Increased Mortality with Repeat Lumpectomy Alone After Ipsilateral Breast Tumor Recurrence

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• The efficacy of repeat lumpectomy for ipsilateral breast tumor recurrence (IBTR) following breast-conserving surgery remains uncertain.
• Mastectomy is often considered standard, but less invasive options are sought for recurrent tumors.

Purpose of the Study:

• To compare the survival outcomes of repeat lumpectomy versus mastectomy for patients with IBTR.
• To evaluate the impact of radiation therapy in conjunction with repeat lumpectomy.

Main Methods:

• A population-based analysis of 5,098 patients with IBTR from the Surveillance, Epidemiology, and End Results registry (1973-2013).
• Risk-adjusted Cox proportional hazard regression and propensity score-matching analysis (PSMA) were employed.
• Outcomes assessed included overall and cancer-specific mortality.

Main Results:

• Repeat lumpectomy was associated with significantly higher overall mortality (HR, 1.522) and cancer-specific mortality (HR, 1.666) compared to mastectomy.
• No significant difference in overall mortality was observed for repeat lumpectomy with radiation therapy (RT) versus mastectomy.
• Patients with small IBTR (≤1 cm) undergoing repeat lumpectomy with RT showed similar survival rates to those undergoing mastectomy.

Conclusions:

• Repeat lumpectomy for IBTR is linked to increased mortality in real-world observational data.
• For small IBTR tumors, repeat lumpectomy combined with RT presents a viable alternative to mastectomy, potentially guiding treatment decisions.