Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer.

Abner, Anthony; Recht, Abram; Eberlein, T.J.; Come, S. E.; Shulman, L. N.; Hayes, Daniel; Connolly, James L.; Schnitt, S J; Silver, Barbara; Harris, J.R.

doi:10.1200/jco.1993.11.1.44

Cited by 179 publications

(88 citation statements)

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“…7,8 In a study from the Joint Center for Radiation Therapy performed in patients with noninvasive or focally invasive recurrent tumors, there were no chest wall recurrences observed at a median follow-up of 39 months. 8 In contrast, 7% of patients who presented with an invasive in-breast local recurrence developed a subsequent chest wall recurrence. In a series of patients from Sweden, chest wall recurrences occurred in 19% of 65 patients after mastectomy for local in-breast recurrence at a median follow-up of 13 years.…”

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

“…3,4,[6][7][8][9][10][11][12][13][14][15][16][17] These studies demonstrated that a second local recurrence in the form of a chest wall recurrence occurs in approximately 2-32% of patients. Thus, mastectomy after in-breast local recurrence does not necessarily eliminate the risk of subsequent secondary local recurrences at the chest wall.…”

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

“…Recurrences that are primarily invasive are associated with worse survival than recurrences that are primarily noninvasive. 8,18 A purely noninvasive in-breast recurrence is reported to occur in approximately 10% of patients initially treated with breast conservation for invasive disease as opposed to approximately 60% of patients treated with breast conservation for ductal carcinoma in situ (DCIS). 1,3,18,19 Death after a noninvasive breast recurrence is extremely rare and generally results from distant metastases associated with the originally diagnosed invasive breast carcinoma.…”

Section: Survival After Mastectomy For In-breast Local Recurrencementioning

confidence: 99%

“…6,8,9,17,27 The evaluation of these studies is difficult because of the lack of information regarding margin status and use of breast imaging at the time of in-breast local recurrence. Many of the series do not indicate whether clear surgical margins were obtained at the time of local excision of the recurrence, and numerous patients were treated before modern-day standard mammography and sonography were available to select appropriate patients for breast-conserving approaches (i.e., no evidence of multicentricity or diffuse suspicious microcalcifications).…”

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

“…Many of the series do not indicate whether clear surgical margins were obtained at the time of local excision of the recurrence, and numerous patients were treated before modern-day standard mammography and sonography were available to select appropriate patients for breast-conserving approaches (i.e., no evidence of multicentricity or diffuse suspicious microcalcifications). Abner et al 8 reported a local recurrence rate of 31% at a median follow-up of 39 months, and Voogd et al 17 reported a local recurrence rate of 38% at a median follow-up of 52 months. It is interesting to note that in the series by Voogd et al, 17 the local recurrence rate after local excision was not found to be significantly different from that reported after mastectomy (38% vs. 25%; P ϭ 0.27).…”

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

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Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

Section: Survival After Mastectomy For In-breast Local Recurrencementioning

confidence: 99%

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

Section: Patient Outcomes After Conservative Surgery Alone For Inbreamentioning

confidence: 99%

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Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast

