Breast-conserving Therapy Group Research Articles

The EORTC 22922/10925 trial investigating regional nodal irradiation in stage I-III breast cancer: Outcomes according to locoregional and systemic therapies

The EORTC 22922/10925 trial aimed to investigate the impact on overall survival (OS) of elective internal mammary and medial supraclavicular (IM-MS) radiation therapy (RT) in breast cancer stage I–III. Surgery for the primary tumour and axillary lymph nodes, chest wall RT, boost RT after whole breast RT in breast conserving therapy (BCT), RT to operated axilla, and systemic therapy were per physician’s preference. The aim of the current analysis is to assess breast cancer outcomes according to different locoregional and systemic therapy used in the trial. Material/MethodsData with a median follow-up of 15.7 years were extracted from the trial’s case report forms. Kaplan-Meier curves of disease-free and OS and cumulative incidence curves of breast cancer events were produced. An exploratory analysis of the effect of the type of locoregional and systemic therapy on breast cancer outcomes was conducted using the Cox model or the Fine & Gray model accounting for competing risks, both models being adjusted for baseline patient and disease characteristics and treatment. The significance level was set at 5 %, 2-sided. ResultsOf the 4,004 patients included, 625 (16%) did not receive any postoperative systemic therapy, 1,185 (30%) received endocrine therapy only, 994 (25%) chemotherapy only, and 1,200 (30%) both chemotherapy and endocrine therapy, without differences between the randomisation arms.Administration and type of therapy was associated with age, menopausal status, clinical T- and N-stage and ER status (p < 0.0001). Local control was better with mastectomy (with/without postmastectomy RT) as compared to BCT, but mastectomy was associated with more distant metastasis (DM) as first event. Similarly, DM as first event occurred more in the BCT group that received a boost as compared to no boost and in those who received RT to the lower axillary level. IM-MS RT reduced significantly regional recurrences and improved disease-free survival in a sensitivity stratified analysis. OS was worse with mastectomy as compared to BCT and with irradiation of the axilla but better with sentinel node dissection and adjuvant combined chemo and hormonal therapy. ConclusionDifferent components of therapy influenced the site of first event. IM-MS RT improved outcomes in different breast cancer outcomes were most probably related that the group were balanced due to the trial arms and stratification methods.

Ipsilateral recurrence and breast cancer outcomes in carriers of BRCA1/2 pathogenic variants according to locoregional treatments.

e12584 Background: Our previous study of 255 breast cancer (BC) patients, carriers of BRCA1/2 pathogenic variants (PV), showed that patients who underwent mastectomy without post-mastectomy radiotherapy (PMRT) had higher rates of local recurrence (LR) than those who underwent PMRT or breast-conserving therapy (BCT). Our aim was to verify our previous findings in a larger cohort. Methods: Clinical data was extracted from the medical records of BRCA1/2 mutation carriers with BC, treated at a single institution between 1/2006-12/2022. Data extracted included demographics, tumor characteristics, disease stage, surgical and oncological treatment, use of RT and disease outcomes. Results: Overall, 481 BC patients with BRCA1/2 germline mutations were identified, 20 of them presented with synchronous bilateral disease. Median follow-up time was 75.3 months (range 12.5-211). After excluding 16 patients with metastatic de novo disease and 1 patient not operated for medical reasons, 464 patients with 484 primary tumors were analyzed. Of these, 234 (48.3%) mastectomies (84% were skin- or nipple-sparing, SSM/NSM, 16% total mastectomy) and 250 (51.7%) BCT were performed. In the non-PMRT group (n=153) there was earlier disease stage at diagnosis (77.6% of tumors were Tis and T1N0) compared to the PMRT group (n=81) and BCT group (4.9% and 45%, respectively, p&lt;0.001). All had free surgical margins. LR rate in the study cohorts was 20/153 breasts (13.1%) in the non-PMRT group compared with 1/81 breasts (1.2%) in the PMRT group (p=0.003), and 16/250 (6.4%) in the BCS group (p=0.024). All but one recurrence were invasive. Cumulative incidence of LR at 5 and 10 years was 14.1% and 15.9% in the non-PMRT, compared to 4.4% and 9.4% in BCT group, respectively (p=0.034). No significant difference in overall survival was observed (p=0.39). Conclusions: BRCA1/2 PV carriers treated with mastectomy without PMRT had higher rates of LR than those who underwent mastectomy and PMRT or BCT, despite earlier stage disease. Further studies are needed to compare these outcomes to non- BRCA1/2 carriers and find means to improve local control in these patients.

Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy: A Systematic Review and Meta-analysis of the Literature.

Autologous fat grafting (AFG) is often used to reconstruct defects after breast conservation therapy (BCT). However, concerns exist about the possibility of AFG-related recurrence or metastasis. This study aims to evaluate the literature to evaluate oncologic outcomes in patients undergoing AFG at the time of BCT. A systematic review of articles related to AFG based reconstruction at the time of BCT from 1970 to 2021 was performed via PubMed. Patients were grouped based on the presence or lack of AFG usage at the time of BCT, and oncologic outcomes and complications were compared. Of the 146 articles identified, 15 were included. Nine hundred patients underwent BCT alone and 1063 patients underwent BCT with AFG patients. Similar average follow-up time was observed between the groups, 58.7 months (BCT only) and 55.2 months (BCT with AFG). On pooled analysis, no difference was identified in local recurrence 4.8% (43 patients) of the BCT group and 3% (32 patients) in the AFG group (P = 0.8), metastasis 4.8% (43 patients) of the BCT group and 6.9% (73 patients) in the AFG group (P = 0.3), or fat necrosis (P = 0.44). Meta-analysis additionally did not identify any statistically significant odds ratios between the BCT only group and BCT with AFG group when evaluated for total recurrence, local recurrence, metastasis or fat necrosis. The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting has safe outcomes.

Effect of Breast Conservation Therapy vs Mastectomy on Overall Survival and Breast Cancer-Specific Survival Among Men With Stage I-II Breast Cancer: Analysis of SEER, 2000-2018

BackgroundMale breast cancer is a rare malignant tumor, and outcomes of breast conservation therapy (BCT) are currently lacking. MethodThe retrospective, population-based cohort study included 1369 stage I-II (T1–2 N0–1 M0) male breast cancer patients from the SEER database (2000-2018). The patients were grouped in two groups: BCT group and mastectomy group, according to surgical and radiation therapy. Kaplan-Meier method and univariable Cox proportional hazard analysis were used to compare overall survival (OS) and breast cancer-specific survival (BCSS) between two treatment groups. Propensity score matching (PSM) was performed to balance the confounding factors. ResultsOf the 1369 men, 97 (7%) patients received BCT, 1272 (93%) received mastectomy alone. The 5- and 10-year OS rates were 92.3% and 80.7% for BCT group compared with 80.4% and 61.4% for mastectomy group. The 5- and 10-year BCSS rates were 96.5% and 93.9% for patients undergoing BCT, as compared with 93.1% and 84.4% for patients undergoing mastectomy. Compared with mastectomy group, BCT group showed improved OS (hazard ratio [HR], 0.294; 95% CI 0.138-0.623, P = .002) and BCSS (hazard ratio [HR], 0.182; 95% CI 0.040-0.820, P = .027). Of the 791 patients with T1 stage, BCT showed insignificant association with OS (hazard ratio [HR], 0.555; 95% CI 0.207-1.488, P = .242) and BCSS (hazard ratio [HR], 1.217; 95% CI 0.171-8.675, P = .844). ConclusionThe results of this cohort study suggest that BCT is at least equivalent to mastectomy in male breast cancer patients. The underlying mechanism of this association needs further research.

Short- and long-term recurrence of early-stage invasive ductal carcinoma in middle-aged and old women with different treatments

Most new cases and the highest mortality rates of breast cancer occur among middle-aged and old women. The recurrence rate of early-stage invasive ductal carcinoma (IDC) among women aged ≥ 50 years and receiving different treatments remains unclear. Therefore, this study was conducted to determine these rates. We used Surveillance, Epidemiology, and End Results (SEER) data for this nationwide population-based cohort study. All women aged ≥ 50 years and diagnosed with early-stage IDC between 2000 and 2015 were identified and divided into three treatment groups, namely, breast conservation therapy (BCT), mastectomy alone (MAS), and mastectomy with radiation therapy (MAS + RT). The recurrence rates of IDC among these groups were then compared. The BCT group had a lower short-term recurrence risk than the MAS and MAS + RT groups (hazard ratio [HR]: 1.00 vs. 2.90 [95% CI 1.36–2.66] vs. 2.07 [95% CI 0.97–4.44]); however, the BCT group also had a higher long-term recurrence risk than MAS and MAS + RT groups (HR 1.00 vs. 0.30 [95% CI 0.26–0.35] vs. 0.43 [95% CI 0.30–0.63]). The high long-term recurrence rate of the BCT group was especially prominent at the 10- and 15-year follow-ups. The results provide valuable evidence of the most reliable treatment strategy for this population. Further studies including more variables and validation in other countries are warranted to confirm our findings.

Breast-conserving therapy is associated with better survival than mastectomy in Early-stage breast cancer: A propensity score analysis.

BackgroundRecent retrospective studies have reported that breast‐conserving therapy (BCT) led to improved overall survival (OS) than mastectomy in some populations. We aimed to compare the efficacy of BCT and mastectomy using the SEER database.Materials and methodsBetween 2010 and 2015, 99,790 eligible patients were identified. We included early‐stage breast cancer patients with 5cm or smaller tumors and three or fewer positive lymph nodes in our study. We compared the OS and breast cancer‐specific survival (BCSS) results among patients with BCT and those with mastectomy. Kaplan‐Meier plots, Cox proportional hazard regressions, competing risk analysis, and multivariate regressions were used to evaluate the outcomes. Propensity‐score matching was used to assemble a cohort of patients with similar baseline characteristics.ResultsIn our study, 77,452 (77.6%) patients underwent BCT and 22,338 (22.4%) underwent mastectomy. The 5‐year OS rate was 94.7% in the BCT group and 87.6% in the mastectomy group, and the 5‐year BCSS was 97.2% in the BCT and 94.3% in the mastectomy group. Multivariate analysis in the matched cohort showed that women underwent mastectomy was associated with worse OS (Hazard ratio (HR) = 1.79; 95% confidence intervals (CIs) = 1.59–2.02, p < 0.001) and BCSS (HR = 1.88; 95% CIs = 1.61–2.18, p < 0.001) results compared with those underwent BCT. Patients with different subtypes and age group (>50 years old; ≤50 years old) received BCT showed significantly better OS and BCSS results than those received mastectomy. The effect of surgery choice on survival yielded similar results either for all patients or matched cohorts.ConclusionsOur study showed that BCT was associated with improved survival compared with mastectomy in early‐stage breast cancer patients. It seems advisable to encourage patients to receive BCT rather than mastectomy in early‐stage patients when feasible and appropriate.

Quality of Life in Patients with Breast Cancer following Breast Conservation Surgery: A Systematic Review and Meta-Analysis.

To evaluate the health-related quality-of-life (QOL) outcomes in surgical breast cancer survivors who received breast conservation therapy (BCT) compared to mastectomy, we utilized a systematic review to conduct observational studies of QOL in patients with breast cancer following breast conservation therapy from their inception until October 2021. The PubMed, the Cochrane Library, and the Web of Science databases were systematically searched to retrieve the observational studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were applied as an effect estimate and calculated using Stata 15 software. Nine studies comprising 2301 patients were included. The results showed that no significant differences compared to mastectomy were detected for global health status (P=0.971 and P=0.613), physical function (P=0.099), emotional function (P=0.096), cognitive function (P=0.377), social function (P=0.602), sexual functioning (P=0.072), and sexual enjoyment (P=0.142), while role function (P=0.036), body image (P=0.000), and future perspective (P=0.012) showed a significant difference for BCT when compared to mastectomy. When compared to breast reconstruction (BR), the BCT group was inferior at physical function (P=0.002) and cognitive function (P=0.040) but superior at body image (P=0.001). When used the Functional Assessment of Cancer Therapy (FACT) tool, BCT has better results in physical function (P=0.000), emotional function (P=0.000), and social function (P=0.000) than mastectomy. QOL outcomes after BCT were better than mastectomy in body image, future perspective, and role function. BCT may be an acceptable option in the study setting for breast cancer patients who pursue high QOL.

Breast conserving therapy for central breast cancer in the United States

IntroductionAlthough central breast cancer is not a contraindication to breast conserving, most surgeons still choose to perform total mastectomy. The safety of breast conserving treatment for central breast cancer is still unclear. The purpose of this study is to evaluate the long-term survival outcome of central breast cancer.Materials and methodsUsing SEER database to explore the trend of surgical procedures for patients with central breast cancer. The patients were divided into breast conserving group and non-breast conserving group. Multivariate logistic regression was used to evaluate predictors of breast conserving surgery in central breast cancer. The clinicopathological variables were adjusted through the multivariable Cox risk model, and the stage and T stage were stratified to compare survival results.ResultsA total of 8702 patients with central breast cancer underwent surgical treatment from 2010 to 2015. There were 3870 patients in the breast conserving group and 4832 patients in the non-breast conserving group. The breast preservation rate was 44.4%, which rose from 39.9% in 2010 to 51% in 2015. Elderly patients (p < 0.001) and low tumor malignancy were predictors of breast conserving therapy. In the 1:1 matched case–control analysis, breast cancer-specific survival (BCSS) (p < 0.001) and overall survival (OS) (p < 0.001) in breast conserving therapy group were still higher than those of non-breast conserving. In the subgroup analysis of T staging and stage, the breast conserving therapy group still had higher OS and BCSS.ConclusionIn central breast cancer, breast-conserving therapy is safe and optional.

