Management of Multifocal-Multicentric Breast Cancer: Current Perspective

Abstract

RezumatIncidenţa cancerului de sân multicentric (MC) şi multifocal (MF) are rezultate diverse printre diferitele studii clinice existente în prezent, în principal, din cauza lipsei unei clasificãri şi a unei definiţii standardizatea a acestor douã entitãţi diferite. Tratamentul chirurgical optim pentru cancerul de sân multiplu ipsilateral, rãmâne un subiect de discuţie. Chirurgia conservatoare a sânului are o contraindicaţie relativã în tratamentul cancerului multifocal şi al cancerul multicentric. În acest review narativ am analizat diferenţele dintre cancerul de sân MF şi cel MC, rolul rezonanţei magnetice în detecţia leziunilor multiple ale sânului şi în luarea deciziei tratamentului chirurgical. Am evaluat date din literatura legate de fezabilitatea chirurgiei conservatoare a sânului şi de modalitãţile de tratament loco regional. Studii recente au arãtat cã tratamentul chirurgical conservator al pacientelor cu cancer de sân MF/MC împreunã cu radioterapie şi terapie sistemicã adjuvantã pot avea rate scãzute de recidivã. Pentru a confirma aceste rezultate sunt necesare studii prospective.Cuvinte cheie: sân, cancer, chirurgia conservatoare a sânului, mastectomie, cancer de sân multicentric, cancer de sân multifocal, mastectomie nipplesparing, reconstrucţie mamarã AbstractThe incidence of multifocal (MF) and multicentric (MC) breast cancer has a wide variation among different clinical studies, mostly due to the lack of a standardized classification and definition of these two separate entities. The optimal surgical treatment for multiple ipsilateral breast cancer remains a long debated subject. Multifocal and multicentric breast cancer is usually considered a relative contraindication for breast conserving therapy (BCT). In this narrative review we analyzed differences between MC and MF early breast cancer, the role of magnetic resonance imaging (MRI) in detection of multiple breast lesions, and its role in the surgical approach. We evaluate data from the litera-

Expression of Fibroblast Growth Factor 5 (FGF5) and Its Influence on Survival of Breast Cancer Patients

“…For patients with localized BC, surgery is recommended. About 6% of patients with localized BC will finally develop metastatic disease and 10–40% have systemic relapse [ 6 ]. Chemotherapy, radiotherapy, and immunotherapy are recommended for the treatment of BC patients with metastatic disease.…”

“…Chemotherapy, radiotherapy, and immunotherapy are recommended for the treatment of BC patients with metastatic disease. Although great progresses (including the discovery of novel therapeutic targets and the understanding of mechanisms of resistance to treatment) have been made for the management of patients with metastatic BC, the disease remains incurable, which causes at least half a million deaths related to the disease per year [ 6 – 11 ]. Therefore, it is important to develop novel prognostic markers associated with clinical outcomes of BC patients and to develop targeted agents that disrupt specific biological processes critical to growth of cancer cells.…”

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

“…Meta-analysis of data from nineteen studies showed that MRI detected additional disease in 16% of women leading to conversion from wide local excision to mastectomy in 11.3% of cases [33,39]. Multicentric breast cancer has traditionally been among the indications for mastectomy; however, BCS can also be safely performed in these patients on a condition that tumors are completely excised with negative surgical margins with acceptable cosmetic outcomes [40]. In our study, 99 patients (31.2%) had multifocal/multicentric breast cancer in total, and 62 (25.9%) patients with multifocal/multicentric BC in group 1 had a chance to save the breast by using PM + MLDF surgical technique.…”

Does the classification system for multifocal and multicentric breast cancers alter breast conservation rates?

“…This marks a significant departure from earlier guidelines where multicentric disease was considered an absolute contraindication to BCT . With this paradigm shift, it has been recognized that the use of quadrants to distinguish multifocality from multicentricity may be inappropriate as it is based on arbitrary parameters which do not take into account anatomical considerations . In contrast, the segment classification gives attention to the approximate distribution of the mammary lobes and the sick lobe hypothesis, potentially optimizing local control when the affected segment(s) is(are) excised.…”

“…4 With this paradigm shift, it has been recognized that the use of quadrants to distinguish multifocality from multicentricity may be inappropriate as it is based on arbitrary parameters which do not take into account anatomical considerations. 5 In contrast, the segment classification gives attention to the approximate distribution of the mammary lobes and the sick lobe hypothesis, 3 potentially optimizing local control when the affected segment(s) is(are) excised. It also provides a different perspective from the quadrant classification in terms of preoperative planning.…”