Skip to main content
Erschienen in: Indian Journal of Surgical Oncology 1/2023

29.08.2020 | Original Article

Is Survival with Conservative Breast Therapy Becoming Superior to That with Modified Radical Mastectomy Alone for the Treatment of Early Breast Cancer in This Era?

verfasst von: Mona M. Sayed, Dalia O. Mohamed, Marwa S. F. Hassan, Mahmoud H. Elshoieby, Maha S. Elnaggar, Lamia M. Khallaf, Mayada F. Sedik, Salah M. Khallaf

Erschienen in: Indian Journal of Surgical Oncology | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

This study aims to assess survival rates in early breast cancer patients treated by conservative breast therapy (CBT), including radiotherapy, compared with those treated by modified radical mastectomy (MRM) alone. The South Egypt Cancer Institute and the Assiut University Oncology Department patients’ records, from January 2010 to December 2017, were searched for T1-2N0-1M0 breast cancer patients treated by CBT or MRM. Patients who did not receive chemotherapy were excluded to reduce the treatment variation. The 5-year locoregional disease-free survival (LRDFS) was 97.3% for the CBT patients was and 98.0% for the MRM patients (P = .675). The 5-year distant disease-free survival (DDFS) was 93.6% for CBS and 85.7% for MRM (P = 0.033). The DFS was 91.9% for the BCT patients and 85.3% for the MRM patients (P = 0.045). The 5-year OS was 98.2% for the CBT patients and 94.3% for the MRM patients, (P = 0.02). By Cox regression analysis, the CBT resulted in significantly better OS, (P = 0.018) and the HR = 0.350, 95% CI 0.146–0.837. The adjusted OS, estimated by the propensity score-based weights, remained superior in CBT than in MRM patients (P < 0.001). CBT resulted in better DDFS, DFS, and OS than MRM. Future randomized trials are needed to confirm these findings and determine the cause.
Literatur
1.
Zurück zum Zitat Mohammad H, Forouzanfar KJF, Delossantos AM, Lozano R, Lopez AD, Murray CJL, Naghavi M (2011) Breast and cervical cancer in 187 countries between 1980 and 2010: a systematicanalysis. TheLancet 6736:61351–61352 Mohammad H, Forouzanfar KJF, Delossantos AM, Lozano R, Lopez AD, Murray CJL, Naghavi M (2011) Breast and cervical cancer in 187 countries between 1980 and 2010: a systematicanalysis. TheLancet 6736:61351–61352
2.
Zurück zum Zitat Arriagada R, Le MG, Rochard F, Contesso G (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 14:1558–1564 Available at:CrossRefPubMed Arriagada R, Le MG, Rochard F, Contesso G (1996) Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 14:1558–1564 Available at:CrossRefPubMed
3.
Zurück zum Zitat Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, Mcgale P et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 378(9804):1707–1716. https://doi.org/10.1016/S0140-6736(11)61629-2CrossRef Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, Mcgale P et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 378(9804):1707–1716. https://​doi.​org/​10.​1016/​S0140-6736(11)61629-2CrossRef
4.
Zurück zum Zitat Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2005) 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 366:2087–2106CrossRefPubMed Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2005) 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 366:2087–2106CrossRefPubMed
5.
Zurück zum Zitat Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232CrossRefPubMed Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232CrossRefPubMed
6.
Zurück zum Zitat Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMed Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMed
7.
Zurück zum Zitat Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J (2014) Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg 149:267–274CrossRefPubMed Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J (2014) Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg 149:267–274CrossRefPubMed
8.
Zurück zum Zitat Hwang ES, Lichtensztajn DY, Gomez SL, Fowble B, Clarke CA (2013) Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer 119:1402–1411CrossRefPubMed Hwang ES, Lichtensztajn DY, Gomez SL, Fowble B, Clarke CA (2013) Survival after lumpectomy and mastectomy for early stage invasive breast cancer: the effect of age and hormone receptor status. Cancer 119:1402–1411CrossRefPubMed
9.
Zurück zum Zitat Hartmann-Johnsen OJ, Karesen R, Schlichting E, Nygard JF (2015) Survival is better after breast conserving therapy than mastectomy for early stage breast cancer: a registry-based follow-up study of Norwegian women primary operated between 1998 and 2008. Ann Surg Oncol 22:3836–3845CrossRefPubMedPubMedCentral Hartmann-Johnsen OJ, Karesen R, Schlichting E, Nygard JF (2015) Survival is better after breast conserving therapy than mastectomy for early stage breast cancer: a registry-based follow-up study of Norwegian women primary operated between 1998 and 2008. Ann Surg Oncol 22:3836–3845CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Zhou X, Li Y (2016) Local recurrence after breast-conserving surgery and mastectomy following neoadjuvant chemotherapy for locally advanced breast cancer - a meta-analysis. Breast Care (Basel) 11(5):345–351CrossRefPubMed Zhou X, Li Y (2016) Local recurrence after breast-conserving surgery and mastectomy following neoadjuvant chemotherapy for locally advanced breast cancer - a meta-analysis. Breast Care (Basel) 11(5):345–351CrossRefPubMed
