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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2012

01-11-2012 | Breast Oncology

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

Authors: Oreste Gentilini, MD, Edoardo Botteri, MSc, Paolo Veronesi, MD, Claudia Sangalli, MSc, Andres Del Castillo, MD, Bettina Ballardini, MD, Viviana Galimberti, MD, Mario Rietjens, MD, Marco Colleoni, MD, Alberto Luini, MD, Umberto Veronesi, MD

Published in: Annals of Surgical Oncology | Issue 12/2012

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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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Metadata
Title
Repeating Conservative Surgery after Ipsilateral Breast Tumor Reappearance: Criteria for Selecting the Best Candidates
Authors
Oreste Gentilini, MD
Edoardo Botteri, MSc
Paolo Veronesi, MD
Claudia Sangalli, MSc
Andres Del Castillo, MD
Bettina Ballardini, MD
Viviana Galimberti, MD
Mario Rietjens, MD
Marco Colleoni, MD
Alberto Luini, MD
Umberto Veronesi, MD
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 12/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2404-5

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