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0107 Outcomes of immediate reconstruction with absorbable polypropylene mesh in breast conserving surgery for early breast cancer
S46
Poster Session I. Radiotherapy/IORT
0107
Outcomes of immediate reconstruction with absorbable polypropylene mesh in breast conserving surgery for early breast cancer
C. Yom1 , Y. Park1 , W. Bae1 , M. Koo2 , B. Moon2 . 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 2 Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea Goals: As early breast cancer increases, the cosmetic outcomes are getting more and more attention. There are various kinds of reconstruction methods including implant, flap surgery, and even autologous fat injection. The aim of this study is to evaluate the immediate and long-term outcome of absorbable polypropylene mesh in breast cancer. Methods: From July 2005 until November 2008, 64 patients who underwent breast conserving operation for breast cancer with immediate absorbable polypropylene mesh insertion at Sungkyunkwan University Kangbuk Samsung Hospital were enrolled in this study. We divided the patients into two groups according to follow-up period. Group A was defined by patients with follow-up duration less than 1 year and Group B more than 1 year. The cosmetic outcomes including symmetricity, shape, volume, nipple–areolar status, subjective satisfaction by grading system (excellent, fair, poor) with scoring (1−5) were investigated. Results: Mean age was 44.9±10.2 years old (range 18−70). Final diagnosis was invasive cancers in 47 (73.4%) patients including ductal, mucinous and medullary type, and carcinoma in situ of ductal and papillary type in 14 (21.9%) patients. One of dermatofibrosarcoma protuberans and 2 malignant phyllodes patients were included. Group A was 21 cases (32.8%) and Group B was 43 cases(67.2%). In one patient, excessive seroma developed postoperatively and repetitive aspiration was required during the following year. No case of infection was observed. Excellent cosmetic result was revealed in 80.9% of Group A and 86.0% of Group B. Poor result was seen in only 1 case (4.8%) of Group A. Conclusion: Although the number of the patients and follow-up periods were limited, our data suggest that immediate reconstruction using absorbable polypropylene mesh for early breast cancer shows outstanding cosmetic result without increasing operative morbidity. We expect that future prospective randomized analysis may provide solid evidence for present study.
0108
Early result: Volume replacement with Polyglatin910 mesh for breast reconstruction after endoscopic breast conservative surgery of early breast cancer
H. Shin1 , J. Lee1 , H. Park2 , B. Moon3 . 1 Breast surgery, Myungji Hospital Kwandong University College of Medicine, Koyang, Kyunggi, 2 Breast surgery, Gachon University of Medical and Science, Incheon, 3 Breast surgery, School of Medicine, Ewha Womans University, Seoul, South Korea Goals: We introduce a new technique using a Vicryl mesh made with Polyglatin910 for breast reconstruction after breast conserving surgery. Methods: Fourteen patients that underwent endoscopic breast conserving surgery and reconstruction (volume replacement with the use of a Vicryl mesh) were evaluated for quality of life (QOL), surgery related complications and cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to resection margin positive disease. Results: The patient ages ranged from 37 to 66 years (mean age, 50.3 years) and all of the patients had an early breast cancer diagnosis (less than stage 2b). In general, the patients were satisfied with the outcome concerning quality of life. The patients were especially satisfied with the cosmetic outcome. Satisfaction increased with longer follow-up compared to shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within tissue fluid collection as seen on ultrasonography. At 20 months after surgery, the skin and breast shape recovered. Conclusion: The results of this study have shown that with a relatively short follow-up period breast reconstruction with Polyglatin910 mesh made from oxidized regenerated cellulose has resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.
Thursday, 12 March 2009
Thursday, 12 March 2009
Radiotherapy/IORT 0110
Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy
P. Karlsson1 , B.F. Cole1 , M. Colleoni1 , M. Roncadin1 , B. Chua1 , G. Gruber1 . 1 International Breast Cancer Study Group, Bern, Switzerland Goals: To evaluate the association between timing of radiotherapy (RT) and clinical outcome (local recurrence, disease-free survival and overall survival) among patients treated with adjuvant endocrine therapy and breast conserving surgery. Methods: Patient information was obtained from IBCSG Trials VII, VIII and IX. Analysis was restricted to treatment groups receiving adjuvant endocrine therapy. Patients were divided into two groups based on the median number of days from surgery until RT, as well as into four groups based on the time from surgery until RT as follows: 8 weeks, >8 to 16 weeks, >16 to 24 weeks, and >24 weeks. Endpoints were time to local recurrence, disease-free survival (DFS) and overall survival (OS). These were measured both from randomization and from the start of RT. The latter represents a landmark analysis which accounts for the fact that the time to event must exceed the number of days from surgery until RT. The RT-timing groups were compared using standard survival analysis techniques. Proportional hazards regression analysis was used to perform comparisons after adjustment for baseline factors. Results: 964 patients with breast conserving surgery and adjuvant radio- and endocrine therapy were available for analysis. The mean number of days from surgery until start of RT was 84 days, with a median of 77 days (standard deviation: 45 days). RT timing was significantly associated with a number of baseline factors, including age, menopausal status, estrogenreceptor status, and vessel invasion. After adjustment for these factors, no significant effect of RT timing was found. Adjusted hazard ratios (shorter interval between surgery and RT relative to longer interval) are 0.94 (95% confidence interval [CI]: 0.47 to 1.87; p = 0.86) for local recurrence, 1.05 (95 CI: 0.82 to 1.34; p = 0.73) for DFS, and 1.07 (95 CI: 0.77 to 1.49; p = 0.67) for OS. The actuarial 10-year local-relapse-free rates were 94% among patients beginning RT within 77 days of surgery and 95% for patients beginning RT more than 77 days after surgery. Conclusion: RT timing is significantly associated with baseline factors such as age, menopausal status, estrogen-receptor status, and vessel invasion. After adjustment for these factors, RT timing was not significantly associated with time to local relapse, DFS or OS.
