Repeat conservative breast surgery for patients with breast cancer recurring in the same breast

The aim of this study was to establish the criteria for selecting the best candidates to receive a second breast–conserving surgery (BCS) after ipsilateral breast tumor recurrence (IBTR- reappearance of a breast tumor on the same side).  

Some patients with primary breast cancer who receive BCS and radiotherapy will develop IBTR. In these patients, mastectomy (removal of the entire breast) is still considered the treatment of choice. This study tried to establish criteria for the selection of patients who may benefit from a repeat BCS.  

The study included 314 patients with operable IBTR. For the primary cancer, all the patients were treated with BCS followed by radiotherapy. 161 of the patients had a second conservative surgery, without subsequent radiotherapy. Participants were followed up for 4-164 months after surgery.

The median age at IBTR was 53 years (ranged between <35 to >60); 64% of the patients received chemotherapy for the secondary cancer (IBTR); 9.3% were given hormonal plus chemotherapy; 19.9% received only hormonal therapy and 6.8% had no systemic therapy at all. The rate of survival, measured 5 years after IBTR treatment, was 84%.

Women with larger IBTR (size > 2 cm) that occurred within 48 months after initial surgery had significantly increased risk of a further local reappearance of the tumor (71%)after repeating BCS. On the other hand, patients with smaller (size < 2 cm) IBTR occurring later (at least 49 months after the initial BCS) had about 15% chances of developing another local tumor.

Some patients with IBTR are interested in breast preservation and are opposed to mastectomy, which still represent the standard of care. This study found that patients with a recurrent tumor smaller than 2 cm which occurred at least 48 months after the primary cancer represent the best candidates for repeating conservative surgery.

The main limitation of this study is the selection of patients. Out of 314 patients, 161 received a second BCS mainly because of more favorable presentation, therefore representing a subgroup of patients with the theoretically best-estimated prognosis. The authors do not specify how many patients in each group received systemic therapies after surgery. The process of patient selection to recurrent BCS could improve if relying on MRI (magnetic resonance imaging) breast scans performed before surgery. Only a few of the study patients received MRI mainly because they were diagnosed in the pre-MRI era.