margin status influence on the outcome of patients treated with breast conserving surgery
نویسندگان
چکیده
background: b re a st con s er v i n g surg e ry ( b c s ) f o l l owed b y loc a l rad i ot h e ra p y is the standard t r eatment for e a rly sta g e of breast cancer. margin stat u s may have an important impact on local recurren c e and over a ll s u rvival of patients treated with bcs, but this h a s not b een defined adequately. in this study, we in ve stigated the rela t io n ship between microsco p ic margi n s and outco m e of bcs. methods: three hundred eig h ty f o ur pa t ien t s trea t e d with bcs b e tween 1 999 and 2010 were i n cluded in our study. all s u rgeries w e re p e rformed by a sin g le sur g ical t e am. mar g ins w e re defined as cl ose if sur g ical m argi n s were less than 2 mm, as free if sur g ical m a rgi n s were more t h an 2 mm and as p o siti v e if m alignant cel l s w e re p r e s ent in o n e of the ti s s u e ed g e s . d e mograp h ic, cl i nical, a n d pathologic a l factors a s well as biological markers, rec u rrence, and sur v ival rates were comp a red between the close and t h e free mar g ins gr oups. results: the mean age of patients at the time of diag n osis was 54.2 years. there were 34 (9%) recurren c e c a ses and o v erall s u rviv a l w a s 128.7 m o nths and ten ye a rs s u rviv a l rate w a s 81 % . th er e was n o s ign i ficant d i f f e r ence bet w een the close and the free mar g ins grou p s in t e r m s of de m o gr a phic parame t ers, tumor characte r is t ics, bi o lo g ical facto r s (es t r o g e n a nd pro g es t e ro n e recep t or status) and lymp h o vasc u lar invasion. also rec u rrence rate did not d i ffer sig n ificantly between the s e two g ro u ps. conclusion: our study indica t e s that there is no significant d ifferen c e bet w een t h e patients with c l o s e and the f r ee mar g ins in t e r m s o f t reat m ent r e s u lt s . t he re is n o cle a r co ns ens u s in the sur ge o n s ’ commu ni ty over t h e d e finition of a c ceptable margin width in bcs, so a d ditional studies ar e required to find the right a n swer.
منابع مشابه
Margin Status Influence on the Outcome of Patients Treated with Breast Conserving Surgery
BACKGROUND Breast conserving surgery (BCS) followed by local radiotherapy is the standard treatment for early stage of breast cancer. Margin status may have an important impact on local recurrence and overall survival of patients treated with BCS, but this has not been defined adequately. In this study, we investigated the relationship between microscopic margins and outcome of BCS. METHODS T...
متن کاملMammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery
The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcifica...
متن کاملThe Practice Patterns and Perceptions of Korean Surgeons Regarding Margin Status after Breast-Conserving Surgery
Two consecutive surveys for breast surgeons in Korea were conducted to comprehend the practice patterns and perceptions on margin status after breast-conserving surgery. The surveys were conducted online in 2014 (initial) and 2016 (follow-up). A total of 126 and 88 responses were obtained in the initial and follow-up survey, respectively. More than 80% of the respondents replied to routinely ap...
متن کاملThe impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy.
OBJECTIVE The aim of the study was to investigate the parameters affecting positive margin and the impact of positive margin on outcomes after breast-conserving therapy in patients with breast cancer. METHODS Characteristics and survival of 705 patients attempted breast-conserving therapy between January 1994 and December 2004 were retrospectively analyzed using χ(2) tests, the Kaplan-Meier m...
متن کاملIntraoperative radiological margin assessment in breast-conserving surgery.
UNLABELLED A prospective study was lead in order to analyze the accuracy of an X-ray device settled in the operating room for margin assessment, when performing breast-conserving surgery. PATIENTS AND METHODS One hundred and seventy patients were included. All lesions were visible on the preoperative mammograms. An intraoperative X-ray of the lumpectomy specimen was systematically performed f...
متن کاملمنابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
iranian journal of cancer preventionجلد ۴، شماره ۴، صفحات ۱۷۷-۱۸۲
کلمات کلیدی
[
'
b
r
e
a
s
t
n
e
o
p
l
a
s
m
'
,
'
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
'
,
'
r
e
c
u
r
r
e
n
c
e
'
,
'
m
a
r
g
i
n
x
a
0
r
e
f
e
r
e
n
c
e
s
1
.
a
k
b
a
r
i
x
a
0
m
x
a
0
e
'
,
'
a
b
a
c
h
i
z
a
d
e
h
x
a
0
k
'
,
'
k
h
a
y
a
m
z
a
d
e
h
x
a
0
m
'
,
'
t
a
b
a
t
a
b
a
e
e
m
'
,
'
e
s
n
a
a
s
h
a
r
i
f
g
'
,
'
m
o
t
l
a
g
h
a
'
,
'
e
t
a
l
.
c
a
n
c
e
r
i
n
i
r
a
n
.
q
o
m
'
,
'
d
a
r
o
l
f
e
k
r
'
,
'
i
n
p
e
r
s
i
a
n
'
,
'
2
0
0
8
.
