Is breast conservation surgery feasible in ipsilateral cancer recurrence with previous radiotherapy?

Abstract

Introduction: Breast-conserving surgery (BCS) is the preferred modality
for early breast cancer, yet there is a significant research gap in understanding
the feasibility of BCS in ipsilateral recurrent breast cancer
(IRBC) post-radiotherapy. This systematic review aims to investigate the
outcomes of repeat BCS (rBCS) in managing IRBC, providing crucial
insights for clinicians and patients in evaluating treatment options.
Methods: The PRISMA framework guided data collection from PubMed
and Embase. A qualitative systematic approach involved descriptive and
thematic analysis, examining patterns and consistencies in outcome findings
across identified studies. Due to the nature of the research, no statistical
analysis was conducted.
Results: Four papers, employing a 95% confidence level, were included.
Studies revealed a 2.103 risk ratio for second local recurrence (SLR) after
rBCS compared to mastectomy. Pooled data indicated SLR rates of
15.7% for BCS and 10.3% for mastectomy, with a 5-year overall survival
(OS) rate of 86.8 and 79.8%, respectively. Repeat radiotherapy showed a
protective effect for SLR and a small OS benefit favoured rBCS. However,
this came with overall evidence certainty. Other studies found a 5-year OS
of 77 and 87% after rBCS, with oncological advantages for adjunctive
radiotherapy. Post-IBTR, 84% had a 5-year survival rate, while multivariate
analysis highlighted factors influencing SLR.
Conclusion: This systematic review suggests that rBCS may be considered
in a subset of patients with IBCR after BCS and RT. Individual assessment
encompassing tumour-size and duration prior to relapse shows
importance approach feasibility. However, further research would
improve subject knowledge and aid in optimal patient selection.