title: Ipsilateral breast tumor reappearance in patients treated with conservative surgery after primary chemotherapy. The role of surgical margins on outcome.
abstract: OBJECTIVE
  To evaluate the ipsilateral breast tumor reappearance (IBTR) rate after breast conservative surgery (BCS) following primary chemotherapy (PC) and to assess whether positive margins affects IBTR rate and overall survival (OS).
  
  
  METHODS
  Three hundred nine women candidates for mastectomy received PC before surgery. One hundred ninety-five patients (63.1%) underwent BCS and 114 patients (36.9%) a modified radical mastectomy.
  
  
  RESULTS
  After a median follow-up of 41 months (range 7-90), 13 patients of the 195 treated with BCS had an IBTR (6.7%), 6 patients had a regional relapse (3.1%), 28 women had distant metastases (14.4%). Twenty-three patients died of breast cancer (11.8%). Twenty-four patients treated with BCS had positive margins (12.3%). At 3 years, the crude cumulative incidence of local recurrence was 4.7% in women with negative margins, and 13.3% in women with positive margins (P=0.05). Cumulative incidence of distant metastases was similar in patients with positive and negative margins (P=0.16) and there was no significant difference in terms of OS according to the margin status (P=0.577).
  
  
  CONCLUSIONS
  BCS after PC has an acceptable rate of IBTR. After a short follow-up, the presence of positive margins does not affect OS.
authors.affiliation: Division of Breast Surgery, European Institute of Oncology, Milan, Italy. oreste.gentilini@ieo.it
authors.forename: Oreste
authors.initials: O
authors.lastname: Gentilini
authors.forename: Mattia
authors.initials: M
authors.lastname: Intra
authors.forename: Sara
authors.initials: S
authors.lastname: Gandini
authors.forename: Giulia
authors.initials: G
authors.lastname: Peruzzotti
authors.forename: Erik
authors.initials: E
authors.lastname: Winnikow
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D005472:Fluorouracil