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Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial

Year 2021, , 1011 - 1015, 01.10.2021
https://doi.org/10.28982/josam.926930

Abstract

Background/Aim: Multifocal breast cancers (MFBCs) still have undiscoverable clinical significance. Being the standard surgical management for early breast cancer, implementation of breast-conservation therapy (BCT) as a surgical procedure for multifocal breast cancers is still questionable and needs a solid basis of clinical evidence via prospective randomized control trials.
Methods: A prospective study was conducted on female patients with operable multifocal breast cancer excluding those diagnosed with inflammatory breast cancer and those to receive neoadjuvant therapy. Surgical management was selected randomly and comprised either modified radical mastectomy (MRM) or different techniques of oncoplastic breast surgery (OPS) with a sealed envelope system based on clinical evaluation and recent guidelines for management at the Surgical Oncology Unit, Alexandria University from May 2017-May 2018. The patients were followed up until February 2021 with a median follow-up of 39 months postoperatively to assess recurrence. Analysis of different clinicopathological factors was performed to evaluate the reliability of OPS in the surgical management of MFBCs.
Results: A total of 132 patients were initially assessed for the eligibility criteria. Finally, 58 patients in the OPS group and 56 patients in the MRM group were followed up until the end of the study period. After a median follow-up of 39 months post-operatively for both groups, three patients belonging to the oncoplastic group suffered from local recurrence (5.2%). Two patients who had MRM had distant recurrence (3.6%). Although recurrence behavior was different between both groups, this was not statistically significant.
Conclusion: OPS is an oncologically safe surgical option for selected cases of multifocal breast cancer.

Supporting Institution

ALEXANDRIA FACULTY OF MEDICINE ,ALEXANDRIA EGYPT

References

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  • 2. Mona P Tan, Nadya Y Sitoh, Yih Yiow Sitoh. Optimizing breast conservation treatment for multifocal and multicentric breast cancer: A Worthwhile Endeavour? World J Surg. 2016;40:315-22.
  • 3. Van la Parra RF, de Roos WK, Constant CM, Bavelaar-Croon C D, Barneveld P C, Bosscha K. A prospective validation study of sentinel lymph node biopsy in multicentric breast cancer. SMMaC trial. Eur J Surg Oncol. 2014;40:1250-5.
  • 4. Wilkinson LS, Given-Wilson R, Hall T, Potts H, Sharma AK, Smith E. Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol. 2005;60:573-8.
  • 5. Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004;183:1149-57.
  • 6. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: Systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248-58.
  • 7. John R Benson, Ismail Jatoi, Masakazu Toi. Surgical management of multiple ipsilateral breast cancers. Future Oncol. 2019;15:1185-91.
  • 8. NCCN guidelines at : https://www.nccn.org/professionals/physician_gls/default.aspx accessed at May 2018
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  • 11. Bauman L, Barth RJ, Rosenkranz KM. Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol. 2010;17:S325-9.
  • 12. Kapoor NM, Chung A, Huynh K, Giuliano AE. Preliminary results: double lumpectomies for multicentric breast cancer. Am Surg. 2012;78:1345-8.
  • 13. Ustaalioglu BO, Bilici A, Kefeli U, Şeker M, Oncel M, Gezen C, et al. The importance of multifocal/multicentric tumor on the disease-free survival of breast cancer patients. Am J Clin Oncol. 2012;35:580-6.
  • 14. Wolters R, Wöckel A, Janni W, Novopashenny I, Ebner F, Kreienberg R, et al. Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective Multicenter cohort study of 8,935 patients. Breast Cancer Res Treat. 2013;142:579-90.
  • 15. Ataseven B, Lederer B, Blohmer JU, Denkert C, Gerber B, Heil J, et al. Impact of multifocal and multicentric disease on surgery and locoregional. Distant and overall survival of 6.134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2015;22:1118-27.
  • 16. Patani N, Carpenter R. Surgical and aesthetic considerations of conservational surgery for multifocal/ multicentric breast cancer. Breast J. 2010;16:222-32.
  • 17. Kaplan J, Giron G, Tartter PI, Bleiweiss IJ, Estabrook A, Smith SR. Breast conservation in patients with multiple ipsilateral synchronous cancers. J Am Coll Surg. 2003;197(5):726-9
  • 18. Julious SA. Estimating sample sizes in clinical trail. CRC:2009.
  • 19. Tot T, Gere M, Pekar G, Tarjan M, Hofmeyer S, Hellberg D, et al. Breast cancer multifocality, disease extent, and survival. Hum Pathol. 2011;42(11):1761-9.
  • 20. Chung AP, Huynh K, Kidner T, Mirzadehgan P, Sim MS, Giuliano AE. Comparison of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer. J Am Coll Surg. 2012;215(1):137-46.
  • 21. Boyages J, Jayasinghe UW, Coombs N. Multifocal breast cancer and survival: each focus does matter particularly for larger tumours. Eur J Cancer. 2010;46(11):1990-6.
  • 22. Joergensen LE, Gunnarsdottir KA, Lanng C, Moeller S, Rasmussen BB. Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996–2001. Breast. 2008;17(6):587-91.
  • 23. Pedersen L, Gunnarsdottir KA, Rasmussen BB, Moeller S, Lanng C. The prognostic influence of multifocality in breast cancer patients. Breast. 2004;13(3):188-93.
  • 24. Vera-Badillo FE, Napoleone M, Ocana A, Templeton AJ, Seruga B, Al-Mubarak M, et al. Effect of multifocality and multicentricity on outcome in early stage breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2014;146(2):235-44.
  • 25. Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S, et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi7-23.
  • 26. Leopold KA, Recht A, Schnitt SJ, Connolly JL, Rose MA, Silver B, et al. Results of Conservative Surgery and Radiation Therapy for Multiple Synchronous Cancers of One Breast. Int J Radiat Oncol Biol Phys. 1989;16(1):11-6.
  • 27. Lim W, Park EH, Choi SL, Seo JY, Kim HJ, Chang MA, et al. Breast conserving surgery for multifocal breast cancer. Ann Surg. 2009;249:87-90.
  • 28. Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat. 2009;113:577-83.
  • 29. Kari M Rosenkranz, Karla Ballman, Linda McCall, Charlotte Kubicky, Laurie Cuttino, Huong Le-Petross, 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;25:2858-66.
Year 2021, , 1011 - 1015, 01.10.2021
https://doi.org/10.28982/josam.926930

