Breast-Conserving Therapy for Multiple Ipsilateral Breast Cancer After Neoadjuvant Systemic Therapy

The ACOSOG Z11102 trial demonstrated the safety of breast-conserving surgery (BCS) with adjuvant radiation in women with multiple ipsilateral breast cancer (MIBC) undergoing upfront surgery, reporting a 5-year local recurrence (LR) of ~3%. However, the oncologic safety of BCS in women with MIBC receiving neoadjuvant systemic therapy (NST) remains uncertain.

Patients with stage I-III unifocal or MIBC who underwent BCS following NST from 2016 to 2023 were identified in a prospectively maintained institutional database. MIBC was defined preoperatively as the presence of 2-3 foci of biopsy-proven breast cancer with at least 2 cm of intervening normal breast tissue and at least one focus of invasive disease.

A total of 1515 patients were identified: 73 (4.8%) with MIBC and 1442 (95.2%) with unifocal disease. Baseline clinicopathologic characteristics were similar between groups. Median age was 55 years, and most received neoadjuvant chemotherapy (82.2% vs. 83.4%). Molecular subtype distribution was similar between cohorts (p = 0.97). Of the patients with MIBC, 48 (65.8%) underwent single-site lumpectomy, 23 (31.5%) two-site lumpectomy, and 2 (2.7%) three-site lumpectomy. At median follow-up of 34.7 months, there was no difference in LR (1.4% vs. 3.1%, p = 0.40), distant recurrence (5.5% vs. 4.6%, p = 0.37), or breast cancer mortality (4.1% vs. 2.6%, p = 0.45) between groups.

In this retrospective analysis of women with MIBC who underwent BCS after NST, local recurrence (LR) was 1.4% at 3-year median follow-up, which was similar to patients with unifocal breast cancer. These findings suggest BCS is a safe surgical option in well-selected patients with MIBC undergoing NST.