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Lumpectomy vs Mastechtomy

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Debaura211 View Drop Down
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    Posted: Aug 03 2020 at 11:14am
This forum has helped me explore the different choices we have in our treatment of TNBC, often not enough bur sometimes too many. I am finishing up chemo - TC/AC next week and have to make a decision about surgery - lumpectomy or mastectomy.

I've had a partial response with tumor in left breast now under 1 cm; no known lymph node involvement. Two surgeons and med. onc. have recommended lumpectomy but now I'm wondering whether a mastectomy would be the better option. Ive lost sleep over the possibility of same site recurrence even though the docs tell me the odds of this are only 3-5% . I understand with a lumpectomy I will need radiation, and with a mastectomy, if more than 3 nodes are removed, I'll also need radiation. I'm 65 years old, not concerned about either having yearly mammograms or reconstruction. I want to have confidence in my decision; I've done my research and read forum postings, but its still a tough call for me.

I'll ultimately make this decision for myself, of course, but just wondered how others make it. Thanks for listening.
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Aug 03 2020 at 7:11pm
Debaura,

This is a tough decision and when given the choice, a very personal one.  Sometimes having a genetic mutation or larger tumor or node involvement, may limit surgery options.  There have been studies suggesting that lumpectomy plus radiation has a better overall disease free survival than mastectomy without radiation.  I'll try to find the links and post for you.

Published in Oncology

Journal Scan / Research · June 12, 2019

Survival of T1-2N0M0 Triple-Negative Breast Cancer Treated With Breast-Conserving Therapy vs Mastectomy

  • This analysis of the SEER database was undertaken to evaluate outcomes with breast-conserving therapy (BCT) vs mastectomy among patients with T1-2N0M0 triple-negative breast cancer. Both overall survival and breast cancer–specific survival were better with BCT.
  • There was no evidence of a survival benefit with radiotherapy following mastectomy in patients with T1-2N0M0 disease. BCT was associated with superior overall survival relative to either mastectomy alone or mastectomy with radiotherapy.

Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer

Purpose

The aim of this study is to compare the treatment outcomes of breast conserving surgery (BCS) plus radiotherapy (RT) versus mastectomy for patients with pT1-2N1 triple-negative breast cancer (TNBC).

Materials and Methods

Using two multicenter retrospective studies on breast cancer, a pooled analysis was performed among 320 patients with pT1-2N1 TNBC. All patients who underwent BCS (n=212) receivedwhole breast RTwith orwithoutregional nodal RT,while nonewho underwent mastectomy (n=108)received it. All patients received taxane-based adjuvant chemotherapy. The median follow-up periods were 65 months in the BCS+RT group, and 74 months in the mastectomy group.

Results

The median age of all patients was 48 years (range, 24 to 70 years). Mastectomy group had more patients with multiple tumors (p < 0.001), no lymphovascular invasion (p=0.001), higher number of involved lymph node (p=0.028), and higher nodal ratio ≥ 0.2 (p=0.037). Other characteristics were not significantly different between the two groups. The 5-year locoregionalrecurrence-free, disease-free, and overall survivalrates of BCS+RT group versus mastectomy group were 94.6% versus 87.7%, 89.5% versus 80.4%, and 95.0% versus 87.8%, respectively, and the differences were statistically significant after adjusting for covariates (p=0.010, p=0.006, and p=0.005, respectively).

Conclusion

In pT1-2N1 TNBC, breast conservation therapy achieved better locoregional recurrencefree, disease-free, and overall survival rates compared with mastectomy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192926/


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Debaura211 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Debaura211 Quote  Post ReplyReply Direct Link To This Post Posted: Aug 04 2020 at 9:32am
Donna,
I've been following your posts on this site and they've been most helpful. Your response with these articles came at a time of anxiety and second-guessing and took that away, for which I am grateful. All I can do is go with the best information I have at the time, and factor in personal considerations. Although no two cases are the same, I'm sticking with lumpectomy with radiation, with confidence.

Thank you.
Deborah
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