BREAST CONSERVING THERAPY (BCT)
The objective of surgical therapy of mamma carcinoma today is the conservation of the breast, in so far as there are no contraindications. In the early 1990s mastectomy was largely replaced by breast conserving therapies (BCT). The main principle of BCT is tumour resection in healthy tissue, sentinel lymph node identification (see III) and the subsequent radiotherapy of the remaining gland tissue in the operated breast.
This procedure allows BCT and mastectomy to achieve equal significance with regard to local recurrence and over all survival rates. Whether further systemic therapy (anti-hormone therapy, chemotherapy, antibody therapy) is required depends on a whole range of parameters. Prognostic and predictive factors have a decisive influence on individual decisions about adjuvant therapy recommendations for an individual patient and an individual tumour.
The objective is a “custom made” therapy for the individual patient.
Contra-indications for BCT, in addition to multi-centricity and inflammatory components, are an unfavourable size ratio between the breast and the tumour. Further contra-indications are Lymphangiosis carcinomatosa (intrusion of cancerous cells into the lymph vessels of the breast) or adherence (large-scale attachment) of the tumour to the skin or the breast muscle. In the case of previous BCT and radiotherapy in the recurrence situation, a mastectomy should also be discussed.
The rate of BCTs was included in the S3 Leitlinien der Deutschen Krebsgesellschaft (Guidelines of the German Cancer Society) and the Deutschen Gesellschaft für Senologie (German Society for Senology) and is included within the framework of quality control. Nowadays BCT should be attainable for about two thirds of patients and is to be aimed for even when complex operations are performed to reconfigure the breast.
Before any tumour operation on the breast the histological diagnosis of the tumour by pre-operative punch or vacuum biopsy should be ensured. This then allows for considerable differentiation in the surgical procedure. Thanks to today´s significantly improved procedures for the early identification of tumours, we are increasingly confronted with tumours which are so small that they cannot be palpated. In order that the suspected area in the mammary gland can nevertheless be located as precisely as possible, it has to be marked by a radiologist before the operation. Fine needle marking monitored by mammograph or ultrasound or, in rare cases by magnetic scan resonance, has proved to be the most reliable method. However, even in the case of palpable tumours, we prefer fine needle marking to be carried out as the palpable tumour often appears to be larger than the actual malignant tumour due to peritumorous inflammation.
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