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Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
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Breast-Conserving Therapy for Multiple Ipsilateral Breast Cancer After Neoadjuvant Systemic Therapy.

Monika K Masanam1,2,3, Jennifer R Bellon2,3,4, José P Leone2,3,5

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Summary

Breast-conserving surgery (BCS) is safe for multiple ipsilateral breast cancer (MIBC) patients receiving neoadjuvant systemic therapy (NST). Local recurrence rates for MIBC after BCS and NST were similar to those with unifocal disease.

Keywords:
Breast-conserving surgeryMultiple ipsilateral breast cancerNeoadjuvant systemic therapy

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Cancer Research

Background:

  • Previous trials established breast-conserving surgery (BCS) safety for multiple ipsilateral breast cancer (MIBC) with upfront surgery.
  • The oncologic safety of BCS in MIBC patients receiving neoadjuvant systemic therapy (NST) remained uncertain.

Purpose of the Study:

  • To evaluate the safety and oncologic outcomes of BCS in patients with MIBC who underwent NST.
  • To compare local recurrence (LR) rates between MIBC and unifocal breast cancer patients treated with BCS after NST.

Main Methods:

  • Retrospective analysis of 1515 patients (73 with MIBC, 1442 with unifocal disease) who underwent BCS after NST (2016-2023).
  • MIBC defined preoperatively as 2-3 foci with ≥2 cm intervening normal tissue.
  • Outcomes assessed included local recurrence, distant recurrence, and breast cancer mortality.

Main Results:

  • No significant differences in LR (1.4% vs. 3.1%), distant recurrence (5.5% vs. 4.6%), or breast cancer mortality (4.1% vs. 2.6%) between MIBC and unifocal groups.
  • MIBC patients underwent single-site (65.8%), two-site (31.5%), or three-site (2.7%) lumpectomies.
  • Median follow-up was 34.7 months.

Conclusions:

  • BCS is a safe surgical option for well-selected MIBC patients undergoing NST.
  • The oncologic outcomes of BCS after NST for MIBC are comparable to those for unifocal breast cancer.