For Tom

[Lani]

I cannot remember all the particulars regarding your mother's breast cancer, but I do remember you experienced great consternation trying to get the doctors to recognize and act on her inadequate surgical margins. I do not remember if she received radiation therapy, but maybe this article will prove
useful (and reassuring) to you if she did:

4 August 2006
Surgical margin re-excision requirement defined
Not all breast cancer patients with non-negative surgical margins require further surgery, US researchers say.

Gary Freeman, from Fox Chase Cancer Center in Philadelphia, Pennsylvania, and colleagues examined the impact of re-excision on 1044 women with stage I or II disease, a close (? 2 mm) or positive margin, and who were scheduled for radiotherapy.

The patients were divided into three groups according to whether they did not undergo further excision (group 1, n=199), underwent re-excision and were free of tumor (group 2, n=546), or had residual disease detected on re-excision (group 3, n=299).

Following-up the women for a median of 6.7 years, the 10-year rate for local control in groups 1, 2, and 3, was 95%, 94%, and 94%, respectively.

Examining data from group 2 and 3 patients further, the researchers found that a positive finding on re-excision was predicted by an initial positive tumor margin, positive lymph nodes, stage T2 disease, and a positive or unknown extensive intraductal component (EIC) status.

Specifically, the likelihood of positive residual disease was ?15% in node-negative patients with a close initial margin without EIC and stage T1 or T2 disease, rising to 30–40% in those with an additional poor prognostic factor of positive margins, lymph nodes or EIC.

For patients with all three poor prognostic factors, the risk of disease on re-excision rose to over 80%, Freeman et al state.

"Our findings suggest that re-excision produced additional diagnostic information, distinguishing between a subset of women at extremely low risk of developing local recurrence (Group 2, 5%), and a subset at slightly greater risk of recurrence (Group 3, 9%)," the team summarize.

They believe that the policy of re-excision in all patients without a 2 mm or greater margin led to unnecessary surgery in two-thirds of patients who had no residual disease.

The authors therefore conclude: "The necessity of re-excision for close or positive margins needs to be carefully weighed according to the likelihood of finding residual disease in a re-excision specimen, its effect on breast cosmesis, and the magnitude of risk reduction it could afford for local recurrence after radiotherapy."



Int J Rad Oncol Biol Physics 2006; 65: 1416–1421

http://www.redjournal.org/article/PI...03695/fulltext
© 2006 CMG