title: When can a second conservative approach be considered for ipsilateral breast tumour recurrence?
abstract: BACKGROUND
  Mastectomy is considered the treatment of choice in patients with ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS).
  
  
  METHODS
  One hundred and sixty-one patients with invasive IBTR who underwent a second conservative approach were retrospectively evaluated in order to describe prognosis, determine predictive factors of outcome and select the subset of patients with the best local control.
  
  
  RESULTS
  Fifty-seven patients (35.4%) relapsed after IBTR. Thirty-four patients (21.1%) had further in-breast recurrences and four patients (2.5%) had skin relapses. Five years cumulative incidence of local relapse was 31.4%. Twenty-four patients (17.8%, 5 years cumulative incidence) died during the follow-up. At the multivariate analysis, recurrent tumour size >2 cm was found to affect local-disease-free survival [hazard ratio (HR): 2.8, 95% confidence interval (CI) 1.2-6.2], whereas Ki-67 >or=20% and time to relapse <or=48 months were associated with disease-free survival (HR: 1.7, 95% CI 1.0-3.1, and HR: 2.1, 95% CI 1.2-3.6, respectively). Absence of oestrogen receptors affected overall survival (HR: 2.5, 95% CI 1.1-6.0). Among 64 patients with recurrent tumour <or=2 cm and time to IBTR >48 months, eight (12.8%, 5 years cumulative incidence) had further local relapses.
  
  
  CONCLUSIONS
  Some patients with IBTR might receive a second BCS, especially when a good local control can be estimated (small recurrent tumour, late relapse), also taking into account patients' preference.
authors.affiliation: Division of Breast Surgery, European Institute of Oncology, Milan, Italy. oreste.gentilini@ieo.it
authors.forename: O
authors.initials: O
authors.lastname: Gentilini
authors.forename: E
authors.initials: E
authors.lastname: Botteri
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.forename: B
authors.initials: B
authors.lastname: Santillo
authors.forename: N
authors.initials: N
authors.lastname: Peradze
authors.forename: R C
authors.initials: RC
authors.lastname: Saihum
authors.forename: M
authors.initials: M
authors.lastname: Intra
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: A
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: U
authors.initials: U
authors.lastname: Veronesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018579:Patient Selection; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome