Local Treatment Of Breast Cancer Research Articles

Analysis of risk factors for recurrence within 12 months after surgery in patients with breast cancer receiving neoadjuvant therapy at a Brazilian cancer center.

e13039 Background: Early recurrence following treatment for localized breast cancer typically occurs within 5 years, and is commonly linked to high-risk clinicopathologic factors. However, literature focusing on risk factors for earlier recurrence timeframes is scarce, particularly within the neoadjuvant treatment population. Therefore, this study aims to investigate potential predictors for recurrence within 12 months post-surgery in breast cancer patients submitted to neoadjuvant therapy. Methods: This is an observational, descriptive, retrospective study involving 310 patients with recurrent breast cancer who received neoadjuvant therapy between January 2007 and March 2022, at AC Camargo Cancer Center in São Paulo, Brazil. Patients were compared based on relapse time after surgery (<12 months or ≥12 months), and risk factors were analyzed using the Chi-Square test or Fisher’s Exact test. Results: From 310 patients analyzed, 108 relapsed within 12 months and 202 after this period. Factors predicting recurrence in less than 12 months included: Histologic grade (HG) III ( p < 0.01); nuclear grade (NG) III ( p < 0.001); mitotic counts >20/mm2 ( p = 0.02); Ki67 > 20% ( p = 0.010); triple negative breast cancer (TNBC) and HER2+/HR- subtypes ( p < 0.001); interruption of neoadjuvant therapy due to disease progression or toxicity ( p < 0.001); chemotherapy dose reduction or delay ( p = 0.001); omission of adjuvant radiotherapy ( p < 0.001) and interruption of adjuvant HER2 targeted therapy ( p < 0.001). Menopausal status, Residual Cancer Burden (RCB) index, type of surgery and clinical stage showed no significant correlation with the outcome. Conclusions: Recurrence in less than 12 months was associated with intrinsic factors, such as HG III, NG III, high mitotic counts, Ki67 > 20%, TNBC, as well as interruption or delay of neoadjuvant therapy, omission of adjuvant radiotherapy and interruption or delay of HER2 targeted therapy, pointing out potential risk factors in this population.

Implantable, 3D-Printed Alginate Scaffolds with Bismuth Sulfide Nanoparticles for the Treatment of Local Breast Cancer via Enhanced Radiotherapy.

Surgical removal of tumor tissue remains the primary clinical approach for addressing breast cancer; however, complete tumor excision is challenging, and the remaining tumor cells can lead to tumor recurrence and metastasis over time, which substantially deteriorates the life quality of the patients. With the aim to improve local cancer radiotherapy, this work reports the fabrication of alginate (Alg) scaffolds containing bovine serum albumin (BSA)-coated bismuth sulfide (Bi2S3@BSA) nanoradiosensitizers using three-dimensional (3D) printing. Under single-dose X-ray irradiation in vitro, Alg-Bi2S3@BSA scaffolds significantly increase the formation of reactive oxygen species, enhance the inhibition of breast cancer cells, and suppress their colony formation capacity. In addition, scaffolds implanted under tumor tissue in murine model show high therapeutic efficacy by reducing the tumor volume growth rate under single-dose X-ray irradiation, while histological observation of main organs reveals no cytotoxicity or side effects. 3D-printed Alg-Bi2S3@BSA scaffolds produced with biocompatible and biodegradable materials may potentially lower the recurrence and metastasis rates in breast cancer patients by inhibiting residual tumor cells following postsurgery as well as exhibit anticancer properties in other solid tumors.

Preparation and antitumor study of intelligent injectable hydrogel: Carboxymethyl chitosan–aldehyde gum Arabic composite graphene oxide hydrogel

In this study, we used polyaldehyde gum Arabic (OGA) and carboxymethyl chitosan (CMCS) as a gel matrix to form an injectable self-healing hydrogel by Schiff-base bonding. Further, graphene oxide (GO) was loaded with doxorubicin (DOX) to the hydrogel, which resulted in a CMCS-OGA/GO@DOX hydrogel. We achieved a DOX drug loading capacity of 43.80 ± 1.13 %. Rheological studies showed that GO hydrogels have improved mechanical properties. The in vitro release profile showed pH responsiveness with 88.21 % DOX release at pH 5.5. Biocompatibility studies showed that the hydrogel composition had good cytocompatibility with L929 cells. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay showed a cell survival rate of 93.88 % within 48 h. The DOX-loaded hydrogel exhibited higher cell mortality in breast cancer cells (4 T1), with an inhibition rate of 79.4 % at 48 h. Acridine orange/ethidium bromide staining experiments on 4 T1 cells showed that when loaded with the same DOX concentration, the hydrogel significantly reduced the toxic effects on normal cells, whereas it had significant cytotoxic effects on cancer cells. This result indicates that the prepared GO hydrogel drug delivery system can serve as a novel approach for localized breast cancer treatment.

