[Conservative treatment of infiltrating breast cancer smaller than 3 cm of diameter. Effect of local control on survival].
Recurrence of breast tumours after conservative treatment is considered by some as a simple prognosis factor marking risk of distant metastasis. Inversely, others consider small recurrent tumours as the starting point of systemic disease and a possible cause of death. These conflicting opinions could lead to highly opposing management decisions. Following one theory, we would be prone see a new wave of mutilating breast resections and following the other, insufficient tumour resection. The question thus becomes how to treat small, < 3 cm, recurrent tumours. Several factors can help in decision making. The risk of metastasis increases with large sized primary tumours, independently of lymph node invasion. The size number of the recurrent tumour(s) also play a role. Studies of the time interval between treatment and recurrence have shown that early recurrence within 24 months is associated with high risk of metastasis suggesting that in such cases local treatment should be combined with systemic therapy. The controversy will continue to be debated, but the essential element of conservative treatment is to control local invasion of small tumours. Surgical exeresis must be complete and irradiation must be delivered with an optimal dose. It would appear reasonable to limit conservative treatment to patients with a 5-year risk of recurrence below 8% and a 10-year risk below 15%.
Bobin
J Y
JY
Gérard
J P
JP
D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local
Traitement conservateur du cancer mammaire infiltrant de moins de 3 cm de diamètre. Rôle du contrôle local sur la survie.