Jasper Jacob M, Vora Halley, Kantor Olga, McGrath Monica, Bellon Jennifer R, Mittendorf Elizabeth A, King Tari A
Tufts University School of Medicine, Boston, MA, USA.
Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Cancer Res Treat. 2025 Jul;212(2):361-369. doi: 10.1007/s10549-025-07730-6. Epub 2025 May 21.
Mastectomy is traditionally recommended for local recurrence after breast conservation therapy (BCT), the combination of lumpectomy followed by whole-breast radiotherapy. Recent studies suggest that repeat BCT (lumpectomy and re-irradiation) may be feasible for select patients. We sought to evaluate the clinical characteristics, management strategies, and outcomes of patients treated for ipsilateral breast tumor recurrence (IBTR) after initial BCT and assess the impact of a newly adopted multidisciplinary algorithm for repeat BCT (lumpectomy and re-irradiation).
We identified patients with stage 0-III breast cancer treated with initial BCT who underwent surgery for IBTR between January 2016 and May 2023. Patient, tumor, and treatment characteristics were analyzed, and outcomes were compared before and after the adoption of the repeat BCT algorithm.
Among 546 patients treated for IBTR, 48% were eligible for repeat BCT. After criteria adoption, mastectomy rates decreased by 16%. The proportion of eligible patients undergoing lumpectomy alone (BCS) for IBTR increased by 9% while only a modest increase in lumpectomy and re-irradiation (repeat BCT) was observed (7%). Rates of BCS for IBTR were higher than repeat BCT among older patients. Clinical outcomes were comparable between patients treated with BCS, BCT, or mastectomy.
Repeat BCT (lumpectomy and re-irradiation) is a viable option for select patients with IBTR, offering comparable outcomes to mastectomy. The adoption of standardized criteria for repeat BCT has increased its use, highlighting the importance of multidisciplinary approaches in treatment planning.
传统上，对于保乳治疗（BCT，即乳房肿块切除术加全乳放疗）后出现局部复发的情况，建议进行乳房切除术。最近的研究表明，对于部分患者，再次进行保乳治疗（乳房肿块切除术加再次放疗）可能是可行的。我们试图评估初次保乳治疗后同侧乳腺肿瘤复发（IBTR）患者的临床特征、管理策略和治疗结果，并评估新采用的多学科再次保乳治疗（乳房肿块切除术加再次放疗）算法的影响。
我们确定了2016年1月至2023年5月期间接受初次保乳治疗且因IBTR接受手术的0-III期乳腺癌患者。分析了患者、肿瘤和治疗特征，并比较了采用再次保乳治疗算法前后的治疗结果。
在546例接受IBTR治疗的患者中，48%符合再次保乳治疗的条件。采用标准后，乳房切除术的比例下降了16%。因IBTR仅接受乳房肿块切除术（BCS）的符合条件患者的比例增加了9%，而观察到接受乳房肿块切除术加再次放疗（再次保乳治疗）的患者仅略有增加（7%）。老年患者中，IBTR的BCS率高于再次保乳治疗率。接受BCS、保乳治疗或乳房切除术的患者的临床结果相当。
再次保乳治疗（乳房肿块切除术加再次放疗）对于部分IBTR患者是一种可行的选择，其治疗结果与乳房切除术相当。采用标准化的再次保乳治疗标准增加了其应用，突出了多学科方法在治疗规划中的重要性。