Abstract

References

  • 1. Yerushalmi R, Kennecke H, Woods R, Olivotto IA, Speers C, Gelmon KA. Does multicentric/multifocal breast cancer differ from unifocal breast cancer? An analysis of survival and contralateral breast cancer incidence. Breast Cancer Res Treat. 2009;117:365-70.
  • 2. Mona P Tan, Nadya Y Sitoh, Yih Yiow Sitoh. Optimizing breast conservation treatment for multifocal and multicentric breast cancer: A Worthwhile Endeavour? World J Surg. 2016;40:315-22.
  • 3. Van la Parra RF, de Roos WK, Constant CM, Bavelaar-Croon C D, Barneveld P C, Bosscha K. A prospective validation study of sentinel lymph node biopsy in multicentric breast cancer. SMMaC trial. Eur J Surg Oncol. 2014;40:1250-5.
  • 4. Wilkinson LS, Given-Wilson R, Hall T, Potts H, Sharma AK, Smith E. Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol. 2005;60:573-8.
  • 5. Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004;183:1149-57.
  • 6. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: Systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248-58.
  • 7. John R Benson, Ismail Jatoi, Masakazu Toi. Surgical management of multiple ipsilateral breast cancers. Future Oncol. 2019;15:1185-91.
  • 8. NCCN guidelines at : https://www.nccn.org/professionals/physician_gls/default.aspx accessed at May 2018
  • 9. Matthijs V. Nijenhuis, Emiel J.Th. Rutgers.Conservative surgery for multifocal/multicentric breast cancer. The Breast. 2015;24:S96-99.
  • 10. Wilson LD, Beinfield M, McKhamn CF, Haffty BG. Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer. 1993;72:137-42.
  • 11. Bauman L, Barth RJ, Rosenkranz KM. Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol. 2010;17:S325-9.
  • 12. Kapoor NM, Chung A, Huynh K, Giuliano AE. Preliminary results: double lumpectomies for multicentric breast cancer. Am Surg. 2012;78:1345-8.
  • 13. Ustaalioglu BO, Bilici A, Kefeli U, Şeker M, Oncel M, Gezen C, et al. The importance of multifocal/multicentric tumor on the disease-free survival of breast cancer patients. Am J Clin Oncol. 2012;35:580-6.
  • 14. Wolters R, Wöckel A, Janni W, Novopashenny I, Ebner F, Kreienberg R, et al. Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective Multicenter cohort study of 8,935 patients. Breast Cancer Res Treat. 2013;142:579-90.
  • 15. Ataseven B, Lederer B, Blohmer JU, Denkert C, Gerber B, Heil J, et al. Impact of multifocal and multicentric disease on surgery and locoregional. Distant and overall survival of 6.134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2015;22:1118-27.
  • 16. Patani N, Carpenter R. Surgical and aesthetic considerations of conservational surgery for multifocal/ multicentric breast cancer. Breast J. 2010;16:222-32.
  • 17. Kaplan J, Giron G, Tartter PI, Bleiweiss IJ, Estabrook A, Smith SR. Breast conservation in patients with multiple ipsilateral synchronous cancers. J Am Coll Surg. 2003;197(5):726-9
  • 18. Julious SA. Estimating sample sizes in clinical trail. CRC:2009.
  • 19. Tot T, Gere M, Pekar G, Tarjan M, Hofmeyer S, Hellberg D, et al. Breast cancer multifocality, disease extent, and survival. Hum Pathol. 2011;42(11):1761-9.
  • 20. Chung AP, Huynh K, Kidner T, Mirzadehgan P, Sim MS, Giuliano AE. Comparison of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer. J Am Coll Surg. 2012;215(1):137-46.
  • 21. Boyages J, Jayasinghe UW, Coombs N. Multifocal breast cancer and survival: each focus does matter particularly for larger tumours. Eur J Cancer. 2010;46(11):1990-6.
  • 22. Joergensen LE, Gunnarsdottir KA, Lanng C, Moeller S, Rasmussen BB. Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996–2001. Breast. 2008;17(6):587-91.
  • 23. Pedersen L, Gunnarsdottir KA, Rasmussen BB, Moeller S, Lanng C. The prognostic influence of multifocality in breast cancer patients. Breast. 2004;13(3):188-93.
  • 24. Vera-Badillo FE, Napoleone M, Ocana A, Templeton AJ, Seruga B, Al-Mubarak M, et al. Effect of multifocality and multicentricity on outcome in early stage breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat. 2014;146(2):235-44.
  • 25. Senkus E, Kyriakides S, Penault-Llorca F, Poortmans P, Thompson A, Zackrisson S, et al. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi7-23.
  • 26. Leopold KA, Recht A, Schnitt SJ, Connolly JL, Rose MA, Silver B, et al. Results of Conservative Surgery and Radiation Therapy for Multiple Synchronous Cancers of One Breast. Int J Radiat Oncol Biol Phys. 1989;16(1):11-6.
  • 27. Lim W, Park EH, Choi SL, Seo JY, Kim HJ, Chang MA, et al. Breast conserving surgery for multifocal breast cancer. Ann Surg. 2009;249:87-90.
  • 28. Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat. 2009;113:577-83.
  • 29. Kari M Rosenkranz, Karla Ballman, Linda McCall, Charlotte Kubicky, Laurie Cuttino, Huong Le-Petross, 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;25:2858-66.
There are 29 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research article
Authors

