Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation

Marks, Lawrence B.; Gupta, Gaorav P.; Muss, Hyman B.; Ollila, David W.

doi:10.1016/j.ijrobp.2018.07.2021

Cited by 13 publications

(11 citation statements)

References 16 publications

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“…The cumulative in-breast/chest-wall failure rates at 10 years after treatment were 3.0% for the BCT group and 4.0% for the mastectomy group. Compared to historical series, reporting approximately 5-10% in-breast failures after 10 years from treatment, our results compare favorably [46,47]. This finding is in agreement with the reports of other studies, which are all convincing and uniformly show DFS and/or OS benefits for BCT compared to mastectomy in patients with stage I-II breast cancer (Table 6).…”

Section: Discussionsupporting

confidence: 92%

“…It is well known that prevention of locoregional recurrence reduces the risk of breast-cancer-specific death and is related to improvements in OS [55,56]. Many possible reasons for the better outcomes observed for patients with breast cancer undergoing lumpectomy combined with postoperative radiotherapy compared with mastectomy have been already elucidated [46,54,57,58]. Surgery does provide superior local control within resected tissue; however, with tangential radiotherapy techniques, the treated volume is larger (as compared to simple mastectomy) and typically includes unoperated breast tissue in its entirety, part of the muscle, regional lymphatics, draining lymphatics towards the axillary region, subcutaneous lymphatic plexus, and skin [46].…”

Section: Discussionmentioning

confidence: 99%

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Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Ratoša

Plavc

Pislar

et al. 2021

Cancers

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In the current study, we sought to compare survival outcomes after breast-conserving therapy (BCT) or mastectomy alone in patients with stage I-IIA breast cancer, whose tumors are typically suitable for both locoregional treatments. The study cohort consisted of 1360 patients with stage I-IIA (T1–2N0 or T0–1N1) breast cancer diagnosed between 2001 and 2013 and treated with either BCT (n = 1021, 75.1%) or mastectomy alone (n = 339, 24.9%). Median follow-ups for disease-free survival (DFS) and overall survival (OS) were 6.9 years (range, 0.3–15.9) and 7.5 years (range, 0.2–25.9), respectively. Fifteen (1.1%), 14 (1.0%) and 48 (3.5%) patients experienced local, regional, and distant relapse, respectively. For the whole cohort of patients, the estimated 5-year DFS and OS were 96% and 97%, respectively. After stratification based on the type of local treatment, the estimated 5-year DFS for BCT was 97%, while it was 91% (p < 0.001) for mastectomy-only treatment. Inverse probability of treatment weighting matching based on confounding confirmed that mastectomy was associated with worse DFS (HR 2.839, 95% CI 1.760–4.579, p < 0.0001), but not with OS (HR 1.455, 95% CI 0.844–2.511, p = 0.177). In our study, BCT was shown to have improved disease-specific outcomes compared to mastectomy alone, emphasizing the important role of adjuvant treatments, including postoperative radiation therapy, in patients with early-stage breast cancer at diagnosis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Ratoša

Plavc

Pislar

et al. 2021

Cancers

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“…Most BCS patients receive adjuvant breast irradiation and tangential fields will include the lower axilla [60]. This may play a role in the prevention of locoregional relapse with benign sentinel lymph node biopsy (false negative rate of about 10% [61]).…”

Section: Discussionmentioning

confidence: 99%

Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer?

Murphy

Gandhi

2021

Clinical Oncology

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“…This has been seen in a number of studies which have demonstrated improved OS and DFS in BCS compared to mastectomy ( 32 – 38 ). BCS may in fact have superior LRR compared to mastectomy due to a number of factors ( 39 ), including developments in radiation treatment planning which have resulted in increased coverage of residual breast tissue compared to techniques in original trials. Improvements in imaging modalities have resulted in more accurate selection of patients for BCS i.e.…”

Section: Increasing Mastectomy Ratesmentioning

confidence: 99%

Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers

2021

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The management of breast cancer has evolved into a multidisciplinary evidence-based surgical speciality, with emphasis on conservative surgery. A number of landmark trials have established lumpectomy followed by radiation as the standard of care for many patients. The aim of this study is to construct a narrative review of recent developments in the surgical management of breast cancer and how such developments have impacted surgical practice. A comprehensive literature search of Pubmed was conducted. The latest search was performed on October 31st, 2020. Search terms “breast cancer” were used in combinations with specific key words and Boolean operators relating to surgical management. The reference lists of retrieved articles were comprehensively screened for additional eligible publications. Articles were selected and reviewed based on relevance. We selected publications in the past 10 years but did not exclude commonly referenced and highly regarded previous publications. Review articles and book chapters were also cited to provide reference on details not discussed in the academic literature. This article reviews the current evidence in surgical management of early-stage breast cancer, discusses recent trends in surgical practice for therapeutic and prophylactic procedures and provides commentary on implications and factors associated with these trends.

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Mastectomy May Be an Inferior Oncologic Approach Compared to Breast Preservation

Cited by 13 publications

References 16 publications

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Improved Survival after Breast-Conserving Therapy Compared with Mastectomy in Stage I-IIA Breast Cancer

Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer?

Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers

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