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276. Extra-capsular Extension of Axillary Nodal Metastasis in Breast Cancer - Impact on Relapse Patterns
ABSTRACTS The data above indicates that applying the MRSA screening in all elective breast surgery patients is possible. The observed MRSA colonisation across the patient population is increasing. Despite this, with our rigorous screening and eradication policy, no single case of MRSA infection has been recorded over a period of 30 months amongst all elective breast surgery patients. Conclusions: Achieving a 100% compliance level of MRSA screening in elective patients is feasible with dedication and adequate training. The prevalence of MRSA colonisation in patients appears to be increasing. Therefore, active screening is essential for early identification and management of carriers to prevent potential serious infections. Rigorous application of MRSA screening and eradication policy is a rewarding practice that keeps the breast surgery wards MRSA-infection free. 275. Quadruple Metachronous Malignancy in a Single Patient with Multiple Sclerosis-case Report M. Buta1, Z. Milovanovic2, D. Lavrnic3, I. Djurisic4, M. Oruci4, G. Pupic5, R. Dzodic6 1 Institute of Oncology and Radiology, Surgery, Belgrade, Serbia 2 Institute of Oncology and Radiology, Pathology, Belgrade, Serbia 3 University of Belgrade Institute of Neurology of the Clinical Centre of Serbia, Neurology, Belgrade, Serbia 4 Institute of Oncology and Radiology of Serbia, Surgery, Belgrade, Serbia 5 Institute of Oncology and Radiology of Serbia, Pathology, Belgrade, Serbia 6 University of Belgrade Institute of Oncology and Radiology of Serbia, Surgery, Belgrade, Serbia Introduction: Quadruple primary malignancies occur with an incidence of less than 0.1% and less than hundred cases have been published to our best knowledge. We are presenting a patient with multiple sclerosis and triple thyroid carcinoma, double melanoma and a breast cancer. Case report: Over the course of four years we treated a single patient due to stage III (T3, N1a, M0) medullary thyroid carcinoma size 45mm in the right lobe and two micropapillary carcinomas in the left lobe, 1,24mm thick scapular melanoma (Clark II, Breslow II) and 0.85mm thick lumbar melanoma (Clark II, Breslow II) with negative sentinel node, lobular invasive 4mm breast carcinoma with clear resectional margins and negative nodes followed by 20 mg tamoxifen daily. FDG-PET scan peformed one month ago was negative, CA 15-3 level was within normal values and calcitonin level was 83 ng/L. There are no signs of disease recurrence. From 1980 to 2011 only 89 cases of primary quadruple malignancy have been reported. The number of multiple malignancies report is slowly but gradually increasing. Conclusion: Quadruple malignancy is a rare phenomenon in medicine and most cases of multiple malignancies affect one organ in a female patient. Our patient had family history of malignancy on ~ and fatherOs ~ side (father, grandmother and uncle). She has motherOs not received chemotherapy with alkylating agents which are well known cause of secondary cancers. The patient received mitoxanthrone, drug extensively used as a disease-modifying therapy for multiple sclerosis. However, this treatment could be linked to nonmalanocytic skin tumors and increased susceptibility to develop acute promyelocytic leukemia. Further studies and closer clinical attention is needed to clarify the relation between secondary malignancies, applied treatment and endogenous and exogenous carcinogens. 276. Extra-capsular Extension of Axillary Nodal Metastasis in Breast Cancer - Impact on Relapse Patterns D.K. Muduly1, S.V.S. Deo1, N.K. Shukla1, J. Thejus1, D.N. Sharma2, V. Raina3 1 Institute Rotary Cancer Hospital AIIMS, Department of Surgical Oncology, New Delhi, India
821 2 Institute Rotary Cancer Hospital AIIMS, Department of Radiation Oncology, New Delhi, India 3 Institute Rotary Cancer Hospital AIIMS, Department of Medical Oncology, New Delhi, India
Aim: Although lymph nodal involvement is considered the most adverse risk factor for recurrence in breast cancer, there is controversy whether extra-capsular extension (ECE) is an adverse prognostic factor for increased loco-regional or systemic recurrence and survival. The aim of this study was to evaluate the pattern of relapse and survival in patients with ECE and to compare with patients without ECE. Materials and Methods: We performed a retrospective analysis of the prospectively maintained breast cancer database of the patients operated at our Institute between 1995 and 2006. All patients had undergone ALND. Those with lymph node positive disease were analyzed for presence or absence of ECE. The clinical factors, recurrence patterns and survival were analyzed in the two groups and compared. Statistical analysis was done using SPSS sotware. The chi-square test was used to compare proportions of categorical covariates between groups of patients with and without ECE. A p-value of 0.05 was considered significant. Results: The median age was 47 years (range: 20-83 years). Extra-capsular extension was present in 30.3% of node positive patients (220 out of 725 node positive patients). Of the patients with ECE, 54 (24.6%) had less than 4 positive nodes, 74 (33.6%) with 4 to 9 positive nodes and 92 (41.8%) with > 9 positive nodes in axilla. After a median follow-up of 36 months (range: 24 to 189 months), a total of 92 (41.8%) patients had experienced relapse, of which 91 patients had systemic and one patient with local relapse. Out of 91 patients with systemic relapse 74 (33.6%) patients had systemic only, 7 (7.4%) loco-systemic, 7 (7.4%) regional-systemic and 3 (3.1%) loco-regional-systemic relapse. None had only regional or loco-regional relapse. Sites of local failure were chest wall in 13 patients and sites of distant failure were bone (42 patients), lungs (30 patients), liver (29 patients) and brain (15 patients). As compared to patients without ECE, there was statistically significant increased risk of systemic only metastasis in patients with ECE (26% vs 50.8%, p value 0.0007). However the risk of local, regional and loco-regional failure was not increased in patients with ECE. Conclusion: The rate of ECE is 30% in node positive breast cancer. In our experience, ECE significantly increased the risk of systemic metastasis. The risk of loco-regional failure is not increased in patients with ECE as compared to patients without ECE after a complete ALND and irradiation of axilla when indicated. 