Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

Year 2011, , 138 - 142, 01.02.2011

Atakan Sezer Ruşen Coşar Alas İrfan Cicin Zeki Hoşcoşkun Nermin Tunçbilek

https://doi.org/10.5174/tutfd.2010.03298.1

Abstract

Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19). Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4). Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80) months. Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients. Amaç: Lokal ileri evre meme kanserinde neoadjuvan kemoterapi ile hastalar meme koruyucu cerrahi olma şansını yakalayabilmektedir. Bu yazıda lokal ileri evre meme kanseri nedeni neoadjuvan kemoterapi sonrası meme koruyucu cerrahi,aksiler diseksiyon ve sentinel lenf nodu örneklemesi yapılmış hastaların sonuçları değerlendirilmiştir. Gereç ve Yöntemler: Bu çalışmaya 2002-2009 yılları arasında evre IIIA ve IIIB lokal ileri evre meme kanserli 12 hasta alınmıştır. Hastalara cerrahi öncesi antrasiklin bazlı kemoterapi rejimleri uygulanmıştır. Level 2 aksiller lenf nodu diseksiyonu öncesi sentinel lenf nodu örneklemesi, meme koruyucu cerrahi ve sonrasında radyoterapi yapılmıştır. Bulgular: Hastaların beşi evre IIIA, altısı IIIB ve biri evre IIIB idi.Hastalara 3-6 kür arası FAC/FEC rejimleri uygulandı. 8 hastada kısmi, 4'ünde tam yanıt alındı. Aksiller diseksiyon yapılan hastaların 5'inde pozitif lenf nodu görüldü. Lenf nodu ortanca değeri 12 (n:8-19) idi. Beş hastaya sentinel lenf nodu örneklemesi yapıldı.Bir hastada sentinel lenf nodu görüntülenemedi. Diseke edilen sentinel lenf nodu ortanca değeri 3,5 (n:3-4) idi. Hiçbir hastada lokoregional nüks görülmedi. Hastaların ortalama takip süresi 29.8 ay olup, ortanca takip süresi 16 (2-80) ay olarak tespit edildi. 12 hastanın 10'u yaşamakta olup 2'si exitus oldu. Sonuç: Uygun hastalarda multidisipliner çalışma ile neoadjuvan kemoterapi sonrası lokal ileri evre meme kanserlerinde meme koruyucu cerrahi ve sentinel lenf nodu yapılabilinir ve erken evre meme kanserinde olduğu gibi kür sansı sağlanabilir.

Keywords

Breast cancer, locally advanced stage, breast conserving surgery, sentinel lymph node biopsy

Lokal İleri Evre Meme Kanserlerinde Meme Koruyucu Cerrahi ve Sentinel Lenf Nodu Örneklemesi: Tek Merkez Deneyimi

Abstract

Amaç: Lokal ileri evre meme kanserinde neoadjuvan kemoterapi ile hastalar
meme koruyucu cerrahi olma şansını yakalayabilmektedir. Bu yazıda lokal
ileri evre meme kanseri nedeni neoadjuvan kemoterapi sonrası meme
koruyucu cerrahi,aksiler diseksiyon ve sentinel lenf nodu örneklemesi yapılmış
hastaların sonuçları değerlendirilmiştir.
Gereç ve Yöntemler: Bu çalışmaya 2002-2009 yılları arasında evre IIIA
ve IIIB lokal ileri evre meme kanserli 12 hasta alınmıştır. Hastalara cerrahi
öncesi antrasiklin bazlı kemoterapi rejimleri uygulanmıştır. Level 2 aksiller
lenf nodu diseksiyonu öncesi sentinel lenf nodu örneklemesi, meme koruyucu
cerrahi ve sonrasında radyoterapi yapılmıştır.
Bulgular: Hastaların beşi evre IIIA, altısı IIIB ve biri evre IIIB idi.Hastalara
3-6 kür arası FAC/FEC rejimleri uygulandı. 8 hastada kısmi, 4’ünde tam
yanıt alındı. Aksiller diseksiyon yapılan hastaların 5’inde pozitif lenf nodu
görüldü. Lenf nodu ortanca değeri 12 (n:8-19) idi. Beş hastaya sentinel
lenf nodu örneklemesi yapıldı.Bir hastada sentinel lenf nodu görüntülenemedi.
Diseke edilen sentinel lenf nodu ortanca değeri 3,5 (n:3-4) idi.
Hiçbir hastada lokoregional nüks görülmedi. Hastaların ortalama takip sü-
resi 29.8 ay olup, ortanca takip süresi 16 (2-80) ay olarak tespit edildi. 12
hastanın 10’u yaşamakta olup 2’si exitus oldu.
Sonuç: Uygun hastalarda multidisipliner çalışma ile neoadjuvan kemoterapi
sonrası lokal ileri evre meme kanserlerinde meme koruyucu cerrahi
ve sentinel lenf nodu yapılabilinir ve erken evre meme kanserinde olduğu
gibi kür sansı sağlanabilir.

