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Annals of Oncology Advance Access originally published online on December 8, 2006
Annals of Oncology 2007 18(3):468-472; doi:10.1093/annonc/mdl424
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© 2006 European Society for Medical Oncology

breast cancer

When can a second conservative approach be considered for ipsilateral breast tumour recurrence?

O Gentilini1,*, E Botteri2, N Rotmensz2, B Santillo2, N Peradze1, RC Saihum1, M Intra1, A Luini1, V Galimberti1, A Goldhirsch3 and U Veronesi4

1 Division of Breast Surgery
2 Division of Epidemiology and Biostatistics
3 Department of Medical Oncology
4 Scientific Director, European Institute of Oncology, Milan, Italy

* Correspondence to: Dr O. Gentilini, Division of Senology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Tel: +39-02-57489376; Fax: +39-02-57489780; E-mail: oreste.gentilini{at}ieo.it

Background: Mastectomy is considered the treatment of choice in patients with ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS).

Patients and methods: One hundred and sixty-one patients with invasive IBTR who underwent a second conservative approach were retrospectively evaluated in order to describe prognosis, determine predictive factors of outcome and select the subset of patients with the best local control.

Results: Fifty-seven patients (35.4%) relapsed after IBTR. Thirty-four patients (21.1%) had further in-breast recurrences and four patients (2.5%) had skin relapses. Five years cumulative incidence of local relapse was 31.4%. Twenty-four patients (17.8%, 5 years cumulative incidence) died during the follow-up. At the multivariate analysis, recurrent tumour size >2 cm was found to affect local-disease-free survival [hazard ratio (HR): 2.8, 95% confidence interval (CI) 1.2–6.2], whereas Ki-67 ≥20% and time to relapse ≤48 months were associated with disease-free survival (HR: 1.7, 95% CI 1.0–3.1, and HR: 2.1, 95% CI 1.2–3.6, respectively). Absence of oestrogen receptors affected overall survival (HR: 2.5, 95% CI 1.1–6.0). Among 64 patients with recurrent tumour ≤2 cm and time to IBTR >48 months, eight (12.8%, 5 years cumulative incidence) had further local relapses.

Conclusions: Some patients with IBTR might receive a second BCS, especially when a good local control can be estimated (small recurrent tumour, late relapse), also taking into account patients' preference.

Key words: breast-conserving surgery, breast tumour, ipsilateral breast tumour recurrence

Received for publication June 30, 2006. Revision received October 16, 2006. Accepted for publication October 17, 2006.


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