ObjectiveTo systematically evaluate the efficacy, cosmetic outcome and adverse reaction of hypofractionation radiotherapy (HRT) versus conventional radiotherapy (CRT) for early stage breast cancer after breast conserving surgery. MethodsThe databases including CNKI, CBM, VIP, PubMed, EMbase and The Cochrane Library (Issue 1, 2015) were searched from the inception to May 2015 to collect the randomized controlled trials (RCTs) related to HRT versus CRT for early stage breast cancer after breast conserving surgery. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsSix RCTs involving 8 240 patients were included. Meta-analyses results showed, there were no statistical differences between the HRT group and the CRT group in local-regional recurrence rate (5 year: RR=1.01, 95%CI 0.73 to 1.40, P=0.94; 10 year: RR=1.04, 95%CI 0.86 to 1.26, P=0.67), mortality (5 year: RR=0.95, 95%CI 0.85 to 1.08, P=0.45; 10 year: RR=0.97, 95%CI 0.86 o 1.09, P=0.61), photographic breast appearance (RR=0.98, 95%CI 0.91 to 1.05, P=0.56), the incidence of lung fibrosis (5 year: RR=1.07, 95%CI 0.66 to 1.72, P=0.78; 10 year: RR=1.05, 95%CI 0.62 to 1.77, P=0.86), the incidence of rib fracture (5 year: RR=1.00, 95%CI 0.60 to 1.68, P=0.99; 10 year: RR=1.19, 95%CI 0.70 to 2.00, P=0.52), and the incidence of ischemic of heart (5 year: RR=0.88, 95%CI 0.54 to 1.45, P=0.62; 10 year: RR=0.86, 95%CI 0.54 to 1.37, P=0.53). ConclusionHRT could provide similar tumor control as CRT without serious toxicity. Meanwhile HRT is superior to CRT in terms of patient convenience and costs, it should be promoted as adjuvant treatment for early stage breast cancer after breast conserving surgery.
ObjectiveTo assess the cosmetic outcomes and adverse events of MammoSite balloon brachytherapy for Accelerated Partial Breast Irradiation following breast-conserving surgery for patients with early stage breast cancer. MethodsWe searched PubMed, EMbase, Chinese Biomedical Database, Chinese Studies Online, China Journal Full-text Database up to March 2016, to collect clinical trials about MammoSite balloon brachytherapy following breast-conserving surgery for early stage breast cancer. And meta-analyses were performed by OpenMeta and Stata softwares. ResultsTwenty trials involving 3 796 patients were enrolled. The single arm meta-analysis results showed that:the cosmetic results were rated as excellent to good in 93% (95%CI 0.91 to 0.96), and the 5-year incidence of ipsilateral breast tumor recurrence (IBTR) was 3% (95%CI 0.020 to 0.040). ConclusionTo carry out the conclusion above, we still need controlled trials, especially randomized controlled trials (RCTs) to prompt further verification.
Objective To explore the clinical application of tissue flap in repairing the residual cavity formed by breast conserving surgery. Methods Retrospective analysis for clinical data of 120 early breast cancer patients who received breast conserving surgery in our hospital from January 2013 to December 2016 was performed. Among them, 60 cases (observation group) were implemented tissue flap repairing operation while the other 60 cases (control group) were operated by using the traditional surgery method. The clinical data of the two groups were compared analytically in four aspects: postoperative complications, postoperative breast beauty, subjective satisfaction of patients, and postoperative recurrence and metastasis. Results ① Postoperative complications: 3 cases of complications occurred in the control groupand 2 cases in the observation group, and there was no significant difference in the incidence of complications between the 2 groups (χ2=0.209, P=0.648). ② Postoperative breast beauty: in the control group, there were 23 excellent cases, 16 good cases, 12 common cases, and 9 poor cases; in the observation group, there were 51 excellent cases, 5 good cases, 3 common cases, and 1 poor cases. The difference of postoperative breast beauty between the 2 groups was statistically significant (Z=–5.234, P<0.001). ③ Subjective satisfaction of patients: in the control group, 28 cases very satisfied, 18 cases satisfied, 12 cases generally satisfied, and 2 cases dissatisfied; in the observation group, 40 cases satisfied, 18 cases very satisfied, and 2 cases generally satisfied. The subjective satisfaction of the patients in the observation group was better than that of the control group (Z=–4.381, P<0.001). ④ Postoperative follow-up: no recurrence and death occurred in both of 2 groups, but 2 cases occurred metastasis in the control group and 1 case in the observation group. The contrast difference in the incidence of metastasis was not statistically significant (χ2=0.342, P=0.559). Conclusion During breast conserving surgery, the use of surrounding tissue flap to repair residual cavity, compared with traditional breast conserving surgery without tissue flap repairment, does not increase postoperative complications, recurrence, and metastasis, and it has good cosmetic effect after breast surgery, as well as the patients’ subjective satisfaction is good.
