Can Patients with Multiple Breast Cancers in the Same Breast Avoid Mastectomy by Having Multiple Lumpectomies to Achieve Equivalent Rates of Local Breast Cancer Recurrence? Response to the Preliminary Alliance 11102 Trial Report

Excerpt

Rosenkranz and colleagues1 report reassuringly high success rates for breast-conserving surgery (BCS) in women with multiple ipsilateral breast cancers (MIBCs). Surgical management of MIBCs can pose a dilemma when more sensitive imaging modalities detect additional tumor foci that are potentially amenable to adaptive forms of BCS employing oncoplastic techniques.2 Interestingly, there was minimal use of therapeutic mammoplasty among these patients, the majority of whom had two tumors (96%) separated by at least 2 cm, with the largest focus measuring ≤ 15 mm.1 Despite this highly selected group, more than 80% underwent standard BCS without tissue rearrangement, and three-quarters of all conservation patients achieved clear margins with a single operation.1 There is potential for the resection of larger T2 multicentric cancers in the Z11102 trial using more advanced oncoplastic surgery, such as level II mammoplasties.1,2 Furthermore, larger tumors are more likely to require a boost dose and there are concerns about adverse effects from a double radiotherapy boost following BCS for MIBC.2,3 There are limited data from phantom studies on relative positioning and delivery of two separate boosts.2,3 Despite a median largest tumor size of 15 mm, these patients received a boost to each tumor bed (10–16 Gy) that could lead to severe fibrosis, with an estimated 10% increase in volume of breast tissue exposed to > 60 Gy.3 …