Skip to main content

Advertisement

SpringerLink
Log in

Cosmetic Outcomes Following Breast-Conservation Surgery and Radiation for Multiple Ipsilateral Breast Cancer: Data from the Alliance Z11102 Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Diagnoses of multiple ipsilateral breast cancer (MIBC) are increasing. Historically, the primary treatment for MIBC has been mastectomy due to concerns about in-breast recurrence risk and poor cosmetic outcome. The Alliance Z11102 study prospectively assessed cosmetic outcomes in women with MIBC treated with breast-conserving therapy (BCT).

Patients and Methods

Z11102 was a multicenter trial enrolling women with two or three separate sites of biopsy-proven malignancy separated by ≥ 2 cm within the same breast. Cosmetic outcome was a planned secondary endpoint. Data were collected with a four-point cosmesis survey (1 = excellent, 4 = poor) and the BREAST-Q (scored 0–100). All patients undergoing successful breast-conserving therapy were treated with whole-breast radiation. Associations were assessed with Chi square or Fisher’s exact tests as appropriate.

Results

Cosmetic outcome data for 216 eligible women who completed therapy are included in this analysis. Of the 136 patients who completed the survey 2 years postoperatively, 70.6% (N = 96) felt the result was good or excellent, while 3.7% (N = 5) felt the result was poor. We found no significant differences in patient-reported cosmetic outcomes when stratifying by patient age, number of lesions (two or three), number of incisions, number of lumpectomies, or size of largest area of disease. Mean satisfaction score on the BREAST-Q was 77.2 at 6 months following whole-breast radiation and 73.7 at 3 years following surgery.

Conclusions

BCT performed for MIBC results in good or excellent cosmesis for the majority of women. From a cosmetic perspective, BCT is a valid surgical approach to women with MIBC.

Trial registration

ClinicalTrials.gov Identifier: NCT01556243.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fisher B, Anderson S, Bryant J et al. Twenty-year follow up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl Med. 2002; 347(16):1233–41

    Article  Google Scholar 

  2. Veronesi U, Cascinelli N, Mariani L et al. Twenty-year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347(16): 1227–32

    Article  PubMed  Google Scholar 

  3. Lichter AS, Lippman ME, Danforth DN, et al. Mastectomy vs breast conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. JCO. 1992; 10(6):976–983

    Article  CAS  Google Scholar 

  4. Wilson LD, Beinfield M, McKhann CF, Haffty BG. Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer 1993;72:137–42

    Article  CAS  PubMed  Google Scholar 

  5. Leopold KA, Recht A, Schnitt SJ, et al. Results of conservative surgery and radiation therapy for multiple synchronous cancers of one breast. Int J Radiat Oncol Biol Phys 1989;16:11–6

    Article  CAS  PubMed  Google Scholar 

  6. Kurtz JM, Jacquemier J, Amalric R, et al. Breast-conserving therapy for macroscopically multiple cancers. Ann Surg. 1990; 212:38–44

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cochrane RA, Valasiadou P, Wilson ARM, et al. Cosmesis and satisfaction after breast conserving surgery correlates with the percentage of breast volume excised. BJS. 2003; 90(12): 1505–1509

    Article  CAS  Google Scholar 

  8. Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10(2):124–6

    Article  CAS  PubMed  Google Scholar 

  9. Chan SW, Cheung PS, Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg. 2010;34(7):1447–1452

    Article  PubMed  Google Scholar 

  10. Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 1985;56(5):979e90

    Article  Google Scholar 

  11. Coombs NJ, Boyages J. Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol 2005;23(30):7497e502.

    Article  Google Scholar 

  12. Yerushalmi R, Kennecke H, Woods R, Olivotto IA, Speers C, Gelmon KA. Does multicentric/multifocal breast cancer differ from unifocal breast cancer?An analysis of survival and contralateral breast cancer incidence. Breast Cancer Res Treat 2009;117(2):365e70

    Article  CAS  Google Scholar 

  13. Vera-Badillo FE, Napoleone M, Ocana A, Templeton AJ, Seruga B, Al-Mubarak M, et al. Effect of multifocality and multicentricity on outcome inearly stage breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2014;146(2):235e44

    Google Scholar 

  14. Houssami N, Ciatto S, Macaskill P, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 2008;26:3248-58

    Article  PubMed  Google Scholar 

  15. Fischer U, Kopka L, Grabbe E. Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 1999;213:881-8.

    Article  CAS  PubMed  Google Scholar 

  16. Bedrosian I, Mick R, Orel SG, et al. Changes in the surgical management of patients with breast carcinoma based on preoperative magnetic resonance imaging. Cancer 2003;98:468-73.

