Progress of breast conservation surgery for breast cancer_West China Medical Journal

Authors：

YANG Ruoning ^1,2 , WU Yunhao ^1,2 , LU Shan ^1,2 ,  CHEN Jie ^1,2

1. Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Breast Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHEN Jie, Email: chenjiewestchina@163.com

Keywords：

Breast cancer; breast conservation surgery; overall survival

DOI：

10.7507/1002-0179.202201043

Video：

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At present, breast cancer is most common malignant tumor among female population. The treatment of breast cancer comprises surgery, radiotherapy, neoadjuvant and adjuvant therapy, with surgical as the main treatment approach. Common surgical methods for breast cancer include breast conservation surgery (BCS) and mastectomy. This article reviews the recent researches about the survival of breast cancer patients receiving BCS, the quality of life for patients receiving BCS, the survival of young and elderly patients receiving BCS, BCS after neoadjuvant chemotherapy, BCS for patients with breast cancer susceptibility gene mutation, and BCS for patients with ipsilateral breast tumor recurrence, so as to provide reference for the follow-up work of medical staff.

Citation： YANG Ruoning, WU Yunhao, LU Shan, CHEN Jie. Progress of breast conservation surgery for breast cancer. West China Medical Journal, 2023, 38(8): 1269-1275. doi: 10.7507/1002-0179.202201043 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol, 2009, 16(10): 2682-2690.
3.	Zhang BL, Sivasubramaniam PG, Zhang Q, et al. Trends in radical surgical treatment methods for breast malignancies in China: a multicenter 10-year retrospective study. Oncologist, 2015, 20(9): 1036-1043.
4.	Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: a 15-year single-center retrospective study of 18, 502 patients. Medicine (Baltimore), 2016, 95(45): e4201.
5.	Zhang B, Song Q, Zhang B, et al. A 10-year (1999~2008) retrospective multi-center study of breast cancer surgical management in various geographic areas of China. Breast, 2013, 22(5): 676-681.
6.	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 J Med, 2002, 347(16): 1233-1241.
7.	Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med, 1995, 333(22): 1444-1455.
8.	Sarrazin D, Lê MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol, 1989, 14(3): 177-184.
9.	Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med, 1981, 305(1): 6-11.
10.	van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst, 2000, 92(14): 1143-1150.
11.	Poortmans P, Aznar M, Bartelink H. Quality indicators for breast cancer: revisiting historical evidence in the context of technology changes. Semin Radiat Oncol, 2012, 22(1): 29-39.
12.	van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
13.	de Boniface J, Frisell J, Bergkvist L, et al. Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation. Br J Surg, 2018, 105(12): 1607-1614.
14.	de Boniface J, Szulkin R, Johansson ALV. Survival after breast conservation vs mastectomy adjusted for comorbidity and socioeconomic status: a Swedish national 6-year follow-up of 48 986 women. JAMA Surg, 2021, 156(7): 628-637.
15.	Wu SG, Wang Y, Zhou J, et al. Number of negative lymph nodes should be considered for incorporation into staging for breast cancer. Am J Cancer Res, 2015, 5(2): 844-853.
16.	Lagendijk M, van Maaren MC, Saadatmand S, et al. Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129, 692 patients. Int J Cancer, 2018, 142(1): 165-175.
17.	Wang J, Deng JP, Sun JY, et al. Noninferior outcome after breast-conserving treatment compared to mastectomy in breast cancer patients with four or more positive lymph nodes. Front Oncol, 2019, 9: 143.
18.	van Maaren MC, de Munck L, Jobsen JJ, et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients. Breast Cancer Res Treat, 2016, 160(3): 511-521.
19.	de la Rochefordiere A, Asselain B, Campana F, et al. Age as prognostic factor in premenopausal breast carcinoma. Lancet, 1993, 341(8852): 1039-1043.
20.	Cardoso F, Loibl S, Pagani O, et al. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer, 2012, 48(18): 3355-3377.
21.	Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: a systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast, 2015, 24(3): 175-181.
