Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance)

Abstract

PURPOSE Breast-conserving therapy (BCT) is the preferred treatment for unifocal breast cancer (BC). The oncologic safety of BCT for multiple ipsilateral breast cancer (MIBC) has not been demonstrated in a prospective study. ACOSOG Z11102 (Alliance) is a phase II, single-arm, prospective trial designed to evaluate oncologic outcomes in patients undergoing BCT for MIBC. PATIENTS AND METHODS Women age 40 years and older with two to three foci of biopsy-proven cN0-1 BC were eligible. Patients underwent lumpectomies with negative margins followed by whole breast radiation with boost to all lumpectomy beds. The primary end point was cumulative incidence of local recurrence (LR) at 5 years with an a priori rate of clinical acceptability of <8%. RESULTS Among 270 women enrolled between November 2012 and August 2016, there were 204 eligible patients who underwent protocol-directed BCT. The median age was 61 years (range, 40-87 years). At a median follow-up of 66.4 months (range, 1.3-90.6 months), six patients developed LR for an estimated 5-year cumulative incidence of LR of 3.1% (95% CI, 1.3 to 6.4). Patient age, number of sites of preoperative biopsy–proven BC, estrogen receptor status and human epidermal growth factor receptor 2 status, and pathologic T and N categories were not associated with LR risk. Exploratory analysis showed that the 5-year LR rate in patients without preoperative magnetic resonance imaging (MRI; n = 15) was 22.6% compared with 1.7% in patients with a preoperative MRI (n = 189; P = .002). CONCLUSION The Z11102 clinical trial demonstrates that breast-conserving surgery with adjuvant radiation that includes lumpectomy site boosts yields an acceptably low 5-year LR rate for MIBC. This evidence supports BCT as a reasonable surgical option for women with two to three ipsilateral foci, particularly among patients with disease evaluated with preoperative breast MRI.

The Utility of a Novel Bidirectional Lateral Intercostal Artery Perforator Flap for Reconstructing Partial Mastectomy Defects

“…The ability to reconstruct larger defects is becoming more relevant as surgeons document improved survival and decreased recurrence rates for breast conservation versus mastectomy 6 and the safety of breast conservation for larger, multicentric tumors. 7 Spinelli et al 8 recently described the "reverse LICAP" flap where tissue from below the IMF based off LICAPs is used for postmastectomy reconstruction and other benign conditions. They did not address immediate reconstruction of PM defects.…”

Treatment of Early Breast Cancer

“…Vor dem Hintergrund der aktuellen Daten der ACOSOG-Z11 102-Studie [20] zum operativen Vorgehen bei multifokalen Karzinomen, empfahl das SGBCC-Panel bei 2 Tumorläsionen in der ipsilateralen Brust und niedrigem Risiko 2 Tumorektomien als Standard, so dies technisch durchführbar ist (Mehrheitsvotum: 68,18 %). Die Abstimmung erfolgte am Beispiel einer postmenopausalen Patientin mit HR+/HER2− Mammakarzinom ohne Lymphknotenbefall und 2 ipsilateralen Tumoren in 2 benachbarten Quadranten.…”

“…ohne klinisch auffällige axilläre Lymphknoten (cN0/cN1) eingeschlossen werden. Die kumulative Inzidenz für ein Lokalrezidiv lag nach 5 Jahren bei 3,1 % (95 %-Konfidenzintervall [KI]: 1,3-6,4) [20].…”

What's new in surgical oncology breast

“…12,13 The American College of Surgeons Oncology Group (ACOSOG) Z11102 (Alliance) trial was a phase II, single-arm, prospective trial designed to evaluate oncologic outcomes in patients undergoing breastconserving therapy (BCT) for MIBC. 14 Women were eligible if they were ≥40 years of age with two to three foci of biopsy-proven cancer. At least one of the sites had to be invasive breast cancer, the additional sites could be invasive cancer or duct carcinoma in-situ.…”