Local recurrence of breast cancer: Salvage lumpectomy as an option for local treatment

Abstract

Introduction The best local management for breast cancer recurrence following conservative treatment for breast cancer (BC) continues to be an open question. In this study, we compared patients' outcome after salvage lumpectomy (SL) vs mastectomy for ipsilateral breast tumor recurrence (IBTR). Materials and methods Between 1987 and 2014 we identified 121 patients with pT0‐2, N0‐3, M0 BC who had BCT as their primary treatment, and subsequently had IBTR (unifocal). 47 patients underwent SL and 74 salvage mastectomy (SM) as the local treatment for their 1st recurrence. Results Median follow‐up was 14 years (1‐30) from first BC diagnosis. For the SL and SM cohorts, 8 and 10 patients (17%, 13.5%, P = 0.22), respectively, developed subsequent local recurrence as a 3rd event. Although in MVA, woman who underwent SL had higher chances of having a 2nd recurrence (3rd event), P = 0.020, at a median follow‐up of 14 years, 95.8% of SL patients are alive, NED, 85% are mastectomy free. 87% of patients who opted for SM are alive, NED. Having re‐irradiation following SL did not protect against 2nd breast cancer recurrence (3rd event, P = 0.42). Conclusion Salvage lumpectomy following IBTR, while associated with higher second LR rate than SM is not associated with inferior outcome. With survival >95% at 14 years in the SL cohort, salvage lumpectomy with or without re‐radiation, in a selected population (unifocal T), represents an acceptable treatment option for patients in order to delay time to mastectomy without reducing BC survival. Both options should be discussed prior to any surgical decision.

Repeat Breast-Conserving Surgery Versus Salvage Mastectomy for Ipsilateral Breast Tumour Recurrence After Breast-Conserving Surgery in Breast Cancer Patients: A Meta-Analysis

“…Some studies reported that RBCS was not worse than SM ( 12 , 13 , 15 , 21 , 26 , 28 ), and some studies reported the opposite results ( 8 , 10 , 11 , 14 ). Other studies asserted that it did not suggest a worse prognosis, although the SLRR of RBCS was higher ( 25 ), which is consistent with our conclusions. The SLRR of RBCS was approximately7-31% ( 8 , 13 , 14 , 29 , 30 ), and the SLRR of SM was approximately 3-32% ( 8 , 13 , 21 ).…”

“…Therefore, no significant difference in prognosis was observed in our study despite the lower SLRR of RBCS after IBTR than SM. This conclusion is similar to Sellam Y et al (25).…”

“…However, there were only two studies that explicitly offered secondary radiotherapy in our study. Previous studies also supported the opinion that secondary radiotherapy after salvage surgery reduces the SLRR ( 13 , 25 , 26 , 31 – 38 ). Su Y et al.…”

“…However, there were only two studies that explicitly offered secondary radiotherapy in our study. Previous studies also supported the opinion that secondary radiotherapy after salvage surgery reduces the SLRR (13,25,26,(31)(32)(33)(34)(35)(36)(37)(38). Su Y et al (11) reported a worse prognosis after RBCS, poor OS (HR=1.522, 95% CI 1.317-1.759), and poor breast cancerspecific survival (BCSS) (HR =1.666, 95% CI 1.319-2.105).…”

Local-free recurrence survival after breast-conserving surgery and the breast cancer complex treatment

“…Исследования, которые отражают отсутствие статистически значимой разницы (в 5-летней безрецидивной и общей выживаемости) между ОСО c последующей дистанционной лучевой терапией (ДЛТ) и радикальной мастэктомией (РМЭ) были проведены десятилетия назад. Результаты исследований сыграли решающую роль в изменении парадигмы хирургического лечения РМЖ [4][5][6]. За последние годы опубликовано несколько ретроспективных исследований, в которых отмечено преимущество ОСО перед РМЭ по общей выживаемости [7][8][9].…”