22.	Sinnadurai S, Kwong A, Hartman M, et al. Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open, 2019, 3(1): 48-55.
23.	DeSantis CE, Fedewa SA, Goding Sauer A, et al. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin, 2016, 66(1): 31-42.
24.	Rutter CE, Lester-Coll NH, Mancini BR, et al. The evolving role of adjuvant radiotherapy for elderly women with early-stage breast cancer. Cancer, 2015, 121(14): 2331-2340.
25.	Ward MC, Vicini F, Chadha M, et al. Radiation therapy without hormone therapy for women age 70 or above with low-risk early breast cancer: a microsimulation. Int J Radiat Oncol Biol Phys, 2019, 105(2): 296-306.
26.	Kunkler IH, Williams LJ, Jack WJ, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME Ⅱ): a randomised controlled trial. Lancet Oncol, 2015, 16(3): 266-273.
27.	Savard MF, Clemons M, Hutton B, et al. De-escalating adjuvant therapies in older patients with lower risk estrogen receptor-positive breast cancer treated with breast-conserving surgery: a systematic review and meta-analysis. Cancer Treat Rev, 2021, 99: 102254.
28.	Tringale KR, Berger ER, Sevilimedu V, et al. Breast conservation among older patients with early-stage breast cancer: locoregional recurrence following adjuvant radiation or hormonal therapy. Cancer, 2021, 127(11): 1749-1757.
29.	Robson M, Levin D, Federici M, et al. Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations. J Natl Cancer Inst, 1999, 91(24): 2112-2117.
30.	Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet, 2002, 359(9316): 1471-1477.
31.	Robson M, Svahn T, McCormick B, et al. Appropriateness of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: a clinic-based series. Cancer, 2005, 103(1): 44-51.
32.	Pierce LJ, Levin AM, Rebbeck TR, et al. Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage Ⅰ/Ⅱ breast cancer. J Clin Oncol, 2006, 24(16): 2437-2443.
33.	Wan Q, Su L, Ouyang T, et al. Comparison of survival after breast-conserving therapy vs mastectomy among patients with or without the brca1/2 variant in a large series of unselected Chinese patients with breast cancer. JAMA Netw Open, 2021, 4(4): e216259.
34.	van den Broek AJ, Schmidt MK, van’t Veer LJ, et al. Prognostic impact of breast-conserving therapy versus mastectomy of BRCA1/2 mutation carriers compared with noncarriers in a consecutive series of young breast cancer patients. Ann Surg, 2019, 270(2): 364-372.
35.	Huang X, Cai XY, Liu JQ, et al. Breast-conserving therapy is safe both within BRCA1/2 mutation carriers and noncarriers with breast cancer in the Chinese population. Gland Surg, 2020, 9(3): 775-787.
36.	Pierce LJ, Phillips KA, Griffith KA, et al. Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat, 2010, 121(2): 389-398.
37.	Kaufmann M, von Minckwitz G, Bear HD, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol, 2007, 18(12): 1927-1934.
38.	Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol, 2018, 19(1): 27-39.
39.	Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol, 1998, 16(8): 2672-2685.
40.	Rastogi P, Anderson SJ, Bear HD, et al: Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
41.	Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from national surgical adjuvant breast and bowel project B-18. J Natl Cancer Inst Monogr, 2001(30): 96-102.
42.	Mamtani A, Sevilimedu V, Le T, et al. Is local recurrence higher among patients who downstage to breast conservation after neoadjuvant chemotherapy?. Cancer, 2022, 128(3): 471-478.
43.	Wang J, Tang H, Yin K, et al. Second invasive breast cancers in patients treated with breast-conserving therapy. Eur J Surg Oncol, 2021, 47(10): 2492-2498.
44.	Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials. J Clin Oncol, 2006, 24(13): 2028-2037.
45.	Fisher B, Anderson S, Fisher ER, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet, 1991, 338(8763): 327-331.
46.	Bottero M, Borzillo V, Pergolizzi S, et al. The Italian association of radiotherapy and oncology recommendation for breast tumor recurrence: grades of recommendation, assessment, development and evaluation criteria. J Breast Cancer, 2021, 24(3): 241-252.
47.	Gradishar WJ, Anderson BO, Abraham J, et al. Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020, 18(4): 452-478.
48.	Sellam Y, Shahadi ID, Gelernter I, et al. Local recurrence of breast cancer: salvage lumpectomy as an option for local treatment. Breast J, 2019, 25(4): 619-624.
49.	Chen I, Botty Van den Bruele AM, Gillespie EF, et al. Salvage of locally recurrent breast cancer with repeat breast conservation using 45 Gy hyperfractionated partial breast re-irradiation. Breast Cancer Res Treat, 2021, 188(2): 409-414.
50.	Arthur DW, Winter KA, Kuerer HM, et al. Effectiveness of breast-conserving surgery and 3-dimensional conformal partial breast reirradiation for recurrence of breast cancer in the ipsilateral breast: the NRG Oncology/RTOG 1014 Phase 2 clinical trial. JAMA Oncol, 2020, 6(1): 75-82.
51.	Houvenaeghel G, Boher JM, Michel V, et al. Survival after breast cancer local recurrence according to therapeutic strategies. Eur J Surg Oncol, 2017, 43(8): 1409-1414.
52.	Smanykó V, Mészáros N, újhelyi M, et al. Second breast-conserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results. Brachytherapy, 2019, 18(3): 411-419.
53.	Hannoun-Levi JM, Resch A, Gal J, et al. Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO breast cancer working group. Radiother Oncol, 2013, 108(2): 226-231.
54.	Fodor J, Major T, Polgár C, et al. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast, 2008, 17(3): 302-308.
55.	Su Y, Guo R, Xue J, et al. Increased mortality with repeat lumpectomy alone after ipsilateral breast tumor recurrence. Oncologist, 2019, 24(9): e818-e827.
56.	Chen SL, Martinez SR: The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am J Surg, 2008, 196(4): 495-499.
57.	Tralongo P, Surbone A, Serraino D, et al. Major patterns of cancer cure: clinical implications. Eur J Cancer Care (Engl), 2019, 28(6): e13139.
58.	Janz NK, Mujahid M, Lantz PM, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res, 2005, 14(6): 1467-1479.
59.	Ganz PA, Schag AC, Lee JJ, et al. Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?. Cancer, 1992, 69(7): 1729-1738.
60.	Davis LE, Fulton C, Bubis LD, et al. Patient-reported symptoms following mastectomy alone or lumpectomy plus radiation for early stage breast cancer: a cohort study. Breast Cancer Res Treat, 2019, 175(3): 721-731.
61.	Ng ET, Ang RZ, Tran BX, et al. Comparing quality of life in breast cancer patients who underwent mastectomy versus breast-conserving surgery: a meta-analysis. Int J Environ Res Public Health, 2019, 16(24): 4970.
62.	Dominici L, Hu J, Zheng Y, et al. Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg, 2021, 156(10): e213758.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. McGuire KP, Santillan AA, Kaur P, et al. Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol, 2009, 16(10): 2682-2690.
3. Zhang BL, Sivasubramaniam PG, Zhang Q, et al. Trends in radical surgical treatment methods for breast malignancies in China: a multicenter 10-year retrospective study. Oncologist, 2015, 20(9): 1036-1043.
4. Huang NS, Liu MY, Chen JJ, et al. Surgical management of breast cancer in China: a 15-year single-center retrospective study of 18, 502 patients. Medicine (Baltimore), 2016, 95(45): e4201.
5. Zhang B, Song Q, Zhang B, et al. A 10-year (1999~2008) retrospective multi-center study of breast cancer surgical management in various geographic areas of China. Breast, 2013, 22(5): 676-681.
6. 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 J Med, 2002, 347(16): 1233-1241.
7. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med, 1995, 333(22): 1444-1455.
8. Sarrazin D, Lê MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol, 1989, 14(3): 177-184.
9. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med, 1981, 305(1): 6-11.
10. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst, 2000, 92(14): 1143-1150.
11. Poortmans P, Aznar M, Bartelink H. Quality indicators for breast cancer: revisiting historical evidence in the context of technology changes. Semin Radiat Oncol, 2012, 22(1): 29-39.
12. van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
13. de Boniface J, Frisell J, Bergkvist L, et al. Breast-conserving surgery followed by whole-breast irradiation offers survival benefits over mastectomy without irradiation. Br J Surg, 2018, 105(12): 1607-1614.