0111
Soreness and sensitivity to sun exposure 10 to 16 years after breast cancer radiotherapy − a randomized study
D. Lundstedt1 , M. Gustafsson2 , P. Malmstrom ¨ 3 , U. Olofsson4 , E. Holmberg5 , H. Anderson6 , G. Steineck4 , P. Karlsson1 . 1 Oncology, 2 Radiophysics, Sahlgrenska University Hospital, Goteborg, 3 Oncology, ¨ Lund University Hospital, Lund, 4 Clinical Cancer Epidemiology, Sahlgrenska Academy, 5 Oncologic Centre, Sahlgrenska University 6 Oncologic Centre, Lund University Hospital, Lund, ¨ Hospital, Goteborg, Sweden Goals: There is some information on breast-radiotherapy toxicity but we lack data on long-term adverse effects regarding quality of life based on a randomized study. Methods: Between 1991 and 1997, 1187 women with stage I−II lymph node negative breast cancer were randomized in a Swedish study of breast conservation and axillary dissection with or without postoperative radiotherapy (SweBCG91 rt). The breast parenchyma was treated with 50 Gy in two Gy fractions. In 2007 the group comprised 423 alive and recurrence free women born 1931 or later. At the end of 2007 we collected data from this group using a validated questionnaire consisting of 333 questions regarding symptoms and quality of life. In order of believed likelihood, we hypothesized radiation to induce: breast discomfort, edema, skin hyper sensitivity, erysipelas, heart or lung symptoms, rib fractures or decreased shoulder mobility.
Poster Session I. Radiotherapy/IORT
0107
Outcomes of immediate reconstruction with absorbable polypropylene mesh in breast conserving surgery for early breast cancer
C. Yom1 , Y. Park1 , W. Bae1 , M. Koo2 , B. Moon2 . 1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 2 Department of Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea Goals: As early breast cancer increases, the cosmetic outcomes are getting more and more attention. There are various kinds of reconstruction methods including implant, flap surgery, and even autologous fat injection. The aim of this study is to evaluate the immediate and long-term outcome of absorbable polypropylene mesh in breast cancer. Methods: From July 2005 until November 2008, 64 patients who underwent breast conserving operation for breast cancer with immediate absorbable polypropylene mesh insertion at Sungkyunkwan University Kangbuk Samsung Hospital were enrolled in this study. We divided the patients into two groups according to follow-up period. Group A was defined by patients with follow-up duration less than 1 year and Group B more than 1 year. The cosmetic outcomes including symmetricity, shape, volume, nipple–areolar status, subjective satisfaction by grading system (excellent, fair, poor) with scoring (1−5) were investigated. Results: Mean age was 44.9±10.2 years old (range 18−70). Final diagnosis was invasive cancers in 47 (73.4%) patients including ductal, mucinous and medullary type, and carcinoma in situ of ductal and papillary type in 14 (21.9%) patients. One of dermatofibrosarcoma protuberans and 2 malignant phyllodes patients were included. Group A was 21 cases (32.8%) and Group B was 43 cases(67.2%). In one patient, excessive seroma developed postoperatively and repetitive aspiration was required during the following year. No case of infection was observed. Excellent cosmetic result was revealed in 80.9% of Group A and 86.0% of Group B. Poor result was seen in only 1 case (4.8%) of Group A. Conclusion: Although the number of the patients and follow-up periods were limited, our data suggest that immediate reconstruction using absorbable polypropylene mesh for early breast cancer shows outstanding cosmetic result without increasing operative morbidity. We expect that future prospective randomized analysis may provide solid evidence for present study.