2
.
b
a
s
e
l
g
a
x
a
0
j
'
,
'
m
e
n
d
e
l
s
o
h
n
x
a
0
j
.
x
a
0
t
h
e
x
a
0
e
p
i
d
e
r
m
a
l
x
a
0
g
r
o
w
t
h
f
a
c
t
o
r
x
a
0
r
e
c
e
p
t
o
r
x
a
0
a
s
x
a
0
a
x
a
0
t
a
r
g
e
t
x
a
0
f
o
r
x
a
0
t
h
e
r
a
p
y
x
a
0
i
n
x
a
0
b
r
e
a
s
t
c
a
r
c
i
n
o
m
a
.
x
a
0
x
a
0
x
a
0
b
r
e
a
s
t
x
a
0
x
a
0
x
a
0
c
a
n
c
e
r
x
a
0
x
a
0
x
a
0
r
e
s
x
a
0
x
a
0
x
a
0
t
r
e
a
t
.
x
a
0
x
a
0
1
9
9
4
x
a
0
x
a
0
x
a
0
j
a
n
'
,
'
2
9
(
1
)
'
,
1
2
7
,
'
3
8
.
3
.
n
a
g
h
a
v
i
x
a
0
x
a
0
m
.
x
a
0
x
a
0
i
r
a
n
i
a
n
x
a
0
x
a
0
a
n
n
u
a
l
x
a
0
x
a
0
o
f
x
a
0
x
a
0
n
a
t
i
o
n
a
l
x
a
0
x
a
0
d
e
a
t
h
r
e
g
i
s
t
r
a
t
i
o
n
r
e
p
o
r
t
.
m
i
n
i
s
t
r
y
o
f
h
e
a
l
t
h
a
n
d
m
e
d
i
c
a
l
e
d
u
c
a
t
i
o
n
'
,
'
2
0
0
5
.
4
.
m
i
n
i
s
t
r
y
x
a
0
o
f
x
a
0
h
e
a
l
t
h
x
a
0
a
n
d
x
a
0
m
e
d
i
c
a
l
x
a
0
e
d
u
c
a
t
i
o
n
'
,
'
h
e
a
l
t
h
d
e
p
u
t
y
.
n
a
t
i
o
n
a
l
b
u
r
d
e
n
o
f
d
i
s
e
a
s
e
a
n
d
i
n
j
u
r
y
i
n
i
.
r
.
i
r
a
n
'
,
'
2
0
0
6
.
5
.
j
o
r
d
a
n
x
a
0
x
a
0
x
a
0
v
c
.
x
a
0
x
a
0
s
e
r
m
s
'
,
'
m
e
e
t
i
n
g
x
a
0
x
a
0
t
h
e
x
a
0
x
a
0
x
a
0
p
r
o
m
i
s
e
x
a
0
x
a
0
x
a
0
o
f
m
u
l
t
i
f
u
n
c
t
i
o
n
a
l
m
e
d
i
c
i
n
e
s
.
j
n
a
t
l
c
a
n
c
e
r
i
n
s
t
.
2
0
0
7
m
a
r
7
'
,
'
9
9
(
5
)
'
,
3
5
0
,
'
6
.
6
.
f
i
s
h
e
r
x
a
0
b
'
,
'
a
n
d
e
r
s
o
n
x
a
0
s
'
,
'
b
r
y
a
n
t
x
a
0
j
'
,
'
m
a
r
g
o
l
e
s
e
x
a
0
r
g
'
,
'
d
e
u
t
s
c
h
m
'
,
'
f
i
s
h
e
r
e
r
'
,
'
e
t
a
l
.
t
w
e
n
t
y
'
,
'
y
e
a
r
f
o
l
l
o
w
'
,
'
u
p
o
f
a
r
a
n
d
o
m
i
z
e
d
x
a
0
x
a
0
x
a
0
t
r
i
a
l
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
c
o
m
p
a
r
i
n
g
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
t
o
t
a
l
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
m
a
s
t
e
c
t
o
m
y
'
,
'
l
u
m
p
e
c
t
o
m
y
'
,
'
a
n
d
l
u
m
p
e
c
t
o
m
y
p
l
u
s
i
r
r
a
d
i
a
t
i
o
n
f
o
r
t
h
e
t
r
e
a
t
m
e
n
t
o
f
i
n
v
a
s
i
v
e
b
r
e
a
s
t
c
a
n
c
e
r
.
n
e
n
g
l
j
m
e
d
.
2
0
0
2
o
c
t
1
7
'
,
'
3
4
7
(
1
6
)
'
,
1
2
3
3
,
'
4
1
.
7
.
b
l
i
c
h
e
r
t
'
,
'
t
o
f
t
m
'
,
'
n
i
e
l
s
e
n
m
'
,
'
d
ü
r
i
n
g
m
'
,
'
m
ø
l
l
e
r
s
'
,
'
r
a
n
k
f
'
,
'
o
v
e
r
g
a
a
r
d
m
'
,
'
e
t
a
l
.
l
o
n
g
'
,
'
t
e
r
m
r
e
s
u
l
t
s
o
f
b
r
e
a
s
t
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
v
s
.
m
a
s
t
e
c
t
o
m
y
f
o
r
e
a
r
l
y
s
t
a
g
e
i
n
v
a
s
i
v
e
b
r
e
a
s
t
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
c
a
n
c
e
r
'
,
2
0
,
'
y
e
a
r
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
f
o
l
l
o
w
'
,
'
u
p
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
o
f
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
t
h
e
x
a
0
d
a
n
i
s
h
r
a
n
d
o
m
i
z
e
d
x
a
0
d
b
c
g
'
,
'
8
2
t
m
x
a
0
p
r
o
t
o
c
o
l
.
x
a
0
a
c
t
a
x
a
0
o
n
c
o
l
.
x
a
0
2
0
0
8
'
,
'
4
7
(
4
)
'
,
6
7
2
,
'
8
1
.
