Surgical management of ipsilateral breast tumour recurrence after breast conserving therapy: mastectomy or further local excision?

Abstract

Introduction. The overall risk of ipsilateral breast tumour recurrence (IBRT) following breast conserving therapy (BCT) ranges from 2% to 35%. Total mastectomy is uniformly recommend for IBRT following BCT. However evidence released recently suggests that there may be a change in clinical practice in the near future.

Material and methods. The Pubmed database for 1990–2013 was searched and we included articles on IBRT forearly breast cancer patients after breast conserving therapy. Only selected articles, published in English or German, were reviewed.

Results. The risk of IBRT after BCT in the last three decades gradually decreased from 10–15% to a few percent. Local excision of IBRT is not associated with higher risk of second local recurrence, when compared to “salvage” total stectomy (7–32% vs 4–32%). Local excision of IBRT with re-irradiation brings promising results. In recent studies the risk of a second IBRT in re-excised and re-irradiated cases ranged from 0% to 3% and is this not worse when compared to the currently reported risk of first IBRT following breast conservation.

Conclusions. This review shows that clinical practice is to perform (apart from widely recommended total mastectomy) also local excision of IBRT following BCT. In recent years re-irradiation is more commonly used. The risk of second IBRT does not seem to be higher than the local recurrence risk following “salvage” total mastectomy. Local excision of IBRT appears to be particularly promising in small, late and hormonal receptors showing positive IBRT. Treatment for IBRT needs to be verified in properly designed prospective comparative studies.