Mastectomy modified radical

Local therapy of early-stage breast cancer consists of modified radical mastectomy or lumpectomy plus external-beam radiation therapy. The surgical approach to the ipsilateral axilla may consist of a full level I/II axillary lymph node dissection or a lymph node mapping procedure with sentinel lymph node biopsy. 

Breast-conserving therapy (BCT) is appropriate primary therapy for most women with stage I and II disease it is preferable to modified radical mastectomy because it produces equivalent survival rates with cosmetically superior results. BCT consists of lumpectomy (i.e., excision of the primary tumor and adjacent breast tissue) followed by radiation therapy (RT) to prevent local recurrence. 

Brief History. R.J. is a 57-year-old woman who was diagnosed with metastatic breast cancer 1 year ago, at which time she underwent a modified radical mastectomy followed by antineoplastic drugs. The cancer, however, had evidently metastasized to other tissues, including bone. She recently developed pain in the lumbosacral region, which was attributed to metastatic skeletal lesions in the lower lumbar vertebrae. She was admitted to the hospital to pursue a course of radiation treatment to control pain and minimize bony... 

A 37-year-old premenopausal woman with breast cancer (ER and PR positive) is being started on hormonal therapy after a modified radical mastectomy. She is still interested in having children in the future, if possible. Which of the following regimens is most appropriate for her ... 

Most breast cancers are diagnosed in early stages before the disease has disseminated to sites distant from the breast. Treatment consists of local management, as well as systemic adjuvant therapy with chemotherapy, hormonal therapy, or a combination of these. Breast-conservation therapy, which consists of complete removal of the tumor (lumpectomy), combined with breast irradiation and axillary lymph node sampling, is currently the preferred method of treatment for most patients with localized breast cancer. Patients who are not candidates for breast conservation or who do not choose this local therapy will generally receive the modified radical mastectomy. 

Direct randomized comparisons unfortunately are very rare. However, the two Stockholm breast cancer trials in women treated with modified radical mastectomy provide a comparison of postoperative radiotherapy and chemotherapy with a median follow-up of 18 years (Rutqvist and Johansson 2006). All patients had node-positive disease or a tumor diameter exceeding 30 mm. The radiation dose was 46 Gy in 2-Gy fractions to the chest wall, axilla, supraclavicular fossa, and the ipsilateral internal mammary nodes. Ghemotherapy initially consisted of 12 cycles (later 6 cycles) of cyclophosphamide 100 mg/m orally on days 1-14, methotrexate 40 mg/m i.v. on days 1 and 8, and 5-fiuorouracil 600 mg/m i.v. on days 1 and 8 (CMF). In the trial that included premenopausal patients, 291 were allocated to CMF and 256 to radiotherapy. In each arm, 12% were node negative. Sixty-two and 64% were estrogen-receptor positive, respectively. Locoregional recurrence was observed in 14% after radiotherapy and 24% after chemotherapy (hazard ratio 0.67, p = 0.048). The absolute benefit increased with the number of positive lymph nodes. As might be expected, fewer patients developed distant recurrence after CMF and the eventual difference in breast cancer deaths was 50% versus 56%. This... 

Madden JL (1965) Modified radical mastectomy. Surg Gynecol Obstet 121 1221-1230... 

Socially, she never imbibed alcohol or smoked anything. Her family history included breast cancer in her mother and her older sister. Both sustained multiple "lumpectomies" and the mother had had a single modified radical mastectomy on the right. Both were without persistent sequela for more than 5 years. Both mother and sister had experienced significant problems with premenstrual syndrome... 

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