Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers

Abstract

Background. Conservative surgery (CS) and radiation therapy (RT) as an alternative to mastectomy is controversial in patients with two or more lesions in the same breast. The authors reviewed their experience with CS and RT in the management of patients with synchronous ipsilateral breast cancer (SIBC). Methods. Of 1060 patients treated with CS and RT at the authors' facilities before December 1988, 13 (1.2%) presented with SIBC. All lesions were identified macroscopically and confirmed microscopically as carcinoma. After excision, patients were treated with radiation to the breast for a median tumor bed dose of 65 Gy, and regional lymphatics were treated as clinically indicated to a median dose of 48 Gy. These cases were retrospectively reviewed. Results. As of February 1992, with a median follow‐up of 71 months, the 5‐year actuarial survival rate of the 13 patients was 81%. Three of the 13 (23%) had an ipsilateral breast recurrence, resulting in a 72‐month actuarial breast recurrence rate of 25%, compared with a rate of 12% in our singular lesion population. Two of these patients remain alive, no evidence of disease at 135 and 93 months after diagnosis. The third patient had chest wall progression and died with metastatic disease at 64 months. Invasive lobular histology and three separate lesions were identified in two of the three patients with subsequent local recurrence. Conclusions. The local recurrence rate in conservatively treated patients with SIBC is greater than that seen in patients with single lesions, but because of the small sample size, significant conclusions are not possible. Although the data are limited on this subject, these results support consideration of CS and RT as an option in the management of selected patients who favor a breast conservation management approach. Cancer 1993; 72:137–42.

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

“…The 24 studies had retrospective observational designs, comprising 17 comparative studies20, 21, 22, 23 27, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 and seven case series28 44, 45, 46, 47, 48, 49 ( Table 1; Table   S1, supporting information). The studies included a total of 3537 women with MIBC undergoing BCS: 2677 with tumours defined as MF, 292 as MC, and 568 not defined as either MF or MC, but reported as MIBC.…”

“…The studies included a total of 3537 women with MIBC undergoing BCS: 2677 with tumours defined as MF, 292 as MC, and 568 not defined as either MF or MC, but reported as MIBC. Assessment of the observational studies using the NOS showed that three20 27, 43 were of high quality (score at least 7) and 1421, 22, 23 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 of moderate quality (score 4–6) ( Table   S2, supporting information).…”

“…Seventeen studies20 21, 27 28, 32 34, 35, 36, 37 40, 41, 42 44, 46, 47, 48, 49 were from single centres, four33 38, 39 45 involved two centres, and there were three multicentre studies22 23, 43 comprising a regional cancer registry (British Columbia Cancer Agency)43, a German regional study group (BRENDA Study Group: Breast Cancer Care under Evidence‐based Guidelines)23 and a substudy within three multicentre RCTs of neoadjuvant chemotherapy (German Breast Group (Gepar) trials)22 ( Table 1; Table   S1, supporting information).…”

“…35–169) in comparative studies and 22 (14–43) in case series. Diagnostic methods for evaluating MIBC were recorded in six of the seven case series44, 45, 46, 47, 48, 49 and nine27 32, 33 35, 36, 37, 38, 39, 40 of the 17 comparative studies. In these 15 studies, 258 of 592 patients (43·6 per cent) were diagnosed by postoperative pathology and 294 (49·7 per cent) before surgery: clinical examination (129, 21·8 per cent), radiology (103, 17·4 per cent) or undefined methods (62, 10·5 per cent).…”

“…In these 15 studies, 258 of 592 patients (43·6 per cent) were diagnosed by postoperative pathology and 294 (49·7 per cent) before surgery: clinical examination (129, 21·8 per cent), radiology (103, 17·4 per cent) or undefined methods (62, 10·5 per cent). The remaining 40 patients (6·8 per cent) were classified as having MIBC based on lesion detection at surgery32 38, 39. Where preoperative diagnostic methods were defined, ultrasound imaging was reported in four27 33, 40 46 and MRI in three35 47, 49 studies.…”