title: Repeating conservative surgery after ipsilateral breast tumor reappearance: criteria for selecting the best candidates.
abstract: BACKGROUND
  Mastectomy is still considered the treatment of first choice in patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and whole-breast radiotherapy.
  
  
  METHODS
  We retrospectively evaluated 161 patients with invasive IBTR who underwent a second BCS in order to describe prognosis, determine predictive factors of outcome, and select the subset of patients with the best local control. Median follow-up after IBTR was 81 months.
  
  
  RESULTS
  Median age at IBTR was 53 years. Five-year overall survival after IBTR was 84 % (95 % confidence interval [CI] 78-89). Five-year cumulative incidence of a second local event after IBTR was 29 % (95 % CI 22-37). At the multivariate analysis, IBTR size >2 cm and time to relapse ≤48 months significantly increased the risk of local reappearance (hazard ratio [HR] 3.3, 95 % CI 1.6-7.0; and HR 1.9, 95 % CI 1.1-3.5). The 5-year cumulative incidence of a further local reappearance of the tumor after repeating BCS was 15.2 % in the patients with IBTR ≤2 cm and time to IBTR >48 months, 31.2 % in the patients with IBTR ≤2 cm and time to IBTR ≤48 months, and 71.2 % in patients with IBTR >2 cm (P < 0.001).
  
  
  CONCLUSIONS
  The best candidates for a second BCS are those with small (≤2 cm) and late (>48 months) IBTR. The information about the risk of a further local reappearance after repeating BCS should be shared with the patients in the decision making process.
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: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.forename: Claudia
authors.initials: C
authors.lastname: Sangalli
authors.forename: Andres
authors.initials: A
authors.lastname: Del Castillo
authors.forename: Bettina
authors.initials: B
authors.lastname: Ballardini
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
authors.forename: Marco
authors.initials: M
authors.lastname: Colleoni
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors