Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome

Ann Oncol. 2009 Jun;20(6):1008-12. doi: 10.1093/annonc/mdn732. Epub 2009 Jan 15.


Background: In the case of ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS), a second conservative surgical approach maybe considered in some motivated patients whereas in others mastectomy is unavoidable.

Patients and methods: From 1997 to 2004, 282 patients presented at the European Institute of Oncology with an operable invasive IBTR after BCS. One hundred and sixty-one (57%) underwent a second conservative surgery, whereas 121 patients (43%) were given a mastectomy and represent the study population. We investigated the prognosis and determined predictive factors of outcome.

Results: Median time from primary breast cancer to IBTR was 41 months (range 5-213). Recurrences were T2-T4 and/or multifocal in 83 cases (68.6%). With a median follow-up of 5 years after mastectomy, 5-year overall survival (OS) and disease-free survival (DFS) were 73.3% [95% confidence interval (CI) 65.0% to 81.6%] and 50.4% (95% CI 40.9% to 59.8%), respectively. At the multivariate analysis, early onset of IBTR, presence of vascular invasion and Ki67 >or=20 of the recurrent tumour were found to significantly affect both DFS and OS.

Conclusions: In women who need mastectomy for IBTR, early onset of the relapse, high proliferation index and presence of vascular invasion represent the worst prognostic factors.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / surgery*
  • Female
  • Humans
  • Mastectomy*
  • Mastectomy, Segmental
  • Middle Aged
  • Neoplasm Recurrence, Local / surgery*
  • Prognosis
  • Risk Factors
  • Treatment Failure
  • Treatment Outcome