• Radiation Oncology Journal
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• v.30 no.3
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• pp.124-131
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• 2012

Purpose: To determine whether triple negative (TN) early stage breast cancers have poorer survival rates compared with other molecular types. Materials and Methods: Between August 2000 and July 2006, patients diagnosed with stage I, II early stage breast cancers, in whom all three markers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor [HER]-2) were available and treated with modified radical mastectomy or breast conserving surgery followed by radiotherapy, were retrospectively reviewed. Results: Of 446 patients, 94 (21.1%) were classified as TN, 57 (12.8%) as HER-2 type, and 295 (66.1%) as luminal. TN was more frequently associated with young patients younger than 35 years old (p = 0.002), higher histologic grade (p < 0.0001), and nuclear (p < 0.0001). The median follow-up period was 78 months (range, 4 to 130 months). There were 9 local relapses (2.0%), 15 nodal (3.4%), 40 distant metastases (9.0%), and 33 deaths (7.4%) for all patients. The rates of 5-year OS, DFS, LFS, and DMFS for all patients were 95.5%, 89.9%, 95.4%, and 91.7%, respectively. There were no significant differences in OS, DFS, LFS, and DMFS between triple negative and other subtypes (p > 0.05). Conclusion: We found that patients with TN early stage breast cancers had no difference in survival rates compared with other molecular subtypes. Prospective study in homogeneous treatment group will need for a prognosis of TN early stage breast cancer.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.376-383
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• 2012

Background No consensus has been reached regarding the outcome of management of local recurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This study demonstrated the presentation, management, and outcomes of local recurrence after immediate TRAM breast reconstruction. Methods A comparison was conducted among 1,000 consecutive patients who underwent immediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutive patients who underwent only modified radical mastectomy without reconstruction (MRM group) from January 2001 to December 2009. The presentation, treatment, and outcome including aesthetics and overall survival rate were analyzed. Results Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwent TRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRM only (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skin graft was required in 4 patients in the MRM-LR group, whereas only one patient required a skin graft to preserve the mound shape in the TRAM-LR group. The breast mound was maintained in all 17 patients that survived in the TRAM-LR group even after wide excision. The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group (P=0.276). Conclusions Local recurrence after immediate TRAM flap breast reconstruction could be detected without delay and managed effectively by multiple modalities without reducing overall survival rates. Breast mound reconstruction with soft autologous tissue allowed for primary closure in most of the cases. In all of the patients who survived, the contour of their reconstructed breast remained.

• Asian Oncology Nursing
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• v.4 no.1
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• pp.62-70
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• 2004

The purpose of this study was to use as a basic data to develop suitable nursing intervention program and decide an appropriate intervention time after assessing shoulder range of motion in postmastectomy from 2 weeks to 3 month. 147 patients are chosen as study subject among patients who were in recovery of 2weeks, 1month, 2months and 3 months after surgical operation which is modified radical mastectomy. Data were collected at oncology medicine local and general surgery local in Seoul National University Hospital from May, 2003 to October, 2003. The range of motion of the shoulder(flexion, extension, abduction, internal rotation, external rotation) were examined. Analysis of data that shoulder range of motion average and standard deviation, percentage of the unaffected side and affected side compare with normal shoulder range of motion. Paired t-test was adopted to analyze the difference between affected side and unaffected side. Conclusion from this study is as following, 1. The most serious problem was external rotation (0.56%) and internal rotation is the next (19.9%) in 5 kinds of shoulder range of motion in 2 weeks after surgical operation 2. There was no difference in internal rotation after post operation 3 months but there were differences and shown to recover more than 90% in flexion and abduction. Also shoulder function incresed in flextion less than 80% and more than 80% in external rotation. As this study finding was shown that shoulder range of motion did not get back perfectly except of internal rotation and extension in point of 3 months after breast cancer surgical operation. External rotation was specially shown the lowest result so it is needed to exercise for improving their physical functioning recovery in postmastectomy patients. And it is suggested to study for helping to postmastectomy patients' physical and psycosocial functions with the early rehabilitation program which is based on these results.

