Annals of Oncology Advance Access originally published online on January 15, 2009
Annals of Oncology 2009 20(6):1008-1012; doi:10.1093/annonc/mdn732
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breast cancer |
Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome
1 Division of Epidemiology and Biostatistics
2 Division of Breast Surgery
3 Scientific Director, European Institute of Oncology, Milan, Italy
* Correspondence to: Dr E. Botteri, Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Tel: +39-2-57489820; Fax: +39-2-57489813; E-mail: edoardo.botteri{at}ieo.it.
Background: In the case of ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS), a second conservative surgical approach maybe considered in some motivated patients whereas in others mastectomy is unavoidable.
Patients and methods: From 1997 to 2004, 282 patients presented at the European Institute of Oncology with an operable invasive IBTR after BCS. One hundred and sixty-one (57%) underwent a second conservative surgery, whereas 121 patients (43%) were given a mastectomy and represent the study population. We investigated the prognosis and determined predictive factors of outcome.
Results: Median time from primary breast cancer to IBTR was 41 months (range 5–213). Recurrences were T2–T4 and/or multifocal in 83 cases (68.6%). With a median follow-up of 5 years after mastectomy, 5-year overall survival (OS) and disease-free survival (DFS) were 73.3% [95% confidence interval (CI) 65.0% to 81.6%] and 50.4% (95% CI 40.9% to 59.8%), respectively. At the multivariate analysis, early onset of IBTR, presence of vascular invasion and Ki67 
20 of the recurrent tumour were found to significantly affect both DFS and OS.
Conclusions: In women who need mastectomy for IBTR, early onset of the relapse, high proliferation index and presence of vascular invasion represent the worst prognostic factors.
Key words: breast tumour, breast-conserving surgery, ipsilateral breast recurrence, mastectomy
Received for publication September 5, 2008. Accepted for publication November 4, 2008.