Body Image and Quality of Life Correlation after Treatment in Thai Breast Cancer Patients

Objective: This study aimed to identify the correlation between body image (BI) perception and quality of life (QoL) in Thai breast cancer patients. Moreover, we investigated the change of BI and QoL over time in breast cancer patients who underwent mastectomy and breast conserving therapy (BCT). Materials and Methods: Sixty Thai breast cancer patients who diagnosed at least one year at MSMC during July, 2016 to April, 2017 were asked to complete the questionnaires. We collected demographic data and history of breast cancer treatment from medical record. All participants were evaluated about BI and QoL by completed Thai version of body image scale (TBIS), EORTC QLQ-C30 and EORTC QLQ BR-23. The data were assessed at month 0 and 6th. Spearman&rsquo;s rho Correlations and repeated measures ANOVA were used to analyze the relation and change of BI and QoL over time. Results: Thirty patients underwent BCT. Mean age was 54.7 years and 73.3 percent was in early stage breast cancer. Moderate correlation were presented between BI and emotional functioning, and upset by hair loss. BCT group had lower score statistical significant in physical functioning, social functioning and future perspective comparing to mastectomy group. Additionally, patients whose age more than 55 years had better QoL in social functioning and other functional measurements (p-value &lt;0.05) than younger patients. Changing of BI between mastectomy and BCT over 6-month period did not affect by time but time and type of surgery interaction had been found in TBIS score (F (1, 58)=6.79, p=0.012). Global health status in both group were decreased overtime (F (1, 58)=5.84, p=0.019). Conclusion: BI was correlated to QoL in Thai breast cancer patients. Younger patients had lower QoL comparing to older patients. BI perception and QoL had changed over time depend on type of surgery. Keywords: Quality of life; Body image; Breast cancer; Surgery; Thai

Conservative Treatment versus Surgical Treatment in the Management of Large Invasive Lobular Carcinoma

Abstract Background: The safety of breast conservation therapy (BCT) has not been demonstrated in large ILC tumors, poten-tially contributing to the higher mastectomy rates seen in ILC. Aim of Study: The aim of our study was to identify patients with of breast ILC measuring 4cm and evaluated difference in recurrence free survival (RFS) between those treated with BCT versus mastectomy. Patients and Methods: This is a retrospective study of patients treated for ILC, 60 consecutive treated women with unilateral Stage I or II invasive lobular breast carcinoma were treated with axillary dissection and either mastectomy or conservative breast therapy (n=30) or BCS (n=30), they were admitted to Surgical Oncology Department and General Surgery Department Sayed Galal University Hospital, Al-Azhar University. Results: Disease free survival after 5-years was 81.3% in BCT group and 87.2% in mastectomy group, and after 10- years was 81.3% in group BCT and 72.1% in mastectomy group. Conclusion: For patients with large size ILC, BCT provides similar tumor control as mastectomy, provided that negative margins are achieved. Our findings can be used to help patients and providers make informed choices about surgical options for ILC, which currently has a higher rate of mastectomy than that of IDC.

Breast-Conserving Therapy Has Better Prognosis for Tumors in the Central and Nipple Portion of Breast Cancer Compared with Mastectomy: A SEER Data-Based Study.

Background and ObjectivesCurrently, the location of primary tumor was an independent prognostic factor of breast cancer. Tumors in the central and nipple portion (TCNP) had poor prognosis compared to other peripheral quadrants. The breast-conserving therapy (BCT) is becoming increasingly common worldwide in breast cancer operations. However, whether the availability of BCT was performed for TCNP remained a matter of debate. We sought to investigate whether BCT was suitable for TCNP with respect to survival outcomes, compared with mastectomy therapy.MethodsUtilizing the Surveillance, Epidemiology, and End Results (SEER) database, we obtained TCNP breast cancer patients diagnosed during the period of 2010–2015. One-to-one (1:1) propensity score matching (PSM) was applied to construct a matched sample consisting of pairs of BCT and mastectomy groups. Univariate and multivariate Cox proportional hazard models were applied to estimate the factors associated with breast cancer-specific survival (BCSS) and overall survival (OS). Survival analysis was performed with the Kaplan–Meier method.ResultsIn the overall cohort, a total of 9,900 patients were enrolled. We found that patients with BCT showed significantly better BCSS (log-rank, p < 0.001) and OS (log-rank, p < 0.001) than the mastectomy group before PSM. The same finding was also shown in 5,820 patients after PSM. Additionally, none of the subgroups, including age, sex, race, histological grade, AJCC stage, and molecular subtype undergoing mastectomy therapy, had better BCSS than BCT.ConclusionsOur study was the first research to show that BCT exhibited superior prognosis in the cohort of TCNP from SEER databases than mastectomy therapy. This finding could provide a cue for treatment strategies for suitable TCNP patients, especially those with a strong willingness to conserve their breasts.

