Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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 microcalcifications
    • 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 in this patient would be a relative contraindication for breast-conserving surgery in this patient
  • 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:
      • This could be accomplished in one operation in 67% of cases
    • 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.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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