Local recurrences of breast cancer after organ-sparing treatment: the site of oncoplastic resections and risk factors

DOI: https://doi.org/10.29296/25877305-2021-08-01
Download full text PDF
Issue: 
8
Year: 
2021

A. Zikiryakhodzhaev(1)–3, MD; E. Rasskazova(1), Candidate of Medical Sciences; D. Omarova(2);
F. Khugaeva(2); D. Ortabaeva(1); A. Tregubova(1); Professor I. Reshetov(2), Academician of the Russian
Academy of Sciences, MD; Professor A. Kaprin(3, 4), Academician of the Russian Academy of Sciences, MD
(1)P.A. Herzen Moscow Oncology Research Institute, Branch, National Medical Radiology Research Center,
Ministry of Health of Russia (2)I.M. Sechenov First Moscow State Medical University (Sechenov University),
Ministry of Health of Russia (3)Peoples’ Friendship University of Russia, Moscow (4)National Medical
Radiology Research Center, Ministry of Health of Russia, Obninsk

Breast cancer (BC) holds the lead in the structure of cancer incidence in women. A comprehensive approach to treating BC patients, which includes highly effective drug treatment options and postoperative radiation therapy, allows surgeons to perform operations of various volumes: from tumorectomies to radical mastectomies with breast reconstruction. Organ-sparing operations (OSO) in the combined/combination treatment of BC lead to equal relapse-free and overall survival rates compared to mastectomies, despite the higher frequency of local relapses. The widespread use of oncoplastic resections over the past decades, which combine the principles of oncological safety and aesthetic surgery, has made it possible to expand indications for organ-sparing treatment in BC. Today, the issues of oncological safety of OSO involving both conventional (tumorectomy, lumpectomy, quadranectomy) and oncoplastic resections do not lose their relevance. In addition, owing to a personalized approach to treating BC, the question of determining the predictors of local relapse after OSO remains interesting. This paper provides a literature review reflecting the oncological results of OSO in BC patients, as well as the factors influencing the frequency of local recurrences.

Keywords: 
oncology
breast cancer
organ-sparing treatment
oncoplastic resections
local recurrences
hormone therapy
breast resection



It appears your Web browser is not configured to display PDF files. Download adobe Acrobat или click here to download the PDF file.