Immune evasion of dormant disseminated tumor cells is due to their scarcity and can be overcome by T cell immunotherapies

The period between "successful" treatment of localized breast cancer and the onset of distant metastasis can last many years, representing an unexploited window to eradicate disseminated disease and prevent metastases. We find that the source of recurrence-disseminated tumor cells (DTCs) -evade endogenous immunity directed against tumor neoantigens. Although DTCs downregulate major histocompatibility complex I, this does not preclude recognition by conventional Tcells. Instead, the scarcity of interactions between two relatively rare populations-DTCs and endogenous antigen-specific Tcells-underlies DTC persistence. This scarcity is overcome by any one of three immunotherapies that increase the number of tumor-specific Tcells: Tcell-based vaccination, or adoptive transfer of Tcell receptor or chimeric antigen receptor Tcells. Each approach achieves robust DTC elimination, motivating discovery of MHC-restricted and -unrestricted DTC antigens that can be targeted with Tcell-based immunotherapies to eliminate the reservoir of metastasis-initiating cells in patients.

348P Long-term opioid use following treatment of localized breast cancer: A real-world analysis

348P Long-term opioid use following treatment of localized breast cancer: A real-world analysis

Radiation Therapy-Induced Toxicity in a Breast Cancer Patient With Variance of Unknown Significance in the Ataxia Telangiectasia Gene

Abstract Breast conservation has been an effective part of the multimodality treatment of localized breast cancer. Appropriate candidates for breast conservation include patients with early stage disease. However, there are certain absolute contraindications for breast cancer, including radiation during pregnancy, multiple positive margins, and homozygosity mutations in the ataxia telangiectasia mutated (ATM) gene. ATM, an autosomal-recessive disorder, is associated with the childhood onset of neurologic impairment, immunodeficiency, and ocular and cutaneous telangiectasias. Typically, patients with heterozygous ATM mutations remain candidates for breast conservation. However, ATM mutations have been linked to increased sensitivity to radiation therapy and, in some cases, to severe toxicity. We present a case of a 51-year-old woman with variance of unknown significance (VUS) in her ATM gene, who was treated with adjuvant radiation and subsequently developed fibrosis, reduced shoulder movement, and telangiectasias. Thus, our case highlights the need for patients with VUS to be appropriately counseled on radiotoxicity.

In situ forming alginate/gelatin hybrid hydrogels containing doxorubicin loaded chitosan/AuNPs nanogels for the local therapy of breast cancer

In this study, pH-sensitive in situ gelling hydrogels based on oxidized alginate and gelatin-containing doxorubicin (DOX) loaded chitosan/gold nanoparticles (CS/AuNPs) nanogels were fabricated via Schiff-base bond formation. The obtained CS/AuNPs nanogels indicated a size distribution of about 209 nm with a zeta potential of +19.2 mV and an encapsulation efficiency of around 72.6 % for DOX. The study of the rheological properties of hydrogels showed that the value of G' is higher than G″ for all hydrogels, which confirms the elastic behavior of hydrogels in the applied frequency range. The rheological and texture analysis demonstrated the higher mechanical properties of hydrogels containing β-GP and CS/AuNPs nanogels. The release profile of DOX after 48 h indicates the 99 % and 73 % release amount at pH = 5.8 and pH = 7.4, respectively. MTT cytotoxicity study showed that the prepared hydrogels are cytocompatible on MCF-7 cells. By the Live/Dead assay, it was demonstrated that the cultured cells on DOX-free hydrogels were almost alive in the presence of CS/AuNPs nanogels. However, the hydrogel-containing drug and free DOX in the same concentration caused high death of MCF-7 cells as expected, which showed the potential of the developed hydrogels for application in the local treatment of breast cancer.

