Breast Conservative Surgery (BCT )
• Involves resection of primary
breast cancer with a margin of normal-appearing breast tissue,
adjuvant radiation therapy with or without assessment of axillary lymph node
status.
• Surgical
procedures employed: wide local excision, lumpectomy,
quadrantectomy
• BCT is
currently treatment for women with DCIS, Stage I and Stage II invasive breast cancer.
Suitable
candidates for BCT
• The cancer
is solitary,
with no clinical or mammographic evidence of cancer elsewhere in the
breast.
• The tumor
can be
excised with tumor-free surgical margins without producing a
cosmetically
unacceptable breast.
• There are no
contraindications to radiation.
• The
patients are willing and motivated for breast conservation.
Contraindications
for BCT:
Absolute
contraindications
1. Pregnancy
is an absolute contraindication to the use
of breast irradiation.
2. Women
with two or more primary tumors in separate quadrants of the breast or with
diffuse
malignant appearing microcalcifications.
3. A history
of prior therapeutic irradiation to the breast region that would require
treatment to an
excessively high total-radiation dose to a
significant volume.
4.
Persistent positive margins after reasonable surgical attempts.
Relative
contraindications:
1. History
of collagen vascular disorders (Scleroderma and active lupus erythematosus but
not the
rheumatoid arthritis).
2. Presence
of multiple gross tumours in the same quadrant and indeterminate calcifications
3. Large
tumour in small breast.
4. Breast
size, large pendulous breast presents difficulty in delivering uniform
radiation dose.
5. Centrally
located tumour, for which removal of nipple areola complex is required to
obtain a
tumour free
margin.
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