| Background and Objective:Breast cancer is common malignant tumor against women's health, incidence rate is the first among women tumor around the world. With the deepening of the biological characteristics of breast cancer, it is to know that breast cancer is a systemic disease. Comprehensive treatment is particularly important. Surgical procedure is changing. From 1882 Halsted "classic" radical surgery to present methed. But the surgical method for breast cancer has been controversial. With the deepening of medical research and the conduct of prospective clinical studies, breast conserving surgery has become an important form of surgery. Many clinical studies have proven that proper application of breast-conserving surgery for large breast cancer can cure disease and improve patient quality of life to achieve double effect. If the tumor bump is too large to be qualified for breast-conserving surgery, direct breast-conserving surgery affects not only the postoperative breast appearance but also the greater the risk of local recurrence. Although there is no sufficient evidence to prove neoadjuvant chemotherapy instead of standard postoperative adjuvant chemotherapy can improve disease-free survival and overall survival rate of patients, It really can increase the rate of breast conserving and do not lead to the increase in local recurrence. We discuss clinical application of breast-conserving therapy after neoadjuvant chemotherapy for large breast cancer by retrospective analysis of 46 cases clinical data.Methods:From January 2005 to May 2006,46 cases with T:3-6cm, N0-2, M0 breast cancer were treated with 4-6 cycles of neoadjuvant chemotherapy. According to the effect of chemotherapy, clinical assessment and the wishes of patients,46 patients were treated with breast-conserving. We evaluated the cosmetic results after breast surgery, gathered datas on local recurrence rate, disease free survival rate and overall survival rate and compared with 73 cases by modified radical mastectomy at the same clinical stage. Long-term evaluation of patients on local recurrence, disease-free survival and overall survival. All data were processed with SPSS 13.0 statistical software, differences between the groups were compared using T test, P<0.05 as significant difference.Results:Cosmetic results of 46 cases with breast-conserving surgery were graded, excellent plus good was up to 91.3%. The patients were regularly followed up. the longest follow-up of 5.2 years and the shortest follow-up of 4 years, the average 4.5 years follow-up. It was found that the ipsilateral breast local recurrence in 1 cases (2.2%), ipsilateral supraclavicular lymph node metastasis in 1 case (2.2%),local recurrence with distant metastasis in 1 cases (2.2%), isolated distant metastasis in 1 cases (2.2%), Breast cancer-related death in 1 cases (breast cancer specific mortality of 2.2%),.4-year cumulative local recurrence rate was 2.2%, rate of disease-free survival was 89.1%,overall survival was 97.8%. The same period,73 cases of modified radical mastectomy as the control group in our hospital were followed up.lt was found that local recurrence in 2 cases (2.7%), ipsilateral supraclavicular lymph node metastasis in 1 case (1.3%), local recurrence with distant metastasis in 1 cases (1.3%), isolated distant metastasis in 2 cases (2.7%), Breast cancer-related death in 2 cases (breast cancer specific mortality of 2.7%),.4-year cumulative local recurrence rate was 2.7%, rate of disease-free survival was 89.0%,overall survival was 97.3%. Two groups were no significant difference among local recurrence,disease-free survival and overall survival.Conclusions: The effect of breast-conserving therapy is without contraindications by neoadjuvant chemotherapy for large breast cancer, chemotherapy, radiotherapy and endocrine therapy. Breast conserving surgery is feasible to large breast cancer. Breast conserving surgery with combined therapy in large breast cancer can achieve better cosmetic effect and long-term effects. |
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