Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2017

Open Access 01-07-2017 | Epidemiology

Omitting re-excision for focally positive margins after breast-conserving surgery does not impair disease-free and overall survival

Authors: Elvira L. Vos, Sabine Siesling, Margreet H.A. Baaijens, Cornelis Verhoef, Agnes Jager, Adri C. Voogd, Linetta B. Koppert

Published in: Breast Cancer Research and Treatment | Issue 1/2017

Login to get access

Abstract

Purpose

In contrast to other countries, the Dutch breast cancer guideline does not recommend re-excision for focally positive margins after breast-conserving surgery (BCS) in invasive tumor and does recommend whole-breast irradiation including boost. We investigated whether omitting re-excision as compared to performing re-excision affects prognosis with a retrospective population-based cohort study.

Methods

The total cohort included 32,119 women with primary BCS for T1–T3 breast cancer diagnosed between 2003 and 2008 from the nationwide Netherlands cancer registry. The subcohort included 10,433 patients in whom the resection margins were registered. Outcome measures were 5-year ipsilateral breast tumor recurrence (IBTR) rate, 5-year disease-free survival (DFS) rate, and 10-year overall survival (OS) rate.

Results

In the total cohort, 25,878 (80.6%) did not have re-excision, 2368 (7.4%) had re-excision by BCS, and 3873 (12.1%) had re-excision by mastectomy. Five-year IBTR rates were 2.1, 2.8, and 2.9%, respectively (p = 0.001). In the subcohort, 7820 (75.0%) had negative margins without re-excision, 492 (4.7%) had focally positive margins without re-excision, 586 (5.6%) had focally positive margins and underwent re-excision, and 1535 (14.7%) had extensively positive margins and underwent re-excision. Five-year IBTR rate was 2.3, 2.9, 1.1, and 2.9%, respectively (p = 0.099). Compared to omitting re-excision, performing re-excision for focally positive margins was associated with lower risk of IBTR (adjusted HR 0.30, 95% CI 0.11–0.82), but not with DFS (adjusted HR 0.83 95% CI 0.59–1.17) nor with OS (adjusted HR 1.17 95% CI 0.87–1.59).

