Whatever true recurrence or new primary consideration, the standard treatment of a
2nd ipsilateral breast tumor event (IBTE) remains salvage radical mastectomy. Why?
Because we always did that! What is the real level of evidence supporting this treatment
strategy? It is very low! It is interesting to note retrospectively that, at the time
of promotion of radio-surgical breast conservative approach for the primary in place
of radical mastectomy in the 1980's,
1
,
2
other teams already thought to propose the same strategy in case of a 2nd IBTE.
3
Why was avoiding the radical disfiguring aspect and psychological consequences of
mastectomy a key point for primary treatment but not considered as well for 2nd IBTE?
For almost 40 years, breast conservative strategies for 2nd IBTE were reported, based
on lumpectomy alone or lumpectomy plus re-irradiation of the tumor bed. According
to those results, it is remarkable to consider that the rate of a 3rd IBTE after salvage
lumpectomy is about 20% while after a 2nd radio-surgical breast treatment this rate
remained below 10% and similar to the results obtained after salvage mastectomy (SM).
4
More recently, data published by the Breast Cancer Working Group of GEC-ESTRO demonstrated
a 5-year rate of 3rd IBTE after 2nd conservative treatment (CT) combining lumpectomy
plus re-irradiation with interstitial multicatheter brachytherapy of approximately
5%.
5
This is more or less the same result after conservative radio-surgical approach for
de-novo tumors.- Hannoun-Levi J.M.
- Resch A.
- Gal J.
- et al.
GEC-ESTRO Breast Cancer Working Group
Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO Breast Cancer Working Group.
Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO Breast Cancer Working Group.
Radiother Oncol. 2013; 108: 226-231
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast.N Engl J Med. 1981; 305: 6-11
- Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.N Engl J Med. 1985; 312: 665-673
- Results of salvage surgery for mammary recurrence following breast-conserving therapy.Ann Surg. 1988; 207: 347-351
- Local treatment options for ipsilateral breast tumour recurrence.Cancer Treat Rev. 2013; 39: 737-741
- Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO Breast Cancer Working Group.Radiother Oncol. 2013; 108: 226-231
- Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.N Engl J Med. 2002; 347: 1227-1232
- Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial.JAMA. 2011; 305: 569-575
- Managing a small recurrence in the previously irradiated breast: is there a second chance for breast conservation?.Oncology (Williston Park). 2009; 23: 933-940
- Salvage radiotherapy for local failures of lumpectomy and breast irradiation.Radiother Oncol. 1997; 42: 25-29
- Mature follow-up of low dose rate brachytherapy following ipsilateral breast tumor recurrence in patients initially treated with breast conservation therapy.J Solid Tumors. 2012; 2: 8-15
Article info
Publication history
Published online: December 17, 2016
Accepted:
November 28,
2016
Identification
Copyright
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
