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A Systematic Review and Meta-Analysis on the Role of Repeat Breast-Conserving Surgery for the Management of Ipsilateral Breast Cancer Recurrence

Tollan, C.J.; Pantiora, E.; Valachis, A.; Karakatsanis, A.; Tasoulis, M.K.

Annals of Surgical Oncology 29(10): 6440-6453

2022

ISSN/ISBN: 1534-4681
PMID: 35849299
Accession: 080117731

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Summary
The standard surgical management of ipsilateral breast cancer recurrence (IBCR) in patients previously treated with breast-conserving surgery (BCS) and radiotherapy (RT) is mastectomy. Recent international guidelines provide conflicting recommendations. The aim of this study was to perform a systematic literature review and meta-analysis of the oncological outcomes in patients with IBCR treated with repeat BCS (rBCS). The MEDLINE and EMBASE databases were searched for relevant English-language publications, with no date restrictions. All relevant studies providing sufficient data to assess oncological outcomes (second local recurrence [LR] and overall survival [OS]) of rBCS for the management of IBCR after previous BCS and RT were included (PROSPERO registration CRD42021286123). Forty-two observational studies met the criteria and were included in the analysis. The pooled second LR rate after rBCS was 15.7% (95% confidence interval [CI] 12.1-19.7), and 10.3% (95% CI 6.9-14.3) after salvage mastectomy. On meta-analysis of comparative studies (n = 17), the risk ratio (RR) for second LR following rBCS compared with mastectomy was 2.103 (95% CI 1.535-2.883; p < 0.001, I2 = 55.1%). Repeat RT had a protective effect (coefficient: - 0.317, 95% CI - 0.596 to - 0.038; p = 0.026, I2 = 40.4%) for second LR. Pooled 5-year OS was 86.8% (95% CI 83.4-90.0) and 79.8% (95% CI 74.7-84.5) for rBCS and salvage mastectomy, respectively. Meta-analysis of comparative studies (n = 20) showed a small OS benefit in favor of rBCS (RR 1.040, 95% CI 1.003-1.079; p = 0.032, I2 = 70.8%). Overall evidence certainty was very low. This meta-analysis suggests rBCS could be considered as an option for the management of IBCR in patients previously treated with BCS and RT. Shared decision making, appropriate patient selection, and individualized approach are important for optimal outcomes.

