THE ROLE OF MASTECTOMY IN PATIENTS WITH STAGE I-II BREAST-CANCER PRESENTING WITH GROSS MULTIFOCAL OR MULTICENTRIC DISEASE OR DIFFUSE MICROCALCIFICATIONS
B. Fowble et al., THE ROLE OF MASTECTOMY IN PATIENTS WITH STAGE I-II BREAST-CANCER PRESENTING WITH GROSS MULTIFOCAL OR MULTICENTRIC DISEASE OR DIFFUSE MICROCALCIFICATIONS, International journal of radiation oncology, biology, physics, 27(3), 1993, pp. 567-573
Citations number
28
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: Women with Stage I-II invasive breast cancer who present with
gross multicentric disease or diffuse microcalcifications have a sign
ificant risk of breast recurrence when treated with conservative surge
ry and radiation. The purpose of this report is to present the results
of mastectomy in this group of patients. Methods and Materials: Betwe
en 1982 and 1989, 88 patients with clinical Stage I-II breast cancer w
ho presented with clinical and mammographic evidence of gross multicen
tric disease or diffuse microcalcifications underwent modified radical
mastectomy. Median followup was 4 years for the 57 patients with gros
s multicentric disease and 5.6 years for 31 patients with diffuse micr
ocalcifications. At the time of mastectomy, 42% of patients were found
to have positive axillary nodes. Following mastectomy, 15 patients re
ceived post mastectomy radiation and 35 patients received adjuvant sys
temic chemotherapy. Results: When compared to a group of 1295 patients
with unifocal Stage I-II breast cancer, treated with conservative sur
gery and radiation during the same time period, patients with gross mu
lticentric disease and diffuse microcalcifications had a significantly
higher incidence of greater-than-or-equal-to 4 positive nodes, patien
ts with gross multicentric disease had a lower incidence of positive r
esection margins following mastectomy and patients with diffuse microc
alcifications were younger. The 5-year actuarial risk of an isolated l
ocal-regional recurrence was 8% for patients with gross multicentric d
isease or diffuse microcalcifications and 7% for patients with unifoci
al disease. Patients with gross multicentric disease or diffuse microc
alcifications and greater-than-or-equal-to 4 positive axillary nodes w
ho did not receive post mastectomy radiation had an increased risk for
local regional recurrence. There were no significant differences in t
he 5-year actuarial overall or relapse-free survival (88% and 73% gros
s multicentric disease, 97% and 86% diffuse microcalcifications and 90
% and 79% unifocal disease), freedom from distant metastasis (76% gros
s multicentric disease, 90% diffuse microcalcifications, 86% unifocal
disease) or incidence of contralateral breast cancer (10% gross multic
entric disease, 13% diffuse microcalcifications, 8% unifocal disease)
among the three groups. Conclusion: The present study demonstrates no
increased risk of local-regional recurrence in patients with gross mul
ticentric disease or diffuse microcalcifications undergoing mastectomy
in contrast to the increased risk of breast recurrence in patients wi
th gross multicentric disease undergoing conservative surgery and radi
ation. Indications for post mastectomy radiation include greater-than-
or-equal-to 4 positive nodes or close or positive surgical margins. De
spite a significantly higher incidence of greater-than-or-equal-to 4 p
ositive nodes, patients with gross multicentric disease and diffuse mi
crocalcifications have a 5-year actuarial overall and relapse-free sur
vival comparable to a group of patients with unifocal disease treated
with conservative surgery and radiation.