Outcome after Mastectomy for Ipsilateral Breast Tumor Recurrence after Breast Conserving Surgery

Abstract

Ipsilateral breast tumor recurrence (IBTR) is a risk after breast conserving surgery, and is traditionally treated with mastectomy. Given the limited literature on outcome after mastectomy for IBTR, we evaluated our long-term data for this group. A retrospective review was conducted using a database of 2101 breast cancer patients at a single institution. Fifty-nine patients underwent breast conserving surgery and experienced an IBTR. Exclusion criteria included repeat lumpectomy or metastatic disease before mastectomy. Patients presented with invasive ductal (58%), invasive lobular (7%), other invasive (11%), or ductal carcinoma in situ (24%). Initial tumors were Tis (24%), T1 (42%), T2 (20%), T3 (2%), or not recorded (12%). IBTR lesions were Tis (20%), T1 (46%), T2 (25%), or T3 (9%). Median follow-up after mastectomy was 4.6 years. Thirteen patients (22%) had post-mastectomy recurrence (PMR), which decreased overall survival ( P = 0.002). PMR was more common with larger IBTR tumors ( P = 0.03), specifically IBTR ≥ T2 ( P = 0.003). Eighty-five per cent of PMR occurred within 2 years of mastectomy. Mastectomy for IBTR remains effective treatment for most patients, but the risk of PMR remains. Patients with IBTR tumors >2 cm have an increased risk of PMR. Strict follow-up should be routine, especially during the first 24 months.

Regional lymphatic recurrence after salvage surgery for ipsilateral breast tumor recurrence of breast cancer without local treatment for regional lymphatic basin

“…In our study, during a median follow‐up after IBTR of 3.7 years, 9 of 102 patients (8.8%) in whom the axillary procedure was omitted at IBTR surgery developed RLR. This RLR rate (8.8%) was higher than that in other reports (range, 3.1–7.5%) . One of the reasons for this difference may be the difference in the definition of RLR.…”

“…RLR is generally rare compared to local or distant recurrence after IBTR . To the best of our knowledge, this study is the first to investigate risk factors of RLR after IBTR.…”

“…Another reason for the difference may be that of treatment for regional lymph nodes before and after IBTR. Previous reports did not describe treatment for regional lymph nodes at the time of primary surgery and salvage for IBTR, which is considered an important factor relating to RLR after IBTR. To examine a more reliable RLR rate, we used only patients with IBTR who underwent breast‐conserving surgery with axillary dissection or SNB only with no metastatic nodes in the primary surgery, and received salvage surgery for IBTR without local treatment for the regional lymphatic basin (surgery or radiotherapy) for the analysis.…”