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. 2023 Jun 10;41(17):3184-3193.
doi: 10.1200/JCO.22.02553. Epub 2023 Mar 28.

Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance)

Judy C Boughey  1 , Kari M Rosenkranz  2 , Karla V Ballman  3 , Linda McCall  4 , Bruce G Haffty  5 , Laurie W Cuttino  6 , Charlotte D Kubicky  7 , Huong T Le-Petross  8 , Armando E Giuliano  9 , Kimberly J Van Zee  10 , Kelly K Hunt  8 , Olwen M Hahn  11 , Lisa A Carey  12 , Ann H Partridge  13
Affiliations

Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance)

Judy C Boughey et al. J Clin Oncol. .

Abstract

Purpose: Breast-conserving therapy (BCT) is the preferred treatment for unifocal breast cancer (BC). The oncologic safety of BCT for multiple ipsilateral breast cancer (MIBC) has not been demonstrated in a prospective study. ACOSOG Z11102 (Alliance) is a phase II, single-arm, prospective trial designed to evaluate oncologic outcomes in patients undergoing BCT for MIBC.

Patients and methods: Women age 40 years and older with two to three foci of biopsy-proven cN0-1 BC were eligible. Patients underwent lumpectomies with negative margins followed by whole breast radiation with boost to all lumpectomy beds. The primary end point was cumulative incidence of local recurrence (LR) at 5 years with an a priori rate of clinical acceptability of <8%.

Results: Among 270 women enrolled between November 2012 and August 2016, there were 204 eligible patients who underwent protocol-directed BCT. The median age was 61 years (range, 40-87 years). At a median follow-up of 66.4 months (range, 1.3-90.6 months), six patients developed LR for an estimated 5-year cumulative incidence of LR of 3.1% (95% CI, 1.3 to 6.4). Patient age, number of sites of preoperative biopsy-proven BC, estrogen receptor status and human epidermal growth factor receptor 2 status, and pathologic T and N categories were not associated with LR risk. Exploratory analysis showed that the 5-year LR rate in patients without preoperative magnetic resonance imaging (MRI; n = 15) was 22.6% compared with 1.7% in patients with a preoperative MRI (n = 189; P = .002).

Conclusion: The Z11102 clinical trial demonstrates that breast-conserving surgery with adjuvant radiation that includes lumpectomy site boosts yields an acceptably low 5-year LR rate for MIBC. This evidence supports BCT as a reasonable surgical option for women with two to three ipsilateral foci, particularly among patients with disease evaluated with preoperative breast MRI.

Trial registration: ClinicalTrials.gov NCT01556243.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Ann H. Partridge

Patents, Royalties, Other Intellectual Property: I receive small royalty payments for coauthoring the breast cancer survivorship section of UpToDate

Open Payments Link: https://openpaymentsdata.cms.gov/physician/835197

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Flow diagram of patients enrolled on Z11102.
FIG 2.
FIG 2.
Cumulative incidence of LR after breast-conserving surgery with whole breast radiation in multiple ipsilateral breast cancer. Shaded region is the 95% confidence interval for the cumulative incidence curve. LR, local recurrence; NE, not estimable.
See this image and copyright information in PMC

References

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