• Radiation Oncology Journal
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• 제26권1호
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• pp.10-16
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• 2008

목적: 조기 유방암에서 유방보존치료와 유방절제술의 치료 성적을 비교하고, 예후 인자를 알아보고자 하였다. 대상 및 방법: 1994년 9월부터 2002년 12월까지 본원에서 근치적 수술을 받은 병리학적 병기 $T1{\sim}2N0$ 유방암 환자 1,200명을 후향적으로 분석하여 유방보존치료와 유방절제술을 사이의 차이를 비교해 보았다. 결과: 분석에 포함된 1,174명의 환자 중 601명이(51.2%) 유방보존치료를 받았고 573명이(48.8%) 유방절제술을 받았다. 유방절제술을 받은 군에서 유의하게 종양의 크기가 컸고, 다발성(multicentricity), 에스트로겐 및 프로게스테론 수용체 음성 등의 인자가 더 많은 경향을 보였다. 유방보존치료 및 유방절제술을 받은 환자의 10년 생존율은 각각 91.96%와 91.01%였고(p=0.1274), 10년 무병생존율은 각각 80.48%와 84.95%(p=0.8795)로 유의한 차이를 보이지 않았다. 결론: 조기 유방암에서 유방보존치료 내지는 유방절제술을 받은 군 사이에 환자 특성의 차이는 일부 있었으나 생존율에서 유의한 차이를 보이지 않았다.

• Radiation Oncology Journal
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• 제22권1호
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• pp.11-16
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• 2004

목적: 유방 관상피내암 환자들의 유방 보존술 및 방사선 치료 후 생존율과 국소 재발률, 재발 양상 및 국소 재발에 영향을 준 인자들을 분석하고, 적절한 치료법을 결정하고자 하였다. 대상 및 방법: 1995년 6월부터 2001년 12월까지 유방 관상피내암으로 유방 보존술 후 방사선 치료를 받았던 96명의 환자를 대상으로 후향적 분석을 시행하였다. 수술은 국소 절제 또는 광범위 절제가 시행되었고, 일부에서 액와 림프절 곽청술이 시행되었다. 방사선 치료는 전 유방에 50.4 Gy /28회를 조사하였고, 절단면에 종양이 있거나 절단면에서 종양이 가까웠던 경우($\leq$ 2 mm) 일부에서 종양이 있었던 부위에 $10\~14$ Gy를 추가 조사하였다. 전체 환자의 중앙 추적 관찰기간은 43개월($12\~102$개월)이었다. 결과: 5년 국소 무병생존율, 생존율은 각각 $91\%,\;100\%$였다. 국소 재발은 6명($6.3\%$)에서 발생하였고, 이 중 침윤성 유방암으로 재발한 환자는 1명이었다. 수술에서 재발까지의 기간은 1명을 제외하고는 모두 2년 이상이었다. 주위 림프절 재발이나 원격전이는 없었다. 재발한 환자 중 5명은 유방 전절제술 후 무병생존 중이고, 1명은 구제 치료예정이다. 국소 재발에 영향을 준 인자들에 대해 분석했을 때, 연령, 절단면 상태, comedo type, 핵분화도 모두 국소 재발에 영향을 주지 않는 것으로 나타났다. 수술 범위에 따라서도 국소 재발에 차이를 보이지 않았고(p=0.30), 절단면이 종양에서 가까웠던 경우 초기 종양 부위에 추가 조사도 국소 재발에 영향을 주지 않았다(p=1.0). 결론: 유방 관상피내암의 치료로 유방 보존술 및 방사선 치료 시행 후 높은 국소 제어율과 생존율을 얻을 수 있었다. 종양이 절단면을 침범하지 않는 한 절단면과 종양과의 거리와 추가 방사선 조사는 국소 재발에 영향을 주지 않는 것으로 나타났으나 향후 더 많은 환자로 장기적인 추적관찰이 필요할 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권1호
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• pp.315-320
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• 2014

Purpose: The purpose of this study was to investigate the recurrence pattern and characteristics of patients based on the 2013 St. Gallen surrogate molecular subtypes after breast-conserving surgery (BCS) in Chinese women. Methods: This retrospective analysis included 709 consecutive breast cancer patients undergoing BCS from 1999-2010 at our institution. Five different surrogate subtypes were created using combined expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. Locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) rates were calculated. Results: The 5-year LRRFS, DMFS, and DFS rates were 90.5%, 88.2%, and 81.5%, respectively. Multivariate analysis revealed that young age, node-positive disease, and HER2 enrichment were independent prognostic factors in LRRFS patients. There was also an independent prognostic role of lymph node-positive disease in DMFS and DFS patients. Patients with luminal A tumors had the most favorable prognosis, with LRRFS, DMFS, and DFS rates of 93.2%, 91.5%, and 87.4% at 5 years, respectively. Conversely, HER-2-enriched tumors exhibited the highest rate of locoregional recurrence (20.6%). Conclusion: Surrogate subtypes present with significant differences in RFS, DMFS, and LRRFS. Luminal A tumors have the best prognosis, whereas HER2-enriched tumors have the poorest.

• Radiation Oncology Journal
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• 제27권3호
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• pp.153-162
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• 2009

목 적: 초기 유방암에서 유방 보존 수술과 방사선치료 후 실패양상과 생존율 및 미용효과를 알아보고자 하였다. 대상 및 방법: 1992년 1월부터 2002년 12월까지 계명대학교 동산의료원에서 유방보존수술과 방사선치료를 받은 초기 유방암환자 154명을 대상으로 하였다. TNM 병기는 1기 90명, IIa기 50명, IIb기 11명이었다. 모든 환자는 유방의 부분절제술과 동측 액와림프절 곽청술을 시행하고 방사선치료를 하였다. 유방의 방사선치료는 동측 전체 유방에 6 MV 광자선으로 50~54 Gy를 5주에서 6주간에 조사하였고 원발병소에 추가 방사선은 전자선으로 10~16 Gy를 조사하였다. 항암화학요법은 75명에서 방사선치료 전후에 시행하였고 호르몬치료는 92명에서 Tamoxifen을 사용하였다. 추적관찰기간은 13개월에서 179개월로 중앙값이 92.5개월이었다. 결 과: 전체환자의 5년, 10년 생존율은 97.3%, 94.5%이었다. 5년, 10년 무병생존율은 92.5%, 88.9%이었고 구제 치료후 5년, 10년 무병생존율은 93.9%, 90.2%이었다. 다변량 분석상 수술 후 방사선치료까지의 기간이($\leq$6 weeks vs. >6 weeks, p=0.017) 무병생존율에 있어서 통계적으로 유의한 예후 인자였다. 주된 실패양상은 원격전이였고 다발성으로 치료 후 중앙값 55.5개월에 전이를 하였다. 원격전이의 호발부위는 폐였다. 미용결과는 80.7%에서 좋음에서 매우 좋음으로 나타났다. 결 론: 초기 유방암에서 유방보존수술과 방사선치료는 우수한 생존율과 미용결과를 보인다고 생각된다. 또한 유방 보존수술 후 방사선치료는 가능한 한 빨리, 6주 이내에 시행되는 것이 좋을 것으로 생각된다.

• Journal of Breast Disease
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• 제6권2호
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• pp.52-59
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• 2018

Purpose: This study aimed to determine whether clinicopathological factors are potentially associated with successful breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) and develop a nomogram for predicting successful BCS candidates, focusing on those who are diagnosed with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative tumors during the pre-NAC period. Methods: The training cohort included 239 patients with an HR-positive, HER2-negative tumor (${\geq}3cm$), and all of these patients had received NAC. Patients were excluded if they met any of the following criteria: diffuse, suspicious, malignant microcalcification (extent >4 cm); multicentric or multifocal breast cancer; inflammatory breast cancer; distant metastases at the time of diagnosis; excisional biopsy prior to NAC; and bilateral breast cancer. Multivariate logistic regression analysis was conducted to evaluate the possible predictors of BCS eligibility after NAC, and the regression model was used to develop the predicting nomogram. This nomogram was built using the training cohort (n=239) and was later validated with an independent validation cohort (n=123). Results: Small tumor size (p<0.001) at initial diagnosis, long distance from the nipple (p=0.002), high body mass index (p=0.001), and weak positivity for progesterone receptor (p=0.037) were found to be four independent predictors of an increased probability of BCS after NAC; further, these variables were used as covariates in developing the nomogram. For the training and validation cohorts, the areas under the receiver operating characteristic curve were 0.833 and 0.786, respectively; these values demonstrate the potential predictive power of this nomogram. Conclusion: This study established a new nomogram to predict successful BCS in patients with HR-positive, HER2-negative breast cancer. Given that chemotherapy is an option with unreliable outcomes for this subtype, this nomogram may be used to select patients for NAC followed by successful BCS.

