İsa KARACA, Girayhan ÇELİK, İsa SÖZEN, Mehmet Zafer SABUNCUOĞLU, Serdar ACAR, İsmail ZİHNİ, Mümtaz ERAKIN, Muhammed Selim BODUR, Recep Çetin

Metastatik Meme Kanseri Hastalarında Salvage Mastektomi

Amaç: Meme kanseri dünyada en fazla görülen kadın kanseridir. Kanser büyüyebilir, metastaz yapabilir, ciltte ülser veya nekroza neden olabilir. Kemoterapi ile kontrol edilemeyen meme kanserinde kanama, ülserasyon, enfeksiyon durumlarında palyasyon amaçlı “tuvalet mastektomi veya salvage mastektomi” uygulanmaktadır. Uyguladığımız salvage mastektomi olgularını sunarak literatüre katkı sağlamayı amaçladık.Materyal ve Metot: Kliniğimizde Ocak 2010 - Aralık 2019 tarihleri arasındaki salvage mastektomi vakaları değerlendirildi. Olguların demografik verileri, memedeki tutulum şekli, postoperatif patoloji sonuçları, uzak metastaz ve genel sağ kalım durumu incelendi. Bulgular: Belirtilen tarihler arasında 22 adet tuvalet mastektomi olgusu incelendi. 14 olguda cilde ülsere lezyon, 6 tanesinde ciltte ülser olmadan cilt tutulumu tespit edildi. Hastaların hepsine salvage mastektomi uygulandı. 3 hastaya mastektomi sonrası deri grefti uygulandı. Tüm hastalarda cerrahi sınır negatifti. Hospitalizasyon esnasında hiçbir hastada mortalite görülmemiştir. Genel sağkalım 40 ay (min: 35 ay - max: 60 ay) olarak saptandı.Tartışma - Sonuç: Metastatik meme kanserlerinde salvage mastektomi, konfor ve primer tümörün kontrolünde palyatif olarak uygulanan bir yöntemdir. Çalışmalar göstermiştir ki, primer tümörün temiz cerrahi sınırla çıkarılması metastatik meme kanserinde sağkalım avantajı ve artmış hayat kalitesi sağlar. Bu hastalar multidisipliner onkolojik yaklaşımla değerlendirilmeli, cerrahiye uygun hastaların seçimi ve takibi bu ekiple yapılmalıdır.

Anahtar Kelimeler:

Salvage mastektomi, meme kanseri, cilt tutulumu, ülser, palyatif cerrahi

Salvage Mastectomy in Metastatic Breast Cancer Patients

Objective: Breast cancer is the most common female cancer in the world. Cancer can grow, metastasize, cause skin ulcers or necrosis. In cases of bleeding, ulceration and infection in breast cancer that cannot be controlled by chemotherapy, “toilet mastectomy or salvage mastectomy” is applied for palliation. We aimed to contribute to the literature by presenting the cases of salvage mastectomy we performed.Material and Method: Salvage mastectomy cases in our clinic between January 2010 and December 2019 were evaluated. Demographic data of the cases, type of involvement in the breast, postoperative pathology results, distant metastasis and overall survival were analyzed.Results: Between the specified dates, 22 toilet mastectomy cases were examined. There were ulcerated lesions on the skin in 14 cases, and skin involvement without ulcers on the skin in 6 of them. All patients underwent salvage mastectomy. Skin grafting was applied to 3 patients after mastectomy. Surgical margin was negative in all patients. No mortality was observed in any patient during hospitalization. Overall survival was determined as 40 months (min: 35 months - max: 60 months).Conclusions: Salvage mastectomy in metastatic breast cancer is a palliative method for comfort and control of primary tumor. Studies have shown that removal of the primary tumor with a clean surgical margin provides a survival advantage and improved quality of life in metastatic breast cancer. These patients should be evaluated with a multidisciplinary oncological approach, and the selection and follow-up of patients suitable for surgery should be done by this team.

Keywords:

Salvage mastectomy, breast cancer, skin involvement, ulcer, palliative surgery,

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[1] Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), 394-424.
[2] TC Sağlık Bakanlığı. (2016) Türkiye Kanser Kontrol Programı 2013–2018. TC Sağlık Bakanlığı; Ankara, Türkiye: 2016.
[3] Singletary, S. E., Connolly, J. L. (2006). Breast cancer staging: working with the sixth edition of the AJCC Cancer Staging Manual. CA: a cancer journal for clinicians, 56(1), 37-47.
[4] Plevritis, S. K., Munoz, D., Kurian, A. W., Stout, N. K., Alagoz, O., Near, A. M. et al. (2018). Association of screening and treatment with breast cancer mortality by molecular subtype in US women, 2000-2012. Jama, 319(2), 154-164.
[5] Kent, C. L., McDuff, S. G., Salama, J. K. (2020). Oligometastatic breast cancer: where are we now and where are we headed?—a narrative review. Ann Palliat Med, 9, 62-72.
[6] Tham, Y. L., Sexton, K., Kramer, R., Hilsenbeck, S., Elledge, R. (2006). Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer, 107(4), 696-704.
[7] Ozmen V. (2010) Meme Hastalıkları Dernekleri etkinlikleri. Meme Sağlığı Dergisi 2010; 6: 43-44.
[8] Soran, A. (2018). Are we close to the end of the primary tumor resection discussion for de novo stage IV BC?. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 45(2), 81-82.
[9] Khan, S. A., Stewart, A. K., Morrow, M. (2002). Does aggressive local therapy improve survival in metastatic breast cancer?. Surgery, 132(4), 620-627.
[10] Babiera, G. V., Rao, R., Feng, L., Meric-Bernstam, F., Kuerer, H. M., Singletary, S. E.et al. (2006). Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor. Annals of surgical oncology, 13(6), 776-782.
[11] Rao, R., Feng, L., Kuerer, H. M., Singletary, S. E., Bedrosian, I., Hunt, K. K. et al. (2008). Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Annals of surgical oncology, 15(6), 1696-1702.
[12] Fields, R. C., Jeffe, D. B., Trinkaus, K., Zhang, Q., Arthur, C., Aft, R. et al. (2007). Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site of metastasis. Annals of surgical oncology, 14(12), 3345-3351.
[13] Gnerlich, J., Jeffe, D. B., Deshpande, A. D., Beers, C., Zander, C., Margenthaler, J. A. (2007). Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988–2003 SEER data. Annals of surgical oncology, 14(8), 2187-2194.
[14] Rapiti, E., Verkooijen, H. M., Vlastos, G., Fioretta, G., Neyroud-Caspar, I., Sappino, A. P. et al. (2006). Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J clin oncol, 24(18), 2743-2749.