title: Surgical management of ipsilateral breast tumor recurrence.
abstract: OBJECTIVE
  Approximately 10-15% of breast cancer patients treated by breast conserving surgery (BCS) and adjuvant radiotherapy (RT) will develop ipsilateral breast tumor recurrence (IBTR). International guidelines suggest total mastectomy as treatment of choice for IBTR following lumpectomy and RT. Nevertheless, there is evidence that second BCS might be equally sufficient.
  
  
  METHODS
  Patients with IBTR diagnosed between 1990 and 2014 after BCS and RT were included (n = 170). 34.1% women underwent secondary BCS, whereas 65.9% were treated by mastectomy. We determined predictive factors for time to local progression (TTP), disease free survival (DFS), and overall survival (OS) comparing these two groups.
  
  
  RESULTS
  Median follow-up after primary IBTR was 49 months (59 months for patients still alive at time of analysis). Five-year IBTR-free rate after secondary BCS was 77.6% (SD ± 6.1%) and 75.0% (SD ± 4.5%) for patients after mastectomy. Five-year DFS was 57.3% (SD ± 8.2%), and 61.9% (SD ± 5.5%), five-year OS was 84.7% (SD ± 5.8%), and 72.6% (SD ± 5.1%), respectively. Prior adjuvant systemic therapy, muscular invasion, and skin infiltration were independent significant risk factors for a shorter TTP. Additionally, lymphovascular infiltration (LVI) in the IBTR increased the risk for a shorter DFS. LVI, muscular invasion, and skin infiltration were identified as independent significant risk factors for a shorter OS.
  
  
  CONCLUSIONS
  No significant difference in local control, DFS, and OS was seen between IBTR patients treated either by secondary BCS or mastectomy. Our data suggest that secondary BCS for IBTR patients after initial BCS and RT is feasible in selected patients.
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany. Electronic address: thomas.kolben@med.uni-muenchen.de.
authors.forename: T
authors.initials: T
authors.lastname: Kolben
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: T M
authors.initials: TM
authors.lastname: Schwarz
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Goess
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Blume
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Degenhardt
authors.affiliation: Munich Cancer Registry (MCR) of the Munich Cancer Center (MCC), Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Engel
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Wuerstlein
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Ditsch
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Harbeck
authors.affiliation: Breast Center, Department for Obstetrics and Gynecology and Comprehensive Cancer Center of LMU, University Hospital Munich - Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kahlert
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Breast cancer; Breast conserving therapy; Ipsilateral breast recurrence; Mastectomy; Surgery