• Archives of Plastic Surgery
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• 제47권2호
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• pp.153-159
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• 2020

Background Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit. Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates. Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers. Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3257-3265
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• 2015

Background: Radiotherapy is an important treatment of choice for breast cancer patients after breast-conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. Materials and Methods: Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. Results: All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left-sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. Conclusions: Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2771-2776
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• 2014

Background: Breast cancer screening and higher quality mammography have resulted in an increase in the diagnosis of ductal carcinoma in situ worldwide. We compared the incidence and other factors in our cases of ductal carcinoma in situ between two recent decades. Materials and Methods: Medical records of cases of ductal carcinoma in situ who had been admitted to the surgery wards of the Cancer Institute of Tehran, Iran were evaluated from March 1993 to March 2003 as phase 1, and from April 2003 to April 2013 as phase 2. Results: Ratio of ductal carcinoma in situ to overall breast cancer was 1.27 and 3.93 in phases 1 and 2, respectively. Rates of excisional or incisional biopsies versus core needle biopsies and clinically versus mammographically detected cases as well as median size of tumors dropped between the 2 phases while a substantial rise in the number of patients attending for screening was seen in this time period. Surgical treatments followed a trend from modified radical mastectomy and axillary lymphatic dissection toward breast conserving surgery and sentinel node dissection or no axillary intervention. Conclusions: Our study shows a considerable trend toward earlier detection of breast cancer and evolution of treatment strategies toward standard less invasive surgery of DCIS in Iran.

• Asian Pacific Journal of Cancer Prevention
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• 제16권11호
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• pp.4685-4690
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• 2015

Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in post breast-conserving therapy (BCT) women. Materials and Methods: This cross-sectional study concerned one-year post-completed BCT Thai women. The data included subjective and objective CO with a questionnaire covering demographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG) performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B). Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breast cancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman's rank correlation Results: A total 127 participants volunteered for the study. The participant characteristics were age 52(${\pm}9$), Buddhist 87%, married 65%, body mass index 25.0(${\pm}4.6$), breast cup size A-C 91%, college educated 60%, employed 66%, ECOG 0-1 95%, tumor size less than or equal to 2 cm 55%, no lymph node metastasis 98%, and taking tamoxifen 57%. Two percent of the participants regretted their decision to undergo BCT. The SRCO was excellent in 2%, good in 68%, fair in 30%, and poor in 0%. For SRBS, rates were 17%, 58%, 24% and 1% for excellent, good, fair and poor cosmetic outcomes, respectively. The BCCT scores were excellent 24%, good 39%, fair 32%, and poor 6%. The median total QOL score of the participants was 130 (93-144). There was no significant correlation between CO and FACT-B scores. Conclusions: The significance of CO for FACT-B in Thai women with breast cancer could not be assessed in detail because of a very low level of correlation. The results may be due to the effects of cultural background.

• 대한임상검사과학회지
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• 제53권3호
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• pp.233-240
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• 2021

유방 보존술 중 절제면 동결절편검사는 빠른 시간 내에 암세포의 유무를 판단하고 환자의 수술 범위 및 예후에 중요한 영향을 미친다. 그러나 유방조직의 특성상 많은 지방조직으로 구성되어 있고, 지방조직의 양에 따라 유방조직 동결절편검사의 정확도에 많은 영향을 미칠 수 있다. 이에 본 연구에서는 유방 보존술에서 시행하는 절제면 동결절편검사에 새로운 방법을 적용하여 기존의 동결절편검사와 비교 분석하였다. 동결절편블록의 표면을 알코올로 닦아내면 지방조직이 순간적으로 용해되면서 실질조직이 표면으로 노출될 것이라 예상하였다. 실제로 총 98례 중 기존의 동결절편검사보다 개선된 동결절편검사에서 더 높은 실질조직 비율을 얻는 경우는 37례였다. 또한 개선된 동결절편검사에서 더 높은 실질조직 비율을 얻은 37례 중 이전의 동결절편검사에서는 음성으로 진단되었으나, 개선된 동결절편검사와 영구표본조직 슬라이드에서 관상피내암으로 진단이 나온 경우는 2례였다. 비록 turn around time (TAT) 등의 한계점이 존재하지만, 본 연구 결과의 적용에 대한 논의를 계속한다면 동결절편검사 시 조직학적 병리검사의 진단 정확성을 재고할 것이라고 사료되며, 환자 안전에도 직접적인 영향을 미칠 것이라고 판단된다.