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Annals of Surgical Oncology

, Volume 23, Issue 6, pp 1852–1859 | Cite as

Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis

  • Francesca De Lorenzi
  • Pietro Loschi
  • Vincenzo Bagnardi
  • Nicole Rotmensz
  • Gabriel Hubner
  • Giovanni Mazzarol
  • Roberto Orecchia
  • Viviana Galimberti
  • Paolo Veronesi
  • Marco Angelo Colleoni
  • Antonio Toesca
  • Nickolas Peradze
  • Rietjens Mario
Breast Oncology

Abstract

Background

Oncoplastic surgery is a well-established approach that combines conserving treatment for breast cancer and plastic surgery techniques. Although this approach has been described for T2 tumors, no long-term oncologic follow-up and no comparison with patients undergoing mastectomy has been published. The purpose of the study was to demonstrate that oncoplastic surgery is a safe and reliable treatment for managing invasive primary T2 breast cancer.

Methods

We compared a consecutive series of 193 T2 patients who have undergone oncoplastic surgery (study group) with 386 T2 patients who have undergone mastectomy (control group). The endpoints evaluated were disease-free survival (DFS), overall survival (OS), cumulative incidence of local recurrence (CI-L), regional recurrence (CI-R), and distant recurrence (CI-D), all measured from the date of surgery.

Results

Median follow-up is 7.4 years. The OS is similar within the two groups: 87.3 and 87.1 % at 10 years in the ONC group and control group, respectively (p value, adjusted for multifocality and tumor size, 0.74). Also, the DFS is similar in both groups: 60.9 and 56.3 % at 10 years in the ONC group and control group, respectively. The incidence of local events is slightly higher in the oncoplastic group, whereas the incidence of regional events is slightly higher in the mastectomy group. These differences are not statistically significant. The cumulative incidence of distant events is similar within the two groups.

Conclusions

To our knowledge, the present study provides the best available evidence to suggest that oncoplastic approach is a safe and reliable treatment for managing invasive pT2 breast cancers.

Keywords

Overall Survival Mastectomy Group Muscular Flap Pedicled Reduction Additional Boost Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

None of the authors has any commercial associations or financial interests to disclose. None of the authors received any funding for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s). Statement of Istitutional review board approval and/or statement of conforming to the declaration of Helsinky. This study is in compliance with the principles of the Helsinki Declaration.