8
.
a
k
b
a
r
i
m
e
'
,
'
k
h
a
y
a
m
z
a
d
e
h
m
'
,
'
k
h
o
s
h
n
e
v
i
s
s
j
'
,
'
n
a
f
i
s
i
n
'
,
'
a
k
b
a
r
i
a
.
f
i
v
e
a
n
d
t
e
n
y
e
a
r
s
s
u
r
v
i
v
a
l
i
n
b
r
e
a
s
t
c
a
n
c
e
r
p
a
t
i
e
n
t
&
'
,
'
#
0
3
9
'
,
'
s
m
a
s
t
e
c
t
o
m
i
e
s
v
s
.
b
r
e
a
s
t
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
i
e
s
p
e
r
s
o
n
a
l
e
x
p
e
r
i
e
n
c
e
.
i
r
a
n
j
c
a
n
c
e
r
p
r
e
v
.
2
0
0
8
'
,
'
1
(
2
)
'
,
5
3
,
'
6
.
9
.
e
a
r
l
y
x
a
0
b
r
e
a
s
t
c
a
n
c
e
r
x
a
0
t
r
i
a
l
i
s
t
s
&
'
,
'
#
0
3
9
'
,
'
c
o
l
l
a
b
o
r
a
t
i
v
e
x
a
0
g
r
o
u
p
.
r
a
d
i
o
t
h
e
r
a
p
y
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
f
o
r
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
e
a
r
l
y
x
a
0
x
a
0
x
a
0
x
a
0
b
r
e
a
s
t
x
a
0
x
a
0
x
a
0
c
a
n
c
e
r
.
x
a
0
x
a
0
c
o
c
h
r
a
n
e
d
a
t
a
b
a
s
e
s
y
s
t
r
e
v
.
2
0
0
2
'
,
'
(
2
)
'
,
'
c
d
0
0
3
6
4
7
.
1
0
.
c
l
a
r
k
e
m
'
,
'
c
o
l
l
i
n
s
r
'
,
'
d
a
r
b
y
s
'
,
'
d
a
v
i
e
s
c
'
,
'
e
l
p
h
i
n
s
t
o
n
e
p
'
,
'
e
v
a
n
s
x
a
0
e
'
,
'
e
t
x
a
0
a
l
.
x
a
0
e
f
f
e
c
t
s
x
a
0
o
f
x
a
0
r
a
d
i
o
t
h
e
r
a
p
y
x
a
0
a
n
d
x
a
0
o
f
d
i
f
f
e
r
e
n
c
e
s
x
a
0
i
n
x
a
0
t
h
e
x
a
0
e
x
t
e
n
t
x
a
0
o
f
x
a
0
s
u
r
g
e
r
y
x
a
0
f
o
r
x
a
0
e
a
r
l
y
x
a
0
b
r
e
a
s
t
c
a
n
c
e
r
o
n
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
a
n
d
1
5
'
,
'
y
e
a
r
s
u
r
v
i
v
a
l
'
,
'
a
n
o
v
e
r
v
i
e
w
o
f
t
h
e
r
a
n
d
o
m
i
s
e
d
t
r
i
a
l
s
.
l
a
n
c
e
t
.
2
0
0
5
d
e
c
1
7
'
,
'
3
6
6
(
9
5
0
3
)
'
,
2
0
8
7
,
'
1
0
6
.
1
1
.
f
r
e
e
d
m
a
n
g
'
,
'
f
o
w
b
l
e
b
'
,
'
h
a
n
l
o
n
a
'
,
'
n
i
c
o
l
a
o
u
n
'
,
'
f
e
i
n
d
'
,
'
h
o
f
f
m
a
n
j
'
,
'
e
t
a
l
.
p
a
t
i
e
n
t
s
w
i
t
h
e
a
r
l
y
s
t
a
g
e
i
n
v
a
s
i
v
e
c
a
n
c
e
r
w
i
t
h
c
l
o
s
e
o
r
p
o
s
i
t
i
v
e
m
a
r
g
i
n
s
t
r
e
a
t
e
d
w
i
t
h
c
o
n
s
e
r
v
a
t
i
v
e
s
u
r
g
e
r
y
a
n
d
r
a
d
i
a
t
i
o
n
h
a
v
e
a
n
i
n
c
r
e
a
s
e
d
r
i
s
k
o
f
b
r
e
a
s
t
r
e
c
u
r
r
e
n
c
e
t
h
a
t
i
s
d
e
l
a
y
e
d
b
y
a
d
j
u
v
a
n
t
s
y
s
t
e
m
i
c
t
h
e
r
a
p
y
.
x
a
0
i
n
t
x
a
0
j
x
a
0
r
a
d
i
a
t
x
a
0
o
n
c
o
l
x
a
0
b
i
o
l
x
a
0
p
h
y
s
.
x
a
0
1
9
9
9
x
a
0
j
u
l
x
a
0
1
5
'
,
'
4
4
(
5
)
'
,
1
0
0
5
,
'
1
5
.
