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Long-term Prognosis of Patients With Axillary Recurrence After Axillary Dissection for Invasive Breast Cancer
response rate of 66.7% among patients given Herceptin compared with 26% among patients not given Herceptin (26%). Despite this study’s limitations, the authors did a nice job at tackling the complexities of the surgical decision-making process, and, as stated, the findings may serve as the basis for a prospective study. G. V. Babiera, MD
References 1. Green MC, Buzdar AU, Smith T, et al: Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 23:5983-5992, 2005. 2. Buzdar AU, Ibrahim NK, Francis D, et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel and epirubicin chemotherapy: Results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23:3676-3685, 2005.
Full-Thickness Chest Wall Resection for Recurrence of Breast Malignancy Kolodziejski LS, Wysocki WM, Komorowski AJ Breast J 11:273-277, 2005 Kolodziejski and colleagues described their experience with fullthickness chest wall resection for postmastectomy locoregional recurrence in 13 consecutive patients. Chest wall recurrence after mastectomy is certainly a difficult surgical situation, and controversy continues regarding the need for large chest-wall resections for patients whose prognosis is generally grim. Although the authors described a technique for full-thickness chest wall resection with autologous reconstruction of the chest wall defect, it is important to consider treatment for patients with chest-wall recurrence on an individual basis, given the heterogeneity of such cases. A. B. Chagpar, MD, MSc
References 1. Wright FC, Walker J, Law CH, et al: Outcomes after localized axillary node recurrence in breast cancer. Ann Surg Oncol 10:1054-1058, 2003. 2. Newman LA, Hunt KK, Buchholz T, et al: Presentation, management, and outcome of axillary recurrence from breast cancer. Am J Surg 180:252-256, 2000.
The Prognostic Significance of Axillary Lymph-Node Micrometastases in Breast Cancer Patients Kuijt GP, Voogd AC, van de Poll-Franse LV, et al Eur J Surg Oncol 31:500-505, 2005 Thus continues the quest to determine the significance of micrometastatic disease with regard to clinical outcome for patients with breast cancer. Here the authors report their attempt to clarify this unsettled issue and found that micrometastatic disease in the population studied adversely affected survival and was not equivalent clinically to node-negative disease. I think these findings are noteworthy, considering the debate that rages over the prognostic significance of axillary micrometastatic disease and therefore the treatments offered to patients with evidence of such disease. Findings such as these add to the growing body of knowledge on this subset of patients, allowing better understanding of overall outcomes that ultimately translates into better overall disease management strategies. The search for the clinical significance of a micrometastasis, and that for even more subtle evidence of metastatic disease, will continue as diagnostic methods become more and more sensitive. One hopes that this search will provide further insight into what this may portend for our patients. S. J. Hoover, MD
How Mammillary Fistulas Should be Managed Hanavadi S, Pereira G, Mansel RE Breast J 11:254-256, 2005
Long-term Prognosis of Patients With Axillary Recurrence After Axillary Dissection for Invasive Breast Cancer Voogd AC, Cranenbroek S, de Boer R, et al Eur J Surg Oncol 31:485-489, 2005 In this report Voogd and colleagues provided additional strong findings demonstrating the importance of aggressive management for breast cancer that recurs regionally in the axilla. Others1,2 have similarly demonstrated that multimodality therapy can result in prolonged survival in 30% to 50% of such cases. Axillary failure is clearly an adverse prognostic event, especially if it occurs after only a brief disease-free interval since the time of diagnosis and is accompanied by synchronous distant organ metastasis. However, it should not be assumed that such patients cannot be treated effectively with salvage therapy. A combination of local therapy (surgery and radiation) with systemic therapy will yield some good outcomes. Patients who are well enough to tolerate treatment should be given every opportunity to avoid the morbidity and painful sequelae of axillary disease invading neurovascular structures. L. A. Newman, MD, MPH
This report from Mansel and colleagues represents a 10-year review (1990-2001) of the management of mammillary fistulas, an uncommon breast condition. Interestingly, Mansel published an article with Bundred on this very topic in 1991.1 Both papers had the same conclusions regarding treatment, but the current report failed to mention or include the findings of the previous article. Both studies involved 34 women; the 1991 report also included 2 men, but the current report included only 1 man. Hmmm. Of Mansel’s 217 citations in PubMed, these were the only 2 on mammillary fistulas. Bundred, Mansel’s co-author on the 1991 article, has contributed 8 articles on mammillary fistulas, which is commendable considering that PubMed includes only 23 articles on this condition. In the 2 articles published since 1991, the focus was on a positive association of cigarette smoking and periductal inflammation with mammillary fistulas. The limited literature on this topic seems to support periductal inflammation/mastitis as an underlying cause of fistula formation and smoking as an associated factor.2 Yet in the current 10-year review, smoking history was not mentioned at all. Further, given the rarity of this particular condition, one might expect that an investigator who retrospectively reviews the data at
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Breast Diseases: A Year Book Quarterly Vol 17 No 1 2006
73 73
References 1. Green MC, Buzdar AU, Smith T, et al: Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol 23:5983-5992, 2005. 2. Buzdar AU, Ibrahim NK, Francis D, et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel and epirubicin chemotherapy: Results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol 23:3676-3685, 2005.
