Is repeat breast conservation possible for small ipsilateral breast cancer recurrence?

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) often involves small tumors.
• While mastectomy is recommended by some guidelines, repeat breast-conserving surgery (re-BCS) is preferred by many patients.
• This study evaluates re-BCS versus mastectomy for small IBTR prognosis.

Purpose of the Study:

• To compare the oncological outcomes of re-BCS and mastectomy in patients with small IBTR.
• To identify patient subgroups who may be suitable candidates for re-BCS.

Main Methods:

• Analysis of a population-based cohort from the Surveillance, Epidemiology, and End Results database (1999-2015).
• Inclusion of 3648 patients with small IBTR, comparing outcomes between mastectomy (n=2831) and re-BCS (n=817).
• Utilized multivariable Cox regression and propensity score matching to assess overall survival (OS) and breast cancer-specific survival (BCSS).

Main Results:

• Re-BCS was associated with significantly worse OS (HR 1.342) and BCSS (HR 1.454) compared to mastectomy.
• Omission of radiation after re-BCS correlated with poorer survival, particularly in estrogen receptor (ER)-negative IBTR.
• No significant survival differences were found between re-BCS with radiation and mastectomy; surgical approach was not an independent factor in ER-positive IBTR.

Conclusions:

• Re-BCS for small IBTR warrants careful consideration due to potential survival disadvantages.
• Estrogen receptor (ER) status is a critical factor in selecting patients for re-BCS.
• Radiation therapy following re-BCS may enhance oncological safety and improve survival outcomes.