1
2
.
k
u
n
o
s
c
'
,
'
l
a
t
s
o
n
l
'
,
'
o
v
e
r
m
o
y
e
r
b
'
,
'
s
i
l
v
e
r
m
a
n
p
'
,
'
s
h
e
n
k
r
'
,
'
k
i
n
s
e
l
l
a
x
a
0
x
a
0
t
'
,
'
e
t
x
a
0
x
a
0
a
l
.
x
a
0
x
a
0
b
r
e
a
s
t
x
a
0
x
a
0
c
o
n
s
e
r
v
a
t
i
o
n
x
a
0
x
a
0
s
u
r
g
e
r
y
a
c
h
i
e
v
i
n
g
&
'
,
'
g
t
'
,
'
o
r
=
2
x
a
0
x
a
0
x
a
0
m
m
x
a
0
x
a
0
t
u
m
o
r
'
,
'
f
r
e
e
x
a
0
x
a
0
x
a
0
m
a
r
g
i
n
s
x
a
0
x
a
0
x
a
0
r
e
s
u
l
t
s
x
a
0
x
a
0
x
a
0
i
n
d
e
c
r
e
a
s
e
d
l
o
c
a
l
'
,
'
r
e
g
i
o
n
a
l
r
e
c
u
r
r
e
n
c
e
r
a
t
e
s
.
b
r
e
a
s
t
j
.
2
0
0
6
j
a
n
'
,
'
f
e
b
'
,
'
1
2
(
1
)
'
,
2
8
,
'
3
6
.
1
3
.
v
a
r
g
a
s
x
a
0
c
'
,
'
k
e
s
t
i
n
x
a
0
l
'
,
'
g
o
x
a
0
n
'
,
'
k
r
a
u
s
s
x
a
0
d
'
,
'
c
h
e
n
x
a
0
p
'
,
'
g
o
l
d
s
t
e
i
n
n
'
,
'
e
t
a
l
.
f
a
c
t
o
r
s
a
s
s
o
c
i
a
t
e
d
w
i
t
h
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
a
n
d
x
a
0
x
a
0
c
a
u
s
e
'
,
'
s
p
e
c
i
f
i
c
x
a
0
x
a
0
s
u
r
v
i
v
a
l
x
a
0
x
a
0
i
n
x
a
0
x
a
0
p
a
t
i
e
n
t
s
x
a
0
x
a
0
w
i
t
h
x
a
0
x
a
0
d
u
c
t
a
l
c
a
r
c
i
n
o
m
a
i
n
s
i
t
u
o
f
t
h
e
b
r
e
a
s
t
t
r
e
a
t
e
d
w
i
t
h
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
t
h
e
r
a
p
y
o
r
m
a
s
t
e
c
t
o
m
y
.
i
n
t
j
r
a
d
i
a
t
o
n
c
o
l
b
i
o
l
p
h
y
s
.
2
0
0
5
d
e
c
1
'
,
'
6
3
(
5
)
'
,
1
5
1
4
,
'
2
1
.
1
4
.
s
i
n
g
l
e
t
a
r
y
x
a
0
s
e
.
x
a
0
s
u
r
g
i
c
a
l
x
a
0
m
a
r
g
i
n
s
x
a
0
i
n
x
a
0
p
a
t
i
e
n
t
s
x
a
0
w
i
t
h
e
a
r
l
y
'
,
'
s
t
a
g
e
b
r
e
a
s
t
x
a
0
x
a
0
x
a
0
c
a
n
c
e
r
x
a
0
x
a
0
x
a
0
t
r
e
a
t
e
d
x
a
0
w
i
t
h
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
b
r
e
a
s
t
c
o
n
s
e
r
v
a
t
i
o
n
t
h
e
r
a
p
y
.
a
m
j
s
u
r
g
.
2
0
0
2
n
o
v
'
,
'
1
8
4
(
5
)
'
,
3
8
3
,
'
9
3
.
1
5
.
o
l
s
o
n
t
p
'
,
'
h
a
r
t
e
r
j
'
,
'
m
u
ñ
o
z
a
'
,
'
m
a
h
v
i
d
m
'
,
'
b
r
e
s
l
i
n
t
.
f
r
o
z
e
n
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
s
e
c
t
i
o
n
x
a
0
x
a
0
a
n
a
l
y
s
i
s
x
a
0
f
o
r
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
i
n
t
r
a
o
p
e
r
a
t
i
v
e
x
a
0
x
a
0
x
a
0
x
a
0
m
a
r
g
i
n
a
s
s
e
s
s
m
e
n
t
d
u
r
i
n
g
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
r
e
s
u
l
t
s
i
n
l
o
w
r
a
t
e
s
o
f
r
e
'
,
'
e
x
c
i
s
i
o
n
a
n
d
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
.
a
n
n
s
u
r
g
o
n
c
o
l
.
2
0
0
7
o
c
t
'
,
'
1
4
(
1
0
)
'
,
2
9
5
3
,
'
6
0
.
