Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy

Bruele, Astrid Botty Van den; Chen, Ishita; Sevilimedu, Varadan; Le, Tiana; Morrow, Monica; Braunstein, Lior Z.; Cody, Hiram S.

doi:10.1007/s10549-020-06080-9

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…Following BCS, 5%–10% of patients will develop IBTR, 49,50 for which mastectomy remains standard care, 51 but for which reconservation surgery (RCS)—first proposed by Kurtz in 1991 52 —appears increasingly feasible. More than half of our most recent patients with IBTR have had RCS with breast cancer‐specific survival comparable to that of mastectomy, but with selection bias (older age and longer disease‐free interval) favoring RCS 53 . With propensity matching, a large multicenter European study has found no differences in outcome between RCS ( n = 377) and mastectomy ( n = 377) 54 .…”

Section: De‐escalation Of Surgery For Ibtrmentioning

confidence: 99%

Five decades of progress in surgical oncology: Breast

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Cody

2022

Journal of Surgical Oncology

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Surgery remains the single most effective treatment for breast cancer but coincident with a deeper understanding of tumor biology and advances in multidisciplinary care (encompassing breast imaging, systemic adjuvant therapy, radiotherapy, and genomics) continues to de-escalate, supported by strong level I data. We have moved from mastectomy to breast conservation, and from routine axillary dissection to sentinel lymph node biopsy to selective omission of axillary node staging altogether. We have further de-escalated through consensus over margin width in breast conservation, through improvements in neoadjuvant therapy, and by demonstrating no benefit for upfront surgery in patients with stage IV disease.For patients with ipsilateral breast tumor recurrence, reconservation surgery and reirradiation are promising. Cell cycle and immune checkpoint inhibitors, when added to conventional systemic therapy, have now moved beyond stage IV disease to phase III trials in the adjuvant and neoadjuvant settings, promising even further de-escalation of surgery. Finally, with genomic profiling we are moving away from the primacy of axillary node status for prognostication and into a new era allowing prediction of response to therapy.

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Section: De‐escalation Of Surgery For Ibtrmentioning

confidence: 99%

Five decades of progress in surgical oncology: Breast

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Cody

2022

Journal of Surgical Oncology

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“…To date, re-conservation has proven increasingly popular and was recently found to have grown from 27% between 2000 and 2004 to 61% between 2015 and 2019 [62].…”

Section: Second Breast Conservative Surgery For Ipsilateral Breast Tumor Recurrence: the New Standard Of Treatmentmentioning

confidence: 99%

“…Currently, there is no phase III prospective randomized trial comparing these two treatment options [62]. Recently, the GEC-ESTRO breast cancer working group used a propensity score-matched cohort analysis to compare oncological outcomes between 377 patients subjected to second BCS and 377 treated with salvage mastectomy.…”

Section: Second Breast Conservative Surgery For Ipsilateral Breast Tumor Recurrence: the New Standard Of Treatmentmentioning

confidence: 99%

“…Again, a recent single institution study conducted at the Memorial Sloan Kettering Cancer Center retrospectively compared the oncological outcome of treating isolated IBTR following breast conservation surgery (322 pts) either with breast re-conservation (40%) or with salvage mastectomy (60%) [62]. Older age, long disease free-interval, lack of radiotherapy and use of the endocrine therapy as the initial adjuvant treatment were the clinical elements that significantly correlated with higher rates of re-conservations options [62].…”

Section: Second Breast Conservative Surgery For Ipsilateral Breast Tumor Recurrence: the New Standard Of Treatmentmentioning

confidence: 99%

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Breast Cancer Surgery: New Issues

et al. 2021

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Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.

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“…Even with routine practice of breast-conserving surgery (BCS) and adjuvant radiotherapy, ipsilateral breast tumor recurrence (IBTR) accounts for 5-15% of all cancer recurrence in patients with early-stage breast cancer (EBC) [1,2]. The standard of care for IBTR is salvage mastectomy in light of previous radiation treatment [3]. Repeat BCS with reirradiation could be an alternative to mastectomy in some highly selected patients [4] However, the optimal axillary management in patients with IBTR is still under debate, particularly in those who have been previously treated with sentinel lymph node biopsy (SLNB).…”

Section: Introductionmentioning

confidence: 99%

Omission of axillary surgery for ipsilateral breast tumor recurrence with negative nodes after previous breast-conserving surgery: is it oncologically safe?

Lin

Liu

et al. 2022

Breast Cancer Res Treat

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Purpose Salvage mastectomy is traditionally recommended for patients who developed ipsilateral breast tumor recurrence (IBTR) in light of previous breast irradiation. However, it remains controversial whether surgical axillary staging (SAS) is necessary for IBTR patients with negative nodes. This study aimed to evaluate the oncologic safety of omitting SAS for IBTR. Methods We retrospectively identified patients who developed invasive IBTR with negative nodes after undergoing breast-conserving surgery (BCS) from 2010 to 2018. Patterns of care in nodal staging were analyzed based on prior axillary staging status. Clinicopathologic characteristics and adjuvant treatment of the initial tumor, as well as the IBTR, were compared between the SAS and no SAS groups. Kaplan–Meier method and Cox regression model were utilized to compare the locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates after IBTR removal between the two groups. Results A total of 154 IBTR patients were eligible for final analysis. Compared to the no SAS group, SAS group was less likely to undergo ALND (15.1 vs 73.3%, p < 0.001) at initial BCS, had a longer recurrence interval (2.8 vs 2.1 years, p = 0.03), and were more likely to have discordant molecular subtype (35.8 vs 12.9%, p = 0.001) and different quadrant location (37.7 vs 19.8%, p = 0.02) with primary tumor. However, the extent of axillary staging did not affect systemic or radiation recommendations. In the subgroup of patients without previous ALND, the clinicopathologic characteristics were roughly comparable. No significant differences were observed in LRRFS, DMFS or OS between the two groups. Conclusion For node-negative IBTR patients, we observed selection bias on the basis of prior ALND, shorter recurrence interval, and concordant molecular subtype favoring no SAS but comparable LRRFS, DMFS, and OS. These results support a wider consideration of sparing SAS in the management of IBTR, especially in patients without previous ALND.

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Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy

Cited by 12 publications

References 22 publications

Five decades of progress in surgical oncology: Breast

Five decades of progress in surgical oncology: Breast

Breast Cancer Surgery: New Issues

Omission of axillary surgery for ipsilateral breast tumor recurrence with negative nodes after previous breast-conserving surgery: is it oncologically safe?

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