Breast conservation therapy versus mastectomy in the surgical management of invasive lobular carcinoma measuring 4 cm or greater

Background: The safety of breast conservation therapy (BCT) has not been demonstrated in large ILC tumors, potentially contributing to the higher mastectomy rates seen in ILC. Methods: We queried a prospectively maintained database to identify patients with ILC measuring >= 4 cm and evaluated difference in recurrence free survival (RFS) between those treated with BCT versus mastectomy using a multivariate model. Results: Of 180 patients, 30 (16.7%) underwent BCT and 150 (83.3%) underwent mastectomy. Patients undergoing mastectomy were younger (56.6 vs. 64.3 years, p = 0.003) and had larger tumors (7.2 vs. 5.4 cm, p < 0.001). While tumor size, nodal stage, receptor subtype, and margin status were significantly associated with RFS, there was no difference in RFS at 5 (p = 0.88) or 10 (p = 0.65) years for individuals undergoing BCT versus mastectomy. Conclusions: For patients with ILC >= 4 cm, BCT provides similar tumor control as mastectomy, provided that negative margins are achieved. Published by Elsevier Inc.

Automated summary

For patients with ILC tumors measuring >= 4 cm, there was no significant difference in recurrence free survival between those treated with breast conservation therapy (BCT) and mastectomy, as long as negative margins are achieved. The key factor affecting outcomes is the margin status.