Abstract P2-12-07: Local recurrence of breast cancer: Salvage lumpectomy as a safe option for local treatment
Authors: Sellam Y , Akiva Ben David M , Galper S , Dromi Shahadi I , Zippel D , Symon Z , Gelernter I 
Published: February 2018

Introduction: The best local management for breast cancer recurrence following conservative treatment for breast cancer (BC) continues to be an open question. In this study, we compared patients' outcome after salvage lumpectomy vs. patients who underwent mastectomy for ipsilateral breast tumor recurrence (IBTR).

Materials and methods: Between 1987 and 2014 we identified 121 patients with pT0-2, N0-3, M0 BC who had breast conserving surgery and radiation as their primary treatment, and subsequently had IBTR (unifocal). 47 patients underwent salvage lumpectomy (SL) and 74 salvage mastectomy (SM) as the local treatment for their 1st recurrence.

Results:

Median follow-up was 14 years (2-30) from first BC diagnosis. All consecutive identified patients, 121, were included in the study. At 1st recurrence, 47 patients (39%) chose to undergo SL for their IBTR, and 74 patients (61%) opted for SM.

The mean age at 1st diagnosis of BC for SL group and SM, was 52 and 47 years, respectively (p=0.006). With similar T in both groups, most patients had T1 (43%), and T2 (34%) at first diagnosis (p=0.722). The women who opted later for SM had more ALND surgery (58% vs. 33%, p=0.023) and received more neoadjuvant chemotherapy (20% vs. 4%, p=0.022) at their first BC diagnosis.

The median DFI at 1st recurrence for SL and SM group was 12 and 7 years, respectively (p=0.011). 51 local recurrences (41%) were true recurrences by location and histology. In the SL group, 78% had a documented discussion (consideration for SL vs. SM) with a surgeon/oncologist/radiation oncologist prior to surgical decision, and 70% underwent a breast MRI before final decision. Only 45% in the SM group had a discussion and 59% underwent MRI before the decision.

Following surgery for their recurrence, sixteen women (34%) of SL group underwent re-irradiation (partial breast RT) and 20 (27%, p=0.04) in the SM group (chest wall scar).

For the SL and SM cohorts, 8 and 10 patients (17%, 13.5%, p=0.22) respectively, developed subsequent local recurrence as a 3rd event. The median DFI between 2nd and 3rd recurrence for SL and SM was 6.5 and 15.5 years, respectively (p=0.081).

In a multivariate analysis, age at 1st diagnosis, T at 1st and 2nd recurrence, number of dissected/+ve LN, grade, type of axillary surgery as well as neo/adjuvant chemotherapy and HER2 status (both in primary and at recurrence), had no effect on 2nd recurrence occurrence for both groups; however, in MVA, undergoing SL had higher chances of having a 2nd recurrence (3rd event), p=0.020. Having re-irradiation following SL did not protect against 2nd recurrence (3rd event, p=0.42).

At a median follow-up of 14 years, 95.7% of SL patients are alive, NED, 85% are mastectomy free. 84% of patients who opted for SM are alive, NED.

Conclusions: Salvage lumpectomy following IBTR, while associated in MVA with higher second local recurrence rate than SL is not associated with inferior survival. With survival &gt;95% at 14 years in the SL cohort, salvage lumpectomy with or without re-radiation, in a selected population (unifocal T), represents an acceptable treatment option for patients in order to delay time to mastectomy and keep the original breast without reducing BC survival. Both options should be discussed prior to any surgical decision.

Citation Format: Sellam Y, Akiva Ben David M, Galper S, Dromi Shahadi I, Zippel D, Symon Z, Gelernter I. Local recurrence of breast cancer: Salvage lumpectomy as a safe option for local treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-07.