Abstract
Breast conserving surgery followed by radiation therapy is the accepted standard of care for a majority of women with early-stage invasive breast cancer and ductal carcinoma in situ. While there are relatively few contraindications to breast conserving surgery, there are several areas of controversy and special circumstances in the selection of patients for breast conserving therapy followed by radiation therapy to the whole breast that warrant specific discussion. Discussed in this chapter is breast conserving surgery in the setting of BRCA1/2 mutations, in the setting of collagen vascular disease, and in women who received prior radiation therapy to the chest for Hodgkin’s disease or other malignancies.
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References
Easton DF. How many more breast cancer predisposition genes are there? Breast Cancer Res. 1999;1:14–7.
Easton DF, Steele L, Fields P, et al. Cancer risks in two large breast cancer families linked to BRCA2 on chromosome 13q12-13. Am J Hum Genet. 1997;61:120–8.
Ford D, Easton DF, Peto J. Estimates of the gene frequency of BRCA1 and its contribution to breast and ovarian cancer incidence. Am J Hum Genet. 1995;57:1457–62.
Ford D, Easton DF, Stratton M, et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium. Am J Hum Genet. 1998;62:676–89.
Robson ME, Boyd J, Borgen PI, et al. Hereditary breast cancer. Curr Probl Surg. 2001;38:387–480.
Anon. Cancer risks in BRCA2 mutation carriers. The Breast Cancer Linkage Consortium. J Natl Cancer Inst. 1999;91:1310–6.
Ansquer Y, Gautier C, Fourquet A, et al. Survival in early-onset BRCA1 breast-cancer patients. Institut Curie Breast Cancer Group. Lancet. 1998;352:541.
Robson ME, Chappuis PO, Satagopan J, et al. A combined analysis of outcome following breast cancer: differences in survival based on BRCA1/BRCA2 mutation status and administration of adjuvant treatment. Breast Cancer Res. 2004;6:R8–17.
Seynaeve C, Verhoog LC, Van De Bosch LM, et al. Ipsilateral breast tumour recurrence in hereditary breast cancer following breast-conserving therapy. Eur J Cancer. 2004;40:201050–8.
Anon. Prevalence and penetrance of BRCA1 and BRCA2 mutations in a population-based series of breast cancer cases. Anglian Breast Cancer Study Group. Br J Cancer. 2000;83:1301–8.
Alpert TE, Haffty BG. Conservative management of breast cancer in BRCA1/2 mutation carriers. Clin Breast Cancer. 2004;5:37–42.
Haffty BG. Molecular and genetic markers in the local-regional management of breast cancer. Semin Radiat Oncol. 2002;12:329–40.
Robson M, Svahn T, McCormick B, et al. Appropriateness of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: a clinic-based series. Cancer. 2005;103:44–51.
Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet. 2002;359:1471–7.
Pierce LJ, Levin AM, Rebbeck TR, et al. Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol. 2006;24:2437–43.
Robson M, Levin D, Federici M, et al. Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations. J Natl Cancer Inst. 1999;91:220102–7.
Steinmann D, Bremer M, Rades D, et al. Mutations of the BRCA1 and BRCA2 genes in patients with bilateral breast cancer. Br J Cancer. 2001;85:850–8.
Kirova YM, Stoppa-Lyonnet D, Savignoni A, et al. Risk of breast cancer recurrence and contralateral breast cancer in relation to BRCA1 and BRCA2 mutation status following breast-conserving surgery and radiotherapy. Eur J Cancer. 2005;41:2304–2010.
Pierce LJ, Strawderman M, Narod SA, et al. Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol. 2000;18:3360–9.
Narod SA, Brunet JS, Ghadirian P, et al. Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Hereditary Breast Cancer Clinical Study Group. Lancet. 2000;356:1876–81.
Rebbeck TR. Prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers. J Clin Oncol. 2000;18:100S–3.
Wo J, Taghian A. Radiotherapy in setting of collagen vascular disease. Int J Radiat Oncol Biol Phys. 2007;69:1347–53.
Lin A, Abu-Isa E, Griffith KA, et al. Toxicity of radiotherapy in patients with collagen vascular disease. Cancer. 2008;20103:648–53.
Fleck R, McNeese MD, Ellerbroek NA, et al. Consequences of breast irradiation in patients with pre-existing collagen vascular diseases. Int J Radiat Oncol Biol Phys. 1989;17:829–33.
Morris MM, Powell SN. Irradiation in the setting of collagen vascular disease: acute and late complications. J Clin Oncol. 1997;15:2728–35.
De Naeyer B, De Meerleer G, Braems S, et al. Collagen vascular diseases and radiation therapy: a critical review. Int J Radiat Oncol Biol Phys. 1999;44:975–80.
Phan C, Mindrum M, Silverman C, et al. Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy. Cancer J. 2003;9:461–6.
Rakfal SM, Deutsch M. Radiotherapy for malignancies associated with lupus: case reports of acute and late reactions. Am J Clin Oncol. 1998;21:54–7.
Robertson JM, Clarke DH, Pevzner MM, et al. Breast conservation therapy. Severe breast fibrosis after radiation therapy in patients with collagen vascular disease. Cancer. 1991;68: 502–8.
Ross JG, Hussey DH, Mayr NA, et al. Acute and late reactions to radiation therapy in patients with collagen vascular diseases. Cancer. 1993;71:3744–52.
Chen AM, Obedian E, Haffty BG. Breast-conserving therapy in the setting of collagen vascular disease. Cancer J. 2001;7:480–91.
Travis LB, Hill D, Dores GM, et al. Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma. J Natl Cancer Inst. 2005;97:1428–37.
Cutuli B, Borel C, Dhermain F, et al. Breast cancer occurred after treatment for Hodgkin’s disease: analysis of 133 cases. Radiother Oncol. 2001;59:247–55.
Wolden SL, Hancock SL, Carlson RW, et al. Management of breast cancer after Hodgkin’s disease. J Clin Oncol. 2000;18:765–72.
Intra M, Leonardi MC, Gatti G, et al. Intraoperative radiotherapy during breast conserving surgery in patients previously treated with radiotherapy for Hodgkin’s disease. Tumori. 2004;90:13–6.
Deutsch M, Gerszten K, Bloomer WD, et al. Lumpectomy and breast irradiation for breast cancer arising after previous radiotherapy for Hodgkin’s disease or lymphoma. Am J Clin Oncol. 2001;24:33–4.
Alpert TE, Kuerer HM, Arthur DW, et al. Ipsilateral breast tumor recurrence after breast conservation therapy: outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int J Radiat Oncol Biol Phys. 2005;63:845–51.
Arthur DW, Vicini FA. Accelerated partial breast irradiation as a part of breast conservation therapy. J Clin Oncol. 2005;23:1726–35.
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Haffty, B.G. (2010). Controversial Indications for Breast Conserving Therapy and Radiation. In: Dirbas, F., Scott-Conner, C. (eds) Breast Surgical Techniques and Interdisciplinary Management. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6076-4_75
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DOI: https://doi.org/10.1007/978-1-4419-6076-4_75
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