title: Local treatment options for ipsilateral breast tumour recurrence.
abstract: OBJECTIVE
  In case of ipsilateral breast tumour recurrence (IBTR), radical mastectomy represents the treatment option frequently proposed. A second conservative treatment (2ndCT) has been proposed using either lumpectomy alone or associated with a re-irradiation of the tumor bed. However, in both clinical situations, the proof level of such therapeutic approaches remains low, based on cased-series or retrospective studies (level C).
  
  
  METHODS
  In order to assess the different strategies of local treatment proposed in case of IBTR, a PubMed literature review was performed using the following keywords: breast cancer, ipsilateral recurrence, mastectomy, radiation therapy, brachytherapy. Four different salvage options were analyzed: (a) salvage mastectomy alone; (b) salvage mastectomy with postoperative re-irradiation; (c) 2ndCT with surgery alone; (d) 2ndCT with re-irradiation.
  
  
  RESULTS
  The rate of second local recurrence is about 10% [3-32%], about 25% [7-36%] and about 10% [2-26%], after salvage mastectomy, salvage lumpectomy alone or combined with a re-irradiation of the tumor bed respectively. However, the 5-year overall survival rates after salvage mastectomy and 2ndCT seem to be equivalent (≈75%) mainly influenced by distant metastatic progression.
  
  
  CONCLUSIONS
  In terms of Evidence Based Medicine, different options can be discussed such as Phase III or II randomized trials comparing salvage mastectomy versus 2ndCT, retrospective studies based on a matched-pair analysis or observatory studies. Those study designs need to be carefully analyzed to be able to propose new treatment options for women who experience an IBCR.
authors: Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, France. jean-michel.hannoun-levi@nice.unicancer.fr
authors: Jean-Michel
authors: JM
authors: Hannoun-Levi
authors: Tarik
authors: T
authors: Ihrai
authors: Adel
authors: A
authors: Courdi
mesh_terms: D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015409:Mastectomy, Radical; D015412:Mastectomy, Segmental; D012008:Recurrence; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Breast cancer; Conservative treatment; Local recurrence