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Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy

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Abstract

Background

Breast conservation therapy (BCT) is well established for the management of primary operable breast cancer, with oncologic outcomes comparable to those of mastectomy. It remains unclear whether re-conservation therapy (RCT) is suitable for those patients who develop ipsilateral breast tumor recurrence (IBTR), for whom mastectomy is generally recommended.

Methods

We identified women who underwent BCT for invasive or ductal carcinoma in situ and developed IBTR as a first event, comparing the pattern of subsequent events and survival for those treated by RCT versus mastectomy.

Results

Of 16,968 patents who had BCT, 322 (1.9%) developed an isolated IBTR as a first event between 1999 and 2019. 130 (40%) had RCT and 192 (60%) mastectomy. Compared to mastectomy, the RCT patients were older (66 vs 53, < 0.001), had a longer disease-free interval (DFI: 5.8 vs 2.7 years (p < 0.001)), were less likely to have received RT (p < 0.001), endocrine therapy (ET) (p < 0.005) or combined RT/ET (< 0.001) as initial treatment, but the characteristics of their initial primary cancers and of their IBTR were comparable. At a median follow-up of 10.7 years following initial BCT and 6.5 years following IBTR, there were no differences in BCSS or OS between RCT and mastectomy.

Conclusion

For BCT patients who developed IBTR as a first event, we observed comparable BCSS and OS from time of initial treatment and from time of IBTR, whether treated by RCT or mastectomy. These results support wider consideration of RCT in the management of IBTR, especially in the setting of older age and longer DFI.

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Funding

The preparation of this manuscript was supported in part by NIH/NCI Cancer Center Support Grant No. P30CA008748 to Memorial Sloan Kettering Cancer Center.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Astrid Botty Van den Bruele, Tiana Le, Monica Morrow & Hiram S. Cody III

  2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Ishita Chen & Lior Z. Braunstein

  3. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 300 East 66th St, New York, NY, 10065, USA

    Varadan Sevilimedu

Authors
  1. Astrid Botty Van den Bruele
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  2. Ishita Chen
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  3. Varadan Sevilimedu
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  4. Tiana Le
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  5. Monica Morrow
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  6. Lior Z. Braunstein
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  7. Hiram S. Cody III
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Corresponding author

Correspondence to Hiram S. Cody III.

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Conflict of interest

Monica Morrow has received speaker honoraria from Genomic Health. All remaining authors (Botty, Chen, Sevilimedu, Le, Braunstein, and Cody) declare no conflicts of interest.

Ethical approval

This is a retrospective cohort study conducted under IRB approval and does not contain any studies with human participants or animals performed by any of the authors.

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Van den Bruele, A.B., Chen, I., Sevilimedu, V. et al. Management of ipsilateral breast tumor recurrence following breast conservation surgery: a comparative study of re-conservation vs mastectomy. Breast Cancer Res Treat 187, 105–112 (2021). https://doi.org/10.1007/s10549-020-06080-9

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  • DOI: https://doi.org/10.1007/s10549-020-06080-9

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