Ipsilateral Breast Cancer Recurrence: Characteristics, Treatment, and Long-Term Oncologic Results at a High-Volume Center

Up to 10% of patients treated with breast-conserving surgery (BCS) will develop an ipsilateral breast cancer recurrence (IBCR). Salvage mastectomy is considered the treatment of choice for IBCR, even if a second BCS is feasible. IBCR patients undergoing mastectomy have a significantly worse survival compared to second BCS. Repeat BCS can still be evaluated and proposed to IBCR patients. Introduction: Salvage mastectomy is considered the treatment of choice for ipsilateral breast cancer recurrence (IBCR), even if a second breast-conserving surgery (BCS) is feasible. The purpose of this study was to describe the characteristics of IBCR patients, to compare the 2 therapeutic options in terms of long-term outcomes, and to identify independent factors that may predict the type of treatment. Patients and Methods: A total of 309 IBCR patients who underwent either repeat BCS or mastectomy were identified. All the analyzed patients with IBCR had true recurrence. Results: Repeat BCS and salvage mastectomy were performed in 143 and 166 patients, respectively. Age < 65 years (59.6% vs 37.1% if age >= 65 years; odds ratio, 2.374; 95% confidence interval, 0.92-5.24; P=.018) and disease-free interval < 24 months (15.7% vs 10.5% if disease-free interval >= 24 months; odds ratio, 2.705; 95% confidence interval, 1.42-5.97; P=.007) were found to significantly increase the probability of receipt of mastectomy. Disease-free survival rates at 3, 5, and 10 years were 79.2%, 68.2%, and 36.9%; and 77.2%, 65.9%, and 55.3% in patients receiving repeat BCS or mastectomy, respectively (P=.842). Overall survival rates at 3, 5, and 10 years were 95.4%, 91.4%, and 68.5%; and 87.3%, 69.3%, and 57.9%, respectively, in patients receiving repeat BCS or mastectomy (P=.018). Conclusion: Salvage mastectomy should not be considered the only treatment option for IBCR. A second BCS can still be evaluated and proposed to IBCR patients, with acceptable locoregional control and survival. The risk of poor long-term prognosis after mastectomy should be shared with the patient. (C) 2020 Elsevier Inc. All rights reserved.