CHEST WALL RESECTION FOR LOCOREGIONAL RECURRENCE OF BREAST CANCER

A FEASIBLE AND EFFECTIVE

Authors

Keywords:

breast neoplasm, neoplasm recurrence, local, neoplasm recurrence, localthoracic surgery, survival

Abstract

Objective: The aim of this study was to evaluate survival after chest wall resection for breast cancer locoregional recurrence. Secondary endpoints were symptomatic control and safety of the procedure. Method: This was a retrospective review including all patients who underwent chest wall resection for breast cancer local recurrence at the Division of Thoracic Surgery of the School of Medicine of São Paulo University, from January 1998 to November 2011. Full thickness chest wall resection involving bones and/or soft tissues was performed to achieve macroscopical free margins. Results: Eighteen patients were included in this study with a mean followup of 83.5 months. The interval between mastectomy and chest wall recurrence (CWR) was 4.2 years (0.5 to 9 years). The resection was complete in 12 patients (66%) and incomplete in 6 (33%), in whose resection would involve amputation of an upper limb. Mean tumor size was 8.25 cm and resection of the costal arch was necessary in 10 patients. There was no operation death and after two years, 66% of patients were alive. Six patients died due to distant recurrence of breast cancer on patients who died to inflammatory acute abdomen. The mean survival among patients who died was 25.2 months (12 to 42 months). At the last follow-up visit, eleven patients were alive. Conclusion: CWR for locally recurrent breast cancer is feasible and safe in selected patients, who did not develop metastatic disease, allowing good quality of life for a considerable period. Larger and prospective series are needed to endorse our findings.

Downloads

Download data is not yet available.

Author Biographies

Bruna Salani Mota, Universidade de São Paulo

Gynecology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo

Fernando Conrado Abrão, Universidade Federal de São Paulo

Thoracic Surgery Department, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo

Maíra Teixeira Dória, Universidade Federal de São Paulo

Gynecology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo

Alexandre Mendonça Munhoz, Universidade Federal de São Paulo

Plastic Surgery Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo

References

Luini A, Gatti G, Zurrida S, Talakhadze N, Brenelli F, Gilardi D, et al. The evolution of the conservative approach to breast cancer. Breast. 2007;16(2):120-9. https://doi.org/10.1016/j.breast.2006.11.001

Piato JR, Barros AC, Pincerato KM, Sampaio AP, Pinotti JA. Sentinel lymph node biopsy in breast cancer after neoadjuvant chemotherapy. A pilot study. Eur J Surg Oncol. 2003;29(2):118-20.

van der Pol CC, van Geel AN, Menke-Pluymers MB, Schmitz PI, Lans TE. Prognostic factors in 77 curative chest wall resections for isolated breast cancer recurrence. Ann Surg Oncol. 2009;16(12):3414-21. https://doi.org/10.1245/s10434-009-0662-7

Fisher B, Slack NH, Cavanaugh PJ, Gardner B, Ravdin RG. Postoperative radiotherapy in the treatment of breast cancer: results of the NSABP clinical trial. Ann Surg. 1970;172(4):711-732.

Probstfeld MR, O’Connell TX. Treatment of locally recurrent breast carcinoma. Arch Surg. 1989;124(10):1127-30. https://doi.org/10.1001/archsurg.1989.01410100025005

Le MG, Arriagada R, Spielmann M, Guinebretiere JM, Rochard F. Prognostic factors for death after an isolated local recurrence in patients with early-stage breast carcinoma. Cancer. 2002;94(11):2813-20. https://doi.org/10.1002/cncr.10572

Borner M, Bacchi M, Goldhirsch A, Greiner R, Harder F, Castiglione M, et al. First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research. J Clin Oncol. 1994;12(10):2071-7. https://doi.org/10.1200/JCO.1994.12.10.2071

Skoracki RJ, Chang DW. Reconstruction of the chestwall and thorax. J Surg Oncol. 2006;94(6):455-65. https://doi.org/10.1002/jso.20482

Slavin SA, Love SM, Goldwyn RM. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps. Plast Reconstr Surg. 1994;93(6):1191-204; discussion 1205-7.

Arruda EG, Munhoz AM, Montag E, Filassi JR, Gemperli R. Immediate chest wall reconstruction during pregnancy: surgical management after extended surgical resection due to primary sarcoma of the breast. J Plast Reconstr Aesthet Surg. 2014;67(1):115-8. https://doi.org/10.1016/j.bjps.2013.06.007

Munhoz AM, Montag E, Arruda E, Okada A, Brasil JA, Gemperli R, et al. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap. Plast Reconstr Surg. 2011;127(6):2186-97. https://doi.org/10.1097/PRS.0b013e318213a038

Kamby C, Sengelov L. Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer. A prospective study with more than 10 years of follow up. Breast Cancer Res Treat. 1997;45(2):181-92.

Downey RJ, Rusch V, Hsu FI, Leon L, Venkatraman E, Linehan D, et al. Chest wall resection for locally recurrent breast cancer: is it worthwhile? J Thorac Cardiovasc Surg. 2000;119(3):420-8.

Nielsen HM, Overgaard J, Grau C, Christensen JJ, Overgaard M. Audit of the radiotherapy in the DBCG 82 b&c trials--a validation study of the 1,538 patients randomised to postmastectomy radiotherapy. Radiother Oncol. 2005;76(3):285-92. https://doi.org/10.1016/j.radonc.2005.08.002

Schwaibold F, Fowble BL, Solin LJ, Schultz DJ, Goodman RL. The results of radiation therapy for isolated local regional recurrence after mastectomy. Int J Radiat Oncol Biol Phys. 1991;21(2):299-310.

Snyder AF, Farrow GM, Masson JK, Payne WS. Chest-wall resection for locally recurrent breast cancer. Arch Surg. 1968;97(2):246-53.

Rauschecker H, Clarke M, Gatzemeier W, Recht A. Systemic therapy for treating locoregional recurrence in women with breast cancer. Cochrane Database Syst Rev. 2001(4):CD002195. https://doi.org/10.1002/14651858.CD002195

Downloads

Published

2019-04-05

How to Cite

Mota, B. S., Piato, J. R., Abrão, F. C., Dória, M. T., Ricci, M. D., Munhoz, A. M., & Filassi, J. R. (2019). CHEST WALL RESECTION FOR LOCOREGIONAL RECURRENCE OF BREAST CANCER: A FEASIBLE AND EFFECTIVE. Mastology, 29(2), 108–113. Retrieved from https://revistamastology.emnuvens.com.br/revista/article/view/588

Issue

Section

Surgical Technique