Repeating conservative surgery after ipsilateral breast tumor reappearance: Criteria for selecting the best candidates

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Abstract

Background. Mastectomy is still considered the treatment of first choice in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and whole-breast radiotherapy. Methods. We retrospectively evaluated 161 patients with invasive IBTR who underwent a second BCS in order to describe prognosis, determine predictive factors of outcome, and select the subset of patients with the best local control. Median follow-up after IBTR was 81 months. Results. Median age at IBTR was 53 years. Five-year overall survival after IBTR was 84 % (95 % confidence interval [CI] 78-89). Five-year cumulative incidence of a second local event after IBTR was 29 % (95 % CI 22-37). At the multivariate analysis, IBTR size>2 cm and time to relapse ≤48 months significantly increased the risk of local reappearance (hazard ratio [HR] 3.3, 95 % CI 1.6-7.0; and HR 1.9, 95 % CI 1.1-3.5). The 5-year cumulative incidence of a further local reappearance of the tumor after repeating BCS was 15.2 % in the patients with IBTR ≤2 cm and time to IBTR >48 months, 31.2 % in the patients with IBTR ≤2 cm and time to IBTR ≤48 months, and 71.2 % in patients with IBTR>2 cm (P48 months) IBTR. The information about the risk of a further local reappearance after repeating BCS should be shared with the patients in the decision making process.

Original languageEnglish
Pages (from-to)3771-3776
Number of pages6
JournalAnnals of Surgical Oncology
Volume19
Issue number12
DOIs
Publication statusPublished - Nov 2012

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Breast Neoplasms
Recurrence
Segmental Mastectomy
Confidence Intervals
Mastectomy
Incidence
Decision Making
Breast
Radiotherapy
Multivariate Analysis
Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{833a93eddecc405d90275127c6cbc143,
title = "Repeating conservative surgery after ipsilateral breast tumor reappearance: Criteria for selecting the best candidates",
abstract = "Background. Mastectomy is still considered the treatment of first choice in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and whole-breast radiotherapy. Methods. We retrospectively evaluated 161 patients with invasive IBTR who underwent a second BCS in order to describe prognosis, determine predictive factors of outcome, and select the subset of patients with the best local control. Median follow-up after IBTR was 81 months. Results. Median age at IBTR was 53 years. Five-year overall survival after IBTR was 84 {\%} (95 {\%} confidence interval [CI] 78-89). Five-year cumulative incidence of a second local event after IBTR was 29 {\%} (95 {\%} CI 22-37). At the multivariate analysis, IBTR size>2 cm and time to relapse ≤48 months significantly increased the risk of local reappearance (hazard ratio [HR] 3.3, 95 {\%} CI 1.6-7.0; and HR 1.9, 95 {\%} CI 1.1-3.5). The 5-year cumulative incidence of a further local reappearance of the tumor after repeating BCS was 15.2 {\%} in the patients with IBTR ≤2 cm and time to IBTR >48 months, 31.2 {\%} in the patients with IBTR ≤2 cm and time to IBTR ≤48 months, and 71.2 {\%} in patients with IBTR>2 cm (P48 months) IBTR. The information about the risk of a further local reappearance after repeating BCS should be shared with the patients in the decision making process.",
author = "Oreste Gentilini and Edoardo Botteri and Paolo Veronesi and Claudia Sangalli and {Del Castillo}, Andres and Bettina Ballardini and Viviana Galimberti and Mario Rietjens and Marco Colleoni and Alberto Luini and Umberto Veronesi",
year = "2012",
month = "11",
doi = "10.1245/s10434-012-2404-5",
language = "English",
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pages = "3771--3776",
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TY - JOUR

T1 - Repeating conservative surgery after ipsilateral breast tumor reappearance

T2 - Criteria for selecting the best candidates

AU - Gentilini, Oreste

AU - Botteri, Edoardo

AU - Veronesi, Paolo

AU - Sangalli, Claudia

AU - Del Castillo, Andres

AU - Ballardini, Bettina

AU - Galimberti, Viviana

AU - Rietjens, Mario

AU - Colleoni, Marco

AU - Luini, Alberto

AU - Veronesi, Umberto

PY - 2012/11

Y1 - 2012/11

N2 - Background. Mastectomy is still considered the treatment of first choice in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and whole-breast radiotherapy. Methods. We retrospectively evaluated 161 patients with invasive IBTR who underwent a second BCS in order to describe prognosis, determine predictive factors of outcome, and select the subset of patients with the best local control. Median follow-up after IBTR was 81 months. Results. Median age at IBTR was 53 years. Five-year overall survival after IBTR was 84 % (95 % confidence interval [CI] 78-89). Five-year cumulative incidence of a second local event after IBTR was 29 % (95 % CI 22-37). At the multivariate analysis, IBTR size>2 cm and time to relapse ≤48 months significantly increased the risk of local reappearance (hazard ratio [HR] 3.3, 95 % CI 1.6-7.0; and HR 1.9, 95 % CI 1.1-3.5). The 5-year cumulative incidence of a further local reappearance of the tumor after repeating BCS was 15.2 % in the patients with IBTR ≤2 cm and time to IBTR >48 months, 31.2 % in the patients with IBTR ≤2 cm and time to IBTR ≤48 months, and 71.2 % in patients with IBTR>2 cm (P48 months) IBTR. The information about the risk of a further local reappearance after repeating BCS should be shared with the patients in the decision making process.

AB - Background. Mastectomy is still considered the treatment of first choice in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and whole-breast radiotherapy. Methods. We retrospectively evaluated 161 patients with invasive IBTR who underwent a second BCS in order to describe prognosis, determine predictive factors of outcome, and select the subset of patients with the best local control. Median follow-up after IBTR was 81 months. Results. Median age at IBTR was 53 years. Five-year overall survival after IBTR was 84 % (95 % confidence interval [CI] 78-89). Five-year cumulative incidence of a second local event after IBTR was 29 % (95 % CI 22-37). At the multivariate analysis, IBTR size>2 cm and time to relapse ≤48 months significantly increased the risk of local reappearance (hazard ratio [HR] 3.3, 95 % CI 1.6-7.0; and HR 1.9, 95 % CI 1.1-3.5). The 5-year cumulative incidence of a further local reappearance of the tumor after repeating BCS was 15.2 % in the patients with IBTR ≤2 cm and time to IBTR >48 months, 31.2 % in the patients with IBTR ≤2 cm and time to IBTR ≤48 months, and 71.2 % in patients with IBTR>2 cm (P48 months) IBTR. The information about the risk of a further local reappearance after repeating BCS should be shared with the patients in the decision making process.

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U2 - 10.1245/s10434-012-2404-5

DO - 10.1245/s10434-012-2404-5

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

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