• Journal of Korean Academy of Nursing
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• v.25 no.3
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• pp.419-430
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• 1995

There is a need to investigate folk remedies used by patients with breast cancer because there is little information about the subject, even though many Korean women with breast cancer have used folk remedies during and after their treatment. The purpose of this study was to investigate and describe the phenomena and the meaning of folk remedies in order to better understand patients with breast cancer and to suggest directions for comprehensive nursing care. The Questions for the study were as follows What kinds of folk remedies do patients with breast cancer use\ulcorner What are the routes of knowing about folk remedies in patients with breast cancer\ulcorner What are the patterns of the usage of the folk remedies\ulcorner Why do patients with breast cancer use folk remedies\ulcorner What are the meanings of folk remedies to patients with breast cancer\ulcorner To answer these questions, a qualitative research method was used. Thirty-nine patients were recruited from university teaching hospitals from March, 1993 to November 1994. Many of them underwent either modified radical mastectomy or received various adjuvant therapy including chemotherapy, radiation therapy, and hormonal therapy. Data were collected by in-depth interviews, observations, medical records, and analyzed step-by-step using qualitative analysis. The results were as follows : 1. Patients with breast cancer have used many different kinds of folk remedies. 2. Patients with breast cancer did not know the exact effects of the folk remedies. Also the effects could not be exactly proven by the patients. 3. Patients with breast cancer received information about many kinds of folk remedies through various communication systems, such as other patients, their families and relatives, friends, and many types of mass media. 4. To use the folk remedies was one kind of illness behavior that was used by these patients. 5. Folk remedies were used to deal with not only anxiety by the patients themselves but also as the expression of affection and concern by families and relatives. 6. The use of folk remedies was one of the adaptation behaviors in patients with breast cancer whose disease was in the terminal stage. Based on the above findings, one suggestion was made : To continue further studies on folk remedies used by other patients with cancer in order to further explain health and illness behavior of Korean people.

• Radiation Oncology Journal
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• v.22 no.1
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• pp.17-24
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• 2004

Purpose: To evaluate the treatment outcomes after postmastectomy radiotherapy (PMRT) and chemotherapy in patients with breast cancer. Materials and Methods: The PMRT were retrospectively analyzed in 83 patients with stage II-III female breast cancer treated between 1989 and 1995. The median age was 46 years (range, 23-77): Seventy-seven patients had modified radical mastectomies, 5 radical mastectomies and 1 simple mastectomy. Three patients ($4\%$) had pathologically negative axillae, and the remaining 80 ($96\%$) had positive axillae. Eleven, 23, 44 and 5 patients had pathological stages IIA, IIB, IIIA, and IIIB, retrospectively. Eighty ($96\%$) patients were treated with hockey-stick fields. The median dose of PMRT was 50.4 ey, in 1.8 Gy fractions. Adjuvant systemic chemotherapy was given to 74 patients ($89\%$). CMF-based or doxorubicin-containing regimens were given to 54 patients ($55\%$). The median follow-up time was 82 months (range, 8-171) after the mastectomy. Results: The 5 and 10-year overall survival rates for all patients were 65 and $49\%$, respectively. The univariate and multivariate analyses of the factors affecting the overall survival revealed the stage to be the most significant prognostic factor (p=0.002), followed by the combination of chemotherapy. Thirteen patients $16\%$ developed a LRF, at an interval of 4-84 months after radiotherapy, with a median of 20 months. The only significant prognostic factor affecting LRF was the combination of chemotherapy, in both the univariate and multivariate analyses. With respect to the sequence of chemoradiation, the sequence had no saatistical significance (p=0.90). According to the time interval from mastectomy to the onset of radiotherapy, the LRFR of the patients group treated by RT within or after 6 month postmastectomy 6 months were 14 vs. $27\%$ respectively (p=0.24). One third of the pa41en1s (26/83) developed distant metastasis, in 2-92 months, after radiotherapy, with a median of 21 months. The most commonly involved site was bone in 13 cases. The pathological staging was the only significant prognostic factor in both the univariate and multivariate analyses that affected distant failure. Radiological finding of radiation pneumonitis on a simple chest x-ray was shown in $20\%$ (17/83), with a time interval ranging from 2 to 7 months post-radiotherapy, with a median of 3 months. The stable lung fibrosis settled in 11 patients ($65\%$). Conclusion: It was concluded through this analysis that the combination of PMRT with in chemotherapy resulted in better overall survival and local control than PMRT alone in patients needing PMRT.