11.
Zurück zum Zitat Chen D, Lai L, Duan C, Yan M, Xing M, Chen J, Zhang F (2014) Conservative surgery plus axillary radiotherapy vs. modified radical mastectomy in patients with stage i breast cancer. Clin Breast Cancer 14(1):e10–e13CrossRefPubMed Chen D, Lai L, Duan C, Yan M, Xing M, Chen J, Zhang F (2014) Conservative surgery plus axillary radiotherapy vs. modified radical mastectomy in patients with stage i breast cancer. Clin Breast Cancer 14(1):e10–e13CrossRefPubMed
12.
Zurück zum Zitat Maishman T, Cutress RI, Hernandez A et al (2016) Local recurrence and breast oncological surgery in young women with breast cancer: the POSH observational cohort study. Ann Surg 266(1):165–172CrossRef Maishman T, Cutress RI, Hernandez A et al (2016) Local recurrence and breast oncological surgery in young women with breast cancer: the POSH observational cohort study. Ann Surg 266(1):165–172CrossRef
14.
Zurück zum Zitat Fisher S, Gao H, Yasui Y, Dabbs K, Winget M (2015) Survival in stage I-III breast cancer patients by surgical treatment in a publicly funded health care system. Ann Oncol 26:1161–1169CrossRefPubMedPubMedCentral Fisher S, Gao H, Yasui Y, Dabbs K, Winget M (2015) Survival in stage I-III breast cancer patients by surgical treatment in a publicly funded health care system. Ann Oncol 26:1161–1169CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Chen K, Liu J, Zhu L, Su F, Song E, Jacobs LK (2015) Comparative effectiveness study of breast-conserving surgery and mastectomy in the general popula- tion: a NCDB analysis. Oncotarget. 6:40127–40140CrossRefPubMedPubMedCentral Chen K, Liu J, Zhu L, Su F, Song E, Jacobs LK (2015) Comparative effectiveness study of breast-conserving surgery and mastectomy in the general popula- tion: a NCDB analysis. Oncotarget. 6:40127–40140CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Hofvind S, Holen Å, Aas T, Roman M, Sebuødegård S, Akslen LA (2015) Women treated with breast con- serving surgery do better than those with mastectomy independ- ent of detection mode, prognostic and predictive tumor characteristics. Eur J Surg Oncol 41:1417–1422CrossRefPubMed Hofvind S, Holen Å, Aas T, Roman M, Sebuødegård S, Akslen LA (2015) Women treated with breast con- serving surgery do better than those with mastectomy independ- ent of detection mode, prognostic and predictive tumor characteristics. Eur J Surg Oncol 41:1417–1422CrossRefPubMed
18.
Zurück zum Zitat Lagendijk M, van Maaren MC, Saadatmand S et al (2017) Breast con- serving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129,692 patients. Int J Cancer 142:165–175CrossRefPubMed Lagendijk M, van Maaren MC, Saadatmand S et al (2017) Breast con- serving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129,692 patients. Int J Cancer 142:165–175CrossRefPubMed
19.
Zurück zum Zitat Onitilo AA, Engel JM, Stankowski RV, Doi SAR (2015) Survival comparisons for breast conserving surgery and mastectomy revisited: community experience and the role of radiation therapy. Clin Med Res 13:65–73CrossRefPubMedPubMedCentral Onitilo AA, Engel JM, Stankowski RV, Doi SAR (2015) Survival comparisons for breast conserving surgery and mastectomy revisited: community experience and the role of radiation therapy. Clin Med Res 13:65–73CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Christiansen P, Carstensen SL, Ejlertsen B, Kroman N, Offersen B, Bodilsen A et al (2017) Breast conserving surgery ver- sus mastectomy: overall and relative survival—a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol (Madr) 57:19–25CrossRef Christiansen P, Carstensen SL, Ejlertsen B, Kroman N, Offersen B, Bodilsen A et al (2017) Breast conserving surgery ver- sus mastectomy: overall and relative survival—a population based study by the Danish Breast Cancer Cooperative Group (DBCG). Acta Oncol (Madr) 57:19–25CrossRef
21.
Zurück zum Zitat Poortmans PM, Collette S, Kirkove C, van Limbergen E, Budach V, Struikmans H, Collette L, Fourquet A, Maingon P, Valli M, de Winter K, Marnitz S, Barillot I, Scandolaro L, Vonk E, Rodenhuis C, Marsiglia H, Weidner N, van Tienhoven G, Glanzmann C, Kuten A, Arriagada R, Bartelink H, van den Bogaert W, EORTC Radiation Oncology and Breast Cancer Groups (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373:317–327CrossRefPubMed Poortmans PM, Collette S, Kirkove C, van Limbergen E, Budach V, Struikmans H, Collette L, Fourquet A, Maingon P, Valli M, de Winter K, Marnitz S, Barillot I, Scandolaro L, Vonk E, Rodenhuis C, Marsiglia H, Weidner N, van Tienhoven G, Glanzmann C, Kuten A, Arriagada R, Bartelink H, van den Bogaert W, EORTC Radiation Oncology and Breast Cancer Groups (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373:317–327CrossRefPubMed
Metadaten
Titel
Is Survival with Conservative Breast Therapy Becoming Superior to That with Modified Radical Mastectomy Alone for the Treatment of Early Breast Cancer in This Era?
verfasst von
Mona M. Sayed
Dalia O. Mohamed
Marwa S. F. Hassan
Mahmoud H. Elshoieby
Maha S. Elnaggar
Lamia M. Khallaf
Mayada F. Sedik
Salah M. Khallaf
Publikationsdatum
29.08.2020
Verlag
Springer India
Erschienen in
Indian Journal of Surgical Oncology / Ausgabe 1/2023
Print ISSN: 0975-7651
Elektronische ISSN: 0976-6952
DOI
https://doi.org/10.1007/s13193-020-01188-2

Weitere Artikel der Ausgabe 1/2023

Indian Journal of Surgical Oncology 1/2023 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.