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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Historically, multiple ipsilateral breast cancer (MIBC) has been a contraindication to breast-conserving therapy (BCT). We report the feasibility of BCT in MIBC from the ACOSOG Z11102 trial [Alliance], a single arm noninferiority trial of BCT for women with two or three sites of malignancy in the ipsilateral breast.

Methods

Women who enrolled preoperatively in ACOSOG Z11102 were evaluated for conversion to mastectomy and need for reoperation to obtain negative margins. Characteristics of women who successfully underwent BCT and those who converted to mastectomy were compared. Factors were examined for association with the need for margin reexcision.

Results

Of 198 patients enrolled preoperatively, 190 (96%) had 2 foci of disease. Median size of the largest tumor focus was 1.5 (range 0.1–7.0) cm; 49 patients (24.8%) had positive nodes. There were 14 women who underwent mastectomy due to positive margins, resulting in a conversion to mastectomy rate of 7.1% (95% confidence interval [CI] 3.9–10.6%). Of 184 patients who successfully completed BCT, 134 completed this in a single operation. Multivariable logistic regression analysis did not identify any factors significantly associated with conversion to mastectomy or need for margin reexcision.

Conclusions

Breast conservation is feasible in MIBC with 67.6% of patients achieving a margin-negative excision in a single operation and 7.1% of patients requiring conversion to mastectomy due to positive margins. No characteristic was identified that significantly altered the risk of conversion to mastectomy or need for reexcision.

ClinicalTrials.gov Identifier

NCT01556243.

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References

  1. Wilson LD, Beinfield M, McKhann CF, Haffty BG. Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer. 1993;72:137–42.

    Article  CAS  PubMed  Google Scholar 

  2. Leopold KA, Recht A, Schnitt SJ, et al. Results of conservative surgery and radiation therapy for multiple synchronous cancers of one breast. Int J Radiat Oncol Biol Phys. 1989;16:11–6.

    Article  CAS  PubMed  Google Scholar 

  3. Kurtz JM, Jacquemier J, Amalric R, et al. Breast-conserving therapy for macroscopically multiple cancers. Anna Surg. 1990;212:38–44.

    Article  CAS  Google Scholar 

  4. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.

    Article  PubMed  Google Scholar 

  5. Moon WK, Noh DY, Im JG. Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 2002;224:569–76.

    Article  PubMed  Google Scholar 

  6. Berg WA, Gilbreath PL. Multicentric and multifocal cancer: whole-breast US in preoperative evaluation. Radiology. 2000;214:59–66.

    Article  CAS  PubMed  Google Scholar 

  7. Morrow M, Harris JR. More mastectomies: is this what patients really want? J Clin Oncol. 2009;27:4038–40.

    Article  PubMed  Google Scholar 

  8. Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209:180–7 (quiz 294-5).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology. 1999;213:881–8.

    Article  CAS  PubMed  Google Scholar 

  10. Bedrosian I, Mick R, Orel SG, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer. 2003;98:468–73.

    Article  PubMed  Google Scholar 

  11. Lee JM, Orel SG, Czerniecki BJ, Solin LJ, Schnall MD. MRI before reexcision surgery in patients with breast cancer. AJR Am J Roentgenol. 2004;182:473–80.

    Article  PubMed  Google Scholar 

  12. Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25:5203–9.

    Article  PubMed  Google Scholar 

  13. Bendifallah S, Werkoff G, Borie-Moutafoff C, et al. Multiple synchronous (multifocal and multicentric) breast cancer: clinical implications. Surg Oncol. 19:e115–23.

    Article  PubMed  Google Scholar 

  14. Wilkinson LS, Given-Wilson R, Hall T, Potts H, Sharma AK, Smith E. Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol. 2005;60:573–8.

    Article  CAS  PubMed  Google Scholar 

  15. Berg WA, Madsen KS, Schilling K, et al. Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology.

  16. Katipamula R, Degnim AC, Hoskin T, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27:4082–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol. 2009;16:2682–90.

    Article  PubMed  Google Scholar 

  18. Hartsell WF, Recine DC, Griem KL, Cobleigh MA, Witt TR, Murthy AK. Should multicentric disease be an absolute contraindication to the use of breast-conserving therapy? Int J Radiat Oncol Biol Phys. 1994;30:49–53.

