Kolodziejski et al. (2005)

Kolodziejski et al. (2005)
Design: Observational study (prognosis), evidence level: 3
Country: Poland
Inclusion criteria:
Single focus of local recurrence
Ability to undergo FTCWR with 3 cm clear margins
Exclusion criteria:
Distant metastases
Serious respiratory disorders
Population:
Number of patients = 13, age range 29 to 67 years, median age = 58 years
Interventions:
Full thickness chest wall resection (FTCWR) for local post-mastectomy breast cancer recurrence, defined as recurrent tumour destroying or surrounding at least one rib and/or the sternum. Only patients with all layers of the chest wall invaded by recurrence were offered this treatment.

Methodology varied according to the patient but all surgery was undertaken by one reviewer. All chest wall defects were repaired using soft tissue and 3/13 patients had a mesh support. Skeletal defects were not repaired - this was attempted but abandoned due to local reaction.
Outcomes:
Kaplan-Meier analysis was used to estimate median overall survival (OS)
Follow up:
Mean follow-up was 66 months, median follow-up was 54 months (range: 9–144) which was long enough to report on the median OS at 5 years.
Results:
Mean diameter of chest wall defect = 12 cm

3 patients died at 15 months, 40 months and 54 months after disease dissemination. One patient died from unknown cause at 124 months. 2 patients are alive with distant metastases after 136 and 132 months. 6 patients are alive with no evidence of disease after a mean follow-up of 57 months.

No patient suffered recurrence at the site of surgery. The clearance margin was 3cm.

Reconstruction type:
Contralateral breast (n = 5) (NED = 2)
Omentum-mesh-omentum (n = 1) (alive but with metastases)
Epigastric & axillar cut-subcutaneous flap (n = 2) (NED = 1)
Mesh + serratus & latissimus muscle (n = 1)
Neighbouring tissues (n=2) (NED =1; alive but with metastases = 1)
Mesh + pectoral muscles (n = 1) (NED)
Major pectoral muscle (n = 1) (NED)
(NB NED = no evidence of disease)

Median OS rate at 5yrs = 62%
General comments:
This paper observes the outcomes of 13 women who had received FTCWR for breast cancer recurrence at a single treatment centre between 1983 and 2001.

Median age of patient group had been 44 years at the time of mastectomy, which was followed by chemotherapy (n = 7), RT (n = 6), hormone therapy (n = 1) or no further treatment (n = 3).

This group elected not to perform this chest wall surgery on patients with distant metastases.

The long term survival rates may reflect the carefully selected population, which had no evidence of metastatic disease and were chosen on the basis of favourable pre-operative assessment.

From: Chapter 6, Management of specific problems

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Advanced Breast Cancer: Diagnosis and Treatment.
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