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Annals of Oncology Advance Access published online on January 15, 2009
Annals of Oncology, doi:10.1093/annonc/mdn732
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome

E. Botteri1,*, N. Rotmensz1, C. Sangalli2, A. Toesca2, N. Peradze2, H. R. De Oliveira Filho2, A. Sagona2, M. Intra2, P. Veronesi2, V. Galimberti2, A. Luini2, U. Veronesi2,3 and O. Gentilini2

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.

breast tumour, breast-conserving surgery, ipsilateral breast recurrence, mastectomy

Received for publication September 5, 2008. Accepted for publication November 4, 2008.


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