margin status influence on the outcome of patients treated with breast conserving surgery

نویسندگان

me akbari

m akbari

h zirakzadeh

n nafisi

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.

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Margin Status Influence on the Outcome of Patients Treated with Breast Conserving Surgery

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عنوان ژورنال:
iranian journal of cancer prevention

جلد 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 . ' ]

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