Τόμος 6 (1988) – Τεύχος 4 – Άρθρο 1- Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 6 (1988) – Issue 4 – Article 1 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

G. ASSIMAKOPOULOS

6: 195-214 (1988)

PHARMAKON-Press: Epitheorese Klin. Farmakol. Farmakokinet.

6: 195-214 (1988)

Breast cancer remains the leading cause of malignancy-related death in women. For about a century, Halsted (or radical) mastectomy was considered standard therapy for this disease. This mastectomy, which is extremely effective for disease local control, has the disadvantage of being one of the most deforming procedures for management of primary breast cancer. In the last two decades new information has become available on the natural history of breast cancer, which is seen today as a disease spreading very early in the blood system by cancer cells. A number of clinical trials comparing Halsted mastectomy with modi­fied radical mastectomy and simple (or total) mastectomy were conducted in many coun­tries. Radical mastectomy has a slightly lower local recurrence rate than simple or modified radical mastectomy, while no significant differences in survival have been consistently demonstrated among these 3 types of treatment. Simple mastectomy has the highest regional reccurence rate, since the nodes are not removed, and as many as 30% of patients with clinically negative nodes will have metastatic breast cancer within these nodes; at least 50% of these patients subsequently develop regional reccurences. The addition of radiotherapy to mastectomy does not improve overall sur­vival rates, although the rate of local recurrences is lower in the irradiated patients. Even, in clinically node-negative patients who had the nodes removed, irradiated, or untouched, there is no significant difference in total treatment failures between these 3 types of treatment and, at 10 years, the incidence of distant disease is similar. The management of women who present with a small primary tumour has undergone considerable change over recent years. Several clinical trials comparing Halsted mastectomy with con­servative techniques, such as QUART (quadrantectomy, axillary dissection, radio­therapy to the ipsilateral mammary tissue), TART (tumourectomy, axillary dissection, radiotherapy), demonstrated that less than total mastectomy combined with radiothe­rapy may be as effective as more radical operations alone for certain patients with small primary tumours (e.g. stage I). Quadrantectomy is a term coined by Umberto Veronesi in 1973 to define an operation consisting of a large resection of the breast, with the removal of the overlying skin and the underlying pectoralis fascia, so that a “radical” removal of the primary tumour is performed. The axillary dissection is a total one, with excision of all axillary nodes up to the apex of the axilla. The indications for quadrantectomy plus axillary are for the moment limited to small primary carcinoma located not too closely to the areola. For the time being there is evidence that for tumours 2 cm or less in diameter, quadrantectomy plus axillary dissection supplemented by post operative radiothe­rapy give long-term, results not different from the classic Halsted mastectomy.

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