Same-day discharge pathway for breast cancer surgery in patients aged over 80: A feasibility study

The therapeutic strategy in older adults with breast cancer (BC) has always sought to be a model of personalized medicine. The first example was primary endocrine therapy, a less aggressive treatment targeting a biomarker in a frail patient [ [1] Preece P.E. Wood R.A. Mackie C.R. Cuschieri A. Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study. Br Med J (Clin Res Ed). 1982 Mar 20; 284: 869-870https://doi.org/10.1136/bmj.284.6319.869-a Crossref PubMed Scopus (154) Google Scholar ]. Recently, there have been further proposals to de-escalate surgical procedures, to the extreme of considering omitting surgery altogether [ [2] LeMasters T.J. Madhavan S.S. Sambamoorthi U. Vyas A.M. Disparities in the initial local treatment of older women with early-stage breast Cancer: a population-based study. J Womens Health (Larchmt). 2017 Jul; 26: 735-744https://doi.org/10.1089/jwh.2015.5639 Crossref Scopus (10) Google Scholar , [3] Matar R. Barrio A.V. Sevilimedu V. Le T. Heerdt A. Morrow M. et al. Can we successfully De-escalate axillary surgery in women aged ≥ 70 years with ductal carcinoma in situ or early-stage breast Cancer undergoing mastectomy?. Ann Surg Oncol. 2022 Apr; 29: 2263-2272https://doi.org/10.1245/s10434-021-11140-5 Crossref Scopus (1) Google Scholar ]. However, studies have found a negative impact of omission of surgery on survival and quality-of-life in older patients[ 4 Ward S.E. Richards P.D. Morgan J.L. Holmes G.R. Broggio J.W. Collins K. et al. Omission of surgery in older women with early breast cancer has an adverse impact on breast cancer-specific survival. Br J Surg. 2018 Oct; 105: 1454-1463https://doi.org/10.1002/bjs.10885 Crossref PubMed Scopus (25) Google Scholar , 5 Wyld L. Reed M.W.R. Morgan J. Collins K. Ward S. Holmes G.R. et al. Bridging the age gap in breast cancer. Impacts of omission of breast cancer surgery in older women with oestrogen receptor positive early breast cancer. A risk stratified analysis of survival outcomes and quality of life. Eur J Cancer. 2021 Jan; 142: 48-62https://doi.org/10.1016/j.ejca.2020.10.015 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar , 6 Osório F. Barros A.S. Peleteiro B. Barradas A.R. Urbano J. Fougo J.L. et al. Frailty-independent Undertreatment negative impact on survival in older patients with breast Cancer. J Breast Cancer. 2021 Dec; 24: 542-553https://doi.org/10.4048/jbc.2021.24.e45 Crossref Scopus (1) Google Scholar ].

Temperature distribution analysis using a combination of near-infrared laser, gold nanorods, and surface cooling equipment: Temperature distribution study

Metastatic diseases are the primary causes of death among cancer patients. Photothermal therapy, which combines near-infrared lasers, gold nanorods (GNRs), and skin surface cooling equipment, is a promising local treatment for breast cancer, as well as head and neck cancer. However, in this treatment, accurate predictions of the temperature distributions within organisms and uniform distributions of GNRs within tumors are often difficult. This study focused on evaluating composite heat transfer characteristics when laser irradiations were combined with GNRs, and a surface cooling method was applied. The temperature distributions were analyzed using agar as a bio-simulated material. The experimental results revealed that the combination of laser irradiation, GNR injection, and surface cooling could achieve higher temperatures near the GNR injection sites at low surface temperatures. The obtained temperature distributions were quantitatively analyzed using the thermal damage function. When the laser power was set to create a tumor area temperature greater than 45 °C, the tumor area could be treated without causing skin damage when injecting GNRs into the tumor area and cooling the surface. This study demonstrates the effectiveness of this therapy in local treatments of cancer.

Predictors of women's attendance in a home-based adapted physical activity program during localized breast cancer treatment.