Full-Thickness Chest Wall Resection for Recurrence of Breast Malignancy Kolodziejski LS, Wysocki WM, Komorowski AJ Breast J 11:273-277, 2005 Kolodziejski and colleagues described their experience with fullthickness chest wall resection for postmastectomy locoregional recurrence in 13 consecutive patients. Chest wall recurrence after mastectomy is certainly a difficult surgical situation, and controversy continues regarding the need for large chest-wall resections for patients whose prognosis is generally grim. Although the authors described a technique for full-thickness chest wall resection with autologous reconstruction of the chest wall defect, it is important to consider treatment for patients with chest-wall recurrence on an individual basis, given the heterogeneity of such cases. A. B. Chagpar, MD, MSc
References 1. Wright FC, Walker J, Law CH, et al: Outcomes after localized axillary node recurrence in breast cancer. Ann Surg Oncol 10:1054-1058, 2003. 2. Newman LA, Hunt KK, Buchholz T, et al: Presentation, management, and outcome of axillary recurrence from breast cancer. Am J Surg 180:252-256, 2000.
The Prognostic Significance of Axillary Lymph-Node Micrometastases in Breast Cancer Patients Kuijt GP, Voogd AC, van de Poll-Franse LV, et al Eur J Surg Oncol 31:500-505, 2005 Thus continues the quest to determine the significance of micrometastatic disease with regard to clinical outcome for patients with breast cancer. Here the authors report their attempt to clarify this unsettled issue and found that micrometastatic disease in the population studied adversely affected survival and was not equivalent clinically to node-negative disease. I think these findings are noteworthy, considering the debate that rages over the prognostic significance of axillary micrometastatic disease and therefore the treatments offered to patients with evidence of such disease. Findings such as these add to the growing body of knowledge on this subset of patients, allowing better understanding of overall outcomes that ultimately translates into better overall disease management strategies. The search for the clinical significance of a micrometastasis, and that for even more subtle evidence of metastatic disease, will continue as diagnostic methods become more and more sensitive. One hopes that this search will provide further insight into what this may portend for our patients. S. J. Hoover, MD
How Mammillary Fistulas Should be Managed Hanavadi S, Pereira G, Mansel RE Breast J 11:254-256, 2005
Long-term Prognosis of Patients With Axillary Recurrence After Axillary Dissection for Invasive Breast Cancer Voogd AC, Cranenbroek S, de Boer R, et al Eur J Surg Oncol 31:485-489, 2005 In this report Voogd and colleagues provided additional strong findings demonstrating the importance of aggressive management for breast cancer that recurs regionally in the axilla. Others1,2 have similarly demonstrated that multimodality therapy can result in prolonged survival in 30% to 50% of such cases. Axillary failure is clearly an adverse prognostic event, especially if it occurs after only a brief disease-free interval since the time of diagnosis and is accompanied by synchronous distant organ metastasis. However, it should not be assumed that such patients cannot be treated effectively with salvage therapy. A combination of local therapy (surgery and radiation) with systemic therapy will yield some good outcomes. Patients who are well enough to tolerate treatment should be given every opportunity to avoid the morbidity and painful sequelae of axillary disease invading neurovascular structures. L. A. Newman, MD, MPH
This report from Mansel and colleagues represents a 10-year review (1990-2001) of the management of mammillary fistulas, an uncommon breast condition. Interestingly, Mansel published an article with Bundred on this very topic in 1991.1 Both papers had the same conclusions regarding treatment, but the current report failed to mention or include the findings of the previous article. Both studies involved 34 women; the 1991 report also included 2 men, but the current report included only 1 man. Hmmm. Of Mansel’s 217 citations in PubMed, these were the only 2 on mammillary fistulas. Bundred, Mansel’s co-author on the 1991 article, has contributed 8 articles on mammillary fistulas, which is commendable considering that PubMed includes only 23 articles on this condition. In the 2 articles published since 1991, the focus was on a positive association of cigarette smoking and periductal inflammation with mammillary fistulas. The limited literature on this topic seems to support periductal inflammation/mastitis as an underlying cause of fistula formation and smoking as an associated factor.2 Yet in the current 10-year review, smoking history was not mentioned at all. Further, given the rarity of this particular condition, one might expect that an investigator who retrospectively reviews the data at
®
Breast Diseases: A Year Book Quarterly Vol 17 No 1 2006
73 73