Van den Bruele Astrid Botty, Chen Ishita, Sevilimedu Varadan, Le Tiana, Morrow Monica, Braunstein Lior Z, Cody Hiram S
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Breast Cancer Res Treat. 2021 May;187(1):105-112. doi: 10.1007/s10549-020-06080-9. Epub 2021 Jan 12.
Breast conservation therapy (BCT) is well established for the management of primary operable breast cancer, with oncologic outcomes comparable to those of mastectomy. It remains unclear whether re-conservation therapy (RCT) is suitable for those patients who develop ipsilateral breast tumor recurrence (IBTR), for whom mastectomy is generally recommended.
We identified women who underwent BCT for invasive or ductal carcinoma in situ and developed IBTR as a first event, comparing the pattern of subsequent events and survival for those treated by RCT versus mastectomy.
Of 16,968 patents who had BCT, 322 (1.9%) developed an isolated IBTR as a first event between 1999 and 2019. 130 (40%) had RCT and 192 (60%) mastectomy. Compared to mastectomy, the RCT patients were older (66 vs 53, < 0.001), had a longer disease-free interval (DFI: 5.8 vs 2.7 years (p < 0.001)), were less likely to have received RT (p < 0.001), endocrine therapy (ET) (p < 0.005) or combined RT/ET (< 0.001) as initial treatment, but the characteristics of their initial primary cancers and of their IBTR were comparable. At a median follow-up of 10.7 years following initial BCT and 6.5 years following IBTR, there were no differences in BCSS or OS between RCT and mastectomy.
For BCT patients who developed IBTR as a first event, we observed comparable BCSS and OS from time of initial treatment and from time of IBTR, whether treated by RCT or mastectomy. These results support wider consideration of RCT in the management of IBTR, especially in the setting of older age and longer DFI.
保乳治疗（BCT）在原发性可手术乳腺癌的治疗中已得到广泛应用，其肿瘤学结局与乳房切除术相当。对于同侧乳腺肿瘤复发（IBTR）的患者，再次保乳治疗（RCT）是否适用仍不明确，这类患者一般建议行乳房切除术。
我们确定了因浸润性癌或导管原位癌接受保乳治疗且首次出现IBTR的女性，比较了接受再次保乳治疗与乳房切除术患者的后续事件模式和生存率。
在16968例接受保乳治疗的患者中，322例（1.9%）在1999年至2019年间首次出现孤立性IBTR。130例（40%）接受了再次保乳治疗，192例（60%）接受了乳房切除术。与乳房切除术患者相比，再次保乳治疗患者年龄更大（66岁对53岁，<0.001），无病间期更长（无病间期：5.8年对2.7年（p<0.001）），初始治疗时接受放疗（p<0.001）、内分泌治疗（ET）（p<0.005）或放化疗联合治疗（<0.001）的可能性更小，但他们初始原发性癌症和IBTR的特征具有可比性。在首次保乳治疗后中位随访10.7年以及IBTR后中位随访6.5年时，再次保乳治疗和乳房切除术患者的乳腺癌特异生存率（BCSS）或总生存率（OS）无差异。
对于首次出现IBTR的保乳治疗患者，我们观察到，无论是接受再次保乳治疗还是乳房切除术，从初始治疗时以及从IBTR时起的BCSS和OS均具有可比性。这些结果支持在IBTR的治疗中更广泛地考虑再次保乳治疗，尤其是在年龄较大和无病间期较长的情况下。
