Margin Status Influence on the Outcome of Patients Treated with Breast Conserving Surgery

ME Akbari--- ,
M Akbari--- ,
H Zirakzadeh--- ,
N Nafisi--- ,
A Heidari--- ,
F Hosseinizadegan Shirazi---

Abstract


196

Background: Breast conserving surgery (BCS) followed by local radiotherapy is the standard treatment for early stage of breast cancer. Margin status may have an important impact on local recurrence and overall survival of patients treated with BCS, but this has not been defined adequately. In this study, we investigated the relationship between microscopic margins and outcome of BCS.

 

Methods: Three hundred eighty four patients treated with BCS between 1999 and

2010 were included in our study. All surgeries were performed by a single surgical team. Margins were defined as close if surgical margins were less than 2 mm, as free if surgical margins were more than 2 mm and as positive if malignant cells were present in one of the tissue edges. Demographic, clinical, and pathological factors as well as biological markers, recurrence, and survival rates were compared between the close and the free margins groups.

 

Results: The mean age of patients at the time of diagnosis was 54.2 years. There were 34 (9%) recurrence cases and overall survival was 128.7 months and ten years survival rate was 81%. There was no significant difference between the close and the free margins groups in terms of demographic parameters, tumor characteristics, biological factors (estrogen and progesterone receptor status) and lymphovascular invasion. Also recurrence rate did not differ significantly between these two groups.

 

Conclusion: Our study indicates that there is no significant difference between the patients with close and the free margins in terms of treatment results. There is no clear  consensus  in  the  surgeons’  community  over  the  definition  of  acceptable margin width in BCS, so additional studies are required to find the right answer.

Key words: Breast neoplasm; Breast-conserving surgery; Recurrence; Margin

 

References

1. Akbari  M  E  ,  Abachizadeh  K  ,  Khayamzadeh  M

,Tabatabaee M , Esnaashari FG , Motlagh A ,et al. Cancer

in Iran. Qom: Darolfekr, In Persian; 2008.

2. Baselga  J,  Mendelsohn  J.  The  epidermal  growth factor  receptor  as  a  target  for  therapy  in  breast

carcinoma.    Breast    Cancer    Res    Treat.   1994    Jan;

29(1):127-38.

3. Naghavi   M.   Iranian   annual   of   national   death registration report. Ministry of Health and Medical Education, 2005.

4. Ministry  of  Health  and  Medical  Education,  Health

deputy. National Burden of Disease and Injury in I.R.Iran,

2006.

5. Jordan    VC.   SERMs:   meeting   the    promise    of multifunctional medicines. J Natl Cancer Inst. 2007 Mar 7;

99(5):350-6.

6. Fisher  B,  Anderson  S,  Bryant  J,  Margolese  RG,

Deutsch M, Fisher ER, et al. 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. 2002

Oct 17; 347(16):1233-41.

7. Blichert-Toft M, Nielsen M, Düring M, Møller S, Rank

F, Overgaard M, et al. Long-term results of breast conserving surgery vs. mastectomy for early stage invasive breast            cancer:   20-year      follow-up               of             the  Danish randomized  DBCG-82TM  protocol.  Acta  Oncol.  2008;

47(4):672-81.

8. Akbari ME, Khayamzadeh M, Khoshnevis SJ, Nafisi N, Akbari A. Five and ten years survival in breast cancer patient's mastectomies vs. breast conserving surgeries personal experience. Iran J Cancer Prev. 2008; 1(2):53-6.

9. Early  Breast Cancer  Trialists'  Collaborative  Group. Radiotherapy         for        early     breast    cancer.   Cochrane Database Syst Rev. 2002 ;( 2):CD003647.

10. Clarke M, Collins R, Darby S, Davies C, Elphinstone

P,  Evans  E,  et  al.  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. 2005 Dec 17;

366(9503):2087-106.

11. Freedman G, Fowble B, Hanlon A, Nicolaou N, Fein

D, Hoffman J, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy.  Int  J  Radiat  Oncol  Biol  Phys.  1999  Jul  15;

44(5):1005-15.

12. Kunos C, Latson L, Overmoyer B, Silverman P, Shenk

R,   Kinsella   T,   et   al.   Breast   conservation   surgery


achieving>or=2    mm   tumor-free    margins    results    in decreased local-regional recurrence rates. Breast J. 2006

Jan-Feb; 12(1):28-36.

13. Vargas  C,  Kestin  L,  Go  N,  Krauss  D,  Chen  P,

Goldstein N, et al. Factors associated with local recurrence and   cause-specific   survival   in   patients   with   ductal carcinoma in situ of the breast treated with breast- conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys. 2005 Dec 1; 63(5):1514-21.