References: 
  1. The Global Burden of Disease Cancer. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability,and Disability-Adjusted Life-Years for 29 Cancer Groups,1990 to 2017. A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncology. 2019; 5 (12): 1749–69. DOI: 10.1001/jamaoncol.2019.2996
  2. Kaprin A.D., Starinskij V.V., Petrova G.V. Sostojanie onkologicheskoj pomoschi naseleniju Rossii v 2018 godu. M.: RIIS FIAN, 2019 [Kaprin A.D., Starinskii V.V., Petrova G.V. Sostoyanie onkologicheskoi pomoshchi naseleniyu Rossii v 2018 godu. M.: RIIS FIAN, 2019 (in Russ.)].
  3. Lakhtakia R. A Brief History of Breast Cancer: Part I: Surgical domination reinvented. Sultan Qaboos Univ Med J. 2014; 14 (2): e166-9.
  4. Payne W.S., Taylor W.F., Khonsari S. et al. Surgical Treatment of Breast Cancer. Trends and Factors Affecting Survival. Arch Surg. 1970; 101 (2): 105–13. DOI: 10.1001/archsurg.1970.01340260009002
  5. Lukong K.E. Understanding breast cancer – The long and winding road. BBA clinical. 2017; 7: 64–77. DOI: 10.1016/j.bbacli.2017.01.001
  6. Cotlar A.M., Dubose J.J., Rose D.M. History of surgery for breast cancer: radical to the sublime. Curr Surg. 2003; 60 (3): 329–37. DOI: 10.1016/S0149-7944(02)00777-8
  7. Fisher B., Bauer M., Margolese R. et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985; 312 (11): 665–73. DOI: 10.1056/NEJM198503143121101
  8. Fisher B., Redmond C., Poisson R. et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1989; 320 (13): 822–8. DOI: 10.1056/NEJM198903303201302
  9. Fisher B., Anderson S., Bryant J. et al. Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast Cancer. N Engl J Med. 2002; 347 (16): 1233–41. DOI: 10.1056/NEJMoa022152
  10. Veronesi U., Banfi A., Saccozzi R.et al. Conservative treatment of breast cancer. A Trial in Progress at the Cancer Institute of Milan. Cancer. 1977; 39 (6 Suppl): 2822–6. DOI: 10.1002/1097-0142(197706)39:63.0.co;2-
  11. #Veronesi U., Salvadori R., Luini A. et al. Conservative Treatment of Early Breast Cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy. Ann Surg. 1990; 211 (3): 250–9.
  12. Arriagada R., Lê M.G., Rochard F. et al. Conservative Treatment Versus Mastectomy in Early Breast Cancer: Patterns of Failure With 15 Years of Follow-Up Data. J Clin Oncol. 1996; 14 (5): 1558–64. DOI: 10.1200/JCO.1996.14.5.1558
  13. Litière S., Werutsky G., Fentiman I.S. et al. Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012; 13 (4): 412–9. DOI: 10.1016/S1470-2045(12)70042-6
  14. Black D.M., Hunt K.K., Mittendorf E.A. Long term outcomes reporting the safety of breast conserving therapy compared to mastectomy: 20-year results of EORTC 10801. Gland Surg. 2013; 2 (3): 120–3. DOI: 10.3978/j.issn.2227-684X.2013.06.01
  15. Scholl S.M., Fourquet A., Asselain B. et al. Neoadjuvant versus adjuvant chemotherapy in premenopausal patients with tumours considered too large for breast conserving surgery: Preliminary results of a randomised trial: S6. Eur J Cancer. 1994; 30A: 645–52. DOI: 10.1016/0959-8049(94)90537-1
  16. Fisher B., Brown A., Mamounas E. et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1997; 15 (7): 2483–93. DOI: 10.1200/JCO.1997.15.7.2483
  17. Mauriac L., MacGrogan G., Avril A. et al. Neoadjuvant chemotherapy for operable breast carcinoma larger than 3 cm: a unicentre randomized trial with a 124-month median follow-up. Institut Bergonié Bordeaux Groupe Sein (IBBGS). Ann Oncol. 1999; 10 (1): 47–52. DOI: 10.1023/a:1008337009350
  18. Levy A., Borget I., Bahri M. et al. Loco-regional Control After Neo-adjuvant Chemotherapy and Conservative Treatment for Locally Advanced Breast Cancer Patients. Breast J. 2014; 20 (4): 381–7. DOI: 10.1111/tbj.12277
  19. Cho J.H., Park J.M., Park H.S. et al. Oncologic safety of breast-conserving surgery compared to mastectomy in patients receiving neoadjuvant chemotherapy for locally advanced breast cancer. J Surg Oncol. 2013; 108 (8): 531–6. DOI: 10.1002/jso.23439
  20. Sun Y., Liao M., He L. et al. Comparison of breast-conserving surgery with mastectomy in locally advanced breast cancer after good response to neoadjuvant chemotherapy: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2017; 96 (43): e8367. DOI: 10.1097/MD.0000000000008367
  21. Bertozzi N., Pesce M., Santi P.L. et al. Oncoplastic breast surgery: comprehensive review. Eur Rev Med Pharmacol Sci. 2017; 21 (11): 2572–85.
  22. Santos G., Urban C., Edelweiss M.I. et al. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol. 2015; 22 (8): 2500–8. DOI: 10.1245/s10434-014-4301-6
  23. Doğru V., Yaprak M., Durmaz E. et al. Oncoplastic approach to excisional breast biopsies: a randomized controlled, phase 2a trial. Breast Cancer. 2019; 26 (1): 84–92. DOI: 10.1007/s12282-018-0892-2
  24. Gabka C.J., Baumeister R.G., Maiwald G. Advancements of breast conserving therapy by onco-plastic surgery in the management of breast cancer. Anticancer Res. 1998; 18 (3C): 2219–24.
  25. Weber W.P., Soysal S.D., Fulco I. et al. Standardization of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2017; 43 (7): 1236–43. DOI: 10.1016/j.ejso.2017.01.006
  26. Yiannakopoulou E.C., Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol. 2016; 42 (5): 625–30. DOI: 10.1016/j.ejso.2016.02.002
  27. De La Cruz L., Blankenship S.A., Chatterjee A. et al. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann Surg Oncol. 2016; 23 (10): 3247–58. DOI: 10.1245/s10434-016-5313-1