    Article  CAS  PubMed  Google Scholar 

  19. Cho LC, Senzer N, Peters GN. Conservative surgery and radiation therapy for macroscopically multiple ipsilateral invasive breast cancers. Am J Surg. 2002;183:650–4.

    Article  PubMed  Google Scholar 

  20. Gentilini O, Botteri E, Rotmensz N, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat. 2009;113:577–83.

    Article  PubMed  Google Scholar 

  21. Bauman L, Barth RJ, Rosenkranz KM. Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol. 17:325.

    Article  PubMed  Google Scholar 

  22. Ataseven B, Lederer B, Blohmer JU, et al. Impact of multifocal or multicentric disease on surgery and locoregional, distant and overall survival in 6134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2015;22(4):1118–27.

    Article  PubMed  Google Scholar 

  23. Morrow M, Abrahamse P, Hofer T. Trends in reoperation after initial lumpectomy for breast cancer. JAMA Oncol. 2017:3(10):1352–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Walijee JF, Hu ES, Newman LA, et al. Predictors of re-excision in women undergoing breast-conserving therapy for cancer. Ann Surg Oncol. 2008;15(5);1297–303.

    Article  Google Scholar 

  25. O’Sullivan MJ, Li T, Freedman G, et al. The effect of multiple re-excisions on the risk of breast cancer recurrence after breast conserving therapy. Ann Surg Oncol. 2007;3:3133–40.

    Article  Google Scholar 

  26. Haixia J, Weijaun, Yang T, et al. HER2-positive breast cancer is aassociated with an increased risk of positive cavity margins after initial lumpectomy. World J Oncol. 2014:12:289.

    Article  Google Scholar 

  27. Kurnlawan E, Windle I, Wong M, et al. Predictors of surgcal margin status in breast-conserving surgery within a breast screening program. Ann Surg Oncol. 15(9):2542–9.

  28. Coopey S, Smith B, Hanson S, et al. The safety of multiple re-excisions after lumpectomy for breast cancer. Ann Surg Oncol. 2011;18(13):3797–801.

    Article  PubMed  Google Scholar 

  29. Sabel MS, Rogers K, Griffith K, et al. Residual disease after re-excision lumpectomy for close margins. J Surg Oncol. 2009;99(2):99–103.

    Article  PubMed  Google Scholar 

  30. Hadzikadic G, McGuire KP, Ozmen T, et al. Margin width is not predictive of residual disease on re-excision in breast conserving therapy. J Surg Oncol. 2014;109(5):426–30.

    Article  Google Scholar 

Download references

Acknowledgment

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology), U10CA180790, U10CA180854, and U10CA180858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

    Kari M. Rosenkranz MD

  2. Alliance Statistics and Data Center, Weill Medical College of Cornell University, New York, NY, USA

    Karla Ballman PhD

  3. Alliance Statistics and Data Center, Duke University, Durham, NC, USA

    Linda McCall MS

  4. Oregon Health and Science University, Portland, OR, USA

    Charlotte Kubicky MD

  5. Virginia Commonwealth University Health System, Richmond, VA, USA

    Laurie Cuttino MD

  6. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Huong Le-Petross MD & Kelly K. Hunt MD

  7. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Armando Giuliano MD

  8. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kimberly J. Van Zee MD

  9. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Bruce Haffty MD

  10. Mayo Clinic, Rochester, MN, USA

    Judy C. Boughey MD

Authors
  1. Kari M. Rosenkranz MD
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  2. Karla Ballman PhD
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  3. Linda McCall MS
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  4. Charlotte Kubicky MD
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  10. Bruce Haffty MD
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  11. Judy C. Boughey MD
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Corresponding author

Correspondence to Kari M. Rosenkranz MD.

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Rosenkranz, K.M., Ballman, K., McCall, L. et al. The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial. Ann Surg Oncol 25, 2858–2866 (2018). https://doi.org/10.1245/s10434-018-6583-6

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  • DOI: https://doi.org/10.1245/s10434-018-6583-6

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