0108
Early result: Volume replacement with Polyglatin910 mesh for breast reconstruction after endoscopic breast conservative surgery of early breast cancer
H. Shin1 , J. Lee1 , H. Park2 , B. Moon3 . 1 Breast surgery, Myungji Hospital Kwandong University College of Medicine, Koyang, Kyunggi, 2 Breast surgery, Gachon University of Medical and Science, Incheon, 3 Breast surgery, School of Medicine, Ewha Womans University, Seoul, South Korea Goals: We introduce a new technique using a Vicryl mesh made with Polyglatin910 for breast reconstruction after breast conserving surgery. Methods: Fourteen patients that underwent endoscopic breast conserving surgery and reconstruction (volume replacement with the use of a Vicryl mesh) were evaluated for quality of life (QOL), surgery related complications and cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to resection margin positive disease. Results: The patient ages ranged from 37 to 66 years (mean age, 50.3 years) and all of the patients had an early breast cancer diagnosis (less than stage 2b). In general, the patients were satisfied with the outcome concerning quality of life. The patients were especially satisfied with the cosmetic outcome. Satisfaction increased with longer follow-up compared to shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within tissue fluid collection as seen on ultrasonography. At 20 months after surgery, the skin and breast shape recovered. Conclusion: The results of this study have shown that with a relatively short follow-up period breast reconstruction with Polyglatin910 mesh made from oxidized regenerated cellulose has resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.
Thursday, 12 March 2009
Thursday, 12 March 2009
Radiotherapy/IORT 0110
Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy
P. Karlsson1 , B.F. Cole1 , M. Colleoni1 , M. Roncadin1 , B. Chua1 , G. Gruber1 . 1 International Breast Cancer Study Group, Bern, Switzerland Goals: To evaluate the association between timing of radiotherapy (RT) and clinical outcome (local recurrence, disease-free survival and overall survival) among patients treated with adjuvant endocrine therapy and breast conserving surgery. Methods: Patient information was obtained from IBCSG Trials VII, VIII and IX. Analysis was restricted to treatment groups receiving adjuvant endocrine therapy. Patients were divided into two groups based on the median number of days from surgery until RT, as well as into four groups based on the time from surgery until RT as follows: 8 weeks, >8 to 16 weeks, >16 to 24 weeks, and >24 weeks. Endpoints were time to local recurrence, disease-free survival (DFS) and overall survival (OS). These were measured both from randomization and from the start of RT. The latter represents a landmark analysis which accounts for the fact that the time to event must exceed the number of days from surgery until RT. The RT-timing groups were compared using standard survival analysis techniques. Proportional hazards regression analysis was used to perform comparisons after adjustment for baseline factors. Results: 964 patients with breast conserving surgery and adjuvant radio- and endocrine therapy were available for analysis. The mean number of days from surgery until start of RT was 84 days, with a median of 77 days (standard deviation: 45 days). RT timing was significantly associated with a number of baseline factors, including age, menopausal status, estrogenreceptor status, and vessel invasion. After adjustment for these factors, no significant effect of RT timing was found. Adjusted hazard ratios (shorter interval between surgery and RT relative to longer interval) are 0.94 (95% confidence interval [CI]: 0.47 to 1.87; p = 0.86) for local recurrence, 1.05 (95 CI: 0.82 to 1.34; p = 0.73) for DFS, and 1.07 (95 CI: 0.77 to 1.49; p = 0.67) for OS. The actuarial 10-year local-relapse-free rates were 94% among patients beginning RT within 77 days of surgery and 95% for patients beginning RT more than 77 days after surgery. Conclusion: RT timing is significantly associated with baseline factors such as age, menopausal status, estrogen-receptor status, and vessel invasion. After adjustment for these factors, RT timing was not significantly associated with time to local relapse, DFS or OS.
0111
Soreness and sensitivity to sun exposure 10 to 16 years after breast cancer radiotherapy − a randomized study
D. Lundstedt1 , M. Gustafsson2 , P. Malmstrom ¨ 3 , U. Olofsson4 , E. Holmberg5 , H. Anderson6 , G. Steineck4 , P. Karlsson1 . 1 Oncology, 2 Radiophysics, Sahlgrenska University Hospital, Goteborg, 3 Oncology, ¨ Lund University Hospital, Lund, 4 Clinical Cancer Epidemiology, Sahlgrenska Academy, 5 Oncologic Centre, Sahlgrenska University 6 Oncologic Centre, Lund University Hospital, Lund, ¨ Hospital, Goteborg, Sweden Goals: There is some information on breast-radiotherapy toxicity but we lack data on long-term adverse effects regarding quality of life based on a randomized study. Methods: Between 1991 and 1997, 1187 women with stage I−II lymph node negative breast cancer were randomized in a Swedish study of breast conservation and axillary dissection with or without postoperative radiotherapy (SweBCG91 rt). The breast parenchyma was treated with 50 Gy in two Gy fractions. In 2007 the group comprised 423 alive and recurrence free women born 1931 or later. At the end of 2007 we collected data from this group using a validated questionnaire consisting of 333 questions regarding symptoms and quality of life. In order of believed likelihood, we hypothesized radiation to induce: breast discomfort, edema, skin hyper sensitivity, erysipelas, heart or lung symptoms, rib fractures or decreased shoulder mobility.