Chest wall resection for locally recurrent breast cancer: is it worthwhile?
| Autor: | Downey RJ; Divisions of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. downeyr@mskcc.org, Rusch V, Hsu FI, Leon L, Venkatraman E, Linehan D, Bains M, van Zee K, Korst R, Ginsberg R |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2000 Mar; Vol. 119 (3), pp. 420-8. |
| DOI: | 10.1016/s0022-5223(00)70119-x |
| Abstrakt: | Objective: The effectiveness of chest wall resection for locally recurrent breast cancer as cancer treatment remains poorly defined, possibly because of the general impression that locally recurrent disease is a harbinger of rapidly progressive metastatic disease and that extensive surgical treatment in these patients is inappropriate. Reports to date have focused on technical feasibility, not long-term outcome. Methods: We reviewed our experience with 38 women who underwent chest wall resection for locally recurrent breast cancer between October 1987 and May 1997. Overall survival was calculated by the Kaplan-Meier method and the significance of prognostic variables evaluated by log-rank and Cox regression analyses. Results: The operative mortality rate was 0%. Overall survival at 1, 3, and 5 years after chest wall resection was 74%, 41%, and 18%, respectively, and the proportion of patients free of local recurrence at 1, 3, and 5 years was 59%, 42%, and 13%, respectively. Regional nodal disease and size of largest tumor nodule (>4 cm) were significant predictors of local re-recurrence (P <.01, P =.04); lymph node metastasis was the only predictor of long-term survival (P <.01). Patients with and without synchronous sites of metastatic disease had near-identical 3-year survivals. Conclusions: Chest wall resection for locally recurrent breast cancer has a low mortality. However, a significant number of patients have the development of local re-recurrence or metastases, and 5-year survival is limited. It is unlikely that complete resection of all locally recurrent disease improves survival. Future studies should focus on the quality of palliation achieved. |
| Databáze: | MEDLINE |
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