The objective of this study is to evaluate predictors for attendance in a home-based adapted physical activity (APA) program for women with breast cancer during chemotherapy and radiotherapy treatment. This retrospective study was based on two prospective studies (SAPA and APAC), including a total of 73 patients with localized breast cancer during their treatment period. The same APA program lasting 27weeks was proposed and registered. It consisted of three physical activity sessions (two aerobic and one strength training) per week. The predictors (age, height, body weight, body mass index (BMI), VO2peak, 6-min walking test distance (6MWT), fatigue (MFI), quality of life (EORTC-QLQ), anxiety and depression (HADS), and previous physical activity (IPAQ)) were evaluated before the APA program. According to the multivariate regression analysis, the baseline 6MWT distance and quality of life were predictive of good attendance in the APA program. The univariate analysis showed that initial VO2peak, body weight, BMI, and fatigue influenced attendance in the APA program. This study helps to better understand the profile of patients who would be participative or non-participative in an APA program. 6MWT distance and quality of life accounted for 19% of attendance in an APA program before the start of treatment. These correlations between the initial predictors of women with breast cancer and their attendance in the APA program during their treatment period make it possible to adapt physical activity professional practices to these patients.

De-Escalating the Management of In Situ and Invasive Breast Cancer.

Simple SummaryDe-escalation of breast cancer treatment reduces morbidity and toxicity for patients. De-escalation is safe if cancer outcomes, such as recurrence and survival, remain unaffected compared to more radical regimens. This review provides an overview on treatment de-escalation for ductal carcinoma in situ (DCIS), local treatment of breast cancer, and surgery after neoadjuvant systemic therapy. Improvements in understanding the natural history and biology of breast cancer, imaging modalities, and adjuvant treatments have facilitated de-escalation of treatment over time.It is necessary to identify appropriate areas of de-escalation in breast cancer treatment to minimize morbidity and maximize patients’ quality of life. Less radical treatment modalities, or even no treatment, have been reconsidered if they offer the same oncologic outcomes as standard therapies. Identifying which patients benefit from de-escalation requires particular care, as standard therapies will continue to offer adequate cancer outcomes. We provide an overview of the literature on the de-escalation of treatment of ductal carcinoma in situ (DCIS), local treatment of breast cancer, and surgery after neoadjuvant systemic therapy. De-escalation of breast cancer treatment is a key area of investigation that will continue to remain a priority. Improvements in understanding the natural history and biology of breast cancer, imaging modalities, and adjuvant treatments will expand this even further. Future efforts will continue to challenge us to consider the true role of various treatment modalities.

Intraductal Delivery and X-ray Visualization of Ethanol-Based Ablative Solution for Prevention and Local Treatment of Breast Cancer in Mouse Models

Breast cancer is the most prevalent cancer and the second-leading cause of cancer-related death for women in the USA. For high-risk women, prophylactic mastectomy is the most effective primary prevention strategy. Prophylactic mastectomy is an aggressive surgical procedure that completely removes the mammary epithelial cells from which breast cancer arises along with the surrounding tissue. We seek to develop a minimally invasive intraductal procedure as an alternative to prophylactic mastectomy to locally ablate the mammary epithelial cells before they can become malignant. We and others have developed an intraductal delivery procedure to reach and treat these epithelial cells in rodent models of breast cancer. While the mouse mammary gland with a single non-anastomosed ductal tree opening at the nipple has a much less complex and tortuous architecture than the human breast, chemically induced and genetically engineered mouse models of breast cancer are valuable to produce proof-of-concept studies of new preventative strategies. Here, we describe a procedure for intraductal delivery of an ethanol-based ablative solution containing micro-CT/X-ray tantalum-based contrast agent within the mouse mammary ductal tree for the therapeutic purpose of primary prevention of breast cancer. Intraductal delivery of aqueous reagents (e.g., cytotoxic compounds, siRNAs, AdCre) has been previously described in mouse models. Thus, we focus our protocol description on methodological modifications and unique experimental considerations for optimizing delivery of ethanol, for minimizing local and systemic side effects of ethanol administration, and for in vivo visualization of ductal tree filling via micro-CT/fluoroscopy imaging. Visualization of the ductal tree immediately after injection of a contrast-containing solution allows for confirmation of complete filling or unsuccessful outcomes such as underfilling or overfilling. This procedure can be applied for delivery and imaging of other ablative compounds aimed at either preventing tumor formation or locally treating early-stage tumors accessible via the ductal tree.

Intraductal Delivery and X-ray Visualization of Ethanol-Based Ablative Solution for Prevention and Local Treatment of Breast Cancer in Mouse Models.

