The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial

Rosenkranz, Kari M.; Ballman, Karla V.; McCall, Linda; Kubicky, Charlotte Dai; Cuttino, L.W.; Le-Petross, Huong T.; Hunt, Kelly K.; Giuliano, Armando E.; Zee, Kimberly J. Van; Haffty, Bruce G.; Boughey, Judy C.

doi:10.1245/s10434-018-6583-6

Cited by 47 publications

(34 citation statements)

References 30 publications

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“…Multicentric cancer, previously thought to necessitate mastectomy, can be safely managed with breast-conserving surgery if two or more lumpectomies can be done with satisfactory cosmetic outcomes. 69 The widespread use of systemic therapy contributed to the reduction of locoregional recurrence. 70 Rates of locoregional recurrence after breast-conserving surgery followed by radiotherapy are approximately 2-3% at 10 years for ER-positive and HER2-positive tumours and 5% for TNBC, and do not differ significantly from those seen after mastectomy.…”

Section: Early Breast Cancer: Locoregional Therapymentioning

confidence: 99%

Breast cancer

et al. 2021

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Breast cancer is still the most common cancer worldwide. But the way breast cancer is viewed has changed drastically since its molecular hallmarks were extensively characterised, now including immunohistochemical markers (eg, ER, PR, HER2 [ERBB2], and proliferation marker protein Ki-67 [MKI67]), genomic markers (eg, BRCA1, BRCA2, and PIK3CA), and immunomarkers (eg, tumour-infiltrating lymphocytes and PD-L1). New biomarker combinations are the basis for increasingly complex diagnostic algorithms. Neoadjuvant combination therapy, often including targeted agents, is a standard of care (especially in HER2-positive and triple-negative breast cancer), and the basis for de-escalation of surgery in the breast and axilla and for risk-adapted post-neoadjuvant strategies. Radiotherapy remains an important cornerstone of breast cancer therapy, but de-escalation schemes have become the standard of care. ER-positive tumours are treated with 5-10 years of endocrine therapy and chemotherapy, based on an individual risk assessment. For metastatic breast cancer, standard therapy options include targeted approaches such as CDK4 and CDK6 inhibitors, PI3K inhibitors, PARP inhibitors, and anti-PD-L1 immunotherapy, depending on tumour type and molecular profile. This range of treatment options reflects the complexity of breast cancer therapy today.

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Section: Early Breast Cancer: Locoregional Therapymentioning

confidence: 99%

Breast cancer

et al. 2021

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“…If there are two lesions very far apart in different quadrants, separate lumpectomies could be performed with clear margins, followed by radiation [3]. Patients should be made aware of an approximately 30% chance of positive margins requiring margin re-excision; however, the chance of conversion to mastectomy due to positive margins is only around 7% [4]. This particular patient was highly motivated to avoid mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Successful Lumpectomy in a Patient With Multicentric Breast Cancer

Nguyen¹,

Tavana²,

Sadruddin³

et al. 2020

Cureus

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When there is extensive breast cancer, patients typically undergo mastectomy. However, lumpectomy may still be performed for patients who are motivated to avoid a mastectomy and understand the risk for positive margins requiring second surgery in unique cases. This report details the surgical management and clinical reasoning behind lumpectomy for a multicentric breast cancer spanning 5 cm. The lumpectomy was a success with negative margins on final pathology.

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“…The recent ongoing American College of Surgeons Oncology Group (ACOSOG) Z11102 prospective singlearm trial demonstrated in its initial results that 67.6% of the women that underwent BCS for MSIBC successfully completed surgery with negative margins, and with an acceptably low rate of conversion to mastectomy (7.1%). Also, it did not identify any specific patient, imaging or tumor factors that predict patients at increased risk for failure of BCS in the MSIBC population [51]. This study only enrolled patients eligible for BCS and not for mastectomy; however, the SENOMAC study is an ongoing trial that similarly to the Z11102 protocol enroll patients eligible for mastectomy.…”

Section: Breast Surgerymentioning

confidence: 99%

“…The results of trials in progress will enrich our knowledge and provide a sound scientific background for future management guidelines. The final data of ACOSOG Z11102, currently examining LRR following BCS for women with MSIBC [51] and the British MIAMI trial will evaluate the safety of oncoplastic procedures (BCS associated with mammoplasty) in MSIBC [45]. However, the limitation of this study enrolled only 50 patients.…”

Section: Breast Surgerymentioning

confidence: 99%

Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review

et al. 2020

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Multiple synchronous (multifocal or multicentric) ipsilateral breast cancers with heterogeneous histopathology are a rare clinical occurrence, however, their incidence is increasing due to the use of MRI for breast cancer screening and staging. Some studies have demonstrated poorer clinical outcomes for this pattern of breast cancer, but there is no evidence to guide clinical practice. In this multidisciplinary review, we reflect on pathology and molecular characteristics, imaging findings, surgical management including conservation and reconstructive options and approach to the axilla, and the role of chemotherapy and radiotherapy. Multidisciplinary discussions appear decisive in planning an appropriate surgical choice and defining the correct systemic treatment tailored to each clinical condition.

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The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial

Abstract: NCT01556243.

Cited by 47 publications

References 30 publications

Breast cancer

Breast cancer

Successful Lumpectomy in a Patient With Multicentric Breast Cancer

Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review

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