Læknablaðið - 15.10.1990, Page 30

396
LÆKNABLAÐIÐ
fjórðungum brjóstsins (26). Menn eru ekki
á eitt sáttir hvenær mat á árangri skuli fara
fram. Harris og félagar fundu engan mun einu
til fjórum árum eftir meðferð (31). Pierquin
leggur til að útlitsárangur sé ekki dæmdur fyrr
en þremur árum eftir meðferð (34). í rannsókn
Spitaliers kom fram lélegri útlitsárangur
eftir tíu ár miðað við mat fimm árum áður
(35). Danoff og félagar leggja til að mat sé
lagt á árangur tveimur til þremur árum eftir
meðferð (23). I rannsókn Bartelinks kom fram
marktækt lélegri árangur ef holhandarskurður
var framkvæmdur í sömu aðgerð (11).
Til þess að meta betur ofangreinda þætti hjá
íslenskum konum sem farið hafa í fleygskurð
vegna brjóstakrabbameins er nauðsynlegt að
bæta fleiri árum við rannsókn þessa, þannig að
búast megi við marktækum niðurstöðum.
ÞAKKIR
Verkefni þetta var að hluta til styrkt af
Vísindasjóði læknaráðs Landspítalans.
Hrefnu Níelsdóttur ljósmyndara er þakkað
hennar framlag. Dómnefndinni, þeim Jónínu
Helgu Jónsdóttur hjúkrunarfræðingi, Jóni
Hrafnkelssyni krabbameinslækni og Jens
Kjartanssyni lýtalækni er þakkaður þeirra
þáttur.
SUMMARY
The cosmetic results in 49 patients operated with
conservative methods for breast cancer during the
period Jan-83 through Oct-87 have been analyzed.
The mean age of the patients was 54 years. About
half of the patients were under 50 years. The
mean size of the tumour was 15 mm and nine
of the patients had lymph node metastases in the
axilla. Thirty-four (69%) received perioperative
chemotherapy and 42 (86%) postoperative
radiotherapy. The mammograms were reexamined
and no correlation was found between the
radiological findings pre- and postoperatively and
the cosmetic results. Most radiographic changes
resulting from the operation and radiotherapy have
stabilized about 10 months after the operation.
Forty-seven of 49 patients (96%) would prefer
conservative surgery to mastectomy if they were
to choose between the two methods again. Eighty-
four of the patients judged the cosmetic results very
good or good, but a professional panel judged tbe
results very good or good in 69% of the patients.
A statistical analysis did not show any correlation
between the cosmetic results and the patients’ age,
size or localization of the tumour in the breast.
HEIMILDIR
1. Þórarinsson H. Fleygskurður við brjóstakrabbameini.
Heilbrigðismál 1988; 36, 2. tbl.: 21-4.
2. Tabár L, Fagerberg CJG, Gad A et al. Reduction in
mortality from breast cancer after mass screening
with mammography: Lancet 1985; 1: 829-32.
3. Lippmann ME, Lichter AS, Danforth DN. Diagnosis
and management of breast cancer. Philadelphia: WB
Saunders, 1988: 95-154.
4. Mustakallio S. Conservative treatment of breast
carcinoma. Rewiev of 25-year follow-up. Clin Radiol
1972; 23: 110-6.
5. Fisher B, Bauer M, Margolese R et al. Five-year
results of a randomized clinical trial comparing
total mastectomy and segmental mastectomy with
or without radiation in the treatment of breast cancer.
N Engl J Med 1985; 312: 665-73.
6. Henderson IC, Canellos GP. Cancer of the breast:
The past decade. N Engl J Med 1980; 302: 17-30,
78-90.
7. Veronesi U, Saccozzi R, del Vecchio M, Banje A,
Clemente C, DeLena M, Gallus G, Greco M, Luini
A, Mambini E, Masculino G, Rilke F, Salvadori B,
Zecchini A, Zucali R. Comparing radical mastectomy
with quadrantectomy, axillary dissection and
radiotherapy in patients with small cancer of the
breast. N Engl J Med 1981; 305: 6-11.
8. Sarrazin D, Lé MG, Fontaine F, Arriagada R.
Conservative treatment versus mastectomy in T1 or
small T2 breast cancer. A randomized clinical trial.
In: Harris JR, Hellman S, Silen W, eds. Conservative
Management of Breast Cancer. Philadelphia: JB
Lippincott Company, 1983: 101-11.
9. Holmberg L, Omne Ponlén M, Bums T, Adami
H-O, Berström R. Psychosocial adjustment after
mastectomy and breast conserving treatment. Cancer
1989; 64: 969-74.
10. Schain W, Edward BK, Gorrell CR, V. de Moss E,
Lippman E, Gerber H, Lichter AS. Psychosocial and
physical outcomes of primary breast cancer therapy:
mastectomy vs. excisional biopsy and irradiation.
Breast Cancer Res. Treatment 1983; 3: 377-82.
11. Bartelink H, Van Dam F, Van Dongen J.
Psychological effects of breast conserving therapy in
comparison with radical mastectomy. Int J Radiation
Oncol Biol Phys 1985; 11: 381-5.
12. Keynes G. Conservative treatment of cancer of the
breast. Br Med J 1937; 2: 643-7.
13. Peters MV. Wedge resection and irradiation, an
effective treatment in early breast cancer. JAMA
1967; 200: 18-9.
14. Veronesi U, Zucali R, Luini A. Local control and
survival in early breast cancer: The Milan trial. Int
J Radiation Oncol Biol Phys 1986; 12: 717-30.
15. Nolvadex Adjuvant Trial Organisation. Controlled
trial of tamoxifen as single adjuvant agent in
management of early breast cancer. Analysis at six
years. Lancet 1985; 1: 836-40.
16. National Institute of Health Consensus Development.
Conference Statement: Adjuvant chemotherapy for
breast cancer 1985; 5: (12).
17. Beadle GF, Silver B, Botnick L, Hellman S, Harris
JR. Cosmetic results following primary radiation
therapy for early stage breast cancer. Int J Radiation
Oncol Biol Phys 1984; 10: 2131-7.
18. McCormick B, Yahalow J, Louise Cox RN, Shank
B, Massie MJ. The patients perception of her
breast following radiation and limited surgery. Int J
Radiation Oncol Biol Phys 1989; 17: 1299-1302.