Breast cancer is the most prevalent cancer and the second-leading cause of cancer-related death for women in the USA. For high-risk women, prophylactic mastectomy is the most effective primary prevention strategy. Prophylactic mastectomy is an aggressive surgical procedure that completely removes the mammary epithelial cells from which breast cancer arises along with the surrounding tissue. We seek to develop a minimally invasive intraductal procedure as an alternative to prophylactic mastectomy to locally ablate the mammary epithelial cells before they can become malignant. We and others have developed an intraductal delivery procedure to reach and treat these epithelial cells in rodent models of breast cancer. While the mouse mammary gland with a single non-anastomosed ductal tree opening at the nipple has a much less complex and tortuous architecture than the human breast, chemically induced and genetically engineered mouse models of breast cancer are valuable to produce proof-of-concept studies of new preventative strategies. Here, we describe a procedure for intraductal delivery of an ethanol-based ablative solution containing micro-CT/X-ray tantalum-based contrast agent within the mouse mammary ductal tree for the therapeutic purpose of primary prevention of breast cancer. Intraductal delivery of aqueous reagents (e.g., cytotoxic compounds, siRNAs, AdCre) has been previously described in mouse models. Thus, we focus our protocol description on methodological modifications and unique experimental considerations for optimizing delivery of ethanol, for minimizing local and systemic side effects of ethanol administration, and for in vivo visualization of ductal tree filling via micro-CT/fluoroscopy imaging. Visualization of the ductal tree immediately after injection of a contrast-containing solution allows for confirmation of complete filling or unsuccessful outcomes such as underfilling or overfilling. This procedure can be applied for delivery and imaging of other ablative compounds aimed at either preventing tumor formation or locally treating early-stage tumors accessible via the ductal tree.

Diagnostic value of mammography for accompanying non-mass enhancement on preoperative breast MRI.

Successful surgical treatment for localized breast cancer can depend on accurate diagnosis for accompanying non-mass enhancement (NME) on preoperative breast magnetic resonance imaging (MRI). To evaluate the diagnostic value of mammography for accompanying NME adjacent to index cancer on preoperative breast MRI. Among 569 consecutive patients who underwent preoperative breast MRI from January 2016 to August 2018 for ultrasound-guided biopsy-proven breast cancer, 471 patients who underwent initial mammography and subsequent surgery were finally included. Two radiologists retrospectively reviewed preoperative MRI findings of the 471 patients and detected accompanying NME adjacent to index cancer. MRI, mammography, and histopathology findings of the accompanying NME were evaluated using Pearson's chi-square test, Mann-Whitney U test, and logistic regression analysis. The area under the receiver operating characteristic curve (AUC) of MRI and combined MRI and mammography was calculated in differentiating benign from malignant accompanying NME. The reference standard was surgical pathologic findings. MRI revealed 93 accompanying NME lesions in 92 (19.5%) of the 471 patients, showing 55 (59.1%) malignant and 38 (40.9%) benign lesions. On multivariate analysis, malignant NME lesions were more associated with mammography-positive findings (P = 0.000), clumped or clustered ring internal enhancement (P = 0.015), and extensive intraductal component presence of index tumor (P = 0.007) compared with benign lesions. The AUC increased after correlation with mammography showing 0.649 (95% confidence interval [CI] 0.533-0.765) for MRI and 0.833 (95% CI 0.747-0.919) for combined MRI and mammography. Mammography is valuable in predicting malignancy for accompanying NME on preoperative breast MRI.

ALG3 contributes to stemness and radioresistance through regulating glycosylation of TGF-\u03b2 receptor II in breast cancer