References

  1. 1.
    Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer. A trial in progress at the Cancer Institute of Milan. Cancer. 1977;39:2822–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection and radiotherapy in early breast cancer: long term results. Eur J Cancer Clin Oncol. 1986;22:1085–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Mariani L, Salvadori B, Veronesi U, et al. Ten years results of a randomized trial comparing two conservative strategies for small size breast cancer. Eur J Cancer. 1998;149:219–25.Google Scholar
  4. 4.
    Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radiacl mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305:6–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989;320:822–8.CrossRefPubMedGoogle Scholar
  6. 6.
    De Lorenzi F. Oncoplastic surgery: the evolution of breast cancer treatment. Breast J. 2010;16 Suppl:S20–1.CrossRefPubMedGoogle Scholar
  7. 7.
    Rainsbury R. Surgery insight: oncoplastic breast-conserving reconstruction-indications, benefits, choices and outcomes. Nat Clin Pract Oncol. 2007;4:657–64.CrossRefPubMedGoogle Scholar
  8. 8.
    Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2005;31:817–23.CrossRefPubMedGoogle Scholar
  9. 9.
    Petit JY, Rietjens M, Contesso G, Bertin F, Gilles R. Contralateral mastoplasty for breast reconstruction: a good opportunity for glandular exploration and occult carcinomas diagnosis. Ann Surg Oncol. 1997;4:511–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Rietjens M, Petit JY, Contesso G, Bertin F, Gilles R. The role of reduction mammaplasty in oncology. Eur J Plast Surg. 1997;20:245–50.CrossRefGoogle Scholar
  11. 11.
    Rietjens M, De Lorenzi F, Veronesi P, et al. Breast conservative treatment in association with implant augmentation and intraoperative radiotherapy. J Plast Reconstr Aesth Surg. 2006;59:532–5.CrossRefGoogle Scholar
  12. 12.
    De Lorenzi F, Lohsiriwat V, Barbieri B, et al. Immediate breast reconstruction with prostheses after breast conservative treatment plus intraoperative radiotherapy. Long-term aesthetic and oncological outcomes. Breast. 2012;21:374–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Kijima Y, Yoshinaka H, Shinden Y, et al. Oncoplastic breast surgery for centrally located breast cancer. A case series. Gland Surg. 2014;3:62–73.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Carstensen L, Bigaard J. Management of central breast tumors with immediate reconstruction of the nipple-areola complex: a suggested guide. Breast. 2015;24:38–45.CrossRefPubMedGoogle Scholar
  15. 15.
    Moustafa A, Fakhr I. Outcome of different oncoplastic surgical (OPs) techniques for centrally located breast cancer (CLBC). J Egypt Natl Canc Inst. 2014;26:203–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Tan MP, Sitoh NY, Sim AS. Breast conservation treatment for multifocal and multicentric breast cancers in women with small-volume breast tissue. ANZ J Surg. 2014. doi: 10.1111/ans.12942.Google Scholar
  17. 17.
    Kaviani A, Safavi A, Mohammadzadeh N, et al. Oncoplastic surgery in breast conservation: a prospective evaluation of the patients, techniques and oncologic outcomes. Am J Surg. 2014;208:727–34.CrossRefPubMedGoogle Scholar
  18. 18.
    Nahabedian MY, Patel KM, Kaminsky AJ, Cocilovo C, Miraliakbari R. Biplanar oncoplastic surgery: a novel approach to breast conservation for small and medium-sized breasts. Plast Reconstr Surg. 2013;132:1081–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Rancati A, Gonzalez E, Angrifiani C, et al. Oncoplastic options in breast conservative surgery. Gland Surg. 2013;2:163–9.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Munhoz AM, Montag E, Gemperli R. Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg. 2013;2:143–57.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Mansfield L, Agrawal A, Cutress RI. Oncoplastic breast-conserving surgery. Gland Surg. 2013;2:158–62.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Hamdi M. Oncoplastic and reconstructive surgery of the breast. Breast. 2013;22 Suppl 2:S100–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Harvey J, Henderson J, Patel L, Murphy J, Johnson R. Therapeutic mammaplasty: impact on the delivery of chemotherapy. Int J Surg. 2014;12:51–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Driul L, Bernardi S, Bertozzi S, et al. New surfgical trends in breast cancer treatment: conservative interventions and oncoplastic breast surgery. Minerva Ginecol. 2013;65:289–96.PubMedGoogle Scholar
  25. 25.
    Fitzal F, Neher G, Hoch D, et al. An oncoplastic procedure for central and medio-cranial breast cancer. Eur J Surg Oncol. 2007;33:1158–63.CrossRefPubMedGoogle Scholar
  26. 26.
    Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17:1375–91.CrossRefPubMedGoogle Scholar
  27. 27.
    Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6:145–57.CrossRefPubMedGoogle Scholar
  28. 28.
    Clough KB, Kroll S, Audretsch W. An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. 1999;104:409–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Clough KB, Nos C, Salmon RJ, Soussaline M, Durand JC. Conservative treatment of breast cancers by mammaplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg. 1995;96:363–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Petit JY, Garusi C, Greuse M, et al. One hundred and eleven cases of breast conservation treatment with simultaneous reconstruction at IEO, Milan. Tumori. 2002;88:41–7.PubMedGoogle Scholar
  31. 31.
    Santos G, Urban C, Edelweiss MI, et al. Long-term camparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22:2500–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Clough KB, Lewis J, Couturaud B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237:26–34.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kaur N, Petit JY, Rietjens M, et al. Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2005;12:1–7.CrossRefGoogle Scholar
  34. 34.
    Giacalone P, Roger P, Dubon O, et al. Lumpectomy vs. oncoplastic surgery for breast-conserving therapy of cancer. A prospective study about 99 patients. Ann Chir. 2006;131:256–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Giacalone PL, Roger P, Dubon O, et al. Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2007;14:605–14.CrossRefPubMedGoogle Scholar
  36. 36.
    Bogusevicius A, Cepuliene D, Sepetauskiene E. The integrated evaluation of the results of oncoplastic surgery for locally advanced breast cancer. Breast J. 2014;20:53–60.CrossRefPubMedGoogle Scholar
  37. 37.
    Eaton BR, Losken A, Okwan-Duodu D, et al. Local recurrence patterns in breast cancer patients treated with oncoplastic reduction mammaplasty and radiotherapy. Ann Surg Oncol. 2014;21:93–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast. 2007;16:387–95.CrossRefPubMedGoogle Scholar
  39. 39.
    Mansell J, Weiler-MithoffE, Martin J, et al. How to compare the oncological safety of oncoplastic breast conservation surgery—to wide local excision or mastectomy? Breast. 2015;24:497–501.CrossRefPubMedGoogle Scholar
  40. 40.
    Schaverien MV, Doughty JC, Stallard S. Quality of information reporting in studies of standard and oncoplastic breast-conserving surgery. Breast. 2014;23:104–11.CrossRefPubMedGoogle Scholar
  41. 41.
    Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the primary therapy of early breast cancer 2015. Ann Oncol. 2015;26:1533–46.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. Hoboken, NJ: Wiley 1980.Google Scholar
  43. 43.
    Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.CrossRefGoogle Scholar
  44. 44.
  45. 45.
    Orecchia R, Huscher A, Leonardi MC, et al. Irradiation with standard tangential fields in patients treated with conservative surgery and sentinel node biopsy: using a three-dimensional tool to evaluate the first level coverage of the axillary nodes. Br J Radiol. 2005;78:51–4.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Francesca De Lorenzi
    • 1
  • Pietro Loschi
    • 1
  • Vincenzo Bagnardi
    • 2
    • 3
  • Nicole Rotmensz
    • 2
  • Gabriel Hubner
    • 1
  • Giovanni Mazzarol
    • 4
  • Roberto Orecchia
    • 5
  • Viviana Galimberti
    • 6
  • Paolo Veronesi
    • 6
  • Marco Angelo Colleoni
    • 7
  • Antonio Toesca
    • 6
  • Nickolas Peradze
    • 6
  • Rietjens Mario
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryEuropean Institute of OncologyMilanItaly
  2. 2.Division of Epidemiology and BiostatisticsEuropean Institute of OncologyMilanItaly
  3. 3.Department of Statistics and Quantitative MethodsUniversity of Milan-BicoccaMilanItaly
  4. 4.Division of Pathology and Laboratory MedicineEuropean Institute of OncologyMilanItaly
  5. 5.Division of RadiotherapyEuropean Institute of OncologyMilanItaly
  6. 6.Department of SurgeryEuropean Institute of OncologyMilanItaly
  7. 7.Medical SenologyEuropean Institute of OncologyMilanItaly

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