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Breast-Conserving Therapy in Patients with Multiple Lesions
The safety of breast-conserving therapy (BCT) in patients with multiple ipsilateral breast cancer (MIBC) had not been assessed in a prospective clinical trial. Now, in a prospective, phase 2, single-arm trial, investigators evaluated 5-year cumulative incidence of local recurrence (LR) in patients with MIBC undergoing BCT. Women aged ≥40 years with 2 or 3 foci of biopsy-proven cN0-1 breast cancer were enrolled between 2012 and 2016; in 2015, a requirement for preoperative breast MRI was lifted. Treatment entailed lumpectomy, with a requirement for negative margins, followed by whole breast radiation with a boost to each lumpectomy bed. A 5-year LR rate <8% was defined as “clinically acceptable” based on prior reported experience.
Of 270 women enrolled, 204 underwent BCT; the remaining patients were ineligible, converted to mastectomy, did not have negative margins, or withdrew consent. During a median follow-up of 66.4 months, LR occurred in 6 patients, for an estimated 5-year cumulative LR incidence of 3.1%. Age, number of breast cancer sites, estrogen receptor and HER2 status, and pathologic T and N categories were not associated with LR risk. In an exploratory analysis, the 5-year LR rate was 1.7% in the 189 patients who underwent preoperative MRI compared with 22.6% in the 15 patients who did not undergo preoperative MRI.
This trial demonstrates a low 5-year LR rate after BCT with adjuvant radiation for MIBC in women who met the eligibility criteria for this trial. This can now be recommended to MIBC patients, and even more confidently if they have received a preoperative MRI. When used with a combination of high-quality preoperative breast imaging, targeted surgical resection, and careful pathologic assessment of margins, BCT along with appropriate adjuvant systemic therapy can be safe in patients with limited MIBC with an expectation of low LR.
Boughey JC et al.
Title: Local recurrence after breast-conserving therapy in patients with multiple ipsilateral breast cancer: Results from ACOSOG Z11102 (Alliance).
Source: J Clin Oncol 2023 Mar 28; [e-pub]. (Abstract/FREE Full Text)