Treatment restoregeometry recurrence

Detection restoregeometry recurrence in the area of operational fields after mastectomy is proof of the progression of the tumor process, not cured after a mastectomy no matter how much time passed after its execution. According to our data (Dymarskii L. Yu, Bavli J. L., 1976), the average term of the emergence of local recurrence is 30.8 months, and 82,6% of them appear in the first 2 years after surgery. Almost as a rule, in parallel with the recurrences are developing distant metastases. However, the location of the last shows the features of the development of the primary tumor.
Relapses implant character. Single knots in postoperative scar or on the site of the incision for insertion drainage tube is usually move in relation to surrounding tissues, quite well demarcated. Surgical removal of such sites with subsequent gamma-irradiation of the zone in total dose up to 3500-4000 happy is sufficient to cure, but will not prevent the emergence of new implant centers, the pace of development which is not synchronous. In some cases it is necessary to resort to subsequent operations. After radiation treatment shows several courses (usually not less than 3-4) combined chemotherapy with the aim of damage metastatic lesions in the internal organs, the existence of which is likely. Recently in the treatment of relapses successfully used antineoplastic antibiotics (adriablastin and karminomitsin).
Often recurrent nodes are found in the thickness of the subcutaneous tissue away from the scar, subclavian and armpit. Their dimensions are different, paths, fuzzy, mobility is restricted due to infiltration of the surrounding tissue and germination in the muscles.
Similar rest is relapses (their appearance is connected with the abandonment of the wound parts of the tumor or lymph nodes metastases) shows radiation exposure, preferably using sources of high energies (6-15 MeV by C. A. Gromilov et al., 1978). Most use either one or two fields in size 10x14 cm; the total dose of 5000 - 6000 happy. After irradiation in the absence of metastases in supraclavicular nodes strive to produce times residues site. In the postoperative period starting hormone - and chemotherapy on the General principles.
Harder to help patients with multiple local recurrence lymphangiosarcoma character that threaten the transition to the so-called tubular forms, or by combination of recurrence and metastases in supraclavicular nodes. In these cases also start with attempts radiation treatment, if the area of damage chest wall is placed in 2 - 3 fields, each of which can be brought focal dose of at least 3500-4000 happy. At the same time spend hormone therapy. In some cases oophorectomy followed by the introduction of androgens preceded by radiation therapy. After the end of radiation on the background of constant therapy with androgen or estrogen, progestin or (as with the preliminary oophorectomy and without it) designate mnogomernuyu chemotherapy.
Patients in premenopausal and menopausal periods, when the General satisfactory condition treatment is built on the basis of hormonal events (oophorectomy - adrenalectomy - gipofizektomii) (Alexandrov N. N., Pastushenko So Well.. 1972; Stoll, 1977, and others) or hormone therapy combined with chemotherapy.
Almost insurmountable difficulties in achieving at least the stabilization process occur in extensive lymphangiectasia defeats the chest wall and the simultaneous development of multiple metastases in the pleura, lungs, abdominal organs. Attempts radiation therapy in such cases, unsuccessful, and systemic intravenous chemotherapy ineffective. However, sometimes a temporary improvement can be achieved with adriamitina, karminomitsin, the combination of antimetabolites, alkylating drugs, anticancer antibiotics against the background of estrogenotherapy patients in deep menopause or progestins on this background patients in premenopausal or early menopause. In younger patients, the efficiency of treatment is usually minimal. Recently there were messages on the effectiveness of therapy with antihormones in patients of reproductive age.
Thus, the goal of treatment restoregeometry relapse is more complicated, depending on the distribution process, the early appearance of recurrence after mastectomy and relapses in patients of reproductive age.