Multiple synchronous (multifocal and multicentric) breast cancer: Clinical implications

Bendifallah, Sofiane; Werkoff, G.; Borie-Moutafoff, Constance; Antoine, Martine; Chopier, J.; Gligorov, J.; Uzan, Serge; Coutant, Charles; Rouzier, Roman

doi:10.1016/j.suronc.2010.06.001

Cited by 59 publications

(52 citation statements)

References 73 publications

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“…Differing definitions of microscopically clear radial cancer margins were used. Commonly, this comprised radial margins of at least 1 mm23 27, 28 33, 34 40, 44 48, although two studies5 46 used 2 mm or more and one39 required margins of at least 5 mm. Other studies referred to ‘grossly excised’36, 37, 38, ‘tumour‐free margins’22 and ‘clear at the inked margin’41.…”

Section: Resultsmentioning

confidence: 99%

“…There have also been wide ranging expert opinions on optimal surgical treatments3 4. Inherent clinical inconsistencies include variable definitions, large variation in incidences depending on the sensitivity of preoperative imaging (for example mammography versus MRI), underestimating the tumour load using the current TNM staging classification and unknown clinical implications of MIBC, where multifocal (MF) cancers may be clinically and genetically distinguishable from multicentric (MC) ones5. These issues have challenged interstudy comparisons and clinical evidence regarding treatments for MIBC.…”

Section: Introductionmentioning

confidence: 99%

“…MIBC may also include ductal carcinoma in situ (DCIS) and invasive breast cancer5. However, these definitions are problematic, with no breast anatomical boundaries and variably defined distances of clinically apparently normal tissue between cancers; MF cancers are foci separated by 40 mm or les s (or no more than 20 mm), and MC cancers are foci separated by more than 40 mm (or over 20 mm) or tumours in different quadrants6, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

“…Studies6 10, 11 19, 20, 21 23, 26 are conflicting on the prognostic implications of MIBC, with suggestions of increased axillary lymph node involvement latterly using sentinel lymph node biopsy (SLNB), and with worse overall outcomes than those for unifocal cancers19 22, 23. Increased rates of locoregional recurrence (LRR)5 and breast cancer events22 23, 27 28 secondary to BCS for MIBC have been reported, but vary widely across studies. Recently, a clear majority of the St Gallen expert consensus panel3 expressed the opinion that it was possible to treat MF and MC cancers with BCS, where there was margin clearance and whole‐breast RT was planned.…”

Section: Introductionmentioning

confidence: 99%

“…However, this opinion was not contextualized to clinical outcomes specifically differentiating MF and MC cancers, or comparable outcomes following mastectomy as the standard of care. Current guidelines are concordant regarding adjuvant treatments (chemotherapy, endocrine therapy, targeted therapy and RT) informed by tumour subtypes3 5.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

View full text Add to dashboard Cite

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Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Genevay¹,

Viatte²,

Finckh³

et al. 2010

Arthritis & Rheumatism

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Objective. Based on several experimental results and on a preliminary study, a trial was undertaken to assess the efficacy of adalimumab, a tumor necrosis factor ␣ inhibitor, in patients with radicular pain due to lumbar disc herniation.Methods. A multicenter, double-blind, randomized controlled trial was conducted between May 2005 and December 2007 in Switzerland. Patients with acute (duration of <12 weeks) and severe (Oswestry Disability Index score of >50) radicular leg pain and imagingconfirmed lumbar disc herniation were randomized to receive as adjuvant therapy either 2 subcutaneous injections of adalimumab (40 mg) at 7-day intervals or matching placebo. The primary outcome was the score for leg pain, based on a visual analog scale (0-100 mm), which was recorded every day for 10 days and at 6 weeks and 6 months.Results. Of the 265 patients screened, 61 were enrolled; 31 patients were assigned to receive adalimumab, and 4 patients in the placebo group were lost to followup. Over time, the course of leg pain was more favorable in the adalimumab group than in the placebo group (P ‫؍‬ 0.002). However, the effect size was relatively small, and at the last followup visit the difference was 13.8 (95% confidence interval ؊11.5, 39.0). Compared with patients in the placebo group, approximately twice as many patients in the adalimumab group fulfilled the criteria for "responders" and for "low residual disease impact" (P < 0.05), and fewer surgical discectomies were performed (6 versus 13 in the placebo group; P ‫؍‬ 0.04).Conclusion. The addition of a short course of adalimumab to the treatment regimen of patients experiencing acute and severe sciatica resulted in a small decrease in leg pain and in significantly fewer surgical procedures.

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Multifocal/multicentric breast cancer: Does each focus matter?

et al. 2023

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Background: Multifocal (MF) and multicentric (MC) breast cancer cases have been increasingly diagnosed owing to the extensive use of improved preoperative breast imaging. The current tumor-node-metastasis staging system uses the dimension of the largest tumor and recommends reporting the pathological features of the largest tumor in MF/MC breast cancers.Aim: This study aimed to explore whether the largest or aggregate dimensions of MF and MC breast cancers can better predict tumor behavior. We also attempted to study the histological and biological heterogeneities of separate foci in MF and MC breast cancers to determine whether it was necessary to examine each lesion. Methods:We retrospectively analyzed 121 patients with MF/MC (103 with MF and 18 with MC) breast cancers and 484 patients with unifocal breast cancer who were treated at the First Affiliated Hospital of Nanjing Medical University.Two methods were used to record the T stage (using the dimensions of the largest lesion and aggregate dimensions of all lesions). The histological grade, immunohistochemical parameters, and molecular subtypes of the largest lesion and other lesions in MF/MC breast cancers were studied to assess intertumoral heterogeneity. Results:The use of aggregate dimensions upstaged 63 patients with MF/MC breast cancers to a more advanced stage and removed the independent effect of cancer multiplicity on lymph node positivity compared with the use of the largest dimension. Mismatches were found in the pathological type (9.9%), histological grade (4.1%), and molecular subtype (8.3%) among different foci. Conclusion:The tendency of MF/MC breast tumors to metastasize may be related to tumor load, which can be better predicted by the aggregate dimensions of all foci. The use of the current staging systems may require further evaluation and modification. Intertumoral heterogeneity indicates the necessity for pathological and immunohistochemical assessments of each lesion in patients with MF/MC breast cancers.

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Multiple synchronous (multifocal and multicentric) breast cancer: Clinical implications

Cited by 59 publications

References 73 publications

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Multifocal/multicentric breast cancer: Does each focus matter?

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