277. Autologous Tissue Breast Reconstruction - Experience From the Gdynia Cancer Centre M.M. Ostrowski1, W.J. Kruszewski2, J. Jankau3 1 Polish Red Cross Memorial Maritime Hospital, Department of Surgical Oncology, Gdynia, Poland 2 Polish Red Cross Memorial Maritime Hospital Department of Surgical Oncology Gdynia, Medical University of Gdansk Division of Propedeutics of Oncology, Gdynia, Poland 3 Polish Red Cross Memorial Maritime Hospital Department of Surgical Oncology Gdynia Poland, Medical University of Gdansk Department of Plastic Surgery, Gdansk, Poland Background: Reconstructive surgery has become an integral part of the holistic treatment of breast cancer. The purpose of the study was to evaluate the aesthetic outcome and complications in patients treated with autologous pedicled flap reconstruction performed between 2009 2011. Materials and methods: 61 patients (56 treated with delayed and 5 immediate) autologous breast reconstruction. 35 patients (mean age 48) qualified for delayed and 5 for immediate restoration of the breast with Latissimus dorsi flap (LD) and silicone implants.
821 2 Institute Rotary Cancer Hospital AIIMS, Department of Radiation Oncology, New Delhi, India 3 Institute Rotary Cancer Hospital AIIMS, Department of Medical Oncology, New Delhi, India
Aim: Although lymph nodal involvement is considered the most adverse risk factor for recurrence in breast cancer, there is controversy whether extra-capsular extension (ECE) is an adverse prognostic factor for increased loco-regional or systemic recurrence and survival. The aim of this study was to evaluate the pattern of relapse and survival in patients with ECE and to compare with patients without ECE. Materials and Methods: We performed a retrospective analysis of the prospectively maintained breast cancer database of the patients operated at our Institute between 1995 and 2006. All patients had undergone ALND. Those with lymph node positive disease were analyzed for presence or absence of ECE. The clinical factors, recurrence patterns and survival were analyzed in the two groups and compared. Statistical analysis was done using SPSS sotware. The chi-square test was used to compare proportions of categorical covariates between groups of patients with and without ECE. A p-value of 0.05 was considered significant. Results: The median age was 47 years (range: 20-83 years). Extra-capsular extension was present in 30.3% of node positive patients (220 out of 725 node positive patients). Of the patients with ECE, 54 (24.6%) had less than 4 positive nodes, 74 (33.6%) with 4 to 9 positive nodes and 92 (41.8%) with > 9 positive nodes in axilla. After a median follow-up of 36 months (range: 24 to 189 months), a total of 92 (41.8%) patients had experienced relapse, of which 91 patients had systemic and one patient with local relapse. Out of 91 patients with systemic relapse 74 (33.6%) patients had systemic only, 7 (7.4%) loco-systemic, 7 (7.4%) regional-systemic and 3 (3.1%) loco-regional-systemic relapse. None had only regional or loco-regional relapse. Sites of local failure were chest wall in 13 patients and sites of distant failure were bone (42 patients), lungs (30 patients), liver (29 patients) and brain (15 patients). As compared to patients without ECE, there was statistically significant increased risk of systemic only metastasis in patients with ECE (26% vs 50.8%, p value 0.0007). However the risk of local, regional and loco-regional failure was not increased in patients with ECE. Conclusion: The rate of ECE is 30% in node positive breast cancer. In our experience, ECE significantly increased the risk of systemic metastasis. The risk of loco-regional failure is not increased in patients with ECE as compared to patients without ECE after a complete ALND and irradiation of axilla when indicated. 277. Autologous Tissue Breast Reconstruction - Experience From the Gdynia Cancer Centre M.M. Ostrowski1, W.J. Kruszewski2, J. Jankau3 1 Polish Red Cross Memorial Maritime Hospital, Department of Surgical Oncology, Gdynia, Poland 2 Polish Red Cross Memorial Maritime Hospital Department of Surgical Oncology Gdynia, Medical University of Gdansk Division of Propedeutics of Oncology, Gdynia, Poland 3 Polish Red Cross Memorial Maritime Hospital Department of Surgical Oncology Gdynia Poland, Medical University of Gdansk Department of Plastic Surgery, Gdansk, Poland Background: Reconstructive surgery has become an integral part of the holistic treatment of breast cancer. The purpose of the study was to evaluate the aesthetic outcome and complications in patients treated with autologous pedicled flap reconstruction performed between 2009 2011. Materials and methods: 61 patients (56 treated with delayed and 5 immediate) autologous breast reconstruction. 35 patients (mean age 48) qualified for delayed and 5 for immediate restoration of the breast with Latissimus dorsi flap (LD) and silicone implants.