Ahmed Awad This is me 0000-0001-8782-3787

Mostafa Elsayed 0000-0003-4386-6894

Ahmed Elsayed This is me 0000-0002-2316-8864

Tarek Elfayoumi This is me 0000-0002-9506-9590

Mahmoud Alhussini This is me 0000-0002-3169-4338

Publication Date October 1, 2021
Published in Issue Year 2021

Cite

APA Awad, A., Elsayed, M., Elsayed, A., Elfayoumi, T., et al. (2021). Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial. Journal of Surgery and Medicine, 5(10), 1011-1015. https://doi.org/10.28982/josam.926930
AMA Awad A, Elsayed M, Elsayed A, Elfayoumi T, Alhussini M. Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial. J Surg Med. October 2021;5(10):1011-1015. doi:10.28982/josam.926930
Chicago Awad, Ahmed, Mostafa Elsayed, Ahmed Elsayed, Tarek Elfayoumi, and Mahmoud Alhussini. “Oncoplastic Breast Surgery: Is It Reliable in the Treatment of Multifocal Breast Cancer? A Preliminary Report of a Prospective Randomized Controlled Trial”. Journal of Surgery and Medicine 5, no. 10 (October 2021): 1011-15. https://doi.org/10.28982/josam.926930.
EndNote Awad A, Elsayed M, Elsayed A, Elfayoumi T, Alhussini M (October 1, 2021) Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial. Journal of Surgery and Medicine 5 10 1011–1015.
IEEE A. Awad, M. Elsayed, A. Elsayed, T. Elfayoumi, and M. Alhussini, “Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial”, J Surg Med, vol. 5, no. 10, pp. 1011–1015, 2021, doi: 10.28982/josam.926930.
ISNAD Awad, Ahmed et al. “Oncoplastic Breast Surgery: Is It Reliable in the Treatment of Multifocal Breast Cancer? A Preliminary Report of a Prospective Randomized Controlled Trial”. Journal of Surgery and Medicine 5/10 (October 2021), 1011-1015. https://doi.org/10.28982/josam.926930.
JAMA Awad A, Elsayed M, Elsayed A, Elfayoumi T, Alhussini M. Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial. J Surg Med. 2021;5:1011–1015.
MLA Awad, Ahmed et al. “Oncoplastic Breast Surgery: Is It Reliable in the Treatment of Multifocal Breast Cancer? A Preliminary Report of a Prospective Randomized Controlled Trial”. Journal of Surgery and Medicine, vol. 5, no. 10, 2021, pp. 1011-5, doi:10.28982/josam.926930.
Vancouver Awad A, Elsayed M, Elsayed A, Elfayoumi T, Alhussini M. Oncoplastic Breast Surgery: Is it reliable in the treatment of multifocal breast cancer? A preliminary report of a prospective randomized controlled trial. J Surg Med. 2021;5(10):1011-5.