14. Singletary  SE.  Surgical  margins  in  patients  with early-stage breast    cancer    treated  with       breast conservation therapy. Am J Surg. 2002 Nov; 184(5):383-

93.

15. Olson TP, Harter J, Muñoz A, Mahvi DM, Breslin T. Frozen       section   analysis  for        intraoperative     margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol.

2007 Oct; 14(10):2953-60.

16. Noguchi  M,  Minami  M,  Earashi  M,  Taniya  T,

Miyazaki I, Mizukami Y, Pathologic Assessment of Surgical Margins on Frozen and Permanent Sections in Breast Conserving   Surgery.   Breast   Cancer.   1995   Apr   30;

2(1):27-33.

17. Jobsen JJ, Van Der Palen J, Ong F, Meerwaldt JH. Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast- conserving therapy. Acta Oncol. 2007; 46(2):172-80.

18. Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JC, Jager JJ, et al. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer. 2003 May; 39(7):932-44.

19. Dillon  MF,  Hill  AD,  Quinn  CM,  McDermott  EW, O'Higgins N. A pathologic assessment of adequate margin status in breast-conserving therapy. Ann Surg Oncol. 2006

Mar; 13(3):333-9.

20. Akbari ME, Mozaffar M, Heidari A, Zirakzadeh H, Akbari         A,         Akbari   M,         Hosseinizadegan  Shirazi   F. Recurrence and Survival Effect in Breast Conserving Surgery: What are the Predictive and/or Prognostic Factors? 2011 spring; 4(2): 49-54.

21. Kurtz   JM,   Amalric   R,   Brandone   H,   Ayme   Y,

Jacquemier J, Pietra JC, et al. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time  course,  and  prognosis.  Cancer.  1989  May  15;

63(10):1912-7.

22. Silverstein  MJ,  Barth  A,  Poller  DN,  Gierson  ED, Colburn   WJ,   Waisman   JR,   et   al.   Ten-year   results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer.

1995; 31A (9):1425-7.

23. Solin  LJ,  Recht  A,  Fourquet  A,  Kurtz  J,  Kuske  R,

McNeese M, et al. Ten-year results of breast-conserving surgery           and       definitive            irradiation          for        intraductal carcinoma (ductal carcinoma in situ) of the breast. Cancer.

1991 Dec 1; 68(11):2337-44.

24. Dunne C, Burke JP, Morrow M, Kell MR. Effect of

margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009 Apr 1; 27(10):1615-20.


25. Houssami N, Macaskill P, Marinovich ML, Dixon JM, Irwig L, Brennan ME, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early- stage invasive breast cancer treated with breast- conserving           therapy. Eur        J                  Cancer.      2010 Dec;

46(18):3219-32.

26. Fisher  B,  Redmond  C,  Poisson  R,  Margolese  R, Wolmark N, Wickerham L, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989 Mar 30; 320(13):822-

8.

27. van Dongen JA, Bartelink H, Fentiman IS, Lerut T,

Mignolet F, Olthuis G, et al. Factors influencing local relapse  and  survival  and  results  of  salvage  treatment after   breast-conserving   therapy   in   operable   breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and I1 breast cancer. Eur J Cancer. 1992; 28A (4-5):801-5.

28. Taghian  A,  Mohiuddin  M,  Jagsi  R,  Goldberg  S, Ceilley E, Powell S. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005 Apr; 241(4):629-39.

29. Hardy  K,  Fradette  K,  Gheorghe  R,  Lucman  L, Latosinsky  S.  The  impact  of  margin  status  on  local


recurrence   following   breast   conserving   therapy   for invasive carcinoma in Manitoba. J Surg Oncol. 2008 Nov

1; 98(6):399-402.

30. Zavagno G, Goldin E, Mencarelli R, Capitanio G,

Del Bianco P, Marconato R, et al. Role of resection margins in patients treated with breast conservation surgery. Cancer. 2008 May 1; 112(9):1923-31.

31. Luini   A,   Rososchansky   J,   Gatti   G,   Zurrida   S, Caldarella P, Viale G, et al. The surgical margin status

after  breast-conserving  surgery:  discussion  of  an  open issue. Breast Cancer Res Treat. 2009 Jan; 113(2):397-

402.

32. Park CC, Mitsumori M, Nixon A, Recht A, Connolly J,

Gelman R, et al. Outcome at 8 years after breast- conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy  on  local  recurrence.  J  Clin  Oncol.  2000  Apr;

18(8):1668-75.

33. Landis SH, Murray T, Bolden S, Wingo PA. Cancer

statistics, 1998. CA Cancer J Clin. 1998 Jan-Feb; 48(1):6-

29.

34. Nomura K, Sobue T, Nakatani H, Maehara H.Cancer statistics in Japan 2005.Tokyo-Japan foundation for promotion cancer research, 2005.


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