Breast-Conserving Therapy Versus Mastectomy in Young Breast Cancer Patients Concerning Molecular Subtypes: A SEER Population-Based Study

Breast-conserving therapy was once a contraindication in young breast cancer patients (aged ≤40 years). Emerging studies suggest that breast-conserving therapy and mastectomy could achieve similar prognosis in this population. However, the effect of molecular subtype disparity on surgical strategy in these patients remains unclear. Data from 8656 young patients (aged ≤40 years) diagnosed with invasive breast cancer between in 2010 and 2014 were retrospectively reviewed from the Surveillance, Epidemiology, and End Results database. The Cox proportional hazards model was used to evaluate subtype-dependent relationships between the surgical method and survival. Of the 8656 patients, 4132 (47.7%) underwent breast-conserving therapy and 4524 (52.3%) underwent mastectomy. The median follow-up period was 30.0 months. Patients in the breast-conserving therapy group demonstrated better overall survival and breast cancer-specific survival than those in the mastectomy group (both p < 0.05). Patients with different molecular subtypes exhibited significant differences in overall survival and breast cancer-specific survival (p < 0.001). Patients with luminal subtypes experienced better overall survival and breast cancer-specific survival than those with the triple-negative subtype. Multivariate analysis revealed that overall mortality risk of the breast-conserving therapy group was lower than that of the mastectomy group among HR(+)HER-2(-) and HR(-)HER-2(-) patients (overall mortality risk of 36.3% [adjusted hazard ratio = 0.637 {95% confidence interval = 0.448–0.905}, p = 0.012] and 36.0% [adjusted hazard ratio = 0.640 {95% confidence interval = 0.455–0.901}, p = 0.010] respectively.) The breast cancer-specific mortality risk was also lower by a percentage similar to that of the overall mortality risk. In the HR(+)HER-2(+) group, the surgical method was an independent prognostic factor for breast cancer-specific survival (adjusted hazard ratio = 0.275 [95% confidence interval = 0.089–0.849], p = 0.025), while there was a trend that patients with breast-conserving therapy had better overall survival than those with mastectomy (p = 0.056). In the HR(-)HER-2(+) group, no significant difference was observed in overall survival and breast cancer-specific survival (p = 0.791 and p = 0.262, respectively). Breast-conserving therapy resulted in significantly better prognosis in patients with luminal and triple-negative subtypes, while no significant difference was observed in patients with the HER-2 enriched subtype. These results may be helpful in informing clinically precise decision-making for surgery in this population.

Comparing Survival Differences Between Breast-Conserving Therapy and Mastectomy in Patients with Early-Stage Breast Cancer

In 1990 breast-conserving therapy (BCT) was recommended as a preferred treatment for early-stage breast cancer by the NIH consensus statement based on randomized trials demonstrating BCT to have equivalent survival outcomes as mastectomy for early-stage breast cancer patients. BCT became more common while total mastectomy (TM) rates decreased. More recently, patients with early-stage breast cancer are undergoing TM with increasing frequency. In light of increasing TM rates and given significant changes in radiation, surgery and systemic therapies, several groups have examined long-term outcomes for patients undergoing TM vs BCT. Local-regional recurrence (LRR) rates with BCT have been reported to be lower than the 8-10% LRR range reported with the initial randomized trials. In addition, several groups have published slightly improved survival rates in patients undergoing BCT compared with TM. The aim of this study was to evaluate trends in TM rates for treatment of early-stage breast cancer at a single institution and compare overall survival (OS), distant metastasis-free survival (DMFS), LRR and disease-specific survival (DSS) between breast conservation and TM. We identified clinical stage T1–2, N0–1, M0 breast cancer patients who underwent primary surgery from 1/1/2000 to 12/31/2014. TM and BCT rates were evaluated, and multivariable Cox proportional hazards models were used for comparison of survival differences between breast conserving surgery alone (BCS), BCT and TM with or without radiation therapy (RT). Of 12,034 patients included, 800 (6.7%) underwent BCS, 5,986 (49.7%) underwent BCT, 3.618 (30.1%) underwent TM without RT and 1,630 (13.5%) underwent TM with RT. Patients who underwent TM were younger, with more advanced and aggressive disease (larger tumors, positive lymph nodes, higher grade, and more likely to be ER/PR-negative or HER2-positive). TM rates increased over time in patients <=50 years old. At median follow-up time of 6.2 years, multivariable Cox model showed that patients who underwent BCT had a better DSS (HR: 0.8, P=0.02) and OS (HR: 0.7, P<0.001) and had a similar DMFS (HR: 0.9, P=0.3), but had increased LRR (HR: 1.3, P=0.04) compared to patients who underwent TM without RT. In patients undergoing TM with RT, there was no survival benefit found in OS, DSS and DMFS on multivariable analyses compared with patients who underwent BCT. Patients who underwent BCS alone had a worse OS, LRR and DMFS compared to patients undergoing BCT. 5-year LRR and DSS rates were similar between TM without RT and BCT groups. After adjusting for confounding variables, BCT showed improved OS and DSS compared with TM in early-stage breast cancer. These contemporary data may help physicians in surgical decision making for patients who are candidates for either mastectomy or breast conservation since they suggest that BCT is at least equivalent to TM with respect to OS and DSS.

