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Fowble B , Yeh IT , Schultz DJ , Solin LJ , Rosato EF , Jardines L , Hoffman J , Eisenberg B , Weiss MC , Hanks G
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. 1993 Oct 20;27(3) :567-573
AbstractPurpose: Women with Stage I-II invasive breast cancer who present with gross multicentric disease or diffuse microcalcifications have a significant risk of breast recurrence when treated with conservative surgery and radiation. The purpose of this report is to present the results of mastectomy in this group of patients. Methods and Materials: Between 1982 and 1989, 88 patients with clinical Stage I-II breast cancer who presented with clinical and mammographic evidence of gross multicentric disease or diffuse microcalcifications underwent modified radical mastectomy. Median followup was 4 years for the 57 patients with gross multicentric disease and 5.6 years for 31 patients with diffuse microcalcifications. At the time of mastectomy, 42% of patients were found to have positive axillary nodes. Following mastectomy, 15 patients received post mastectomy radiation and 35 patients received adjuvant systemic chemotherapy. Results: When compared to a group of 1295 patients with unifocal Stage I-II breast cancer, treated with conservative surgery and radiation during the same time period, patients with gross multicentric disease and diffuse microcalcifications had a significantly higher incidence of greater-than-or-equal-to 4 positive nodes, patients with gross multicentric disease had a lower incidence of positive resection margins following mastectomy and patients with diffuse microcalcifications were younger. The 5-year actuarial risk of an isolated local- regional recurrence was 8% for patients with gross multicentric disease or diffuse microcalcifications and 7% for patients with unifocial disease. Patients with gross multicentric disease or diffuse microcalcifications and greater-than-or-equal-to 4 positive axillary nodes who did not receive post mastectomy radiation had an increased risk for local regional recurrence. There were no significant differences in the 5-year actuarial overall or relapse-free survival (88% and 73% gross multicentric disease, 97% and 86% diffuse microcalcifications and 90% and 79% unifocal disease), freedom from distant metastasis (76% gross multicentric disease, 90% diffuse microcalcifications, 86% unifocal disease) or incidence of contralateral breast cancer (10% gross multicentric 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 multicentric disease or diffuse microcalcifications undergoing mastectomy in contrast to the increased risk of breast recurrence in patients with gross multicentric disease undergoing conservative surgery and radiation. Indications for post mastectomy radiation include greater-than-or-equal-to 4 positive nodes or close or positive surgical margins. Despite a significantly higher incidence of greater-than-or-equal-to 4 positive nodes, patients with gross multicentric disease and diffuse microcalcifications have a 5-year actuarial overall and relapse-free survival comparable to a group of patients with unifocal disease treated with conservative surgery and radiation.
NotesTimes Cited: 14 English Article MF620 INT J RADIAT ONCOL BIOL PHYS