breast conservation therapy
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Indications
- primary therapy* for most women with stage 1 or 2 breast cancer (initial mean tumor size of 1.47 cm)[3]
* Outcomes equivalant to mastectomy
Contraindications
- absolute contraindications
- patients with multicentric breast malignancies or diffuse microcalcifications on mammography
- predictable unacceptable cosmetic result
- prior radiation treatment for Hodgkin's lymphoma* or other prior history of cumulative radiation in the field of proposed radiation therapy
- pregnancy (unless radiotherapy can be delayed until after delivery)
- repeated positive margins after resection attempts
- relative contraindications
- connective tissue disease, especially scleroderma
- large tumor in a small breast
- large pendulous breasts may lead to technical problems with establishing reproducible radiation field
Procedure
- lumpectomy may be combined with radiation* (4500-5000 cGy [mega voltage radiation])
- sentinal lymph node biopsy
- axillary dissection does not improve outcomes, & increases risk of complications
- 23% of women undergo reexcision on the affected breast[3]
- positive margins after first procedure: 14%[3]
- total mastectomy required in 8.5% of patients[3]
* cumulative dose of radiation recommended for breast-conserving therapy plus that previously received for treatment of Hodgkin's disease exceeds tolerance of normal tissue
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 667
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ 3.0 3.1 3.2 3.3 3.4 Jeevan R et al Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics BMJ 2012;345:e4505 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22791786 <Internet> http://www.bmj.com/content/345/bmj.e4505