Implementing Society of Surgical Oncology and the American Society for Radiation Oncology Margin Guidelines to Reduce Reoperations After Lumpectomy for Early Breast Cancer

A partir d'une revue systématique de la littérature publiée entre janvier 2014 et juillet 2019 et à partir de l'analyse de résumés de conférences, cette méta-analyse évalue l'évolution du taux de réopération après la publication en 2014 des recommandations de la "Society of Surgical Oncology" et de l'"American Society for Radiation Oncology" concernant les marges de résection lors d'une chirurgie conservatrice pour un cancer du sein

Résumé en anglais

Breast-conserving surgery (BCS) and mastectomy for early breast cancer have equivalent survival rates, with a local recurrence rate of 14.3% after 20 years of follow-up in a study. Adequate margin status after BCS is an important determinant of local recurrence. The definition of adequate surgical margins is controversial. The National Surgical Adjuvant Breast and Bowel Project B-06 trial was the only trial that defined no ink on margin as an adequate margin. Subsequent studies on margin status after BCS led to the recommendation of 2 mm as the ideal margin width for optimal local control. However, local recurrence is also determined by the biological quality of a tumor, in which triple-negative breast cancer (negative estrogen receptor, progesterone receptor, and ERBB2 [formerly HER2]) has been shown to have higher local recurrence rate. Modern radiation techniques with an additional radiation dose to the tumor bed, optimal use of adjuvant chemotherapy, hormone therapy, and targeted therapy also reduce local recurrence.