References

Walstra, C.J.E.F.; Schipper, R.-J.; Poodt, I.G.M.; van Riet, Y.E.; Voogd, A.C.; van der Sangen, M.J.C.; Nieuwenhuijzen, G.A.P. 2019: Repeat breast-conserving therapy for ipsilateral breast cancer recurrence: a systematic review European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 45(8): 1317-1327
Nara, M.; Ishihara, S.; Kitano, A.; Tamura, N.; Aruga, T.; Kobayashi, D.; Nakamura, S.; Yamauchi, H. 2022: Does breast-conserving surgery with radiotherapy in BRCA-mutation carriers significantly increase ipsilateral breast tumor recurrence? a systematic review and meta-analysis Breast Cancer 29(3): 394-401
Horsnell, J; Elvers, K; Winters, Z 2014: The role of breast conserving surgery in the treatment of multiple ipsilateral breast cancer: A systematic review European Journal of Surgical Oncology 40(5): 656-657
Carroll, M.C.; Yen, R.W.; Leech, M.; Barth, R.J. 2024: A Systematic Review and Meta-analysis of the Role of Preoperative MRi in In-breast Tumor Recurrence After Breast-Conserving Surgery Annals of Surgical Oncology 31(6): 3926-3938
Walstra, C.J.E.F.; Schipper, R.-J.; van Riet, Y.E.; van der Toorn, P.-P.G.; Smidt, M.L.; Sangen, M.J.C.V.; Voogd, A.C.; Nieuwenhuijzen, G.A.P. 2021: Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands Breast Cancer Research and Treatment 187(2): 499-514
Komoike, Y.; Motomura, K.; Inaji, H.; Kasugai, T.; Koyama, H. 2002: Repeat Lumpectomy for Patients with Ipsilateral Breast Tumor Recurrence after Breast-Conserving Surgery Oncology 64(1): 1-6
Nishimura, R.; Akizuki, M.; Tashima, R.; Ootao, R. 2006: Investigation of factors related to periods to ipsilateral breast tumor recurrence after breast-conserving surgery and measures for preventing recurrence in early breast cancer Breast Cancer 13(2): 152-158
Komoike, Y.; Motomura, K.; Inaji, H.; Kasugai, T.; Koyama, H. 2003: Repeat lumpectomy for patients with ipsilateral breast tumor recurrence after breast-conserving surgery. Preliminary results Oncology 64(1): 1-6
Sener, S.F. 2022: Outcomes from ipsilateral breast tumor recurrence after breast conserving surgery and whole breast irradiation for breast cancer American Journal of Surgery 223(3): 445-446
ElSherif, A.; Shah, C.; Downs-Kelly, E.; Alhareb, A.; Valente, S.A.; Tu, C.; Al-Hilli, Z. 2022: Outcomes of ipsilateral breast tumor recurrence after breast conserving surgery: Repeat lumpectomy as an alternative to salvage mastectomy Surgery 171(3): 673-681
Seto, Y.; Ishitobi, M.; Nakayama, T. 2024: ASO Author Reflections: Do Patients with Ipsilateral Breast Tumor Recurrence Prefer Repeat Breast-Conserving Surgery or Mastectomy? Annals of Surgical Oncology
Khakpour, N.; Lucci, A. 2005: Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: the potential role of partial breast irradiation The Women's Oncology Review 5(1): 75-76
Kuerer, H.M.; Arthur, D.W.; Haffty, B.G. 2004: Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: the potential role of partial breast irradiation Cancer 100(11): 2269-2280
Arthur, D.W.; Winter, K.A.; Kuerer, H.M.; Haffty, B.; Cuttino, L.; Todor, D.A.; Anne, P.R.; Anderson, P.; Woodward, W.A.; McCormick, B.; Cheston, S.; Sahijdak, W.M.; Canaday, D.; Brown, D.R.; Currey, A.; Fisher, C.M.; Jagsi, R.; Moughan, J.; White, J.R. 2020: Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast: the NRG Oncology/RTOG 1014 Phase 2 Clinical Trial JAMA Oncology 6(1): 75-82
Winters, Z.E.; Horsnell, J.; Elvers, K.T.; Maxwell, A.J.; Jones, L.J.; Shaaban, A.M.; Schmid, P.; Williams, N.R.; Beswick, A.; Greenwood, R.; Ingram, J.C.; Saunders, C.; Vaidya, J.S.; Esserman, L.; Jatoi, I.; Brunt, A.M. 2018: Systematic review of the impact of breast-conserving surgery on cancer outcomes of multiple ipsilateral breast cancers Bjs Open 2(4): 162-174
Anber, W.A.; El-Shinawi, M.; Gamaleldin, A.; Fahmy, K. 2025: Breast-Conserving Surgery Versus Modified Radical Mastectomy in the Management of Non-metastatic Inflammatory Breast Cancer: a Systematic Review and Meta-Analysis Cureus 17(11): E97455
Dalberg, K.; Mattsson, A.; Sandelin, K.; Rutqvist, L.E. 1997: Outcome of treatment for ipsilateral breast tumor recurrence following breast-conserving surgery of early-stage breast cancer Breast Cancer Research and Treatment 46(1): 98
Choi, Y.J.; Shin, Y.D.; Song, Y.J. 2016: Comparison of ipsilateral breast tumor recurrence after breast-conserving surgery between ductal carcinoma in situ and invasive breast cancer World Journal of Surgical Oncology 14: 126
Siponen, E.T.; Vaalavirta, L.; Joensuu, H.; Vironen, J.; Heikkilä, P.; Leidenius, M.H.K. 2011: Ipsilateral breast recurrence after breast conserving surgery in patients with small (≤ 2cm) breast cancer treated with modern adjuvant therapies European Journal of Surgical Oncology: the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 37(1): 25-31
Rouzier, R.; Extra, J.M.; Carton, M.; Falcou, M.C.; Vincent-Salomon, A.; Fourquet, A.; Pouillart, P.; Bourstyn, E. 2001: Primary chemotherapy for operable breast cancer: incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conserving surgery Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 19(18): 3828-3835