1
6
.
n
o
g
u
c
h
i
x
a
0
m
'
,
'
m
i
n
a
m
i
x
a
0
m
'
,
'
e
a
r
a
s
h
i
x
a
0
m
'
,
'
t
a
n
i
y
a
x
a
0
t
'
,
'
m
i
y
a
z
a
k
i
i
'
,
'
m
i
z
u
k
a
m
i
y
'
,
'
p
a
t
h
o
l
o
g
i
c
a
s
s
e
s
s
m
e
n
t
o
f
s
u
r
g
i
c
a
l
m
a
r
g
i
n
s
o
n
f
r
o
z
e
n
a
n
d
p
e
r
m
a
n
e
n
t
s
e
c
t
i
o
n
s
i
n
b
r
e
a
s
t
c
o
n
s
e
r
v
i
n
g
x
a
0
x
a
0
s
u
r
g
e
r
y
.
x
a
0
x
a
0
b
r
e
a
s
t
x
a
0
x
a
0
c
a
n
c
e
r
.
x
a
0
x
a
0
1
9
9
5
x
a
0
x
a
0
a
p
r
x
a
0
x
a
0
3
0
'
,
'
2
(
1
)
'
,
2
7
,
'
3
3
.
1
7
.
j
o
b
s
e
n
j
j
'
,
'
v
a
n
d
e
r
p
a
l
e
n
j
'
,
'
o
n
g
f
'
,
'
m
e
e
r
w
a
l
d
t
j
h
.
d
i
f
f
e
r
e
n
c
e
s
i
n
o
u
t
c
o
m
e
f
o
r
p
o
s
i
t
i
v
e
m
a
r
g
i
n
s
i
n
a
l
a
r
g
e
c
o
h
o
r
t
o
f
b
r
e
a
s
t
c
a
n
c
e
r
p
a
t
i
e
n
t
s
t
r
e
a
t
e
d
w
i
t
h
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
t
h
e
r
a
p
y
.
a
c
t
a
o
n
c
o
l
.
2
0
0
7
'
,
'
4
6
(
2
)
'
,
1
7
2
,
'
8
0
.
1
8
.
v
r
i
e
l
i
n
g
c
'
,
'
c
o
l
l
e
t
t
e
l
'
,
'
f
o
u
r
q
u
e
t
a
'
,
'
h
o
o
g
e
n
r
a
a
d
w
j
'
,
'
h
o
r
i
o
t
j
c
'
,
'
j
a
g
e
r
j
j
'
,
'
e
t
a
l
.
c
a
n
p
a
t
i
e
n
t
'
,
'
t
r
e
a
t
m
e
n
t
'
,
'
a
n
d
p
a
t
h
o
l
o
g
y
'
,
'
r
e
l
a
t
e
d
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
e
x
p
l
a
i
n
t
h
e
h
i
g
h
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
r
a
t
e
f
o
l
l
o
w
i
n
g
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
t
h
e
r
a
p
y
i
n
y
o
u
n
g
p
a
t
i
e
n
t
s
?
e
u
r
j
c
a
n
c
e
r
.
2
0
0
3
m
a
y
'
,
'
3
9
(
7
)
'
,
9
3
2
,
'
4
4
.
1
9
.
d
i
l
l
o
n
x
a
0
m
f
'
,
'
h
i
l
l
x
a
0
a
d
'
,
'
q
u
i
n
n
x
a
0
c
m
'
,
'
m
c
d
e
r
m
o
t
t
x
a
0
e
w
'
,
'
o
&
'
,
'
#
0
3
9
'
,
'
h
i
g
g
i
n
s
n
.
a
p
a
t
h
o
l
o
g
i
c
a
s
s
e
s
s
m
e
n
t
o
f
a
d
e
q
u
a
t
e
m
a
r
g
i
n
s
t
a
t
u
s
i
n
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
t
h
e
r
a
p
y
.
a
n
n
s
u
r
g
o
n
c
o
l
.
2
0
0
6
m
a
r
'
,
'
1
3
(
3
)
'
,
3
3
3
,
'
9
.
2
0
.
a
k
b
a
r
i
m
e
'
,
'
m
o
z
a
f
f
a
r
m
'
,
'
h
e
i
d
a
r
i
a
'
,
'
z
i
r
a
k
z
a
d
e
h
h
'
,
'
a
k
b
a
r
i
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
a
'
,
'
a
k
b
a
r
i
x
a
0
x
a
0
m
'
,
'
h
o
s
s
e
i
n
i
z
a
d
e
g
a
n
x
a
0
s
h
i
r
a
z
i
x
a
0
x
a
0
f
.
r
e
c
u
r
r
e
n
c
e
a
n
d
s
u
r
v
i
v
a
l
e
f
f
e
c
t
i
n
b
r
e
a
s
t
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
'
,
'
w
h
a
t
a
r
e
t
h
e
p
r
e
d
i
c
t
i
v
e
a
n
d
/
o
r
p
r
o
g
n
o
s
t
i
c
f
a
c
t
o
r
s
?
2
0
1
1
s
p
r
i
n
g
'
,
'
4
(
2
)
'
,
4
9
,
'
5
4
.