Breast-conserving therapy shows better prognosis in mucinous breast carcinoma compared with mastectomy: A SEER population-based study.

BackgroundMucinous breast carcinoma (MBC) is a relatively rare pathological type of breast cancer. Compared with mastectomy in MBC, the effect and safety of breast‐conserving therapy (BCT) remains unclear. Therefore, we investigated the long‐term prognosis of BCT and mastectomy in T1‐2 stage mucinous breast carcinoma via the Surveillance, Epidemiology, and End Results (SEER) database.MethodsTotally, 8830 patients who were diagnosed of mucinous breast carcinoma between 2004 and 2014 from SEER database were reviewed retrospectively. Cox proportional hazards model and Kaplan‐Meier method were performed for evaluating the relationship between surgical method and prognosis.ResultsOne thousand three hundred and twenty (14.9%) patients underwent mastectomy and 7510 (85.1%) underwent BCT. The median follow‐up time was 77 months. There were more non‐Hispanic white, married, and younger (<65 years) patients, as well as lower stage of tumor sizes, lymph nodes and more favorable histologic grade, ER positive, and PR positive in BCT group (P < .05). Patients in BCT group had relatively better overall survival (OS) than those in mastectomy group. The risk of death from any cause in BCT group was lower than that in mastectomy group significantly (HR = 0.786, 95% CI: 0.703‐0.879, P < .001), while no difference significantly was observed in breast cancer‐specific survival (BCSS) between BCT and mastectomy groups. In stratified analysis according to T stage, BCT group had better OS than mastectomy group for patients of T1 stage (HR = 0.679, 95% CI: 0.589‐0.781, P < .001) or T2 stage (HR = 0.769, 95% CI: 0.646‐0.915, P = .003). In stratified analysis according to the different ages, BCT showed OS benefit in patients at the age of 50‐64 years (HR = 0.587, 95% CI: 0.408‐0.846, P = .004) and the age of 65‐79 years (HR = 0.636, 95% CI: 0.535‐0.758, P = .001). For patients younger than 50 years or not younger than 80 years, there was no difference significantly observed in OS between BCT and mastectomy groups (P > .05).While for patients who received BCT, the use of radiotherapy showed OS benefit.ConclusionsThis large population‐based study indicated patients who received BCT had better prognosis than those received mastectomy in T1‐2 stage MBC, especially in patients at the age of 50‐79 years. The use of radiotherapy showed OS benefit in patients receiving BCT. Breast‐conserving therapy might be preferred over mastectomy especially in locoregional treatment of T1‐2 stage MBC.

Breast conservation therapy confers survival and distant recurrence advantage over mastectomy for stage II Triple Negative Breast cancer

IntroductionRecent studies suggest survival benefit of breast conservation over mastectomy. We evaluated distant recurrence (DR) rates after breast-conservation therapy (BCT) versus mastectomy in our community-based cancer institute. MethodsA retrospective review of patients undergoing treatment of Stage 0–3 breast cancer from January, 2002 to December, 2011 was performed. We evaluated outcomes between those having BCT versus mastectomy. ResultsWe reviewed 4876 patients. There was no significant difference in DR between patients undergoing BCT versus mastectomy in DCIS (n = 904; BCS 521, mastectomy 383; DR = 1/521 vs 1/383; p = 0.09), Stage I (n = 2202; BCT 1505, mastectomy 697; DR = 6/1505 vs 17/697; p = 0.98) or Stage III cancer (n = 417; BCT 87, mastectomy 330; DR = 17/87 vs 59/330; p = 0.50). There was significantly less DR in Stage II patients (n = 1353) undergoing BCT vs mastectomy (32/645 vs 64/708; p = 0.003). Subgroup analysis of Stage II TNBC (n = 198) subgroup analysis showed 104 mastectomy and 94 BCT patients. Those in the BCT group had significantly lower rates of DR (6/94 vs 16/104; p= 0.03) and significantly higher survival (81/94 vs 69/104; p = 0.007) than those undergoing mastectomy. Of Stage II TNBC patients with DR there was no difference in age, lymph node status or tumor size (p > 0.05 for all) in BCT versus mastectomy groups; there was a significant difference in radiation status (94/94 vs. 28/104; p < 0.0001). Radiation was associated with worse outcomes in the mastectomy group (HR 2.32; p = 0.04). ConclusionsWe found significantly less DR in Stage II patients undergoing BCT vs mastectomy. This benefit includes a survival advantage in patients with TNBC undergoing BCT. We could not identify an explanatory factor. Until the difference is understood eligible patients with TNBC should be encouraged to undergo BCT.