BackgroundRadiotherapy is a conventional and effective local treatment for breast cancer. However, residual or recurrent tumors appears frequently because of radioresistance. Novel predictive marker and the potential therapeutic targets of breast cancer radioresistance needs to be investigated.MethodsIn this study, we screened all 10 asparagine-linked glycosylation (ALG) members in breast cancer patients’ samples by RT-PCR. Cell viability after irradiation (IR) was determined by CCK-8 assay and flow cytometry. The radiosensitivity of cell lines with different ALG3 expression was determined with the colony formation assay by fitting the multi-target single hit model to the surviving fractions. Cancer stem-like traits were assessed by RT-PCR, Western blot, and flow cytometry. The mechanisms of ALG3 influencing radiosensitivity was detected by Western blot and immunoprecipitation. And the effect of ALG3 on tumor growth after IR was verified in an orthotopic xenograft tumor models. The association of ALG3 with prognosis of breast cancer patients was confirmed by immunohistochemistry.ResultsALG3 was the most significantly overexpressing gene among ALG family in radioresistant breast cancer tissue. Overexpression of ALG3 predicted poor clinicopathological characteristics and overall survival (OS), and early local recurrence-free survival (LRFS) in breast cancer patients. Upregulating ALG3 enhanced radioresistance and cancer stemness in vitro and in vivo. Conversely, silencing ALG3 increased the radiosensitivity and repressed cancer stemness in vitro, and more importantly inhibition of ALG3 effectively increased the radiosensitivity of breast cancer cells in vivo. Mechanistically, our results further revealed ALG3 promoted radioresistance and cancer stemness by inducing glycosylation of TGF-β receptor II (TGFBR2). Importantly, both attenuation of glycosylation using tunicamycin and inhibition of TGFBR2 using LY2109761 differentially abrogated the stimulatory effect of ALG3 overexpression on cancer stemness and radioresistance. Finally, our findings showed that radiation played an important role in preventing early recurrence in breast cancer patients with low ALG3 levels, but it had limited efficacy in ALG3-overexpressing breast cancer patients.ConclusionOur results suggest that ALG3 may serve as a potential radiosensitive marker, and an effective target to decrease radioresistance by regulating glycosylation of TGFBR2 in breast cancer. For patients with low ALG3 levels, radiation remains an effective mainstay therapy to prevent early recurrence in breast cancer.

The Immutable Burden of Racial Disparities in Breast Cancer

The Immutable Burden of Racial Disparities in Breast Cancer

Trends in Deescalation of Localized Breast Cancer Treatment and Caution for the Most Vulnerable Patients—A Look Back on the Decade That Was

Trends in Deescalation of Localized Breast Cancer Treatment and Caution for the Most Vulnerable Patients—A Look Back on the Decade That Was

Surgical Morbidity of Full-Thickness Chest Wall Resection for Breast Cancer: A Retrospective Study of a National Database

BackgroundFull-thickness chest wall resection (FTCWR) is an underused modality for treating locally advanced primary or recurrent breast cancer invading the chest wall, for which little data exist regarding morbidity and mortality. We examined the postoperative complication rates in breast cancer patients undergoing FTCWR using a large multinational surgical outcomes database. MethodsA retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. All patients undergoing FTCWR for breast cancer between 2007 and 2016 were identified (n = 137). Primary outcome measures included 30-d postoperative morbidity, composite respiratory complications, and hospital length of stay (LOS). The secondary aim was to compare the postoperative morbidity of FTCWR to those of patients undergoing mastectomy. One-to-one coarsened exact matching was conducted between two groups, which were then compared with respect to morbidity, mortality, reoperations, readmissions, and LOS. ResultsThe overall rate of postoperative morbidity was 11.7%. Two patients (1.5%) had respiratory complications requiring intubation. Median hospital LOS was 2 d. In the coarsened exact matching analysis, 122 patients were included in each of the two groups. Comparison of matched cohorts demonstrated an overall morbidity for the FTCWR group of 11.5% compared with 8.2% for the mastectomy group (8.2%) (P = 0.52). ConclusionsFTCWR for the local treatment of breast cancer can be performed with relatively low morbidity and respiratory complications. This is the largest study looking at postoperative complications for FTCWR in the treatment of breast cancer. Future studies are needed to determine the long-term outcomes of FTCWR in this patient population.

To treat or not to treat, that is the question.

Following a diagnosis and surgical treatment for localized breast cancer, medical oncologists present patients with adjuvant systemic therapeutic options that have been shown to reduce the risk of subsequent cancer recurrence. In this commentary, I present the challenge that resulted from my discussions with a patient and family who asked that I not only discuss options and make recommendations but also decide the choice of therapy on her behalf.

Progress in Local Treatment of Breast Cancer: A Narrative Review.

The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the same molecular subtype may receive different individualized surgical treatments aimed at optimizing systemic adjuvant therapy. With a view to retaining the gains made in disease-free and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.