRef

Fisher B. Laboratory and clinical research in breast cancer: a personal adventure: The David A. Karnofsky memorial lecture. Cancer Res 1980;40:3863–3874.PubMed

Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long-term results. Eur J Cancer Clin Oncol 1986;22:1085–1089.PubMedCrossRef

Veronesi U, Bafni A, Salvadori B. Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J cancer 1990;26:668–670.PubMedCrossRef

Fisher B, Redmond C, Fisher E, 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.PubMedCrossRef

Fisher B, Redmond C, Poisson R, et al. Eight year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989;320:822–828.PubMedCrossRef

Hiram S, Cody III, Jerome A. Urban. The role of axillary dissection in managing patients with breast cancer: The case for complete axillary clearance. In: Wise L, Johnson H Jr (editors) Breast cancer: Controversies in management. Armonk, New York, Futura 1994;169–176.

10.

Pal SK, Mittal B. Improving cancer care in India: prospects and challenges. Asian Pac J Cancer Prev 2004;5:226–228.PubMed

11.

Chopra R. The Indian scene. J Clin Oncol 2001;19:1065–1115.

12.

Shukla HS, Melhuish J, Mansel RE, et al. Does local therapy affect survival rates in breast cancer? Ann Surg Oncol 1999;6:455–460.PubMedCrossRef

13.

Overgaard M, Hansen PS, Overgaard J, et al. Postoperative radiotherapy in high risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 1997;337:949–955.PubMedCrossRef

14.

Ragaz J, Stewart MJ, Lee N, et al. Adjuvant radiotherapy and chemotherapy in node positive premenopausal women with breast cancer. N Engl J Med 1997;337:956–962.PubMedCrossRef

15.

Hellman S. Stopping metastasis at their source. N Engl J Med 1997;337:996–997.PubMedCrossRef

16.

Maddox WA, Carpenter JT, Laws HT, et al. Does radical mastectomy still have a place in the treatment of primary operable breast cancer? Arch Surg 1987;122:1317–1320.PubMed

17.

Fletcher GH, McNeese MD, Oswald MJ. Long range results for breast cancer patients treated by radical mastectomy and postoperative radiotherapy without adjuvant chemotherapy: an update. Int J Radiother Oncol Biol Phys 1984;17:11–14.CrossRef

18.

Murid AC, Hayward JL. Radiation therapy and limited surgery are not necessarily as good as modified radical mastectomy for the treatment of breast cancer In: Wise L, Johnson H Jr (editors) Breast cancer controversies in management. Armonk, New York, Futura, 1994;147–164.

19.

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366:2087–2106.

20.

Gillis CR, Hole DJ. Survival outcome of care by specialist surgeons in breast cancer: study of 3786 patients in the west of Scotland. Br Med J 1996;312:145–148.

Title: Effect of Prevailing Local Treatment Options of Breast Cancer on Survival Outside Controlled Clinical Trials: Experience of a Specialist Breast Unit in North India
Authors: Mallika Tewari, MS, MRCSEd
S. Pradhan, MD
M. Kumar, MD
H. S. Shukla, MS, PhD, FRCSEd
Publication date: 01-10-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 10/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0037-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of Prevailing Local Treatment Options of Breast Cancer on Survival Outside Controlled Clinical Trials: Experience of a Specialist Breast Unit in North India

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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