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breast conservation therapy

Indications: - primary therapy* for most women with stage 1 or 2 breast cancer (initial mean tumor size of 1.47 cm) [3] * Outcomes equivalant to mastectomy Contraindications: 1) absolute contraindications - patients with multicentric breast malignancies or diffuse microcalcifications on mammography - predictable unacceptable cosmetic result - prior radiation treatment for Hodgkin's lymphoma* or other prior history of cumulative radiation in the field of proposed radiation therapy - pregnancy (unless radiotherapy can be delayed until after delivery) - repeated positive margins after resection attempts 2) relative contraindications - connective tissue disease, especially scleroderma - large tumor in a small breast - large pendulous breasts may lead to technical problems with establishing reproducible radiation field Procedure: - lumpectomy may be combined with radiation* (4500-5000 cGy [mega voltage radiation]) - sentinal lymph node biopsy - axillary dissection does not improve outcomes, & increases risk of complications - 23% of women undergo reexcision on the affected breast [3] - positive margins after first procedure: 14% [3] - total mastectomy required in 8.5% of patients [3] * cumulative dose of radiation recommended for breast-conserving therapy plus that previously received for treatment of Hodgkin's disease exceeds tolerance of normal tissue

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breast cancer

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surgery

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 667
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  3. Jeevan R et al Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics BMJ 2012;345:e4505 PMID: 22791786 http://www.bmj.com/content/345/bmj.e4505