True recurrence vs. new primary ipsilateral breast tumor relapse: An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management

Are ipsilateral breast tumour invasive recurrences in young (⩽40 years) women more aggressive than their primary tumours?

“…Most authors have also proposed that location would help distinguish the two -with ipsilateral breast tumour recurrences occurring away from the index quadrant more prone to be new primaries (Fisher et al, 1986;Haffty et al, 1993;Smith et al, 2000;Huang et al, 2002). This was confirmed in our series where ipsilateral breast tumour recurrences that had conserved their IBTR vs primary breast cancer B Sigal-Zafrani et al primary tumours' histological types tended to arise more often in the index quadrant than others.…”

“…Their definition according to clinical and histological criteria remains a wild dream. All authors agree on a basic definition of a new primary that is, an ipsilateral breast tumour recurrence with a different histological type from its primary tumour (Haffty et al, 1993;Touboul et al, 1999;Smith et al, 2000;Huang et al, 2002;Komoike et al, 2005). Our series showed a good concordance of the histological type in the ipsilateral breast tumour recurrence.…”

“…We shall examine how different they are from primary tumours and whether there are clinical or histological factors to help distinguish between a re-growth of malignant cells not removed by surgery and not killed by radiotherapy (also called a true recurrence, TR) and a de novo malignancy arising from mammary epithelial cells of residual breast tissues (also known as new primary tumours, NP) (Haffty et al, 1993). Some have implied that ipsilateral breast tumour recurrences should display features of, at least as much aggressiveness (differentiation (Huang et al, 2002), ploidy (Haffty et al, 1993) and percentage of invasiveness (Haffty et al, 1993;Smith et al, 2000;Huang et al, 2002)) to qualify as true recurrences. We shall see whether biological evidence can be found to support this definition.…”

Tumour bed delineation for partial breast/breast boost radiotherapy: What is the optimal number of implanted markers?

“…A strategy that aims to improve the therapeutic ratio in women at relatively low risk of local tumour relapse involves limiting high radiation doses to the index quadrant and reducing or eliminating dose to breast tissue remote from the tumour bed (TB) (4,5). An essential prerequisite of external beam partial breast irradiation (PBI) is accurate localization of the TB, for which many oncologists are using CT imaging.…”

Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry

“…PBI could also reduce normal-tissue doses by restricting higher radiation doses to the volume of breast tissue at highest risk of tumour relapse (16). The combination of prone positioning and PBI is particularly attractive in terms of reducing normal-tissue toxicity.…”