Breast Surgery
Introduction
According to the development of imaging diagnosis, surgical procedure
and new drugs for cancer treatment, operable breast cancer patients are
managed with multi-disciplinary approach. Since the opening of the National
Cancer Center Hospital East in July 1992, 1700 or more cases of primary
breast cancer patients have been operated in this division.
Routine Activities
Two hundred thirteen cases were treated surgically in 2002. We have been
investigating the role of sentinel node biopsy (SNB) in clinically node-negative
breast cancer since 1998. We attempted a feasibility study on SNB followed
by axillary lymph node dissection (ALND) in 200 cases and we proved the
reliability of this promising surgical technique. Since then, SNB is being
examined in practice with vital blue dye (indigocarmine) or combined method
of the dye and radiopharmaceuticals. One hundred thirty nine cases underwent
SNB and 107 cases of them with histologically negative sentinel nodes
were treated without ALND. In this year, modified radical mastectomy was
performed in 53 cases, partial mastectomy with ALND in 49 cases, simple
or partial mastectomy with SNB alone in 107 cases, and excisional biopsy
alone in 4 cases (Table 1). About 65 % of cases underwent breast-conserving
surgery with or without ALND.
A worldwide consensus meeting on adjuvant therapies for high- risk breast
cancer recommended adjuvant chemotherapy and hormonal therapy to prolong
relapse-free survival and overall survival. From the statistics in our
division, relapse-free survival and overall survival rates were similar
to those reported from other cancer centers (Table 2). Adjuvant poly-chemotherapy
given intravenously is recommended for node-negative high-risk, or node-positive
breast cancer patients. In addition, primary chemo-hormonal therapies
are one of the promising strategies for early and advanced breast cancer.
Primary chemotherapy combined with anthracycline and taxan for advanced
breast cancer patients is applied in practice.
Research Activities
An international randomized clinical study of primary hormonal therapy
(PROACT) is underway. The aim in this study is to compare tumor regression
of a new aromatase inhibitor, anastazole, with that of tamoxifen, for
postmenopausal breast cancer patients with positive hormonal receptor.
Surgical treatment is done after primary hormonal therapy for 3 months,
and the same hormonal therapy is continued for 5 years. N-SAS-BC02 is
ongoing to compare anthracycline with taxan for the first-line adjuvant
chemotherapy in node-positive and hormonal receptor-negative breast cancer.
New Developments in 2002
SNB is a less invasive surgical procedure to prevent arm morbidity following
ALND for breast cancer treatment. However, several issues remains uncertain:
optimization of SNB, management of micrometastasis in sentinel nodes,
radiation exposure regarding gamma-probe method, and cost benefits and
quality of life. Several large randomized trials which compare SNB with
ALND are being continued in the United States and Europe. We should observe
our patients treated with SNB alone and investigate the prognosis and
clinical benefits during the long-term period.
S. IMOTO
Number of Cases of Operable Breast Cancer
| Operation |
No.of cases (%)
|
| Modified radical mastectomy |
53(25)
|
| PM + ALND |
49(23)
|
| SM + SNB |
18(8)
|
| PM + SNB |
89(42)
|
| Other |
4(2)
|
Relapse-free Survival and Overall Survival Rates at 6 Years in Breast Cancer Patients Operated on between 1992 and 1997
| No. of nodal metastases (No.) |
RFS (%)
|
OS (%)
|
| 0 (397) |
89
|
96
|
| 1 to 3 (161) |
77
|
88
|
| 4 to 9 (65) |
54
|
76
|
| 10 or more (63) |
43
|
50
|
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