Keywords

Meme kanseri, lokal ileri evre, meme koruyucu cerrahi, sentinel lenf nodu örneklemesi

References

• Asoglu O, Muslumanoglu M, Igci A, Ozmen V, Karanlik H, Ayalp K, ve ark. Breast conserving surgery after primary chemotherapy in locally advanced breast cancer. Acta Chir Belg 2005;105:62-8. [CrossRef]
• Escobar PF, Patrick RJ, Rybicki LA, Weng DE, Crowe JP. The 2003 revised TNM staging system for breast cancer: results of stage re-classiŞ cation on survival and future comparisons among stage groups. Ann Surg Oncol 2007;14:143-7.
• Bergh J, Jonsson PE, Glımelıus B, Nygren P. A systematic over- view of chemotherapy effects in breast cancer. Acta Oncol 2001;40:253-81. [CrossRef]
• Sadetzki S, Oberman B, Zipple D, Kaufman B, Rizel S, Novikov I, et al. Breast conservation after neoadjuvant chemotherapy. Ann Surg Oncol 2005;12:480-7. [CrossRef]
• Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial compar- ing total mastectomy, lumpectomy, and lumpectomy plus irradia- tion for the treatment of invasive breast cancer. N Engl J Med 2002;347:1233-41. [CrossRef]
• Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow up of a randomized study compar- ing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-32. [CrossRef]
• Fitzal F, Gnant M. Breast conservation: evolution of surgical strat- egies. Breast J 2006;12:165-73. [CrossRef]
• B Fisher, C Redmond, R Poisson, R Margolese, N Wolmark, L Wickerham, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or with- out irradiation in the treatment of breast cancer. N Engl Med 1989;320:822-8. [CrossRef]
• Veronesi U, Salvadori B, Luini A, BanŞ A, Zucali R, Del Vecchio M, et al. Conservative treatment of early breast cancer: Long-term results of 1232 cases treated with quadrantectomy, axillary dis- section, and radiotherapy. Ann Surg 1990;211:250-9. [CrossRef]
• National Cancer Institute, DCCPS, Surveillance Research Pro- gram, Cancer Statistics Branch. SEER Program Public Use Data Tapes 1973-1998, 2001.
• Giordano SH. Update on locally advanced breast cancer. Oncolo- gist 2003;8:521-30. [CrossRef]
• Spanos WJ Jr, Montague ED, Fletcher GH. Late complications of radiation only for advanced breast cancer. Int J Radiat Oncol Biol Phys 1980;6:1473-6.
• Swain SM, Sorace RA, Bagley CS, Danforth DN Jr, Bader J, Wes- ley MN, et al. Neoadjuvant chemotherapy in the combined mo- dality approach of locally advanced nonmetastatic breast cancer. Cancer Res 1987;47:3889-94.
• Hortobagyi GN, Blumenschein GR, Spanos W, Montague ED, Buzdar AU, Yap HY, et al. Multimodal treatment of locoregionally advanced breast cancer. Cancer 1983;51:763-8. [CrossRef]
• Fitzal F, Gnant M. Breast conservation: evolution of surgical strat- egies. Breast J 2006;12:165-73. [CrossRef]
• Morrow M. Limiting breast surgery to the proper minimum. Breast 2005;14:523-6. [CrossRef]
• Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year followup of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227-32. [CrossRef]