et al. 2020

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IMPORTANCE Mastectomy is standard for recurrence of breast cancer after breast conservation therapy with whole breast irradiation. The emergence of partial breast irradiation led to consideration of its application for reirradiation after a second lumpectomy for treatment of recurrence of breast cancer in the ipsilateral breast.OBJECTIVES To assess the effectiveness and adverse effects of partial breast reirradiation after a second lumpectomy and whether the treatment is an acceptable alternative to mastectomy. DESIGN, SETTING, AND PARTICIPANTSThe NRG Oncology/Radiation Therapy Oncology Group 1014 trial is a phase 2, single-arm, prospective clinical trial of 3-dimensional, conformal, external beam partial breast reirradiation after a second lumpectomy for recurrence of breast cancer in the ipsilateral breast after previous whole breast irradiation. The study opened on June 4, 2010, and closed June 18, 2013. Median follow-up was 5.5 years. This analysis used all data received at NRG Oncology through November 18, 2018. Eligible patients experienced a recurrence of breast tumor that was less than 3 cm and unifocal in the ipsilateral breast more than 1 year after breast-conserving therapy with whole breast irradiation and who had undergone excision with negative margins.INTERVENTIONS Adjuvant partial breast reirradiation, 1.5 Gy twice daily for 30 treatments during 15 days (45 Gy), using a 3-dimensional conformal technique. MAIN OUTCOMES AND MEASURESThe main outcomes of the present study were the predefined secondary study objectives of recurrence of breast cancer in the ipsilateral breast, late adverse events (>1 year after treatment), mastectomy incidence, distant metastasis-free survival, overall survival, and circulating tumor cell incidence.RESULTS A total of 65 women were enrolled, with 58 evaluable for analysis (mean [SD] age, 65.12 [9.95] years; 48 [83%] white). Of the recurrences of breast cancer in the ipsilateral breast, 23 (40%) were noninvasive and 35 (60%) were invasive. In all 58 patients, 53 (91%) had tumors 2 cm or smaller. All tumors were clinically node negative. A total of 44 patients (76%) tested positive for estrogen receptor, 33 (57%) for progesterone receptor, and 10 (17%) for ERBB2 (formerly HER2 or HER2/neu) overexpression. Four patients had breast cancer recurrence, with a 5-year cumulative incidence of 5% (95% CI, 1%-13%). Seven patients underwent ipsilateral mastectomies for a 5-year cumulative incidence of 10% (95% CI, 4%-20%). Both distant metastasis-free survival and overall survival rates were 95% (95% CI, 85%-98%). Four patients (7%) had grade 3 and none had grade 4 or higher late treatment adverse events. CONCLUSIONS AND RELEVANCEFor patients experiencing recurrence of breast cancer in the ipsilateral breast after lumpectomy and whole breast irradiation, a second breast conservation was achievable in 90%, with a low risk of re-recurrence of cancer in the ipsilateral breast using adjuvant partial breast reirradiation. This finding suggests that this treatment approach is an effecti...

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Local recurrence after breast conservation therapy for early stage breast carcinoma

Voogd

Tienhoven

Peterse

et al. 1999

Cancer

151

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BACKGROUND Controversy exists concerning the roles of mammography and physical examination in the detection of local recurrence after conservation therapy for breast carcinoma. In addition, the prognostic factors for and optimal treatment of patients with local recurrence are uncertain. METHODS At eight radiotherapy institutes, two cancer institutes, and one surgical clinic in the Netherlands, regular follow‐up of patients who underwent breast conservation therapy between 1980 and 1992 identified 266 patients with local recurrence in the breast. These patients exhibited no clinical signs of distant metastases at the time of diagnosis of the local recurrence. Data on the method of detection were available for 189 patients (72%). Local recurrence was diagnosed by mammography alone in 47 cases (25%). Of all patients, 85% underwent salvage mastectomy, 8% underwent local excision, 4% received systemic treatment only, and 3% remained untreated. Specimens of the primary tumor were available for review from 238 of the 266 patients (89%). RESULTS Local recurrences detected by mammography alone were smaller than those detected by physical examination (P = 0.04). At 5 years from the date of salvage treatment, the overall survival rate for all 266 patients was 61% (95% confidence interval [CI], 55–67%), and the distant recurrence free survival rate was 47% (95% CI, 40–53%). For the 25 patients with noninvasive recurrence, these figures were 95% and 94%, respectively. Skin involvement, the extent of recurrence (≤10 mm vs. >10 mm), and both lymph node status and histologic grade of the primary disease were strong predictors for distant metastases in patients with invasive recurrence. CONCLUSIONS Patients with invasive local recurrence more than 1 cm in size are at a substantial risk for distant disease. The better distant disease free survival for patients with recurrence measuring 1 cm or less may indicate that early detection can improve the treatment outcome. Recurrence with skin involvement should be considered generalized disease. Cancer 1999;85:437–46. © 1999 American Cancer Society.

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Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer.

Cited by 179 publications

References 0 publications

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast

Local recurrence after breast conservation therapy for early stage breast carcinoma

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