The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial

Kari M. Rosenkranz, Karla Ballman, Linda McCall, Charlotte Kubicky, Laurie Cuttino, Huong Le-Petross, Kelly K. Hunt, Armando Giuliano, Kimberly J. van Zee, Bruce Haffty, Judy C Boughey

Research output: Contribution to journalArticle

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Abstract

Background: Historically, multiple ipsilateral breast cancer (MIBC) has been a contraindication to breast-conserving therapy (BCT). We report the feasibility of BCT in MIBC from the ACOSOG Z11102 trial [Alliance], a single arm noninferiority trial of BCT for women with two or three sites of malignancy in the ipsilateral breast. Methods: Women who enrolled preoperatively in ACOSOG Z11102 were evaluated for conversion to mastectomy and need for reoperation to obtain negative margins. Characteristics of women who successfully underwent BCT and those who converted to mastectomy were compared. Factors were examined for association with the need for margin reexcision. Results: Of 198 patients enrolled preoperatively, 190 (96%) had 2 foci of disease. Median size of the largest tumor focus was 1.5 (range 0.1–7.0) cm; 49 patients (24.8%) had positive nodes. There were 14 women who underwent mastectomy due to positive margins, resulting in a conversion to mastectomy rate of 7.1% (95% confidence interval [CI] 3.9–10.6%). Of 184 patients who successfully completed BCT, 134 completed this in a single operation. Multivariable logistic regression analysis did not identify any factors significantly associated with conversion to mastectomy or need for margin reexcision. Conclusions: Breast conservation is feasible in MIBC with 67.6% of patients achieving a margin-negative excision in a single operation and 7.1% of patients requiring conversion to mastectomy due to positive margins. No characteristic was identified that significantly altered the risk of conversion to mastectomy or need for reexcision. ClinicalTrials.gov Identifier: NCT01556243.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jul 9 2018

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Segmental Mastectomy
Mastectomy
Breast
Breast Neoplasms
Therapeutics
Reoperation
Neoplasms
Arm
Logistic Models
Regression Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer : An Initial Report from ACOSOG Z11102 (Alliance) Trial. / Rosenkranz, Kari M.; Ballman, Karla; McCall, Linda; Kubicky, Charlotte; Cuttino, Laurie; Le-Petross, Huong; Hunt, Kelly K.; Giuliano, Armando; van Zee, Kimberly J.; Haffty, Bruce; Boughey, Judy C.

In: Annals of Surgical Oncology, 09.07.2018, p. 1-9.

Research output: Contribution to journalArticle

Rosenkranz, Kari M. ; Ballman, Karla ; McCall, Linda ; Kubicky, Charlotte ; Cuttino, Laurie ; Le-Petross, Huong ; Hunt, Kelly K. ; Giuliano, Armando ; van Zee, Kimberly J. ; Haffty, Bruce ; Boughey, Judy C. / The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer : An Initial Report from ACOSOG Z11102 (Alliance) Trial. In: Annals of Surgical Oncology. 2018 ; pp. 1-9.
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title = "The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial",
abstract = "Background: Historically, multiple ipsilateral breast cancer (MIBC) has been a contraindication to breast-conserving therapy (BCT). We report the feasibility of BCT in MIBC from the ACOSOG Z11102 trial [Alliance], a single arm noninferiority trial of BCT for women with two or three sites of malignancy in the ipsilateral breast. Methods: Women who enrolled preoperatively in ACOSOG Z11102 were evaluated for conversion to mastectomy and need for reoperation to obtain negative margins. Characteristics of women who successfully underwent BCT and those who converted to mastectomy were compared. Factors were examined for association with the need for margin reexcision. Results: Of 198 patients enrolled preoperatively, 190 (96{\%}) had 2 foci of disease. Median size of the largest tumor focus was 1.5 (range 0.1–7.0) cm; 49 patients (24.8{\%}) had positive nodes. There were 14 women who underwent mastectomy due to positive margins, resulting in a conversion to mastectomy rate of 7.1{\%} (95{\%} confidence interval [CI] 3.9–10.6{\%}). Of 184 patients who successfully completed BCT, 134 completed this in a single operation. Multivariable logistic regression analysis did not identify any factors significantly associated with conversion to mastectomy or need for margin reexcision. Conclusions: Breast conservation is feasible in MIBC with 67.6{\%} of patients achieving a margin-negative excision in a single operation and 7.1{\%} of patients requiring conversion to mastectomy due to positive margins. No characteristic was identified that significantly altered the risk of conversion to mastectomy or need for reexcision. ClinicalTrials.gov Identifier: NCT01556243.",
author = "Rosenkranz, {Kari M.} and Karla Ballman and Linda McCall and Charlotte Kubicky and Laurie Cuttino and Huong Le-Petross and Hunt, {Kelly K.} and Armando Giuliano and {van Zee}, {Kimberly J.} and Bruce Haffty and Boughey, {Judy C}",
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T1 - The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer

T2 - An Initial Report from ACOSOG Z11102 (Alliance) Trial

AU - Rosenkranz, Kari M.

AU - Ballman, Karla

AU - McCall, Linda

AU - Kubicky, Charlotte

AU - Cuttino, Laurie

AU - Le-Petross, Huong

AU - Hunt, Kelly K.

AU - Giuliano, Armando

AU - van Zee, Kimberly J.

AU - Haffty, Bruce

AU - Boughey, Judy C

PY - 2018/7/9

Y1 - 2018/7/9

N2 - Background: Historically, multiple ipsilateral breast cancer (MIBC) has been a contraindication to breast-conserving therapy (BCT). We report the feasibility of BCT in MIBC from the ACOSOG Z11102 trial [Alliance], a single arm noninferiority trial of BCT for women with two or three sites of malignancy in the ipsilateral breast. Methods: Women who enrolled preoperatively in ACOSOG Z11102 were evaluated for conversion to mastectomy and need for reoperation to obtain negative margins. Characteristics of women who successfully underwent BCT and those who converted to mastectomy were compared. Factors were examined for association with the need for margin reexcision. Results: Of 198 patients enrolled preoperatively, 190 (96%) had 2 foci of disease. Median size of the largest tumor focus was 1.5 (range 0.1–7.0) cm; 49 patients (24.8%) had positive nodes. There were 14 women who underwent mastectomy due to positive margins, resulting in a conversion to mastectomy rate of 7.1% (95% confidence interval [CI] 3.9–10.6%). Of 184 patients who successfully completed BCT, 134 completed this in a single operation. Multivariable logistic regression analysis did not identify any factors significantly associated with conversion to mastectomy or need for margin reexcision. Conclusions: Breast conservation is feasible in MIBC with 67.6% of patients achieving a margin-negative excision in a single operation and 7.1% of patients requiring conversion to mastectomy due to positive margins. No characteristic was identified that significantly altered the risk of conversion to mastectomy or need for reexcision. ClinicalTrials.gov Identifier: NCT01556243.

AB - Background: Historically, multiple ipsilateral breast cancer (MIBC) has been a contraindication to breast-conserving therapy (BCT). We report the feasibility of BCT in MIBC from the ACOSOG Z11102 trial [Alliance], a single arm noninferiority trial of BCT for women with two or three sites of malignancy in the ipsilateral breast. Methods: Women who enrolled preoperatively in ACOSOG Z11102 were evaluated for conversion to mastectomy and need for reoperation to obtain negative margins. Characteristics of women who successfully underwent BCT and those who converted to mastectomy were compared. Factors were examined for association with the need for margin reexcision. Results: Of 198 patients enrolled preoperatively, 190 (96%) had 2 foci of disease. Median size of the largest tumor focus was 1.5 (range 0.1–7.0) cm; 49 patients (24.8%) had positive nodes. There were 14 women who underwent mastectomy due to positive margins, resulting in a conversion to mastectomy rate of 7.1% (95% confidence interval [CI] 3.9–10.6%). Of 184 patients who successfully completed BCT, 134 completed this in a single operation. Multivariable logistic regression analysis did not identify any factors significantly associated with conversion to mastectomy or need for margin reexcision. Conclusions: Breast conservation is feasible in MIBC with 67.6% of patients achieving a margin-negative excision in a single operation and 7.1% of patients requiring conversion to mastectomy due to positive margins. No characteristic was identified that significantly altered the risk of conversion to mastectomy or need for reexcision. ClinicalTrials.gov Identifier: NCT01556243.

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