Repeat lumpectomy and external beam radiation therapy for ipsilateral breast cancer recurrence: a systematic review

Salvage mastectomy is the standard of care for breast cancer patients with ipsilateral breast recurrence (IBR). This systematic review aims to evaluate effectiveness and safety of external beam RT (EBRT) as an accessible modality for repeat BCT.

A systematic literature search was conducted on MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from database inception until September 22, 2024. Clinical studies that investigated the use of second BCT (repeat BCS + post-operative RT) using EBRT were included.

Nine articles representing 8 studies and 569 patients were included. Most studies involved patients with T1 disease (6/8 studies, 75%), and node-negative recurrence (5/8 studies, 63%) partial breast re-irradiation was employed in a majority of studies (7/8 studies, 86%). The most common dose-fractionation schedule was 45 Gy in 30 twice-daily fractions (3/8 studies, 37%), followed by 50 Gy in 25 daily fractions (2/8 studies, 25%). The median follow-up ranged from 1.5 to 15 years. The average local recurrence rate was 10%. On average, grade 3 or worse acute and late skin and soft tissue toxicities were 1% and 3%, respectively. Only one study documented the incidence of long-term cardiac mortality (4% of patients) and one reported incidence of second malignancy (3% of patients). None of the included studies assessed patient-reported outcomes using validated quality of life questionnaires.

Repeat BCT using EBRT is an emerging alternative to salvage mastectomy, offering favourable local control and acceptable rates of treatment-related toxicities.