Conclusion

Omitting re-excision in breast cancer patients for focally positive margins after BCS does not impair DFS and OS, provided that whole-breast irradiation including boost is given.
Appendix
Available only for authorised users
Literature
1.
Houssami N, Macaskill P, Marinovich ML, Morrow M (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21(3):717–730. doi:10.​1245/​s10434-014-3480-5 CrossRefPubMed
2.
Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, Klimberg S, Chavez-MacGregor M, Freedman G, Houssami N, Johnson PL, Morrow M, Society of Surgical O, American Society for Radiation O (2014) 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. J Clin Oncol 32(14):1507–1515. doi:10.​1200/​JCO.​2013.​53.​3935 CrossRefPubMed
3.
Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, Zackrisson S, Cardoso F, Committee EG (2015) Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v8–30. doi:10.​1093/​annonc/​mdv298 CrossRefPubMed
4.
Park S, Park HS, Kim SI, Koo JS, Park BW, Lee KS (2011) The impact of a focally positive resection margin on the local control in patients treated with breast-conserving therapy. Jpn J Clin Oncol 41(5):600–608. doi:10.​1093/​jjco/​hyr018 CrossRefPubMed
5.
Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, Silver B, Hetelekidis S, Abner A, Harris JR, Schnitt SJ (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 18(8):1668–1675CrossRefPubMed
6.
Peterson ME, Schultz DJ, Reynolds C, Solin LJ (1999) Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys 43(5):1029–1035CrossRefPubMed
7.
8.
Smitt MC, Nowels KW, Zdeblick MJ, Jeffrey S, Carlson RW, Stockdale FE, Goffinet DR (1995) The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer 76(2):259–267CrossRefPubMed
9.
Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, Eberlein TJ, Mayzel K, Silver B, Harris JR (1994) The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer 74(6):1746–1751CrossRefPubMed
10.
Solin LJ, Fowble BL, Schultz DJ, Goodman RL (1991) The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer. Int J Radiat Oncol Biol Phys 21(2):279–287CrossRefPubMed
11.
Bosma SC, van der Leij F, van Werkhoven E, Bartelink H, Wesseling J, Linn S, Rutgers EJ, van de Vijver MJ, Elkhuizen PH (2016) Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period. Breast Cancer Res Treat 156(2):391–400. doi:10.​1007/​s10549-016-3732-0 CrossRefPubMed
12.
Jones HA, Antonini N, Hart AA, Peterse JL, Horiot JC, Collin F, Poortmans PM, Oei SB, Collette L, Struikmans H, Van den Bogaert WF, Fourquet A, Jager JJ, Schinagl DA, Warlam-Rodenhuis CC, Bartelink H (2009) Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol 27(30):4939–4947. doi:10.​1200/​JCO.​2008.​21.​5764 CrossRefPubMedPubMedCentral
13.
Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, Schinagl D, Oei B, Rodenhuis C, Horiot JC, Struikmans H, Van Limbergen E, Kirova Y, Elkhuizen P, Bongartz R, Miralbell R, Morgan D, Dubois JB, Remouchamps V, Mirimanoff RO, Collette S, Collette L, EuropeanOrganisation for R, Treatment of Cancer Radiation O, Breast Cancer G (2015) Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 16(1):47–56. doi:10.​1016/​S1470-2045(14)71156-8 CrossRefPubMed
14.
15.
16.
Schouten LJ, Hoppener P, van den Brandt PA, Knottnerus JA, Jager JJ (1993) Completeness of cancer registration in Limburg, The Netherlands. Int J Epidemiol 22(3):369–376CrossRefPubMed
17.
18.
Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, Yao X, Bossuyt V, Harigopal M, Lannin DR, Pusztai L, Horowitz NR (2015) A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med 373(6):503–510. doi:10.​1056/​NEJMoa1504473 CrossRefPubMed
19.
20.
Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, Pierart M, Poortmans PM, Struikmans H, Maat B, Van Limbergen E, Bartelink H (2000) The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. EORTC radiotherapy and breast cancer cooperative groups. Radiother Oncol 55(3):219–232CrossRefPubMed
21.
van Laar C, van der Sangen MJ, Poortmans PM, Nieuwenhuijzen GA, Roukema JA, Roumen RM, Tjan-Heijnen VC, Voogd AC (2013) Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients. Eur J Cancer 49(15):3093–3101. doi:10.​1016/​j.​ejca.​2013.​05.​030 CrossRefPubMed
22.
Haloua MH, Volders JH, Krekel NM, Barbe E, Sietses C, Jozwiak K, Meijer S, van den Tol MP (2016) A nationwide pathology study on surgical margins and excision volumes after breast-conserving surgery: there is still much to be gained. Breast 25:14–21. doi:10.​1016/​j.​breast.​2015.​11.​003 CrossRefPubMed
23.
DeSnyder SM, Hunt KK, Smith BD, Moran MS, Klimberg S, Lucci A (2015) Assessment of practice patterns following publication of the SSO-ASTRO consensus guideline on margins for breast-conserving therapy in stage I and II invasive breast cancer. Ann Surg Oncol 22(10):3250–3256. doi:10.​1245/​s10434-015-4666-1 CrossRefPubMedPubMedCentral
24.
25.
Vrieling C, van Werkhoven E, Maingon P, Poortmans P, Weltens C, Fourquet A, Schinagl D, Oei B, Rodenhuis CC, Horiot JC, Struikmans H, Van Limbergen E, Kirova Y, Elkhuizen P, Bongartz R, Miralbell R, Morgan DA, Dubois JB, Remouchamps V, Mirimanoff RO, Hart G, Collette S, Collette L, Bartelink H, European Organisationfor R, Treatment of Cancer RO, Breast Cancer G (2017) Prognostic factors for local control in breast cancer after Long-term follow-up in the EORTC boost vs no boost trial: a randomized clinical trial. JAMA Oncol 3(1):42–48. doi:10.​1001/​jamaoncol.​2016.​3031 CrossRefPubMed
26.
Metzger-Filho O, Sun Z, Viale G, Price KN, Crivellari D, Snyder RD, Gelber RD, Castiglione-Gertsch M, Coates AS, Goldhirsch A, Cardoso F (2013) Patterns of Recurrence and outcome according to breast cancer subtypes in lymph node-negative disease: results from international breast cancer study group trials VIII and IX. J Clin Oncol 31(25):3083–3090. doi:10.​1200/​JCO.​2012.​46.​1574 CrossRefPubMedPubMedCentral
Metadata
Title
Omitting re-excision for focally positive margins after breast-conserving surgery does not impair disease-free and overall survival
Authors
Elvira L. Vos
Sabine Siesling
Margreet H.A. Baaijens
Cornelis Verhoef
Agnes Jager
Adri C. Voogd
Linetta B. Koppert
Publication date
01-07-2017
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-017-4232-6

Other articles of this Issue 1/2017

Breast Cancer Research and Treatment 1/2017 Go to the issue

Epidemiology

Adherence to guidelines and breast cancer patients survival: a population-based cohort study analyzed with a causal inference approach

Epidemiology

Sleep quality, duration, and breast cancer aggressiveness

Clinical trial

Discerning the clinical relevance of biomarkers in early stage breast cancer

Letter to the Editor

Magee equations and oncotype DX®-a perspective

Preclinical study

Prolactin/androgen-inducible carboxypeptidase-D increases with nitrotyrosine and Ki67 for breast cancer progression in vivo, and upregulates progression markers VEGF-C and Runx2 in vitro

Brief Report

Assessment of the prognostic and discriminating value of the novel bioscore system for breast cancer; a SEER database analysis
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits