When can a second conservative approach be considered for ipsilateral breast tumour recurrence?

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Abstract

Background

Mastectomy is considered the treatment of choice in patients with ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS).

Patients and methods

One hundred and sixty-one patients with invasive IBTR who underwent a second conservative approach were retrospectively evaluated in order to describe prognosis, determine predictive factors of outcome and select the subset of patients with the best local control.

Results

Fifty-seven patients (35.4%) relapsed after IBTR. Thirty-four patients (21.1%) had further in-breast recurrences and four patients (2.5%) had skin relapses. Five years cumulative incidence of local relapse was 31.4%. Twenty-four patients (17.8%, 5 years cumulative incidence) died during the follow-up. At the multivariate analysis, recurrent tumour size >2 cm was found to affect local-disease-free survival [hazard ratio (HR): 2.8, 95% confidence interval (CI) 1.2–6.2], whereas Ki-67 ≥20% and time to relapse ≤48 months were associated with disease-free survival (HR: 1.7, 95% CI 1.0–3.1, and HR: 2.1, 95% CI 1.2–3.6, respectively). Absence of oestrogen receptors affected overall survival (HR: 2.5, 95% CI 1.1–6.0). Among 64 patients with recurrent tumour ≤2 cm and time to IBTR >48 months, eight (12.8%, 5 years cumulative incidence) had further local relapses.

Conclusions

Some patients with IBTR might receive a second BCS, especially when a good local control can be estimated (small recurrent tumour, late relapse), also taking into account patients’ preference.

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