In this study we addressed an important challenge in the management of locally recurrent breast cancer. Traditionally, patients who experience a local recurrence after breast conserving therapy are often advised to undergo total mastectomy. However, many patients decline total mastectomy because they would like to prioritise breast preservation and quality of life. Recognising this need from our patients, in 2012 our institution initiated a pilot programme to offer to eligible patients a second breast conserving treatment combined with intraoperative radiation and this is the background of our study.
What did you do?
We treated in this study 171 patients over 12 years, focussing on those patients who declined to undergo total mastectomy but were otherwise good candidates for conservative management. Eligibility criteria for this study included suitable for second breast conservative treatment, node negative status of the patient, unifocal breast-only disease and age over 50 years and the ability to achieve good cosmetic outcomes. During surgery a single dose of intraoperative radiotherapy was delivered and sometimes additional treatment such as re-operative sentinel node biopsy and the postoperative adjuvant therapy were administered as needed.
Following the treatment patients were followed up for semi-annual visits with a physical exam and breast imaging. The clinical and oncological outcomes were collected and analysed at a median follow-up time of six years.
What did you find?
We found that the median age of the patients that were treated with this modality was 72 years. The median interval between the first treatment and the breast recurrence was around 15 years. The tumour characteristics of our patients at recurrence were generally favourable. An important aspect that we found in our research is that at the six-year follow-up just 22 patients experienced an additional local recurrence. Of these 22 patients, 14 cases experienced limited breast recurrence and were treated successfully with mastectomy with no future disease progression, while 8 patients developed metastatic disease.
What could be the implications of these findings?
The implications of these findings are really important because our results highlight that a carefully selected group of patients can achieve a favourable outcome with a second breast conservative treatment combined with IORT, intraoperative radiotherapy. Excluding high-risk histology and node positive disease, the risk of local recurrence remains very low in these selected patients. Importantly, this approach offers patients a breast conservative alternative to mastectomy, improving their quality of life and avoiding more radical surgical techniques.
Is there anything else you would like to add?
While the current study offers valuable insight, future research could explore a longer follow-up period and a longer patient cohort to define patient selection criteria and assess long-term survival and quality of life findings. This study could offer validated findings, validated results, to offer to our patients a second breast conservative treatment and IORT as an alternative to manage the local recurrence in breast cancer.