2
1
.
k
u
r
t
z
x
a
0
x
a
0
j
m
'
,
'
a
m
a
l
r
i
c
x
a
0
x
a
0
r
'
,
'
b
r
a
n
d
o
n
e
x
a
0
x
a
0
h
'
,
'
a
y
m
e
x
a
0
x
a
0
y
'
,
'
j
a
c
q
u
e
m
i
e
r
j
'
,
'
p
i
e
t
r
a
j
c
'
,
'
e
t
a
l
.
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
a
f
t
e
r
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
a
n
d
r
a
d
i
o
t
h
e
r
a
p
y
.
f
r
e
q
u
e
n
c
y
'
,
'
t
i
m
e
x
a
0
c
o
u
r
s
e
'
,
'
a
n
d
x
a
0
p
r
o
g
n
o
s
i
s
.
x
a
0
c
a
n
c
e
r
.
x
a
0
1
9
8
9
x
a
0
m
a
y
x
a
0
1
5
'
,
'
6
3
(
1
0
)
'
,
1
9
1
2
,
'
7
.
2
2
.
s
i
l
v
e
r
s
t
e
i
n
x
a
0
m
j
'
,
'
b
a
r
t
h
x
a
0
a
'
,
'
p
o
l
l
e
r
x
a
0
d
n
'
,
'
g
i
e
r
s
o
n
x
a
0
e
d
'
,
'
c
o
l
b
u
r
n
x
a
0
x
a
0
w
j
'
,
'
w
a
i
s
m
a
n
x
a
0
x
a
0
j
r
'
,
'
e
t
x
a
0
x
a
0
a
l
.
x
a
0
x
a
0
t
e
n
'
,
'
y
e
a
r
x
a
0
x
a
0
r
e
s
u
l
t
s
c
o
m
p
a
r
i
n
g
m
a
s
t
e
c
t
o
m
y
t
o
e
x
c
i
s
i
o
n
a
n
d
r
a
d
i
a
t
i
o
n
t
h
e
r
a
p
y
f
o
r
d
u
c
t
a
l
c
a
r
c
i
n
o
m
a
i
n
s
i
t
u
o
f
t
h
e
b
r
e
a
s
t
.
e
u
r
j
c
a
n
c
e
r
.
1
9
9
5
'
,
'
3
1
a
(
9
)
'
,
1
4
2
5
,
'
7
.
2
3
.
s
o
l
i
n
x
a
0
l
j
'
,
'
r
e
c
h
t
x
a
0
a
'
,
'
f
o
u
r
q
u
e
t
x
a
0
a
'
,
'
k
u
r
t
z
x
a
0
j
'
,
'
k
u
s
k
e
x
a
0
r
'
,
'
m
c
n
e
e
s
e
m
'
,
'
e
t
a
l
.
t
e
n
'
,
'
y
e
a
r
r
e
s
u
l
t
s
o
f
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
a
n
d
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
d
e
f
i
n
i
t
i
v
e
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
i
r
r
a
d
i
a
t
i
o
n
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
f
o
r
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
i
n
t
r
a
d
u
c
t
a
l
c
a
r
c
i
n
o
m
a
(
d
u
c
t
a
l
c
a
r
c
i
n
o
m
a
i
n
s
i
t
u
)
o
f
t
h
e
b
r
e
a
s
t
.
c
a
n
c
e
r
.
1
9
9
1
d
e
c
1
'
,
'
6
8
(
1
1
)
'
,
2
3
3
7
,
'
4
4
.
2
4
.
d
u
n
n
e
c
'
,
'
b
u
r
k
e
j
p
'
,
'
m
o
r
r
o
w
m
'
,
'
k
e
l
l
m
r
.
e
f
f
e
c
t
o
f
m
a
r
g
i
n
s
t
a
t
u
s
o
n
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
a
f
t
e
r
b
r
e
a
s
t
c
o
n
s
e
r
v
a
t
i
o
n
a
n
d
r
a
d
i
a
t
i
o
n
t
h
e
r
a
p
y
f
o
r
d
u
c
t
a
l
c
a
r
c
i
n
o
m
a
i
n
s
i
t
u
.
j
c
l
i
n
o
n
c
o
l
.
2
0
0
9
a
p
r
1
'
,
'
2
7
(
1
0
)
'
,
1
6
1
5
,
'
2
0
.
2
5
.
h
o
u
s
s
a
m
i
n
'
,
'
m
a
c
a
s
k
i
l
l
p
'
,
'
m
a
r
i
n
o
v
i
c
h
m
l
'
,
'
d
i
x
o
n
j
m
'
,
'
i
r
w
i
g
l
'
,
'
b
r
e
n
n
a
n
m
e
'
,
'
e
t
a
l
.
m
e
t
a
'
,
'
a
n
a
l
y
s
i
s
o
f
t
h
e
i
m
p
a
c
t
o
f
s
u
r
g
i
c
a
l
m
a
r
g
i
n
s
o
n
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
i
n
w
o
m
e
n
w
i
t
h
e
a
r
l
y
'
,
'
s
t
a
g
e
i
n
v
a
s
i
v
e
b
r
e
a
s
t
c
a
n
c
e
r
t
r
e
a
t
e
d
w
i
t
h
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
t
h
e
r
a
p
y
.
e
u
r
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
j
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
c
a
n
c
e
r
.
x
a
0
x
a
0
x
a
0
x
a
0
x
a
0
2
0
1
0
d
e
c
'
,
'
4
6
(
1
8
)
'
,
3
2
1
9
,
'
3
2
.
