title: Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome.
abstract: BACKGROUND
  In the case of ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS), a second conservative surgical approach maybe considered in some motivated patients whereas in others mastectomy is unavoidable.
  
  
  METHODS
  From 1997 to 2004, 282 patients presented at the European Institute of Oncology with an operable invasive IBTR after BCS. One hundred and sixty-one (57%) underwent a second conservative surgery, whereas 121 patients (43%) were given a mastectomy and represent the study population. We investigated the prognosis and determined predictive factors of outcome.
  
  
  RESULTS
  Median time from primary breast cancer to IBTR was 41 months (range 5-213). Recurrences were T2-T4 and/or multifocal in 83 cases (68.6%). With a median follow-up of 5 years after mastectomy, 5-year overall survival (OS) and disease-free survival (DFS) were 73.3% [95% confidence interval (CI) 65.0% to 81.6%] and 50.4% (95% CI 40.9% to 59.8%), respectively. At the multivariate analysis, early onset of IBTR, presence of vascular invasion and Ki67 >or=20 of the recurrent tumour were found to significantly affect both DFS and OS.
  
  
  CONCLUSIONS
  In women who need mastectomy for IBTR, early onset of the relapse, high proliferation index and presence of vascular invasion represent the worst prognostic factors.
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy. edoardo.botteri@ieo.it
authors.forename: E
authors.initials: E
authors.lastname: Botteri
authors.forename: N
authors.initials: N
authors.lastname: Rotmensz
authors.forename: C
authors.initials: C
authors.lastname: Sangalli
authors.forename: A
authors.initials: A
authors.lastname: Toesca
authors.forename: N
authors.initials: N
authors.lastname: Peradze
authors.forename: H R
authors.initials: HR
authors.lastname: De Oliveira Filho
authors.forename: A
authors.initials: A
authors.lastname: Sagona
authors.forename: M
authors.initials: M
authors.lastname: Intra
authors.forename: P
authors.initials: P
authors.lastname: Veronesi
authors.forename: V
authors.initials: V
authors.lastname: Galimberti
authors.forename: A
authors.initials: A
authors.lastname: Luini
authors.forename: U
authors.initials: U
authors.lastname: Veronesi
authors.forename: O
authors.initials: O
authors.lastname: Gentilini
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome