Indications for Breast-Conserving Surgery

Women are candidates for breast-conserving therapy:
- If the tumor is small enough in relation to the size of the breast to permit resection of the tumor with clear margins and an acceptable cosmetic result
Absolute contraindications to breast-conserving therapy include:
- Prior radiation therapy to the breast or chest wall
- Breast cancer early in pregnancy that would necessitate radiation therapy during pregnancy
- Diffuse suspicious, malignant-appearing micro calcifications
- Widespread disease that precludes negative margins with a satisfactory cosmetic result
Retrospective reviews have shown that patients with collagen vascular diseases, specifically scleroderma:
- Are at increased risk of radiation toxicities, even with modern techniques:
  - Therefore, the presence of scleroderma would be a relative contraindication for breast-conserving surgery
There have been attempts to allow for breast-conserving surgery for selected patients with multifocal or multicentric disease:
- Retrospective data suggest that although patients with multifocal or multicentric disease have increased risk of local recurrence and lower disease-free survival:
  - This finding is independent of the type of surgery performed
- The Alliance Z11102 study:
  - Sought to prospectively determine whether patients with multiple ipsilateral breast cancers could safely undergo breast-conserving surgery
  - Initial report in 2018 showed that breast-conserving surgery:
    - Was feasible in 93% of patients
      - And could be accomplished in one operation in 67%
  - Data regarding local regional recurrence will be forthcoming
Percutaneous ablation techniques:
- Such as cryoablation have promising potential for less-invasive management of breast cancer:
  - However, it is not recommended for multicentric disease
- Large multicenter randomized clinical trials are needed to determine long-term efficacy
References
Morrow M, Strom EA, Bassett LW, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52(5):277-300.
Breast cancer. National Comprehensive Cancer Network. 2018. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed September 9, 2018.
Zaremba N, Tamkus D, DiCarlo L, Herman J, Martin M, Bumpers HL. The dilemma of breast cancer treatment and existing collagen vascular disease: a case of scleroderma and review of the literature. Breast J. 2016;22(4):451-455.
Alm El-Din MA, Taghian AG. Breast conservation therapy for patients with locally advanced breast cancer. Semin Radiat Oncol. 2009;19(4):229-235.
Rosenkranz KM, Ballman K, McCall L, Kubicky C, Cuttino L, Le-Petross H, et al. The feasibility of breast-conserving surgery for multiple ipsilateral breast cancer: an initial report from ACOSOG Z11102 (Alliance) Trial. Ann Surg Oncol. 2018;25(10):2858-2866.
Lanza E, Palussiere J, Buy X, et al. Percutaneous image-guided cryoablation of breast cancer: a systematic review. J Vasc Interv Radiol. 2015;26(11):1652-1657.