2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

SURGERY FOR EARLY-STAGE BREAST CANCER
Conclusion
Current risks for LR with lumpectomy to a margin of
tumor not touching ink, and in the axilla after management
of a positive node with sentinel node biopsy alone in patients
undergoing BCS, emphasize the powerful effect of systemic
therapy on local control. As the options for targeted therapy
expand and our ability to tailor the extent of systemic
therapy to an individual patient’s level of risk improves, not
Author’s Disclosures of Potential Conflicts of Interest
Author
Monica Morrow*
*No relevant relationships to disclose.
Employment or
Leadership
Positions
Consultant or
Advisory Role
1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of
differences in the extent of surgery for early breast cancer on local recurrence
and 15-year survival: An overview of the randomised trials. Lancet. 2005;
366(9503):2087-2106.
2. Morrow M, Harris JR. Practice guideline for breast conservation therapy
in the management of invasive breast cancer. J Am Coll Surg. 2007;205:362-
376.
3. Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the
impact of surgical margins on local recurrence in women with early-stage
invasive breast cancer treated with breast-conserving therapy. Eur J Cancer.
2010;46(18):3219-3232.
4. 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):1233-1241.
5. Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral
breast tumor recurrence and locoregional recurrences in patients treated by
breast-conserving therapy in five National Surgical Adjuvant Breast and
Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;
27(15):2466-2473.
6. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of
tamoxifen therapy for breast cancer patients with negative lymph nodes and
estrogen receptor-positive tumors. J Natl Cancer Inst. 1996;88(21):1529-1542.
7. Fisher B, Dignam J, Mamounas EP, et al. Sequential methotrexate and
fluorouracil for the treatment of node-negative breast cancer patients with
estrogen receptor-negative tumors: Eight-year results from National Surgical
Adjuvant Breast and Bowel Project (NSABP) B-13 and first report of findings
from NSABP B-19 comparing methotrexate and fluorouracil with conventional
cyclophosphamide, methotrexate, and fluorouracil. J Clin Oncol. 1996;
14(7):1982-1992.
8. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant
chemotherapy for operable HER2-positive breast cancer. N Engl J Med.
2005;353(16):1673-1684.
9. Solin LJ, Orel SG, Hwang WT, et al. Relationship of breast magnetic
resonance imaging to outcome after breast-conservation treatment with
radiation for women with early-stage invasive breast carcinoma or ductal
carcinoma in situ. J Clin Oncol. 2008;26(3):386-391.
10. Azu M, Abrahamse P, Katz SJ, et al. What is an adequate margin for
breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol.
2010;17(2):558-563.
11. Taghian A, Mohiuddin M, Jagsi R, et al. Current perceptions regarding
surgical margin status after breast-conserving therapy: Results of a survey.
Ann Surg. 2005;241(4):629-639.
12. Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and
receipt of mastectomy for treatment of breast cancer. JAMA. 2009;302(14):
1551-1556.
13. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in
Reexcision Following Breast Conservation Surgery. JAMA. 2012;307(5):467-
475.
14. Hwang N, Schiller DE, Crystal P, et al. Magnetic resonance imaging in
the planning of initial lumpectomy for invasive breast carcinoma: Its effect on
ipsilateral breast tumor recurrence after breast-conservation therapy. Ann
Surg Oncol. 2009;16(11):3000-3009.
15. Kyndi M, Sorensen FB, Knudsen H, et al. Estrogen receptor, progesterone
receptor, HER-2, and response to postmastectomy radiotherapy in
only does survival improve, but local recurrence decreases as
well. These findings have important implications for the
future of local therapy. More aggressive surgical strategies
are unlikely to improve local outcomes for poor-prognosis
cancers in the absence of improved systemic therapies.
Strategies to reduce the extent of surgery in patient subsets
where systemic therapy is available should be sought to
reduce the morbidity of treatment.
Stock
Ownership Honoraria
REFERENCES
Research
Funding
Expert
Testimony
Other
Remuneration
high-risk breast cancer: The Danish Breast Cancer Cooperative Group. J Clin
Oncol. 2008;26(9):1419-1426.
16. Mamounas EP, Tang G, Fisher B, et al. Association between the
21-gene recurrence score assay and risk of locoregional recurrence in nodenegative,
estrogen receptor-positive breast cancer: Results from NSABP B-14
and NSABP B-20. J Clin Oncol. 2010;28(10):1677-1683.
17. Abdulkarim BS, Cuartero J, Hanson J, et al. Increased risk of locoregional
recurrence for women with T1-2N0 triple-negative breast cancer
treated with modified radical mastectomy without adjuvant radiation therapy
compared with breast-conserving therapy. J Clin Oncol. 2011;29(21):2852-
2858.
18. Ho AY, Gupta G, King TA, et al. Favorable Prognosis in Patients with
T1a/bN0 Triple Negative Breast Cancers Treated With Multimodality Therapy.
Cancer. 2012 (In Press).
19. Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a
randomized trial comparing radical mastectomy, total mastectomy, and total
mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567-575.
20. Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of
sentinel-lymph-node resection and conventional axillary-lymph-node dissection
in patients with clinically node-negative breast cancer: Results from the
NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8(10):881-888.
21. Reznik J, Cicchetti MG, Degaspe B, Fitzgerald TJ. Analysis of axillary
coverage during tangential radiation therapy to the breast. Int J Radiat
Oncol Biol Phys. 2005;61(1):163-168.
22. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no
axillary dissection in women with invasive breast cancer and sentinel node
metastasis: A randomized clinical trial. JAMA. 2011;305(6):569-575.
23. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after
sentinel lymph node dissection with or without axillary dissection in patients
with sentinel lymph node metastases: The American College of Surgeons
Oncology Group Z0011 randomized trial. Ann Surg. 2010;252(3):426-432;
discussion 32-33.
24. Grills IS, Kestin LL, Goldstein N, et al. Risk factors for regional nodal
failure after breast-conserving therapy: Regional nodal irradiation reduces
rate of axillary failure in patients with four or more positive lymph nodes. Int
J Radiat Oncol Biol Phys. 2003;56(3):658-670.
25. Yates L, Kirby A, Crichton S, et al. Risk Factors for Regional Nodal
Relapse in Breast Cancer Patients with One to Three Positive Axillary Nodes.
Int J Radiat Oncol Biol Phys (In Press). 2011.
26. Tuttle TM, Habermann EB, Grund EH, et al. Increasing use of
contralateral prophylactic mastectomy for breast cancer patients: A trend
toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203-
5209.
27. Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral
prophylactic mastectomy for unilateral cancer: A report from the National
Cancer Data Base, 1998-2007. Ann Surg Oncol. 2010;17(10):2554-2562.
28. Nichols HB, Berrington de Gonzalez A, Lacey JV, Jr., et al. Declining
incidence of contralateral breast cancer in the United States from 1975 to
2006. J Clin Oncol. 2011;29(12):1564-1569.
29. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the
prevention of breast cancer. Cochrane Database Syst Rev. (Online). 2010(11):
CD002748.
30. Hawley ST, Jagsi R, Morrow M, Katz SJ. Correlates of contralateral
prophylactic mastectomy in a population-based sample. J Clin Oncol. 2011;29
(Abstract 6010).
55