Pameijer et al. (2005)

Pameijer et al. (2005)
Design: Retrospective case series (prognosis), evidence level: 3
Country: United States
Inclusion criteria:
None stated
Exclusion criteria:
None stated
Population:
Number of patients = 22, age range 28 to 74 years, median age = 56 years
Interventions:
Full thickness chest wall resection (FTCWR) for local post-mastectomy breast cancer recurrence, defined as recurrent tumour including full thickness rib and/or the sternum.
Outcomes:
Median post-resection disease-free interval (PFI)
5 yr disease-free and overall survival rates
Follow up:
1 patient died from myocardial infarction.

No details of follow-up were presented.
Results:
All patients had FTCWR to grossly negative margins. 59% patients had pathologically negative margins.

Reconstruction type:
Myocutaneous flap (n = 19)
Marlex mesh (n = 9)
Gortex mesh (n = 11)

Following surgery:
7 patients had wound complications (their median survival was 3.7 years, compared to 6.2 years for those patients without complications)

After FTCWR patients received chemotherapy (n = 15), endocrine therapy (n = 9) or RT (n = 5)

Median PFI = 3.7 years
Survival rate at 5 years = 71%
Disease-free survival rate at 5 years = 67%
There were no significant prognostic factors for survival between previous treatment, nodal status or disease-free interval after primary therapy.
General comments:
This paper describes a retrospective review of case files of patients who had received chest wall resection for recurrent breast cancer at a single centre between 1970 and 2000.

The intent of the FTCWR was categorised as being either palliative or curative, based on the notes of the physician in the case file. Any patient with metastases was classed as receiving palliative therapy.

Primary therapy for breast cancer had included mastectomy (n = 18), RT (n = 8), chemotherapy (n = 10) or endocrine therapy (n = 4)

This paper offers little evidence despite including a ‘meta analysis’ which is a comparison and combination of 5 year survival rates from seven other studies. The methodology is not systematic; there is no comparison of patient characteristics across studies; no test of heterogeneity to determine whether such a study is statistically feasible - the 5 year actuarial survival rates varied from 18% to 71%. These data are not considered further here.

From: Chapter 6, Management of specific problems

Cover of Advanced Breast Cancer
Advanced Breast Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 81.
National Collaborating Centre for Cancer (UK).
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