ObjectiveTo investigate the prognosis after breast conserving surgery (BCS) and modified radical mastectomy (MRM) in patients with stage Ⅰ–Ⅱ breast cancer, and analyze the factors related to locoregional recurrence (LRR).MethodsThe clinicopathologic and prognostic data of patients with stage Ⅰ–Ⅱ breast cancer who underwent the surgical treatment in the First Affiliated Hospital of Chongqing Medical University from January 2011 to December 2014 were analyzed. The clinicopathologic characteristics and prognostic differences of the BCS group and MRM group were compared. The factors related to LRR of patients underwent the BCS and MRM were analyzed.ResultsA total of 1 330 patients with stage Ⅰ–Ⅱ breast cancer were included in this study, including 230 in the BCS group and 1 100 in the MRM group. Compared with the MRM group, the patients in the BCS group had higher height (P<0.001), younger age (P<0.001), smaller tumor diameter (P<0.001), and less axillary lymph node metastasis (P<0.001). Up to August 2019, 149 cases (18 cases in the BCS group and 131 cases in the MRM group) were lost, with a follow-up rate of 88.8%. The median follow-up time was 71 months (4－103 months). The LRR rate of the BCS group was higher than that of the MRM group (6.1% versus 2.5%, χ2=7.002, P<0.01). The locoregional recurrence-free survival of the MRM group was better than that of the BCS group (χ2=7.886, P<0.01). However, there were no statistical differences between the two groups in terms of the distant metastasis-free survival and disease-free survival (P>0.05). In the patients underwent the BCS, the HER-2 was associated with the LRR (P<0.05), and the axillary lymph node metastasis was associated with the LRR in the patients underwent the MRM (P<0.05).ConclusionsAccording to results of this study, although there is a significant difference in locoregional recurrence-free survival between BCS group and MRM group in patients with stage Ⅰ–Ⅱ breast cancer, there are no statistical differences in distant metastasis-free survival and disease-free survival between the two groups. Therefore, it is safe and feasible for choosing appropriate patients with stage Ⅰ–Ⅱ breast cancer to underwent breast-conserving treatment.
ObjectiveTo investigate the safety, economic benefits and psychological effects of day breast conserving surgery for breast cancer. MethodsThe demographic data and clinical data of breast cancer patients undergoing day (day surgery group) and ward (ward surgery group) breast conserving surgeries in West China Hospital of Sichuan University from March 2020 to June 2021 were retrospectively collected; the demographic data, clinical data, medical and related transportation costs, and preoperative and postoperative BREAST-Q scores of breast cancer patients undergoing day (day surgery group) and ward (ward surgery group) breast conserving surgery in West China Hospital of Sichuan University from July 2021 to May 2022 were prospectively collected. The safety, economic benefit, and psychological satisfaction of day surgery was analyzed ResultsA total of 42 women with breast cancer were included in the retrospective study and 39 women with breast cancer were included in the prospective study. In both prospective and retrospective studies, the mean age of patients in both groups were <50 years. There were only statistical differences between the two groups in the aspects of hypertension (P=0.022), neoadjuvant chemotherapy (P=0.037) and postoperative pathological estrogen receptor (P=0.033) in the prospective study. In postoperative complications, there were no statistical differences in the surgical-related complications or anesthesia-related complications between the two groups in either the prospective study or the retrospective study (P>0.05). In terms of the overall cost, we found that the day surgery group was more economical than the ward surgery group in the prospective study (P=0.002). There were no statistical differences in postoperative psychosocical well-being, sexual well-being, satisfaction with breasts and chest condition between the two groups (P>0.05). ConclusionIt is safe and reliable to carry out breast conserving surgery in day surgery center under strict management standards, which can save medical costs and will not cause great psychological burden to patients.