• Woerdeman LA, Hage JJ, Thio EA, Zoetmulder FA, Rutgers EJ. Breast- conserving therapy in patients with a relatively large (T2 or T3) breast cancer: long-term local control and cosmetic outcome of a feasibility study. Plast Reconstr Surg 2004;113:1607-16. [CrossRef]
• Beriwal S, Schwartz GF, Komarnicky L, Garcia-Young JA. Breast- conserving therapy after neoadjuvant chemotherapy: long-term results. Breast J 2006;12:159-64. [CrossRef]
• Singletary SE, McNeese MD, Hortobagyi GN. Feasibility of breast- conservation surgery after induction chemotherapy for locally ad- vanced breast carcinoma.Cancer 1992;69:2849-52. [CrossRef]
• Rouzier R, Pusztai L, Garbay JR, Delaloge S, Hunt KK, Hortobagyi GN, et al. Development and validation of nomograms for redict- ing residual tumor size and the probability of successful conser- vative surgery with neoadjuvant chemotherapy for breast cancer. Cancer 2006;107:1459-66. [CrossRef]
• Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Mar- golese RG, et al. Effect of preoperative chemotherapy on local- regional disease in women with operable breast cancer: Ş ndings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997;15:2483-93.
• Perloff M, Lesnick GJ, Korzun A, Chu F, Holland JF, Thirlwell MP, et al. Combination chemotherapy with mastectomy or radiother- apy for stage III breast cancer: a Cancer and Leukemia Group B study. J Clin Oncol 1988;6:261-9.
• Bonadonna G, Valagussa P, Brambilla C, Ferrari L, Moliterni A, Terenziani M, et al. Primary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute. J Clin Oncol 1998;16:93-100.
• Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Oswald MJ, Outlaw ED, et al. Breast conservation after neoadjuvant chemo- therapy: the MD Anderson cancer center experience. J Clin On- col 2004;22:2303-12. [CrossRef]
• Machiavelli MR, Romero AO, Pérez JE, Lacava JA, Domínguez ME, Rodríguez R, et al. Prognostic signiŞ cance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast car- cinoma. Cancer J Sci Am 1998;4:125-31. [CrossRef]
• McCready DR, Hortobagyi GN, Kau SW, Smith TL, Buzdar AU, Balch CM. The prognostic signiŞ cance of lymph node metasta- ses after preoperative chemotherapy for locally advanced breast cancer. Arch Surg 1989;124:21-5.
• Kilbride KE, Lee MC, Nees AV, Cimmino VM, Diehl KM, Sabel MS, et al. Axillary staging prior to neoadjuvant chemotherapy for breast cancer: predictors of recurrence. Ann Surg Oncol 2008;15:3252-8. [CrossRef]
• Cox CE, Cox JM, White LB, Stowell NG, Clark JD, Allred N, et al. Sentinel node biopsy before neoadjuvant chemotherapy for de- termining axillary status and treatment prognosis in local advanced breast cancer. Ann Surg Oncol 2006;13:483-90. [CrossRef]
• Schrenk P, Hochreiner G, Fridrik M, Wayand W. Sentinel node biopsy performed before preoperative chemotherapy for axil- lary lymph node staging in breast cancer. Breast J 2003;9:282-7. [CrossRef]
• Sabel MS, Schott AF, Kleer CG, Merajver S, Cimmino VM, Diehl KM, et al. Sentinel node biopsy prior to neoadjuvant chemother- apy. Am J Surg 2003;186:102-5. [CrossRef]