A Comparative Matched Study of Breast-Conserving Therapy and Modified Radical Mastectomy in Iranian Women

Background: Breast cancer is the most frequent diagnosed visceral cancer with 13400 new cases annually among Iranian women. Modified radical mastectomy (MRM) was the old standard surgical treatment in patients with breast cancer from 70 years ago and breast-conserving surgery (BCS) with adjuvant radiotherapy was the standard treatment from 30 years ago. Objectives: In this matched historical cohort study, we compared two types of therapy for breast carcinoma: breast-conserving therapy (BCT), and MRM. Methods: Medical records of 6000 patients with breast cancer from the database of Cancer Research Center of Shahid Beheshti University of Medical Sciences were reviewed and 1310 patients who had been treated by BCT (group A) or MRM (group B) were selected based on a time- stratified 1:1 between September 2002 and December 2014 as 10 baseline variables. By log-rank test analysis, their local recurrence (LR), disease free survival (DFS) and overall survival (OS) were evaluated and compared. Results: In groups A and B, the median age at the diagnosis time was 48.11 and 48.64 years old, respectively. Median follow-up time was 71 months since April 2015. 1.68% of patients in group A and 1.07% of patients in group B had local recurrence during the five years of follow up, (P = 0.173). In the group A and B, five years DFS were 87.94% and 80.46%, (P < 0.001) and five years OS were 89.31% and 83.02%, respectively (P = 0.041). Conclusions: The findings of this study showed that 5-year DFS and 5-year OS in BCT group were better than in the MRM group. Longer follow-up time of the patients to compare 10-year DFS and 10-year OS or even 20-year OS between two groups is recommended.

Is quality of life after mastectomy comparable to that after breast conservation surgery? A 5-year follow up study from Mumbai, India

PurposeBreast cancer is the commonest cancer in women worldwide. Surgery is a central part of the treatment. Modified radical mastectomy (MRM) is often replaced by breast conserving therapy (BCT) in high-income countries. MRM is still the standard choice, in low- and middle-income countries (LMICs) as radiotherapy, a mandatory component of BCT is not widely available. It is important to understand whether quality of life (QOL) after MRM is comparable to that after BCT. This has not been studied well in LMICs. We present, 5-year follow-up of QOL scores in breast cancer patients from India.MethodsWe interviewed women undergoing breast cancer surgery preoperatively, at 6 months after surgery, and at 1 year and 5 years, postoperatively. QOL scores were evaluated using FACT B questionnaire. Average QOL scores of women undergoing BCT were compared with those undergoing MRM. Total scores, domain scores and trends of scores over time were analyzed.ResultsWe interviewed 54 women with a mean age of 53 years (SD 9 ± years). QOL scores in all the women, dipped during the treatment period, in all subscales but improved thereafter and even surpassed the baseline in physical, emotional and breast-specific domains (p < 0.05) at 5 years. At the end of 5 years, there was no statistically significant difference between the MRM and BCT groups in any of the total or domain scores.ConclusionQOL scores in Indian women did not differ significantly between MRM and BCT in the long term. Both options are acceptable in the study setting.

Breast-Conserving Therapy Versus Modified Radical Mastectomy in the Early Breast Cancer Management: Oncological Outcome and Quality of Life

