TY - JOUR
T1 - Repeat breast-conserving therapy for ipsilateral breast cancer recurrence
T2 - A systematic review
AU - Walstra, Coco J. E. F.
AU - Schipper, Robert-Jan
AU - Poodt, Ingrid G. M.
AU - van Riet, Yvonne E.
AU - Voogd, Adri C.
AU - van der Sangen, Maurice J. C.
AU - Nieuwenhuijzen, Grard A. P.
N1 - Publisher Copyright:
© 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2019/8
Y1 - 2019/8
N2 - The standard of care for patients with an ipsilateral breast tumour recurrence (IBTR) after breast-conserving therapy (BCT) is a salvage mastectomy. However, there is growing interest in the feasibility of repeat BCT for these patients. This systematic review contains the latest insights on BCT options for patients with an IBTR after initial BCT.A PubMed literature search was performed for articles on BCT options for IBTR after primary lumpectomy followed by radiotherapy. Weighted estimates were calculated for 5- and 10-year local control, distant metastasis-free and overall survival rates. Secondary outcomes were toxicity, cosmesis and quality of life.In total, 34 studies were eligible for analysis, of which 5 reported on repeat breast-conserving surgery (BCS) alone, 10 with mixed populations (BCS +/- RT and/or mastectomy), 18 on repeat BCS followed by re irradiation (whole-breast or partial) and one on quality of life. The weighted estimates for 5-year overall survival for repeat BCS and repeat BCS followed by reirradiation were 77% and 87%, respectively. Five-year local control was 76% for repeat BCS alone and 89% for repeat BCS followed by re-irradiation. Grade III-IV toxicity rates after re-irradiation varied from 0 to 21%, whereas the cosmesis was excellent-good in 29-100% of patients and unacceptable in 0-18%.Repeat BCS followed by re-irradiation, with either whole breast or partial breast re-irradiation, seems a feasible alternative to mastectomy in case of IBTR, in selected patients. Toxicity rates are low and the cosmetic outcome is good, but the size and follow-up of the published patient series is limited. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
AB - The standard of care for patients with an ipsilateral breast tumour recurrence (IBTR) after breast-conserving therapy (BCT) is a salvage mastectomy. However, there is growing interest in the feasibility of repeat BCT for these patients. This systematic review contains the latest insights on BCT options for patients with an IBTR after initial BCT.A PubMed literature search was performed for articles on BCT options for IBTR after primary lumpectomy followed by radiotherapy. Weighted estimates were calculated for 5- and 10-year local control, distant metastasis-free and overall survival rates. Secondary outcomes were toxicity, cosmesis and quality of life.In total, 34 studies were eligible for analysis, of which 5 reported on repeat breast-conserving surgery (BCS) alone, 10 with mixed populations (BCS +/- RT and/or mastectomy), 18 on repeat BCS followed by re irradiation (whole-breast or partial) and one on quality of life. The weighted estimates for 5-year overall survival for repeat BCS and repeat BCS followed by reirradiation were 77% and 87%, respectively. Five-year local control was 76% for repeat BCS alone and 89% for repeat BCS followed by re-irradiation. Grade III-IV toxicity rates after re-irradiation varied from 0 to 21%, whereas the cosmesis was excellent-good in 29-100% of patients and unacceptable in 0-18%.Repeat BCS followed by re-irradiation, with either whole breast or partial breast re-irradiation, seems a feasible alternative to mastectomy in case of IBTR, in selected patients. Toxicity rates are low and the cosmetic outcome is good, but the size and follow-up of the published patient series is limited. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
KW - IBTR
KW - Recurrent breast cancer
KW - Breast-conserving therapy
KW - Repeat breast-conserving therapy
KW - Repeat breast irradiation
KW - QUALITY-OF-LIFE
KW - TERM-FOLLOW-UP
KW - 2ND CONSERVATIVE TREATMENT
KW - TUMOR RECURRENCE
KW - LOCAL RECURRENCE
KW - INTRAOPERATIVE RADIOTHERAPY
KW - RADIATION-THERAPY
KW - WHOLE-BREAST
KW - LOCOREGIONAL RECURRENCE
KW - SALVAGE MASTECTOMY
U2 - 10.1016/j.ejso.2019.02.008
DO - 10.1016/j.ejso.2019.02.008
M3 - (Systematic) Review article
SN - 0748-7983
VL - 45
SP - 1317
EP - 1327
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 8
ER -