    Article  PubMed  Google Scholar 

  17. Bendifallah S, Werkoff G, Borie-Moutafoff C, et al. Multiple synchronous (multifocal and multicentric) breast cancer: clinical implications. Surg Oncol;19:e115-23

  18. Schell A, Rosenkranz K, Lewis PJ. Role of breast MRIin the preoperative evaluation of patients with newly diagnosed breast cancer. AJR. 2009;192(5):1438–1444

    Article  PubMed  Google Scholar 

  19. Hill-Kayser C, Vachani C, Hampshire M et al. Cosmetic outcomes and complications reported by patients having undergone breast-conserving treatment. Int J Radiat Oncol Biol Phys. 2011: 79(4):1048–54

    Article  PubMed  Google Scholar 

  20. Han J, Grothuesman D, Neises M, et al. Quality of life and satisfaction after breast cancer operation. Arch Gynecol Obstet. 2010; 282, 75–82

    Article  PubMed  Google Scholar 

  21. Flanagan M, Zabor E, Romanoff A, et al. A comparison of patient-reported outcomes after breast conserving surgery and mastectomy with implant based reconstruction. Ann Surg Oncol, 2019; 26:3133–3140

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hartsell WF, Recine DC, Griem KL, Cobleigh MA, Witt TR, Murthy AK. Should multicentric disease be an absolute contraindication to the use of breast-conserving therapy? Int J Radiat Oncol Biol Phys 1994;30:49–53

    Article  CAS  PubMed  Google Scholar 

  23. Cho LC, Senzer N, Peters GN. Conservative surgery and radiation therapy for macroscopically multiple ipsilateral invasive breast cancers. Am J Surg 2002;183:650–4

    Article  PubMed  Google Scholar 

  24. Gentilini O, Botteri E, Rotmensz N, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat 2009;113:577–83

    Article  PubMed  Google Scholar 

  25. Bauman L, Barth RJ, Rosenkranz KM. Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol. 2010; 17 Suppl 3:325–22

  26. Ataseven B, Lederer B, Blohmer JU et al. Impact of multifocal or multicentric disease on surgery and locoregional, distant and overall survival in 6134 breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol. 2015;22(4): 1118–27

    Article  PubMed  Google Scholar 

  27. Waljee J, Hu E, Ubel P, et al.Effect of Estetic outcome after breast-conserving surgery on psyhcosocial functioning and quality of life. JCO. 2008; 26(26): 3331–3337

    Article  Google Scholar 

  28. 28 Rosenkranz KM, Ballman K, McCall L, et al. The feasibility of breast-conserving surgery for multiple ipsilateral breast cancer: An initial report from ACOSOG Z11102 (Alliance) trial. Ann Surg Oncol. 2018;25(10):2858–2866

    Article  PubMed  Google Scholar 

  29. Winchester D, Cox J. Standards of diagnosis and management of invasive breast carcinoma. CA Cancer J Clin. 1998:48, 83–107

    Article  CAS  PubMed  Google Scholar 

  30. White JR, Winter K, Cecchini RS, et al. Cosmetic outcome from post-lumpectomy whole breast irradiation (WBI) versus partial breast irradiation (PBI) on the NRG Oncology/NSABP B-39/RTOG 0413 phase III clinical trial. 2019:105(1): S3–4

  31. Klassen A, Dominici L, Fuzesi S, et al. Development and validation of the BREAST-Q breast-conserving therapy module. Ann Surg Oncol. 2020 epub ahead of print

  32. Pusic A, Klassen A, Scott A, et al. Development of a new patient reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg. 2009; 124(2): 345–353

    Article  CAS  PubMed  Google Scholar 

  33. Stolpner I, Heil J, Feibt M, et al. Clinical validation of the BREAST-Q breast-conserving therapy module. Ann Surg Oncol, 2019:26:2759–2767

    Article  PubMed  Google Scholar 

  34. Fisher B, Jeong J, Anderson S. Twenty five year follow up of a randomized trial comparing radical mastectomy, total mastectomy and total mastectomy followed by irradiation. N Engl J Med. 2002; 347(8): 567–75

