Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer

Overview

Journal Breast Cancer (Dove Med Press)

Publisher Dove Medical Press

Date 2021 Jun 3

PMID 34079367

Citations 9

Authors

Francesca Savioli

Subodh Seth

Elizabeth Morrow

Julie Doughty

Sheila Stallard

Andy Malyon

Laszlo Romics

Affiliations

Soon will be listed here.

Abstract

Introduction: Extreme Oncoplastic Breast Conservation Surgery (EOBCS) is offered in selected patients with multifocal or multicentric breast cancer (MFMC). Recent evidence has suggested that EOBCS may be a valuable resource for patients with MFMC who may avoid the risk associated with mastectomy in favour of the benefits of breast conservation without risking their oncological outcomes. Our study examined the practice of EOBCS in two regional breast units in Glasgow, United Kingdom.

Materials And Methods: A prospectively collected database of 50 patients treated with EOBC in two breast units in Glasgow between 2007 and 2018 were evaluated, and clinical outcomes were observed.

Results: Fifty patients (median age 55) underwent EOBCS, of which 43 (86%) had invasive disease. Median tumour size was 55mm (50-90) and multifocal disease was identified in 22 (44%) patients. Nine patients (18%) were found to have positive margins and underwent a second procedure, with 6 (12%) proceeding to mastectomy. Five-year disease free survival rate was 91.5%, while cancer-specific survival was 95.7%.

Conclusion: EOBCS is oncologically safe in short-term follow-up. Large scale studies are required to confirm these preliminary results, in order to offer EOBCS as a valid option to patients with advanced or multifocal breast cancer.

Citing Articles

Comparative analysis of the degree of patient satisfaction after breast-conserving surgery with or without oncoplastic surgery: systematic review and meta-analysis.

Lisboa F, Giorgi L, Figueiredo A, Paulinelli R, de Sousa J Front Surg. 2024; 11:1396432.

PMID: 39086922 PMC: 11289670. DOI: 10.3389/fsurg.2024.1396432.

Breast Conservation Project: Clinical Outcomes of Extreme Oncoplastic Breast-Conserving Therapy Versus Mastectomy for Large and Multiple Lesions.

Jackson K, Millen J, Handy N, Orozco J, Stern S, Fancher C Ann Surg Oncol. 2024; 31(11):7582-7593.

PMID: 39048896 DOI: 10.1245/s10434-024-15799-4.

Oncoplastic surgery in the USA: a review of where we started, where we are today and where we are headed.

Willcox L, Losken A, Garcia Nores G Gland Surg. 2024; 13(5):749-759.

PMID: 38845836 PMC: 11150193. DOI: 10.21037/gs-23-363.

Evolution of breast conserving surgery-current implementation of oncoplastic techniques in breast conserving surgery: a literature review.

Torras I, Cebrecos I, Castillo H, Mension E Gland Surg. 2024; 13(3):412-425.

PMID: 38601289 PMC: 11002492. DOI: 10.21037/gs-23-454.

Oncoplastic breast surgery in Europe.

Daster K, Garcia R, Masannat Y, Kothari A Gland Surg. 2024; 13(2):248-256.

PMID: 38455355 PMC: 10915426. DOI: 10.21037/gs-23-380.

References

Crown A, Laskin R, Rocha F, Grumley J . Extreme oncoplasty: Expanding indications for breast conservation. Am J Surg. 2019; 217(5):851-856. DOI: 10.1016/j.amjsurg.2019.01.004. View

Munhoz A, Montag E, Gemperli R . Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg. 2014; 2(3):143-57. PMC: 4115743. DOI: 10.3978/j.issn.2227-684X.2013.08.02. View

Giacalone P, Roger P, Dubon O, El Gareh N, Rihaoui S, Taourel P . Comparative study of the accuracy of breast resection in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2006; 14(2):605-14. DOI: 10.1245/s10434-006-9098-5. View

McIntosh J, ODonoghue J . Therapeutic mammaplasty--a systematic review of the evidence. Eur J Surg Oncol. 2011; 38(3):196-202. DOI: 10.1016/j.ejso.2011.12.004. View

