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World J Clin Oncol. Apr 10, 2016; 7(2): 234-242
Published online Apr 10, 2016. doi: 10.5306/wjco.v7.i2.234
Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?
Gilles Houvenaeghel, Agnès Tallet, Aurélie Jalaguier-Coudray, Monique Cohen, Marie Bannier, Camille Jauffret-Fara, Eric Lambaudie
Gilles Houvenaeghel, Agnès Tallet, Aurélie Jalaguier-Coudray, Monique Cohen, Marie Bannier, Camille Jauffret-Fara, Eric Lambaudie, Institut Paoli Calmettes and CRCM, Aix Marseille Université, 13009 Marseille, France
Author contributions: All the authors contributed equally to this work.
Conflict-of-interest statement: There is no conflict of interest associated with any of senior author, coauthors, contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gilles Houvenaeghel, MD, Institut Paoli Calmettes and CRCM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009 Marseille, France. houvenaeghelg@ipc.unicancer.fr
Telephone: +33-4-91223532 Fax: +33-4-91223613
Received: June 11, 2015
Peer-review started: June 15, 2015
First decision: September 17, 2015
Revised: October 29, 2015
Accepted: November 24, 2015
Article in press: November 25, 2015
Published online: April 10, 2016
Abstract

The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. Therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCT) of MC/MF tumors. It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A meta-analysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists.

Keywords: Mastectomy, Breast conservative surgery, Multifocal tumors, Multicentric tumors, Radiotherapy, Local recurrence, Breast cancer, Survival

Core tip: Multicentric and multifocal breast tumors should be identified preoperatively in order to adapt surgical treatment. They might be associated with more frequent lymph node involvement and worse prognosis but in most studies, the rates of local recurrence are low and similar to those of unifocal tumors. Breast conservative treatment is a reasonable option in selected patients (age 50-69 years, small tumors and absence of extensive ductal carcinoma in situ). Postoperative radiotherapy, and especially boost radiotherapy must be discussed and evaluated due to the risk of increased toxicity in case of double boost.