ObjectiveTo explore the clinical efficacy of volume displacement techniques for breast defects following breast conserving surgery. MethodsAfter inclusion and exclusion, the patients with breast defects following breast conserving surgery in the Minda Hospital of Hubei Minzu University from February 2013 to March 2020 were retrospectively enrolled, and were assigned into a volume displacement group and volume replacement group according to different surgical techniques. Then the outcomes were compared between the two groups, including short-term efficacy (incision length, operation time, intraoperative blood loss, volume of resected specimen, cosmetic effect, patients’ subjective satisfaction, total postoperative complications, and total hospitalization time) and long-term efficacy (local recurrence rate, 3-year tumor-free survival, and 3-year overall survival). ResultsA total of 208 eligible patients were included in this study, including 105 in the volume displacement group and 103 in the volume replacement group before propensity score matching (PSM); after PMS, a total of 62 patients were enrolled, including 33 in the volume displacement group and 29 in the volume replacement group. No statistical difference was reported in the baseline data between two groups (P>0.05), except that the maximum diameter of lesion in the volume displacement group was smaller than that in the volume replacement group (P<0.05). The incision length, operation time, total hospitalization time, total postoperative complication rate, local recurrence rate, 3-year tumor-free survival rate, and 3-year overall survival rate had no statistical differences between the two groups (P>0.05), whereas the intraoperative blood loss was less (t=3.294, P=0.002) and the volume of resected specimen was smaller (t=2.030, P=0.047) in the volume displacement group as compared with the volume replacement group, and the cosmetic effect and patients’ subjective satisfaction were better in the volume displacement group as compared with the volume replacement group (Z=2.297, P=0.022; Z=2.256, P=0.024). ConclusionThe study analysis with small size samples reveals that volume displacement technique for breast defects following breast conserving surgery can achieve a good cosmetic effect and high patients’ subjective satisfaction without increasing risk of postoperative complications and tumour recurrence, which demonstrates a good long-term efficacy profile.
ObjectiveTo compare the effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery (SMPSL-BCS) in treating early-stage breast cancer patients with tumors in different quadrants. Methods A retrospective analysis was conducted on 200 early-stage breast cancer female patients admitted between January 2023 and December 2023. According to the quadrant where the tumor was located, the patients were allocated into the upper outer quadrant group (UO group), lower outer quadrant group (LO group), upper inner quadrant group (UI group), and lower inner quadrant group (LI group), with 50 cases in each group. There was no significant difference (P>0.05) in the baseline data, including age, body mass index, smoking history, marital status, comorbidities, affected breast side, maximum tumor diameter on ultrasound, maximum pathological tumor diameter, clinical tumor stage, molecular subtype, and disease duration. The operation time, intraoperative blood loss, postoperative drainage volume, and extubation time were recorded and compared between groups. Additionally, the occurrence of early-stage complications (1-3 months after operation; including subcutaneous fluid accumulation, incision infection, superficial skin burns) and late-stage complications (>3 months after operation; including pectoralis major muscle adhesion, changes in breast appearance and shape, sensory discomfort) were assessed. At 6 months after operation, the cosmetic outcome of breast-conserving surgery was rated for all groups. Results The UO group had the shortest operation time, followed by the UI group, LO group, and LI group, showing significant differences between groups (P<0.05). The UO group had the least intraoperative blood loss, followed by the LO group, UI group, and LI group; except for the difference between UO group and LO group, which was not significant (P>0.05), the differences between the other groups were significant (P<0.05). The UO group had the least postoperative drainage volume, followed by the LO group, UI group, and LI group; except for the difference between LO group and UI group, which was not significant (P>0.05), the differences between the other groups were significant (P<0.05). The extubation time of the LI group was significantly longer than that of the other groups (P<0.05). All patients were followed up 4-12 months, with an average of 8 months. And 193 patients were followed up more than 6 months, including 48 patients in UO group, 47 in LO group, 49 in UI group, and 49 in LI group. In the early-stage period, the LI group had a higher incidence of subcutaneous fluid accumulation after tube removal compared to the UO group and LO group (P<0.05), while there was no significant difference in the incidences of other early complications between groups (P>0.05). In the late-stage period, the LI group had significantly higher incidences of pectoralis major muscle adhesion and changes in breast appearance and shape than UO group and LO group (P<0.05), and a significantly higher incidence of sensory discomfort than UO group (P<0.05). There was no significant difference in the incidences of other late-stage complications between groups (P>0.05). At 6 months after operation, the cosmetic outcomes of breast-conserving surgery were significantly better in UO group, LO group, and UI group than in LI group (P<0.05); there was no significant difference between the other groups (P>0.05). Conclusion In the treatment of early-stage breast cancer using SMPSL-BCS, patients with tumors located in the upper outer quadrant show the best effectiveness. The effectivenesses are similar for patients with tumors in the lower outer and upper inner quadrants. However, patients with tumors in the lower inner quadrant do not experience significant advantages. Therefore, it is recommended that SMPSL-BCS should not be the first-choice surgical method for patients with tumors in the lower inner quadrant.