2
6
.
f
i
s
h
e
r
x
a
0
b
'
,
'
r
e
d
m
o
n
d
x
a
0
c
'
,
'
p
o
i
s
s
o
n
x
a
0
r
'
,
'
m
a
r
g
o
l
e
s
e
x
a
0
r
'
,
'
w
o
l
m
a
r
k
n
'
,
'
w
i
c
k
e
r
h
a
m
l
'
,
'
e
t
a
l
.
e
i
g
h
t
'
,
'
y
e
a
r
r
e
s
u
l
t
s
o
f
a
r
a
n
d
o
m
i
z
e
d
c
l
i
n
i
c
a
l
t
r
i
a
l
c
o
m
p
a
r
i
n
g
t
o
t
a
l
m
a
s
t
e
c
t
o
m
y
a
n
d
l
u
m
p
e
c
t
o
m
y
w
i
t
h
o
r
w
i
t
h
o
u
t
i
r
r
a
d
i
a
t
i
o
n
i
n
t
h
e
t
r
e
a
t
m
e
n
t
o
f
b
r
e
a
s
t
c
a
n
c
e
r
.
n
e
n
g
l
j
m
e
d
.
1
9
8
9
m
a
r
3
0
'
,
'
3
2
0
(
1
3
)
'
,
8
2
2
,
'
8
.
2
7
.
v
a
n
d
o
n
g
e
n
j
a
'
,
'
b
a
r
t
e
l
i
n
k
h
'
,
'
f
e
n
t
i
m
a
n
i
s
'
,
'
l
e
r
u
t
t
'
,
'
m
i
g
n
o
l
e
t
f
'
,
'
o
l
t
h
u
i
s
g
'
,
'
e
t
a
l
.
f
a
c
t
o
r
s
i
n
f
l
u
e
n
c
i
n
g
l
o
c
a
l
r
e
l
a
p
s
e
x
a
0
a
n
d
x
a
0
s
u
r
v
i
v
a
l
x
a
0
a
n
d
x
a
0
r
e
s
u
l
t
s
x
a
0
o
f
x
a
0
s
a
l
v
a
g
e
x
a
0
t
r
e
a
t
m
e
n
t
a
f
t
e
r
x
a
0
x
a
0
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
x
a
0
x
a
0
t
h
e
r
a
p
y
x
a
0
x
a
0
i
n
x
a
0
x
a
0
o
p
e
r
a
b
l
e
x
a
0
x
a
0
b
r
e
a
s
t
c
a
n
c
e
r
'
,
'
e
o
r
t
c
t
r
i
a
l
1
0
8
0
1
'
,
'
b
r
e
a
s
t
c
o
n
s
e
r
v
a
t
i
o
n
c
o
m
p
a
r
e
d
w
i
t
h
m
a
s
t
e
c
t
o
m
y
i
n
t
n
m
s
t
a
g
e
i
a
n
d
i
1
b
r
e
a
s
t
c
a
n
c
e
r
.
e
u
r
j
c
a
n
c
e
r
.
1
9
9
2
'
,
'
2
8
a
(
4
'
,
'
5
)
'
,
8
0
1
,
'
5
.
2
8
.
t
a
g
h
i
a
n
x
a
0
a
'
,
'
m
o
h
i
u
d
d
i
n
x
a
0
m
'
,
'
j
a
g
s
i
x
a
0
r
'
,
'
g
o
l
d
b
e
r
g
x
a
0
s
'
,
'
c
e
i
l
l
e
y
e
'
,
'
p
o
w
e
l
l
s
.
c
u
r
r
e
n
t
p
e
r
c
e
p
t
i
o
n
s
r
e
g
a
r
d
i
n
g
s
u
r
g
i
c
a
l
m
a
r
g
i
n
s
t
a
t
u
s
a
f
t
e
r
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
t
h
e
r
a
p
y
'
,
'
r
e
s
u
l
t
s
o
f
a
s
u
r
v
e
y
.
a
n
n
s
u
r
g
.
2
0
0
5
a
p
r
'
,
'
2
4
1
(
4
)
'
,
6
2
9
,
'
3
9
.
2
9
.
h
a
r
d
y
x
a
0
k
'
,
'
f
r
a
d
e
t
t
e
x
a
0
k
'
,
'
g
h
e
o
r
g
h
e
x
a
0
r
'
,
'
l
u
c
m
a
n
x
a
0
l
'
,
'
l
a
t
o
s
i
n
s
k
y
x
a
0
s
.
x
a
0
t
h
e
x
a
0
i
m
p
a
c
t
x
a
0
o
f
x
a
0
m
a
r
g
i
n
x
a
0
s
t
a
t
u
s
x
a
0
o
n
x
a
0
l
o
c
a
l
r
e
c
u
r
r
e
n
c
e
x
a
0
x
a
0
f
o
l
l
o
w
i
n
g
x
a
0
x
a
0
b
r
e
a
s
t
x
a
0
x
a
0
c
o
n
s
e
r
v
i
n
g
x
a
0
x
a
0
t
h
e
r
a
p
y
x
a
0
x
a
0
f
o
r
i
n
v
a
s
i
v
e
c
a
r
c
i
n
o
m
a
i
n
m
a
n
i
t
o
b
a
.
j
s
u
r
g
o
n
c
o
l
.