  28. Clough K.B., van la Parra R.F.D., Thygesen H.H. et al. Long-term Results After Oncoplastic Surgery for Breast Cancer. A 10-year Folow-up. Ann Surg. 2017; 268 (1): 165–71. DOI: 10.1097/SLA.0000000000002255
  29. Kaviani A., Safavi A., Mohammadzadeh N. et al. Oncoplastic surgery in breast conservation: a prospective evaluation of the patients, techniques, and oncologic outcomes. Am J Surg. 2014; 208 (5): 727–34. DOI: 10.1016/j.amjsurg.2014.04.005
  30. Niinikoski L., Leidenius M.H.K., Vaara P. et al. Resection margins and local recurrences in breast cancer: Comparison between conventional and oncoplastic breast conserving surgery. Eur J Surg Oncol. 2014; 45 (6): 976–82. DOI: 10.1016/j.ejso.2019.02.010
  31. Acea-Nebril B., Cereijo-Garea C., Garcia-Novoa A. et al. The role of oncoplastic breast reduction in the conservative management of breast cancer: Complications, survival, and quality of live. J Surg Oncol. 2017; 115 (6): 679–86. DOI: 10.1002/jso.24550
  32. Mansell J., Weiler-Mithoff E., Stallard S. et al. Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast. 2017; 32: 179–85. DOI: 10.1016/j.breast.2017.02.006
  33. Kosasih S., Tayeh S., Mokbel K. et al. Is oncoplastic breast conserving surgery oncologically safe? A meta-analysis of 18,103 patients. Am J Surg. 2020; 220 (2): 385–92. DOI: 10.1016/j.amjsurg.2019.12.019
  34. Arvold N.D., Taghian A.G., Niemierko A. et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 2011; 29 (29): 3885–91. DOI: 10.1200/JCO.2011.36.1105
  35. Aalders K.C., Postma E.L., Strobbe L.J. et al. Contemporary Locoregional Recurrence Rates in Young Patients With Early-Stage Breast Cancer. J Clin Oncol. 2016; 34 (18): 2107–14. DOI: 10.1200/JCO.2015.64.3536
  36. Miles R.C., Gullerud R.E., Lohse C.M. et al. Local Recurrence after Breast-Conserving Surgery: Multivariable Analysis of Risk Factors and the Impact of Young Age. Ann Surg Oncol. 2011; 19 (4): 1153–9. DOI: 10.1245/s10434-011-2084-6
  37. Maishman T., Cutress R.I., Hernandez A. et al. Local Recurrence and Breast Oncological Surgery in Young Women With Breast Cancer: The POSH Observational Cohort Study. Ann Surg. 2017; 266 (1): 165–72. DOI: 10.1097/SLA.0000000000001930
  38. Haffty B.G., Harrold E., Khan A.J. et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet. 2002; 359 (9316): 1471–7. DOI: 10.1016/S0140-6736(02)08434-9
  39. van den Broek A.J., Schmidt M.K., van’t Veer L.J. et. al. Prognostic Impact of Breast-Conserving Therapy Versus Mastectomy of BRCA1/2 Mutation Carriers Compared With Noncarriers in a Consecutive Series of Young Breast Cancer Patients. Ann Surg. 2019; 270 (2): 364–72. DOI: 10.1097/SLA.0000000000002804
  40. Huang X., Cai X.Y., Liu J.Q. et al. Breast-conserving therapy is safe both within BRCA1/2 mutation carriers and noncarriers with breast cancer in the Chinese population. Gland Surg. 2020; 9 (3): 775–87. DOI: 10.21037/gs-20-531
  41. Kirova Y.M., Savignoni A., Sigal-Zafrani B. et al. Is the breast-conserving treatment with radiotherapy appropriate in BRCA1/2 mutation carriers? Long-term results and review of the literature. Breast Cancer Res Treat. 2010; 120 (1): 119–26. DOI: 10.1007/s10549-009-0685-6
  42. Veronesi U., Marubini E., Del Vecchio M. et al. Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst. 1995; 87 (1): 19–27. DOI: 10.1093/jnci/87.1.19
  43. Semiglazov V.F., Semiglazov V.V., Kletsel' A.E. Neinvazivnye i invazivnye opuholi molochnoj zhelezy. SPb, 2006 [Semiglazov V.F., Semiglazov V.V., Kletsel’ A.E. Neinvazivnye i invazivnye opukholi molochnoi zhelezy. SPb, 2006 (in Russ.)].
  44. Antonini N., Jones H., Horiot J.C. et al. Effect of age and radiation dose on local control after breast conserving treatment: EORTC trial 22881-10882. Radiother Oncol. 2007; 82 (3): 265–71. DOI: 10.1016/j.radonc.2006.09.014
  45. Moran M.S., Schnitt S.J., Giuliano A.E. et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014; 88 (3): 553–64. DOI: 10.1016/j.ijrobp.2013.11.012
  46. Lin J., Lin K.J., Wang Y.F. et al. Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy. BMC Cancer. 2020; 20 (1): 451. DOI: 10.1186/s12885-020-06955-6
  47. Holleczek B., Stegmaier C., Radosa J.C. et al. Risk of loco-regional recurrence and distant metastases of patients with invasive breast cancer up to ten years after diagnosis – results from a registry-based study from Germany. BMC Cancer. 2019; 19 (1): 520. DOI: 10.1186/s12885-019-5710-5
  48. Ignatov A., Eggemann H., Burger E. et al. Patterns of breast cancer relapse in accordance to biological subtype. J Cancer Res Clin Oncol. 2018; 144 (7): 1347–55. DOI: 10.1007/s00432-018-2644-2
  49. Valachis A., Mamounas E.P., Mittendorf E.A. et al. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta-analysis. Cancer. 2018; 124 (14): 2923–30. DOI: 10.1002/cncr.31518
  50. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C. et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011; 378 (9804): 1707–16. DOI: 10.1016/S0140-6736(11)61629-2
  51. Wickberg Å., Magnuson A., Holmberg L. et al. Influence of the subtype on local recurrence risk of breast cancer with or without radiation therapy. Breast. 2018; 42: 54–60. DOI: 10.1016/j.breast.2018.08.097
  52. Anderson W.F., Chen B.E., Jatoi I. et al. Effects of estrogen receptor expression and histopathology on annual hazard rates of death from breast cancer. Breast Cancer Res Treat. 2006; 100 (1): 121–6. DOI: 10.1007/s10549-006-9231-y