• Radiation Oncology Journal
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• v.22 no.3
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• pp.184-191
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• 2004

Purpose: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Materials and Methods: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Results: Radical mastectomy was peformed in 64.8$\%$ of total patients and 26$\%$ of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5$\%$ in stage 0, 54.4$\%$ in stage I, and 20.3$\%$ in stage II, Some of the patients (6.6$\%$ of stage I, 10.1$\%$ of stage II and 66.7$\%$ of stage III) not received radiotherapy after BCS. Only 45$\%$ of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Conclusion: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.265-276
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• 2000

Purpose : Between January 1983 and December 1988, 218 female Patients with known breast cancer and positive axillary nodes were treated with adjuvant radiotherapy and chemotherapy following radical mastectomy. Treatment results were retrospectively analysed at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University of College of Medicine. Materials and Methods : The patients were classified into 3 groups; group I included II patients treated with adjuvant chemotherapy alone; in group 2, 52 patients treated with radiotherapy alone; and in group 3, n patients treated with combined chemo-radiotherapy. The mean age was 44 years and ranged from 27 to 70. The median follow-up time was 51 months. Results :Seven-year relapse free and overall survival rates were 56$\%$ and 67$\%$; in group 1, 50$\%$ and 56$\%$ in group 2, 51$\%$ and 65$\%$ and in group 3, 62$\%$ and 75$\%$ respectively. This difference was not statistically significant(p<0.05). The loco-regional failure rates were 13$\%$ and distant failure rates were 33$\%$. There was less risk of loco-regional failure in group 2 and 3 which included radiotherapy (p<0.05). But there was no significantly difference in the rates of distant failure( p>0.05). By univariate analysis, the only significant prognostic factor affecting relapse-free survival was the percentage of positive axillary nodes; and the overall survival significantly correlated with the primary tumor site, the number or percentage of positive axillary nodes, and stage. But in multivariate analysis, the only significant prognostic factor was treatment modality. By univariate analysis of prognostic factors affecting the rates of overall failure and distant failure, the significant prognostic factors was the percentage of positive axillary nodes; and the risk of the loco-regional failure significantly correlated with the treatment modality. Conclusion :In conclusion, these results suggest a potential for decreasing the risk of loco-regional failure with the addition of postoperative radiotherapy to chemotherapy in the premenopausal patients, and in the patients with number or percentage of positive nodes more than 4 or 1/3. The results of this study suggest that the combined chemo-radiotherapy as adjuvant treatment following radical mastectomy was the most effective modaliw in groups of 2$\~$5 cm sized tumor, stage IIB, and in patients with more than 4 or 1/3 of number or percentage of positive nodes.

• Radiation Oncology Journal
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• v.13 no.2
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• pp.163-171
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• 1995

Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy during the past 2 decades. In this country, however, the practice of conservative therapy for early invasive breast cancer has not been generalized yet. The purpose of this report was to evaluate the results and complications of breast conservation therapy in Korean Cancer Center Hospital(KCCH). Materials and Methods: From January 1987 to December 1989. 45 Patients with early breast cancer treated with conservative treatment in KCCH were studied retrospectively Median follow up was 54 months(range, 4 to 82 months) . All patients received partial mastectomy (biopsy, tumorectomy. or quadrantectomy) and radiation therapy. Twenty eight patients received axillary dissection The breast was treated with two opposing tangential fields (total 50 Gy or 50.4 Gy in 5 weeks with daily target dose of 2 Gy or 1.8 Gy) Thirty patients received chemotherapy before and after radio-therapy Eleven patients received hormonal therapy. Results: Five-year survival rate, 5-rear disease free survival rate and 5-year local control rate were 87.2%, 86.5% and 97.6%,$ respectively. Administration of systemic Therapy (chemotherapy or hormonal therapy) correlated with good prognosis but statistically not significant (0.05 < p < 0.1). The severe late complication rate was 8.9% Conclusion: Primary radiation therapy following breast-conserving surgery for early breast cancer is an alternative treatment comparing to radical treatment. Long term follow-up and more patients collection is needed to evaluate the Prognostic factor and cosmetic outcome.