    Article  PubMed  Google Scholar 

  35. Rose M, Svensson H, Handler J, et al. Patient-reported outcomes after oncoplastic breast surgery compared with conventional breast-conserving surgery in breast cancer. Breast Cancer Res Treat. 2020; 180(1):247–256

    Article  PubMed  PubMed Central  Google Scholar 

  36. Patani M, Carpenter R. Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer. Breast J. 2019; 16(3):222–232

    Article  Google Scholar 

  37. Chand N, Browne V, Paramanathan N, et al. Patient-reported outcomes are better after oncoplastic breast conservation than after mastectomy and autologous reconstruction. Plast Reconstr Surg Glob Open. 2017; 5(7):e1419

    Article  PubMed  PubMed Central  Google Scholar 

  38. Crown A, Handy N, Rocha F, et al. Oncoplastic reduction mammoplasty, an effective and safe method of breast conservation. Am J Surg. 2018; 251(5): 910–915

    Article  Google Scholar 

  39. Jagsi R, Li Y, Morrow M, et al. Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: Results of a survey of breast cancer survivors. Ann Surg. 2015; 261(6): 1198–206

    Article  PubMed  PubMed Central  Google Scholar 

  40. Howes BH, Watson D, Xu C, et al. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study. J Plast Reconstr Aesthet Surg. 2016; 69(9):1184–91

    Article  PubMed  Google Scholar 

  41. Volders J, Negenborn V, Haloua M, et al. Breast-specific factors determine cosmetic outcome and patient satisfaction after breast-conserving therapy: Results from the randomized COBALT study. JSO. 2018; 117(5); 1001–1008

    Google Scholar 

  42. O’Connell RL, DiMicco R, Khabra K, et al. Initial experience of the BREAST-Q breast conserving therapy module. Breast Cancer Res Treat. 2016; 160(1): 79–89

    Article  PubMed  Google Scholar 

  43. Krzos A, Stanislawek A, Jedrych M, et al. Satisfaction with the aesthetic effect and quality of life for women after breast conserving therapy (BCT)- Preliminary research. Int J Environ Res Public Health. 2019; 16(23); 4682

    Article  PubMed Central  Google Scholar 

  44. Vrouwe S, Somogyi R, Snell L, et al. Patient-reported outcomes following breast conservation therapy and barriers to referral for partial breast reconstruction. Plast Reconstr Surg. 2018; 141(1):1–9

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

    Kari M. Rosenkranz MD

  2. Alliance Statistics and Data Center, Weill Medical College of Cornell University, New York, NY, USA

    Karla Ballman PhD

  3. Alliance Statistics and Data Center, Duke University, Durham, NC, USA

    Linda McCall MS

  4. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Colleen McCarthy MD & Kimberly J. Van Zee MS, MD

  5. Sutter Cancer Center, Sacramento, CA, USA

    Charlotte D. Kubicky MD

  6. Virginia Commonwealth University Health System, Richmond, VA, USA

    Laurie Cuttino MD

  7. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kelly K. Hunt MD

  8. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Armando Giuliano MD

  9. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Bruce Haffty MD

  10. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Judy C. Boughey MD

Authors
  1. Kari M. Rosenkranz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karla Ballman PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda McCall MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colleen McCarthy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charlotte D. Kubicky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laurie Cuttino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kelly K. Hunt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Armando Giuliano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kimberly J. Van Zee MS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bruce Haffty MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Judy C. Boughey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kari M. Rosenkranz MD.

Ethics declarations

Disclosures

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award nos. U10CA180821 and U10CA180882; UG1CA233290, UG1CA233329, and UG1CA232760. Dr. Karla Ballman discloses an NCI grant to the Alliance Cooperative Cancer Trial group. Dr. Kelly Hunt discloses a Medical Advisory Board role for Armada Health and Merck & Co., and also disclosures research funding to her institution from Armada Health, Merck & Co., Endomagnetics, Lumicell, and OncoNano. Dr. Armando Giuliano discloses an Alliance grant. Dr. Judy Boughey discloses funding from the NCI to Alliance for Clinical Trials in Oncology group for travel to Alliance meetings. All other authors had no disclosures. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. https://acknowledgments.alliancefound.org.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosenkranz, K.M., Ballman, K., McCall, L. et al. Cosmetic Outcomes Following Breast-Conservation Surgery and Radiation for Multiple Ipsilateral Breast Cancer: Data from the Alliance Z11102 Study. Ann Surg Oncol 27, 4650–4661 (2020). https://doi.org/10.1245/s10434-020-08893-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08893-w

Search

Navigation