2
0
0
8
n
o
v
1
'
,
'
9
8
(
6
)
'
,
3
9
9
,
'
4
0
2
.
3
0
.
z
a
v
a
g
n
o
g
'
,
'
g
o
l
d
i
n
e
'
,
'
m
e
n
c
a
r
e
l
l
i
r
'
,
'
c
a
p
i
t
a
n
i
o
g
'
,
'
d
e
l
b
i
a
n
c
o
p
'
,
'
m
a
r
c
o
n
a
t
o
r
'
,
'
e
t
a
l
.
r
o
l
e
o
f
r
e
s
e
c
t
i
o
n
m
a
r
g
i
n
s
i
n
p
a
t
i
e
n
t
s
t
r
e
a
t
e
d
w
i
t
h
b
r
e
a
s
t
c
o
n
s
e
r
v
a
t
i
o
n
s
u
r
g
e
r
y
.
c
a
n
c
e
r
.
2
0
0
8
m
a
y
1
'
,
'
1
1
2
(
9
)
'
,
1
9
2
3
,
'
3
1
.
3
1
.
l
u
i
n
i
x
a
0
x
a
0
a
'
,
'
r
o
s
o
s
c
h
a
n
s
k
y
x
a
0
x
a
0
j
'
,
'
g
a
t
t
i
x
a
0
x
a
0
g
'
,
'
z
u
r
r
i
d
a
x
a
0
x
a
0
s
'
,
'
c
a
l
d
a
r
e
l
l
a
p
'
,
'
v
i
a
l
e
g
'
,
'
e
t
a
l
.
t
h
e
s
u
r
g
i
c
a
l
m
a
r
g
i
n
s
t
a
t
u
s
a
f
t
e
r
x
a
0
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
x
a
0
s
u
r
g
e
r
y
'
,
'
d
i
s
c
u
s
s
i
o
n
x
a
0
o
f
x
a
0
a
n
x
a
0
o
p
e
n
i
s
s
u
e
.
b
r
e
a
s
t
c
a
n
c
e
r
r
e
s
t
r
e
a
t
.
2
0
0
9
j
a
n
'
,
'
1
1
3
(
2
)
'
,
3
9
7
,
'
4
0
2
.
3
2
.
p
a
r
k
c
c
'
,
'
m
i
t
s
u
m
o
r
i
m
'
,
'
n
i
x
o
n
a
'
,
'
r
e
c
h
t
a
'
,
'
c
o
n
n
o
l
l
y
j
'
,
'
g
e
l
m
a
n
r
'
,
'
e
t
a
l
.
o
u
t
c
o
m
e
a
t
8
y
e
a
r
s
a
f
t
e
r
b
r
e
a
s
t
'
,
'
c
o
n
s
e
r
v
i
n
g
s
u
r
g
e
r
y
a
n
d
r
a
d
i
a
t
i
o
n
t
h
e
r
a
p
y
f
o
r
i
n
v
a
s
i
v
e
b
r
e
a
s
t
c
a
n
c
e
r
'
,
'
i
n
f
l
u
e
n
c
e
o
f
m
a
r
g
i
n
s
t
a
t
u
s
a
n
d
s
y
s
t
e
m
i
c
t
h
e
r
a
p
y
x
a
0
o
n
x
a
0
l
o
c
a
l
x
a
0
r
e
c
u
r
r
e
n
c
e
.
x
a
0
j
x
a
0
c
l
i
n
x
a
0
o
n
c
o
l
.
x
a
0
2
0
0
0
x
a
0
a
p
r
'
,
'
1
8
(
8
)
'
,
1
6
6
8
,
'
7
5
.
3
3
.
l
a
n
d
i
s
s
h
'
,
'
m
u
r
r
a
y
t
'
,
'
b
o
l
d
e
n
s
'
,
'
w
i
n
g
o
p
a
.
c
a
n
c
e
r
s
t
a
t
i
s
t
i
c
s
'
,
'
1
9
9
8
.
c
a
c
a
n
c
e
r
j
c
l
i
n
.
1
9
9
8
j
a
n
'
,
'
f
e
b
'
,
'
4
8
(
1
)
'
,
6
,
'
2
9
.
3
4
.
n
o
m
u
r
a
k
'
,
'
s
o
b
u
e
t
'
,
'
n
a
k
a
t
a
n
i
h
'
,
'
m
a
e
h
a
r
a
h
.
c
a
n
c
e
r
s
t
a
t
i
s
t
i
c
s
i
n
j
a
p
a
n
2
0
0
5
.
t
o
k
y
o
'
,
'
j
a
p
a
n
f
o
u
n
d
a
t
i
o
n
f
o
r
p
r
o
m
o
t
i
o
n
c
a
n
c
e
r
r
e
s
e
a
r
c
h
'
,
'
2
0
0
5
.
'
]
میزبانی شده توسط پلتفرم ابری doprax.com
copyright © 2015-2023