14. de Boniface J, Szulkin R, Johansson ALV. Survival after breast conservation vs mastectomy adjusted for comorbidity and socioeconomic status: a Swedish national 6-year follow-up of 48 986 women. JAMA Surg, 2021, 156(7): 628-637.
15. Wu SG, Wang Y, Zhou J, et al. Number of negative lymph nodes should be considered for incorporation into staging for breast cancer. Am J Cancer Res, 2015, 5(2): 844-853.
16. Lagendijk M, van Maaren MC, Saadatmand S, et al. Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129, 692 patients. Int J Cancer, 2018, 142(1): 165-175.
17. Wang J, Deng JP, Sun JY, et al. Noninferior outcome after breast-conserving treatment compared to mastectomy in breast cancer patients with four or more positive lymph nodes. Front Oncol, 2019, 9: 143.
18. van Maaren MC, de Munck L, Jobsen JJ, et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients. Breast Cancer Res Treat, 2016, 160(3): 511-521.
19. de la Rochefordiere A, Asselain B, Campana F, et al. Age as prognostic factor in premenopausal breast carcinoma. Lancet, 1993, 341(8852): 1039-1043.
20. Cardoso F, Loibl S, Pagani O, et al. The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer. Eur J Cancer, 2012, 48(18): 3355-3377.
21. Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: a systematic meta-analysis comparing breast-conserving surgery versus mastectomy. Breast, 2015, 24(3): 175-181.
22. Sinnadurai S, Kwong A, Hartman M, et al. Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings. BJS Open, 2019, 3(1): 48-55.
23. DeSantis CE, Fedewa SA, Goding Sauer A, et al. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin, 2016, 66(1): 31-42.
24. Rutter CE, Lester-Coll NH, Mancini BR, et al. The evolving role of adjuvant radiotherapy for elderly women with early-stage breast cancer. Cancer, 2015, 121(14): 2331-2340.
25. Ward MC, Vicini F, Chadha M, et al. Radiation therapy without hormone therapy for women age 70 or above with low-risk early breast cancer: a microsimulation. Int J Radiat Oncol Biol Phys, 2019, 105(2): 296-306.
26. Kunkler IH, Williams LJ, Jack WJ, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME Ⅱ): a randomised controlled trial. Lancet Oncol, 2015, 16(3): 266-273.
27. Savard MF, Clemons M, Hutton B, et al. De-escalating adjuvant therapies in older patients with lower risk estrogen receptor-positive breast cancer treated with breast-conserving surgery: a systematic review and meta-analysis. Cancer Treat Rev, 2021, 99: 102254.
28. Tringale KR, Berger ER, Sevilimedu V, et al. Breast conservation among older patients with early-stage breast cancer: locoregional recurrence following adjuvant radiation or hormonal therapy. Cancer, 2021, 127(11): 1749-1757.
29. Robson M, Levin D, Federici M, et al. Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations. J Natl Cancer Inst, 1999, 91(24): 2112-2117.
30. Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet, 2002, 359(9316): 1471-1477.
31. Robson M, Svahn T, McCormick B, et al. Appropriateness of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: a clinic-based series. Cancer, 2005, 103(1): 44-51.
32. Pierce LJ, Levin AM, Rebbeck TR, et al. Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage Ⅰ/Ⅱ breast cancer. J Clin Oncol, 2006, 24(16): 2437-2443.
33. Wan Q, Su L, Ouyang T, et al. Comparison of survival after breast-conserving therapy vs mastectomy among patients with or without the brca1/2 variant in a large series of unselected Chinese patients with breast cancer. JAMA Netw Open, 2021, 4(4): e216259.
34. van den Broek AJ, Schmidt MK, van’t Veer LJ, et al. Prognostic impact of breast-conserving therapy versus mastectomy of BRCA1/2 mutation carriers compared with noncarriers in a consecutive series of young breast cancer patients. Ann Surg, 2019, 270(2): 364-372.
35. Huang X, Cai XY, Liu JQ, et al. Breast-conserving therapy is safe both within BRCA1/2 mutation carriers and noncarriers with breast cancer in the Chinese population. Gland Surg, 2020, 9(3): 775-787.
36. Pierce LJ, Phillips KA, Griffith KA, et al. Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat, 2010, 121(2): 389-398.
37. Kaufmann M, von Minckwitz G, Bear HD, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol, 2007, 18(12): 1927-1934.
38. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol, 2018, 19(1): 27-39.
39. Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol, 1998, 16(8): 2672-2685.
40. Rastogi P, Anderson SJ, Bear HD, et al: Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. J Clin Oncol, 2008, 26(5): 778-785.
41. Wolmark N, Wang J, Mamounas E, et al. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from national surgical adjuvant breast and bowel project B-18. J Natl Cancer Inst Monogr, 2001(30): 96-102.
42. Mamtani A, Sevilimedu V, Le T, et al. Is local recurrence higher among patients who downstage to breast conservation after neoadjuvant chemotherapy?. Cancer, 2022, 128(3): 471-478.
43. Wang J, Tang H, Yin K, et al. Second invasive breast cancers in patients treated with breast-conserving therapy. Eur J Surg Oncol, 2021, 47(10): 2492-2498.
44. Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five national surgical adjuvant breast and bowel project node-positive adjuvant breast cancer trials. J Clin Oncol, 2006, 24(13): 2028-2037.
45. Fisher B, Anderson S, Fisher ER, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet, 1991, 338(8763): 327-331.
46. Bottero M, Borzillo V, Pergolizzi S, et al. The Italian association of radiotherapy and oncology recommendation for breast tumor recurrence: grades of recommendation, assessment, development and evaluation criteria. J Breast Cancer, 2021, 24(3): 241-252.
47. Gradishar WJ, Anderson BO, Abraham J, et al. Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2020, 18(4): 452-478.
48. Sellam Y, Shahadi ID, Gelernter I, et al. Local recurrence of breast cancer: salvage lumpectomy as an option for local treatment. Breast J, 2019, 25(4): 619-624.
49. Chen I, Botty Van den Bruele AM, Gillespie EF, et al. Salvage of locally recurrent breast cancer with repeat breast conservation using 45 Gy hyperfractionated partial breast re-irradiation. Breast Cancer Res Treat, 2021, 188(2): 409-414.
50. Arthur DW, Winter KA, Kuerer HM, et al. Effectiveness of breast-conserving surgery and 3-dimensional conformal partial breast reirradiation for recurrence of breast cancer in the ipsilateral breast: the NRG Oncology/RTOG 1014 Phase 2 clinical trial. JAMA Oncol, 2020, 6(1): 75-82.
51. Houvenaeghel G, Boher JM, Michel V, et al. Survival after breast cancer local recurrence according to therapeutic strategies. Eur J Surg Oncol, 2017, 43(8): 1409-1414.
52. Smanykó V, Mészáros N, újhelyi M, et al. Second breast-conserving surgery and interstitial brachytherapy vs. salvage mastectomy for the treatment of local recurrences: 5-year results. Brachytherapy, 2019, 18(3): 411-419.
53. Hannoun-Levi JM, Resch A, Gal J, et al. Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO breast cancer working group. Radiother Oncol, 2013, 108(2): 226-231.
54. Fodor J, Major T, Polgár C, et al. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast, 2008, 17(3): 302-308.
55. Su Y, Guo R, Xue J, et al. Increased mortality with repeat lumpectomy alone after ipsilateral breast tumor recurrence. Oncologist, 2019, 24(9): e818-e827.
56. Chen SL, Martinez SR: The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am J Surg, 2008, 196(4): 495-499.
57. Tralongo P, Surbone A, Serraino D, et al. Major patterns of cancer cure: clinical implications. Eur J Cancer Care (Engl), 2019, 28(6): e13139.
58. Janz NK, Mujahid M, Lantz PM, et al. Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res, 2005, 14(6): 1467-1479.
59. Ganz PA, Schag AC, Lee JJ, et al. Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?. Cancer, 1992, 69(7): 1729-1738.
60. Davis LE, Fulton C, Bubis LD, et al. Patient-reported symptoms following mastectomy alone or lumpectomy plus radiation for early stage breast cancer: a cohort study. Breast Cancer Res Treat, 2019, 175(3): 721-731.
61. Ng ET, Ang RZ, Tran BX, et al. Comparing quality of life in breast cancer patients who underwent mastectomy versus breast-conserving surgery: a meta-analysis. Int J Environ Res Public Health, 2019, 16(24): 4970.
62. Dominici L, Hu J, Zheng Y, et al. Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg, 2021, 156(10): e213758.

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Progress of breast conservation surgery for breast cancer

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