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Repeating Conservative Surgery after Ipsilateral Breast Tumor Reappearance: Criteria for Selecting the Best Candidates

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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 (P < 0.001).

Conclusions

The best candidates for a second BCS are those with small (≤2 cm) and late (>48 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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Authors and Affiliations

  1. Division of Breast Surgery, European Institute of Oncology, Milan, Italy

    Oreste Gentilini MD, Paolo Veronesi MD, Claudia Sangalli MSc, Andres Del Castillo MD, Bettina Ballardini MD, Viviana Galimberti MD, Alberto Luini MD & Umberto Veronesi MD

  2. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Edoardo Botteri MSc

  3. Department of Occupational Health, University of Milan, Milan, Italy

    Edoardo Botteri MSc

  4. School of Medicine, University of Milan, Milan, Italy

    Paolo Veronesi MD

  5. Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy

    Mario Rietjens MD

  6. Research Unit in Medical Senology, Department of Medical Oncology, European Institute of Oncology, Milan, Italy

    Marco Colleoni MD

Authors
  1. Oreste Gentilini MD
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  2. Edoardo Botteri MSc
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  3. Paolo Veronesi MD
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  4. Claudia Sangalli MSc
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  5. Andres Del Castillo MD
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  6. Bettina Ballardini MD
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  7. Viviana Galimberti MD
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  8. Mario Rietjens MD
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  9. Marco Colleoni MD
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  10. Alberto Luini MD
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  11. Umberto Veronesi MD
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Corresponding author

Correspondence to Oreste Gentilini MD.

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Gentilini, O., Botteri, E., Veronesi, P. et al. Repeating Conservative Surgery after Ipsilateral Breast Tumor Reappearance: Criteria for Selecting the Best Candidates. Ann Surg Oncol 19, 3771–3776 (2012). https://doi.org/10.1245/s10434-012-2404-5

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  • DOI: https://doi.org/10.1245/s10434-012-2404-5

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