Male Ca Breast with close margins post MRM

Male Ca Breast with close margins post MRM

abhinavahluwalia 28 Aug 2010 09:01

60 yr male Ca breast - underwent upfront MRM - size of tumor 4X4.5cms - 20 nodes removed all free; Deep surgical margin is 0.3mm - rest free.
questions:
1) what is the definition of close margin after MRM
2) in the above case what will be the further management. - role of adjuvant radiotherapy - as case is T2N0 post MRM and close margin.

Re: Male Ca Breast with close margins post MRM

Rohit Malde 28 Aug 2010 14:00

Hmmm.. Initial gut feeling is to go for Chest wall RT thinking that Male breast cancers generally do poorly.

But then i came across this publication, which puts me in doubt.
http://www.ncbi.nlm.nih.gov/pubmed/9635708
Int J Radiat Oncol Biol Phys. 1998 Jun 1;41(3):599-605.

A close or positive margin after mastectomy is not an indication for chest wall irradiation except in women aged fifty or younger.

Re: Male Ca Breast with close margins post MRM

Nikhilesh Patil 28 Aug 2010 14:38

I agree with Rohit, its hard to justify one over other. I will tend to treat since it is a male breast cancer and they tend to be aggressive. to me anything <6-8mm is close however you also have to see where the tumor is located, which margin is close, is there a possibility of revising ?
Dont know what the rest of the group feels about what is close margin in breast cancer.

Re: Male Ca Breast with close margins post MRM

abhinavahluwalia 28 Aug 2010 15:50

I agree with both of you Rohit and Nikhilesh, Thanks for replying,

actually Male Breast Carcinoma is known for its aggressive behaviour, also that 0.3 mm is far less than what is considered as a clear margin - i think its 1 mm by definition (anybody has an evidence please put it for me) and in this case as it is the deep margin which is close so as to leave the muscle and facia untouched will be a high risk for recurrence — so may be i will go for chest wall RT and then boost to the scar. Further suggestions are welcome.

Re: Male Ca Breast with close margins post MRM

Santam Chakraborty 28 Aug 2010 16:12

Hi,
An update on the patterns of failure http://www.ncbi.nlm.nih.gov/pubmed/14967436?dopt=Abstract
To quote the conclusion:
" This study suggests that not all patients with node-negative breast cancer with positive margins after mastectomy require radiotherapy. Locoregional failure rates approximating 20% were observed in women with positive margins plus at least one of the following factors: age <==50 years, T2 tumor size, grade III histology, or LVI. The absolute and relative improvements in locoregional control with radiotherapy in these situations support the judicious, but not routine, use of PMRT for positive margins after mastectomy in patients with node-negative breast cancer."

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