Secondary breast-conserving surgery feasible for ipsilateral tumor recurrence
SAN ANTONIO — Women with ipsilateral breast tumor recurrence who underwent secondary breast-conserving surgery achieved outcomes comparable to women who underwent mastectomy, according to study results presented at San Antonio Breast Cancer Symposium.
“No significant difference in local control, DFS and OS was seen between ipsilateral breast tumor recurrence patients treated either by secondary breast-conserving surgery or mastectomy,” Thomas Kolben, MD, of the Breast Center and Comprehensive Cancer Center of Ludwig-Maximilians University in Munich, Germany, and colleagues wrote. “Our data suggest that secondary breast-conserving surgery for ipsilateral breast tumor recurrence patients after initial breast-conserving surgery and radiotherapy is feasible in selected patients.”
An estimated 10% to 15% of patients with breast cancer who undergo breast-conserving surgery and adjuvant radiotherapy develop ipsilateral breast tumor recurrence. International guidelines recommend total mastectomy as the preferred treatment option for these patients; however, some research suggests secondary breast-conserving surgery may confer comparable outcomes, according to study background.
Kolben and colleagues analyzed data from 170 women who underwent breast-conserving surgery and radiotherapy, then were subsequently diagnosed with ipsilateral breast tumor recurrence. Ipsilateral recurrences occurred between 1990 and 2014.
After recurrence, two-thirds (65.9%) of women underwent mastectomy, whereas one-third (34.1%) underwent secondary breast-conserving surgery.
Median follow-up after primary ipsilateral breast tumor recurrence was 49 months in the entire population and 59 months for patients who remained alive at the time of analysis.
Women who underwent secondary breast-conserving surgery achieved higher rates of 5-year ipsilateral breast tumor recurrence-free survival (77.6% vs. 75%) and 5-year OS (84.7% vs. 72.6%), whereas 5-year DFS was higher among women who underwent mastectomy (61.9% vs. 57.3%).
Three factors — including receipt of prior adjuvant systemic therapy, skin infiltration and muscular invasion — independently and significantly predicted shorter time to local progression.
Lymphovascular infiltration in the ipsilateral recurrence appeared associated with shorter DFS. Lymphovascular infiltration, skin infiltration and muscular invasion all independently and significantly predicted shorter OS. – by Mark Leiser
Kolben T, et al. Abstract P3-13-02. Presented at: San Antonio Breast Cancer Symposium; Dec. 8-12, 2015; San Antonio.
Disclosure: Please see the abstract for a full list of all researchers’ relevant financial disclosures.