Conservative surgery for multifocal/multicentric breast cancer.

Area of Science:

• Oncology
• Surgical Oncology
• Radiotherapy

Background:

• Multifocal (MF) and multicentric (MC) breast cancer are often considered contraindications for breast-conserving therapy (BCT).
• Historically, concerns about multifocal disease and achieving clear margins have limited BCT options.
• Advances in imaging, surgical techniques, and pathology assessment have improved the feasibility of BCT for these cases.

Purpose of the Study:

• To evaluate the efficacy and safety of breast-conserving therapy (BCT) for multifocal and multicentric breast cancer.
• To determine if optimal cytoreductive surgery followed by adjuvant treatments can achieve good local control in patients with MF/MC breast cancer.
• To assess oncological and cosmetic outcomes in patients with MF/MC breast cancer treated with BCT.

Main Methods:

• Review of recent studies and clinical trials on the management of MF/MC breast cancer.
• Emphasis on the role of advanced imaging (e.g., MRI) for accurate tumor detection and staging.
• Application of oncoplastic surgical techniques for optimal tumor removal and cosmetic results.
• Integration of whole breast irradiation and adjuvant systemic therapies based on tumor biology.

Main Results:

• Optimal cytoreductive surgery, guided by advanced imaging and confirmed by pathology, is crucial for local control.
• Achieving tumor-free margins for all invasive and in situ components is essential.
• Studies indicate that MF/MC breast cancer, when treated with BCT, radiotherapy, and systemic therapy, can achieve low in-breast recurrence rates (<10% at 10 years).
• Equivalent survival outcomes have been observed when comparing BCT with mastectomy for clinically unifocal lesions, suggesting many multifocal lesions are not clinically significant with appropriate treatment.

Conclusions:

• Breast-conserving therapy (BCT) is a viable and safe option for carefully selected patients with multifocal (MF) and multicentric (MC) breast cancer.
• Successful BCT for MF/MC disease relies on precise imaging, adequate surgical resection with clear margins, and appropriate adjuvant therapies.
• Modern oncoplastic techniques and radiotherapy contribute to favorable oncological and cosmetic outcomes, challenging the traditional contraindication for BCT in these cases.