AbstractBackground: Breast cancer is the most common malig-nancy among women. Mastectomy is the current standard surgical procedure for ipsilateral tumor of the breast. However, there is little evidence about the prognostic effect of the surgical procedure (mastectomy versus lumpectomy) for early management of breast cancer. We investigated the breast-conserving therapy versus radical mastectomy in the early breast cancer management, and investigated the effect of treatment modalities on quality of life after breast cancer surgery.Aim of Study: To investigate the oncological outcomes of Breast-Conserving Therapy (BCT) versus Radical Mastec-tomy (MRM) in the early breast cancer management and to investigate the effect of treatment modalities on Quality of Life (QOL) more than 1 year after breast cancer surgery by comparing the QOL of the two groups of patients who under-went Breast Conserving Surgery (BCS) or Modified Radical Mastectomy (MRM).Patients and Methods: A retrospective-prospective cohort study between June 2010 and June 2017, at Zagazig University Hospitals in the General Surgery and Oncology Departments, a group of 456 patients (295 patients in the BCT group, 161 patients in the MRM group) was selected. Of the 456 patients enrolled, 383 patients gave their consent and completed the study questionnaire (177 patients in the BCT group, and 206 patients in the MRM group.Results: After 2-6years of follow-up, the overall survival was lower for BCT group 93.9%. While in MRM group was 94.4% with no statistical difference between both groups regarding this parameter. Quality of life after BCT was found better than MRM in the social and the emotional functions.Conclusions: The breast-conserving-therapy has been shown to be as effective as mastectomy in the treatment of early breast cancer in the local recurrence and overall survival rate of those patients. BCT improves the patients' QOL more than MRM does.

Local Control of Breast Conservation Therapy versus Mastectomy in Multifocal or Multicentric Breast Cancer: A Systematic Review and Meta-Analysis

Objective: Breast conservation therapy (BCT) for female patients with multifocal or multicentric (MF/MC) breast cancer remains controversial. The purpose of the present meta-analysis was to explore whether BCT was feasible for female patients with MF/MC breast cancer and to compare the results of treatment with those of female patients with unifocal breast cancer who underwent BCT and female patients with MF/MC breast cancer who underwent mastectomy. Methods: Online databases, including PubMed and Embase, were independently searched from inception to January 2018 and reviewed by two authors. The present meta-analysis compared local relapse (LR) of BCT versus mastectomy for patients with MF/MC breast cancer and LR of patients with unifocal breast cancer versus patients with MF/MC breast cancer who underwent BCT. Ten studies comprising 19,272 patients were included. Results: The cumulative incidence of LR was 5.6% (65/1,163) for MF/MC disease treated with BCT, 4.2% (750/17,656) for unifocal disease treated with BCT, and 2.0% (9/453) for MF/MC disease treated with mastectomy. Thus, the cumulative incidence of LR for MF/MC patients treated with BCT was significantly higher than for mastectomy (p < 0.001). However, the forest plot analysis showed no significant differences in LR between BCT and mastectomy procedures (OR = 1.22, 95% CI = 0.49–3.00, p = 0.67, I² = 0%). Compared with the unifocal group treated with BCT, BCT for MF/MC breast cancer showed a significant difference in LR (OR = 2.25, 95% CI = 1.48–3.42, p = 0.0001, I² = 0%). Conclusion: The LR of BCT for patients with MF/MC breast cancer was higher than that of BCT for patients with unifocal breast cancer. However, no significant difference was found in the incidence of LR between the BCT group and the mastectomy group in patients with MF/MC breast cancer.

Does addition of postmastectomy radiotherapy improve outcome of patients with pT1-2, N0 triple negative breast cancer as compared to breast conservation therapy?

Triple-negative breast cancers (TNBCs) form a heterogeneous group of cancers typically exhibiting an aggressive behavior resulting in increased risk of locoregional relapse (LRR) and distant metastases. The effect of radiotherapy on LRR risk and overall survival (OS) in women treated with mastectomy alone for early-stage TNBC remains unclear. The aim of this study is to compare the locoregional recurrence rate, disease-free survival (DFS), and OS following breast conservation therapy (BCT) or modified radical mastectomy (MRM) alone in women with stage I and IIA TNBC and to assess the impact of tumor and treatment-related factors. Patients with early-stage (pT1-2, N0) TNBC-treated between January 1, 2010, and December 31, 2011, were identified from the hospital-based registry records. The mean age was 48 years. Forty-nine patients underwent BCT, and 121 underwent MRM. The majority of the patients in both groups had T2 and grade 3 disease. None of the patients had margin positive status after surgery. Five patients had lymphovascular invasion (LVI). At a median follow-up of 50 months (range: 4-83 months), there was no locoregional recurrence (LRR) in either arm. Eight patients relapsed, six developed distant metastases, and one patient each had a new primary in the contralateral breast and ovary. Two patients died of disseminated cancer, one each in the BCT and MRM groups. The five-year DFS was 95.8% and 91.1% for the BCT group and MRM group, respectively, (P = 0.83). The corresponding 5-year OS was 98% and 97.5% (P = 0.527). There was no statistically significant difference in outcome based on age, grade, LVI, or margin status between both groups. This retrospective analysis identified no statistically significant difference in outcome regarding LRR, DFS, or OS in patients treated without adjuvant radiation for women with pT1-T2N0 TNBC who underwent MRM in comparison to BCT.