Decision Making in the Surgical Management of Invasive Breast Cancer-Part 2: Expanded Applications for Breast-Conserving Surgery.

Treatment of early-stage invasive breast cancer with breast-conserving surgery plus radiation therapy (RT) yields overall survival outcomes equivalent to those achieved with mastectomy. Further, breast-conserving surgery is endorsed by the National Comprehensive Cancer Network as being supported by the highest-level, category 1 evidence. Advances in pathologic evaluation, management of multiple tumors, oncoplastic lumpectomy techniques, neoadjuvant chemotherapy, and hypofractionated RT can expand the pool of patients eligible for breast-conserving surgery. Selected patients (for example, patients older than 70 years of age with hormone receptor-positive T1 tumors who are willing to commit to receiving adjuvant endocrine therapy) may be able to forgo RT completely. This article will detail current management approaches to achieving breast conservation in patients with invasive breast cancer, including cases of bulky tumors and/or multiple tumors.