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

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2024 Jul 24

PMID 39048896

Authors

Katherine M Jackson

Janelle-Cheri Millen

Nicketti Handy

Javier I J Orozco

Stacey L Stern

Crystal E Fancher

Janie G Grumley

Affiliations

Soon will be listed here.

Abstract

Introduction: Patients with multiple or large malignant breast lesions are classically considered mastectomy candidates, but extreme oncoplastic breast-conservation surgery (eOBCS) has become an alternative approach. There is a paucity of outcomes data comparing eOBCS with mastectomy.

Methods: We reviewed our prospectively maintained, single-institution database. We included patients with non-metastatic breast cancer with multiple ipsilateral or single large (≥ 5 cm) malignant breast lesions identified preoperatively who underwent either eOBCS or mastectomy. Patient demographics, clinicopathologic features, and surgical, oncologic, and cosmetic outcomes were evaluated.

Results: Seventy-six (88%) patients underwent eOBCS and 10 (12%) underwent mastectomy. Median follow-up was 24.8 months. Mastectomy patients had larger lesions than eOBCS patients (median 70 mm vs. 32.5 mm; p = 0.06). Six (60%) index mastectomy patients underwent at least one additional surgery. For eOBCS patients, 34 (44%) required re-excision, 7 of whom underwent more than one subsequent surgery to obtain negative margins, and 6 (7.9%) ultimately underwent mastectomy. For patients undergoing additional surgery (n = 40), median time between index and final operation was 315 days for mastectomy versus 21 days for eOBCS patients (p < 0.001). Mastectomy patients more frequently experienced complications (p = 0.001) and underwent cosmetic revision (p < 0.001). There was no difference in cosmetic scores, and eOBCS patients reported less pain (p = 0.009). There were two local and three distant recurrences in the eOBCS cohort and one distant recurrence in the mastectomy group.

Conclusion: Breast conservation was attainable in over 90% of eOBCS patients. Increased postoperative complications and discomfort and longer duration of surgical treatment in mastectomy patients without oncologic superiority should drive informed patient discussions.

References

Chung A, Huynh K, Kidner T, Mirzadehgan P, Sim M, Giuliano A . Comparison of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer. J Am Coll Surg. 2012; 215(1):137-46. DOI: 10.1016/j.jamcollsurg.2012.05.006. View

Fang M, Zhang X, Zhang H, Wu K, Yu Y, Sheng Y . Local Control of Breast Conservation Therapy versus Mastectomy in Multifocal or Multicentric Breast Cancer: A Systematic Review and Meta-Analysis. Breast Care (Basel). 2019; 14(4):188-193. PMC: 6751443. DOI: 10.1159/000499439. View

Morrow M, Strom E, Bassett L, Dershaw D, Fowble B, Giuliano A . Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002; 52(5):277-300. DOI: 10.3322/canjclin.52.5.277. View

van Dongen J, Voogd A, Fentiman I, LeGrand C, Sylvester R, Tong D . Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000; 92(14):1143-50. DOI: 10.1093/jnci/92.14.1143. View

Wilson L, Beinfield M, McKHANN C, Haffty B . Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer. 1993; 72(1):137-42. DOI: 10.1002/1097-0142(19930701)72:1<137::aid-cncr2820720126>3.0.co;2-e. View

Neri A, Marrelli D, Megha T, Bettarini F, Tacchini D, De Franco L . "Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases". BMC Surg. 2015; 15:1. PMC: 4324662. DOI: 10.1186/1471-2482-15-1. View

Bleicher R, Ruth K, Sigurdson E, Daly J, Boraas M, Anderson P . Breast conservation versus mastectomy for patients with T3 primary tumors (>5 cm): A review of 5685 medicare patients. Cancer. 2015; 122(1):42-9. PMC: 4707052. DOI: 10.1002/cncr.29726. View

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

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

10.

Kilic B, Bademler S, Ilhan B, Yildirim I, Kucucuk S, Bayram A . Pushing the Limits of Breast-Conserving Surgery with Extreme Oncoplasty. Breast Care (Basel). 2023; 18(5):366-373. PMC: 10601621. DOI: 10.1159/000531533. View

11.

Savioli F, Seth S, Morrow E, Doughty J, Stallard S, Malyon A . Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer. Breast Cancer (Dove Med Press). 2021; 13:353-359. PMC: 8164874. DOI: 10.2147/BCTT.S296242. View

12.

Crown A, Rocha F, Grumley J . Oncoplastic Central Partial Mastectomy and Neoareolar Reduction Mammoplasty with Immediate Nipple Reconstruction: An Initial Report of a Novel Option for Breast Conservation in Patients with Subareolar Tumors. Ann Surg Oncol. 2019; 26(13):4284-4293. DOI: 10.1245/s10434-019-07731-y. View

13.

Shah C, Bremer T, Cox C, Whitworth P, Patel R, Patel A . The Clinical Utility of DCISionRT on Radiation Therapy Decision Making in Patients with Ductal Carcinoma In Situ Following Breast-Conserving Surgery. Ann Surg Oncol. 2021; 28(11):5974-5984. PMC: 8526470. DOI: 10.1245/s10434-021-09903-1. View

14.

Harris J, LEVENE M, Svensson G, Hellman S . Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979; 5(2):257-61. DOI: 10.1016/0360-3016(79)90729-6. View

15.

Corica T, Nowak A, Saunders C, Bulsara M, Taylor M, Williams N . Cosmetic outcome as rated by patients, doctors, nurses and BCCT.core software assessed over 5 years in a subset of patients in the TARGIT-A Trial. Radiat Oncol. 2018; 13(1):68. PMC: 5899392. DOI: 10.1186/s13014-018-0998-x. View

16.

Krebs E, Lorenz K, Bair M, Damush T, Wu J, Sutherland J . Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009; 24(6):733-8. PMC: 2686775. DOI: 10.1007/s11606-009-0981-1. View

17.

Rosso R, DAlonzo M, Bounous V, Actis S, Cipullo I, Salerno E . Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients. Curr Oncol. 2023; 30(2):1461-1472. PMC: 9955792. DOI: 10.3390/curroncol30020112. View

18.

Elsamany S, Alghanmi H, Albaradei A, Abdelhamid R, Madi E, Ramzan A . Assessment of compliance with hormonal therapy in early breast cancer patients with positive hormone receptor phenotype: A single institution study. Breast. 2022; 62:69-74. PMC: 9073292. DOI: 10.1016/j.breast.2022.01.017. View

19.

Boughey J, Rosenkranz K, Ballman K, McCall L, Haffty B, Cuttino L . Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance). J Clin Oncol. 2023; 41(17):3184-3193. PMC: 10256355. DOI: 10.1200/JCO.22.02553. View

20.

de Boniface J, Szulkin R, Johansson A . Medical and surgical postoperative complications after breast conservation versus mastectomy in older women with breast cancer: Swedish population-based register study of 34 139 women. Br J Surg. 2022; 110(3):344-352. PMC: 10364521. DOI: 10.1093/bjs/znac411. View