title: The impact of re-excision and residual disease on local recurrence after breast conservation treatment for patients with early stage breast cancer.
abstract: The current study examined the impact of re-excision and residual disease on local recurrence after breast conservation treatment for patients with negative margins. Patients with residual disease on re-excision had a higher local recurrence rate than other patients. However, with reasonably low local recurrence rates in all subgroups, neither re-excision nor residual disease on re-excision are contraindications for breast conservation treatment.
  
  
  OBJECTIVE
  To evaluate the impact of re-excision and the presence of residual disease on local recurrence for patients who underwent breast conservation treatment (BCT) with negative final resection margins.
  
  
  METHODS
  The records of 902 patients with stage I or II unilateral invasive breast cancer who had BCT were reviewed. The study cohort consisted of patients with negative final resection margins and was divided into 3 subgroups: (a) single excision (n = 332 [37%]), (b) re-excision with no residual disease in the re-excision specimen (n = 440 [49%]), and (c) re-excision with residual disease in the re-excision specimen (n = 130 [14%]). The median follow-up was 6.75 years.
  
  
  RESULTS
  At 15 years, the rates of local failure were 10% for patients with a single excision, 10% for patients with a re-excision without residual disease, and 16% for patients with a re-excision with residual disease (P = .033). There were no significant differences between the 3 groups for overall survival, cause-specific survival, relapse-free survival, or freedom from distant metastases (all P ≥ .082). Multivariate analysis demonstrated an increased risk of local failure for patients with residual disease in the re-excision specimen that was borderline statistically significant (hazard ratio, 2.16; P = .061).
  
  
  CONCLUSIONS
  Despite achieving negative final resection margins, the patients with residual disease in the re-excision specimen had a higher rate of local recurrence than patients who underwent single excision or patients without residual disease on re-excision. However, local recurrence was reasonably low in all 3 subgroups, and, therefore, neither re-excision nor residual disease represent contraindications for BCT.
authors: Department of Radiation Oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors: Ahmed N
authors: AN
authors: Ali
authors: Neha
authors: N
authors: Vapiwala
authors: Mengye
authors: M
authors: Guo
authors: Wei-Ting
authors: WT
authors: Hwang
authors: Eleanor E
authors: EE
authors: Harris
authors: Lawrence J
authors: LJ
authors: Solin
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010414:Pennsylvania; D012086:Reoperation; D016896:Treatment Outcome