Omitting re-excision for focally positive margins after breast-conserving surgery does not impair disease-free and overall survival

Elvira L. Vos, Sabine Siesling, Margreet H. A. Baaijens, Cornelis Verhoef, Agnes Jager, Adri C. Voogd, Linetta B. Koppert*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

27 Citations (Web of Science)

Abstract

Purpose In contrast to other countries, the Dutch breast cancer guideline does not recommend re-excision for focally positive margins after breast-conserving surgery (BCS) in invasive tumor and does recommend whole-breast irradiation including boost. We investigated whether omitting re-excision as compared to performing re-excision affects prognosis with a retrospective population-based cohort study.

Methods The total cohort included 32,119 women with primary BCS for T1-T3 breast cancer diagnosed between 2003 and 2008 from the nationwide Netherlands cancer registry. The subcohort included 10,433 patients in whom the resection margins were registered. Outcome measures were 5-year ipsilateral breast tumor recurrence (IBTR) rate, 5-year disease-free survival (DFS) rate, and 10-year overall survival (OS) rate.

Results In the total cohort, 25,878 (80.6%) did not have re-excision, 2368 (7.4%) had re-excision by BCS, and 3873 (12.1%) had re-excision by mastectomy. Five-year IBTR rates were 2.1, 2.8, and 2.9%, respectively (p = 0.001). In the subcohort, 7820 (75.0%) had negative margins without re-excision, 492 (4.7%) had focally positive margins without re-excision, 586 (5.6%) had focally positive margins and underwent re-excision, and 1535 (14.7%) had extensively positive margins and underwent re-excision. Five-year IBTR rate was 2.3, 2.9, 1.1, and 2.9%, respectively (p = 0.099). Compared to omitting re-excision, performing re-excision for focally positive margins was associated with lower risk of IBTR (adjusted HR 0.30, 95% CI 0.11-0.82), but not with DFS (adjusted HR 0.83 95% CI 0.59-1.17) nor with OS (adjusted HR 1.17 95% CI 0.87-1.59).

Conclusion Omitting re-excision in breast cancer patients for focally positive margins after BCS does not impair DFS and OS, provided that whole-breast irradiation including boost is given.

Original languageEnglish
Pages (from-to)157-167
Number of pages11
JournalBreast Cancer Research and Treatment
Volume164
Issue number1
DOIs
Publication statusPublished - Jul 2017

Keywords

  • Breast-conserving surgery
  • Resection margins
  • Re-excision
  • Re-operation
  • Ipsilateral breast tumor recurrence
  • Disease-free survival
  • Overall survival
  • POPULATION-BASED COHORT
  • NO BOOST TRIAL
  • LOCAL RECURRENCE
  • RADIATION-THERAPY
  • CONSENSUS GUIDELINE
  • SURGICAL MARGINS
  • EORTC BOOST
  • FOLLOW-UP
  • CANCER
  • IRRADIATION

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