Silverstein M . Radical Mastectomy to Radical Conservation (Extreme Oncoplasty): A Revolutionary Change. J Am Coll Surg. 2016; 222(1):1-9. DOI: 10.1016/j.jamcollsurg.2015.10.007. View

Sardanelli F, Giuseppetti G, Panizza P, Bazzocchi M, Fausto A, Simonetti G . Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004; 183(4):1149-57. DOI: 10.2214/ajr.183.4.1831149. View

Nebril B, Novoa A, Polidorio N, Cereijo Garea C, Bouzon Alejandro A, Oses J . Extreme oncoplasty: The last opportunity for breast conservation-Analysis of its impact on survival and quality of life. Breast J. 2019; 25(3):535-536. DOI: 10.1111/tbj.13267. View

Wilkinson L, Given-Wilson R, Hall T, Potts H, Sharma A, Smith E . Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol. 2005; 60(5):573-8. DOI: 10.1016/j.crad.2004.10.015. View

Winters Z, Benson J . Can Patients with Multiple Breast Cancers in the Same Breast Avoid Mastectomy by Having Multiple Lumpectomies to Achieve Equivalent Rates of Local Breast Cancer Recurrence? Response to the Preliminary Alliance 11102 Trial Report. Ann Surg Oncol. 2018; 26(2):700-701. DOI: 10.1245/s10434-018-6982-8. View

10.

Mansell J, Weiler-Mithoff E, Stallard S, Doughty J, Mallon E, Romics L . Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast. 2017; 32:179-185. DOI: 10.1016/j.breast.2017.02.006. View

11.

Caruso F, Catanuto G, De Meo L, Ferrara M, Gallodoro A, Petrolito E . Outcomes of bilateral mammoplasty for early stage breast cancer. Eur J Surg Oncol. 2007; 34(10):1143-7. DOI: 10.1016/j.ejso.2007.09.012. View

12.

Mansfield L, Agrawal A, Cutress R . Oncoplastic breast conserving surgery. Gland Surg. 2014; 2(3):158-62. PMC: 4115745. DOI: 10.3978/j.issn.2227-684X.2013.08.04. View

13.

Baildam A, Bishop H, Boland G, Dalglish M, Davies L, Fatah F . Oncoplastic breast surgery--a guide to good practice. Eur J Surg Oncol. 2007; 33 Suppl 1:S1-23. DOI: 10.1016/j.ejso.2007.04.014. View

14.

Campbell E, Romics L . Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature. Breast Cancer (Dove Med Press). 2017; 9:521-530. PMC: 5552002. DOI: 10.2147/BCTT.S113742. View

15.

Silverstein M, Savalia N, Khan S, Ryan J . Extreme oncoplasty: breast conservation for patients who need mastectomy. Breast J. 2015; 21(1):52-9. PMC: 4303932. DOI: 10.1111/tbj.12356. View

16.

Koppiker C, Noor A, Dixit S, Busheri L, Sharan G, Dhar U . Extreme Oncoplastic Surgery for Multifocal/Multicentric and Locally Advanced Breast Cancer. Int J Breast Cancer. 2019; 2019:4262589. PMC: 6402217. DOI: 10.1155/2019/4262589. View

17.

Romics L, Macaskill E, Fernandez T, Simpson L, Morrow E, Pitsinis V . A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland - An analysis of 589 patients. Eur J Surg Oncol. 2018; 44(7):939-944. DOI: 10.1016/j.ejso.2018.04.004. View

18.

Coombs N, Boyages J . Multifocal and multicentric breast cancer: does each focus matter?. J Clin Oncol. 2005; 23(30):7497-502. DOI: 10.1200/JCO.2005.02.1147. View

19.

Mansell J, Weiler-Mithoff E, Martin J, Khan A, Stallard S, Doughty J . How to compare the oncological safety of oncoplastic breast conservation surgery - To wide local excision or mastectomy?. Breast. 2015; 24(4):497-501. DOI: 10.1016/j.breast.2015.05.003. View

20.

Chang E, Peled A, Foster R, Lin C, Zeidler K, Ewing C . Evaluating the feasibility of extended partial mastectomy and immediate reduction mammoplasty reconstruction as an alternative to mastectomy. Ann Surg. 2012; 255(6):1151-7. DOI: 10.1097/SLA.0b013e31824f9769. View