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. 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.

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