Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery

Salvadori, B; Marubini, Ettore; Miceli, Rosalba; Conti, A.; Cusumano, F; Andreola, Salvatore; Zucali, R; Veronesi, Umberto

doi:10.1046/j.1365-2168.1999.00961.x

Cited by 174 publications

(85 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6 This was not a randomized study; at a median follow-up of 73 months after the second surgery, the overall survival rate at 5 years was 70% in the 134 patients who had undergone a mastectomy compared with 85% of patients who underwent local excision. No difference was noted with regard to the disease-free survival between patients who underwent a mastectomy and those who underwent local reexcision.…”

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 97%

“…A similarly low rate of chest wall recurrence (4%) was reported by Salvadori et al and also may be the result of the inclusion of patients with initial Stage I and Stage II disease. 6 Huang et al 11 found that the rate of local recurrence after mastectomy was significantly higher in patients with a true local recurrence at the site of the initial breast-conserving surgery compared with patients with recurrent tumors detected elsewhere in the breast (18% vs. 2%).…”

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

“…3,4,[6][7][8][9][10][11][12][13][14][15][16][17] These studies demonstrated that a second local recurrence in the form of a chest wall recurrence occurs in approximately 2-32% of patients. Thus, mastectomy after in-breast local recurrence does not necessarily eliminate the risk of subsequent secondary local recurrences at the chest wall.…”

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

“…6,8,9,17,27 The evaluation of these studies is difficult because of the lack of information regarding margin status and use of breast imaging at the time of in-breast local recurrence. Many of the series do not indicate whether clear surgical margins were obtained at the time of local excision of the recurrence, and numerous patients were treated before modern-day standard mammography and sonography were available to select appropriate patients for breast-conserving approaches (i.e., no evidence of multicentricity or diffuse suspicious microcalcifications).…”

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

See 3 more Smart Citations

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

View full text Add to dashboard Cite

Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

show abstract

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 97%

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

See 2 more Smart Citations

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

View full text Add to dashboard Cite

show abstract

“…Local radical resection alone can only be offered to one-third of the patients with recurrence [19,20], and they achieved a 5-year diseasefree survival rate of 45.5% [21]. Although local radical surgery is usually recommended, this may not be feasible in sizeable tumors [22]. Chemotherapy for LRBC has also been explored, but it was not found to be very effective [21].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Iodine-125 Seed Implantation in Locoregionally Recurrent and Unresectable Breast Cancer: a Retrospective Study

Wei

Qin

et al. 2017

Pathol. Oncol. Res.

View full text Add to dashboard Cite

The management of locoregionally recurrent and unresectable breast cancer is a therapeutic challenge. This retrospective study aimed to assess the efficacy of 125 I seed implantation brachytherapy as a palliative management in locoregionally recurrent breast cancer. We analyzed 36 locoregionally recurrent and unresectable breast cancers in our hospital between 2012 and 2016. All patients were treated with CT-guided 125 I seed permanent implantation. The dose distribution of 125 I seeds was calculated using a computerized treatment planning system. Complete response, partial response, stable disease, and local tumor control rates were calculated. Long-term efficacy was assessed based on survival rates ranging from 1 to 4 years. The follow-up period ranged from 6 to 53 months. The median local control was 28 months (95% CI: 16.2-39.8 months). The percentage of patients who showed 6-month, 1-year, 2-year, and 3-year local control was 97.2%, 77.8%, 52.8%, and 33.3%, respectively. Median survival time for all patients was 48 months (95% CI: 40.9-55.1 months); 1-year, 2-year, 3-year, and 4-year survival rates were 97.2%, 80.6%, 63.9%, and 46.5%, respectively. Pain relief response rate was 88.9%. No serious complications were detected during the follow-up period. The results of this study demonstrate that 125 I seed implantation could be considered a feasible and promising minimally invasive therapy for locoregionally recurrent and unresectable breast carcinoma.

show abstract

Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Mastectomy is standard for recurrence of breast cancer after breast conservation therapy with whole breast irradiation. The emergence of partial breast irradiation led to consideration of its application for reirradiation after a second lumpectomy for treatment of recurrence of breast cancer in the ipsilateral breast.OBJECTIVES To assess the effectiveness and adverse effects of partial breast reirradiation after a second lumpectomy and whether the treatment is an acceptable alternative to mastectomy. DESIGN, SETTING, AND PARTICIPANTSThe NRG Oncology/Radiation Therapy Oncology Group 1014 trial is a phase 2, single-arm, prospective clinical trial of 3-dimensional, conformal, external beam partial breast reirradiation after a second lumpectomy for recurrence of breast cancer in the ipsilateral breast after previous whole breast irradiation. The study opened on June 4, 2010, and closed June 18, 2013. Median follow-up was 5.5 years. This analysis used all data received at NRG Oncology through November 18, 2018. Eligible patients experienced a recurrence of breast tumor that was less than 3 cm and unifocal in the ipsilateral breast more than 1 year after breast-conserving therapy with whole breast irradiation and who had undergone excision with negative margins.INTERVENTIONS Adjuvant partial breast reirradiation, 1.5 Gy twice daily for 30 treatments during 15 days (45 Gy), using a 3-dimensional conformal technique. MAIN OUTCOMES AND MEASURESThe main outcomes of the present study were the predefined secondary study objectives of recurrence of breast cancer in the ipsilateral breast, late adverse events (>1 year after treatment), mastectomy incidence, distant metastasis-free survival, overall survival, and circulating tumor cell incidence.RESULTS A total of 65 women were enrolled, with 58 evaluable for analysis (mean [SD] age, 65.12 [9.95] years; 48 [83%] white). Of the recurrences of breast cancer in the ipsilateral breast, 23 (40%) were noninvasive and 35 (60%) were invasive. In all 58 patients, 53 (91%) had tumors 2 cm or smaller. All tumors were clinically node negative. A total of 44 patients (76%) tested positive for estrogen receptor, 33 (57%) for progesterone receptor, and 10 (17%) for ERBB2 (formerly HER2 or HER2/neu) overexpression. Four patients had breast cancer recurrence, with a 5-year cumulative incidence of 5% (95% CI, 1%-13%). Seven patients underwent ipsilateral mastectomies for a 5-year cumulative incidence of 10% (95% CI, 4%-20%). Both distant metastasis-free survival and overall survival rates were 95% (95% CI, 85%-98%). Four patients (7%) had grade 3 and none had grade 4 or higher late treatment adverse events. CONCLUSIONS AND RELEVANCEFor patients experiencing recurrence of breast cancer in the ipsilateral breast after lumpectomy and whole breast irradiation, a second breast conservation was achievable in 90%, with a low risk of re-recurrence of cancer in the ipsilateral breast using adjuvant partial breast reirradiation. This finding suggests that this treatment approach is an effecti...

show abstract

Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery

Abstract: Since the type of surgery did not seem to affect survival, breast conservation can be considered in selected patients with IBTR.

Cited by 174 publications

References 16 publications

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Efficacy of Iodine-125 Seed Implantation in Locoregionally Recurrent and Unresectable Breast Cancer: a Retrospective Study

Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast

Contact Info

Product

Resources

About