Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center

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dc.contributor.advisorCairncross, Lydia Leoneen_ZA
dc.contributor.advisorPanieri, Eugenioen_ZA
dc.contributor.authorNashidengo, Pueya Mekondjoen_ZA
dc.date.accessioned2017-06-06T09:46:23Z
dc.date.available2017-06-06T09:46:23Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: Breast cancer burden is on the increase in the developing world. Breast-conserving therapy (BCT) is prescribed for early breast cancer. It is the wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer presenting to the Groote Schuur Hospital's Oncology and Endocrine Surgical unit, Cape Town South Africa. There has not been a formal audit to review the outcomes of BCT in the unit. Objectives: The objective of this study is to determine and analyse the excision margins for all the wide local excisions and the re-excision and local recurrence rates during the study period. Methods: This is a histopathological and oncology records review of the patients that have undergone BCT in the unit from the 1st of January 2006 until the 31st of December 2010. The University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee granted approval. Data points accrued included patient age, pathological tumour size and nodal status, histological tumour type, oestrogen receptor status, presence of lymphovascular invasion, volume of specimen excised, margin status, management of involved or close margins, completeness of radiotherapy, ipsilateral breast recurrence rate and total duration of follow up. Results: A total of 192 patients had BCT during the study period. The mean age is 53 years (range 25 to 84 years). A median of 229.5 cm3 volume of specimen was excised (range 4 cm3 to 10530 cm3). Infiltrating ductal carcinoma was the commonest histological type at 79.1%. 42.7% were pT1 tumours, 49.0% pT2 tumours and 2.6 % pT3. The resection margin status are: positive margins rate of 15.1%, 8.3 % close margin (≤ 1 mm), 35.9% 1 – 5 mm, 23.4% 6 – 10 mm and > 10 mm 17.2%. An overall of 26 (13.5%) patients underwent a repeat surgical procedure. 16 (8.3%) had re-excision and 10 (5.2%) had a mastectomy. Residual tumour was present in 50% of the re-excisions and 63.6% of mastectomies. As per category of the resection margins, 68.9% of patients with positive margins had repeat surgery (48.3% re-excision and 20.6% mastectomy). 31.1% of patients with positive margins did not have repeat surgery despite the indication due to advanced age, loss to follow up or residual tumour on the deep chest wall margin. 80.8% patients completed radiotherapy treatment post breast-conserving surgery. At a median follow up of 60 months (range 1 to 108 months), a total of 11 (6.8%) patients had ipsilateral breast local recurrence. Median time to recurrence is 39 months (range 12 to 106 months). Conclusion: Positive and close margin re-excision and local recurrence rates in our unit are acceptable and comparable to other units in South Africa and internationally.en_ZA
dc.identifier.apacitationNashidengo, P. M. (2017). <i>Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Surgery. Retrieved from http://hdl.handle.net/11427/24506en_ZA
dc.identifier.chicagocitationNashidengo, Pueya Mekondjo. <i>"Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2017. http://hdl.handle.net/11427/24506en_ZA
dc.identifier.citationNashidengo, P. 2017. Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Nashidengo, Pueya Mekondjo AB - Background: Breast cancer burden is on the increase in the developing world. Breast-conserving therapy (BCT) is prescribed for early breast cancer. It is the wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer presenting to the Groote Schuur Hospital's Oncology and Endocrine Surgical unit, Cape Town South Africa. There has not been a formal audit to review the outcomes of BCT in the unit. Objectives: The objective of this study is to determine and analyse the excision margins for all the wide local excisions and the re-excision and local recurrence rates during the study period. Methods: This is a histopathological and oncology records review of the patients that have undergone BCT in the unit from the 1st of January 2006 until the 31st of December 2010. The University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee granted approval. Data points accrued included patient age, pathological tumour size and nodal status, histological tumour type, oestrogen receptor status, presence of lymphovascular invasion, volume of specimen excised, margin status, management of involved or close margins, completeness of radiotherapy, ipsilateral breast recurrence rate and total duration of follow up. Results: A total of 192 patients had BCT during the study period. The mean age is 53 years (range 25 to 84 years). A median of 229.5 cm3 volume of specimen was excised (range 4 cm3 to 10530 cm3). Infiltrating ductal carcinoma was the commonest histological type at 79.1%. 42.7% were pT1 tumours, 49.0% pT2 tumours and 2.6 % pT3. The resection margin status are: positive margins rate of 15.1%, 8.3 % close margin (≤ 1 mm), 35.9% 1 – 5 mm, 23.4% 6 – 10 mm and > 10 mm 17.2%. An overall of 26 (13.5%) patients underwent a repeat surgical procedure. 16 (8.3%) had re-excision and 10 (5.2%) had a mastectomy. Residual tumour was present in 50% of the re-excisions and 63.6% of mastectomies. As per category of the resection margins, 68.9% of patients with positive margins had repeat surgery (48.3% re-excision and 20.6% mastectomy). 31.1% of patients with positive margins did not have repeat surgery despite the indication due to advanced age, loss to follow up or residual tumour on the deep chest wall margin. 80.8% patients completed radiotherapy treatment post breast-conserving surgery. At a median follow up of 60 months (range 1 to 108 months), a total of 11 (6.8%) patients had ipsilateral breast local recurrence. Median time to recurrence is 39 months (range 12 to 106 months). Conclusion: Positive and close margin re-excision and local recurrence rates in our unit are acceptable and comparable to other units in South Africa and internationally. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center TI - Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center UR - http://hdl.handle.net/11427/24506 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/24506
dc.identifier.vancouvercitationNashidengo PM. Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/24506en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Surgeryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherSurgeryen_ZA
dc.titleFive-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary centeren_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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