• Journal of Korean Public Health Nursing
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• v.13 no.2
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• pp.101-114
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• 1999

This study was designed to investigate the effects of an aquatic exercise program on the shoulder joint function. physical symptom. quality of life and stress among the patients who received modified radical mastectomy between 6 to 12 months prior to their visits. The subjects were 31 women aged between 40 and 60 who visited the out-patient department at Kang Nam St. Mary's Hospital for follow-up care. and were not under the treatment of intravenous cancer chemotherapy or radiation therapy. and had no complications. Twelve of them were assigned to the control group. while nineteen subjects to the experimental group. The aquatic exercise program was developed by the author with the assistance of exercise specialists. The program includes warming uP. aerobic and cooling down exercises in water. The aquatic exercise program for the experimental group was carried out 3 times a week with 60 minutes in each time for 8 weeks from September 20th to November 15th. 1995 in a regular swimming pool in Seoul. Changes in the range of motion of the shoulder joint. muscle strength. physical symptom. quality of life. and stress were examined after the completion of treatment. The data were collected through isokinetic muscle strength evaluation and questionnaire survey before and after the treatment. Paired and unpaired t-test were adopted to analyze the data. The results were as follows ; 1. The increment in the range of motion of the shoulder joint in the experimental group after the exercise was significantly greater than those in the control group. 2. The peak torque of shoulder girdle muscles increased significantly after the exercise in the experimental group only. 3. The physical symptom score decreased significantly after the exercise in the experimental group only. 4. The experimental group revealed significantly higher level of quality of life and lower level of stress after the exercise compared with those before the exercise. whereas the control group showed no significant changes in those levels. These findings may indicate that the aquatic exercise program is effective in increasing the range of motion of the shoulder joint and muscle strength and quality of life. and also effective in decreasing physical symptoms. and the level of stress in postmastectomy patients. Accordingly. the acquatic exercise program' can be adopted as an effective nursing intervention for postmastectomy rehabilitation.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8397-8403
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• 2016

Background: Breast cancer (BCa) is the most common malignancy in Mexican women. A set of histopathological markers has been established to guide BCa diagnosis, prognosis and treatment. Nevertheless, in only a few Mexican health services, such as that of the Secretariat of National Defense (SEDENA for its acronym in Spanish), are these markers commonly employed for assessing BCa. The aim of this study was to explore the association of Ki67, TP53, HER2/neu, estrogenic receptors (ERs) and progesterone receptors (PRs) with BCa risk factors. Materials and Methods: Clinical histories provided background patient information. Immunohistochemical (IHC) analysis was conducted on 48 tissue samples from women diagnosed with BCa and treated with radical mastectomy. The Chi square test or Fisher exact test together with the Pearson and Spearman correlation were applied. Results: On average, patients were $58{\pm}10.4$ years old. It was most common to find invasive ductal carcinoma (95.8%), histological grade 3 (45.8%), with a poor Nottingham Prognostic Index (NPI; 80.4%). ERs and PRs were associated with smoking and alcohol consumption, metastasis at diagnosis and Ki67 expression (p<0.05). PR+ was also related to urea and ER+ (p<0.05). Ki67 was associated with TP53 and elevated triglycerides (p<0.05), and HER2/neu with ER+, the number of pregnancies and tumor size (p<0.05). TP53 was also associated with a poor NPI (p<0.05) and CD34 with smoking (p<0.05). The triple negative status (ER-/PR-/HER2/neu-) was related to smoking, alcohol consumption, exposure to biomass, number of pregnancies, metastasis and a poor NPI (p<0.05). Moreover, the luminal B subty was associated with histological type (p=0.007), tumor size (p=0.03) and high cholesterol (p=0.02). Conclusions: Ki67, TP53, HER2/neu, ER and PR proved to be related to several clinical and pathological factors. Hence, it is crucial to determine this IHC profile in women at risk for BCa. Certain associations require further study to understand physiological/biochemical/molecular processes.