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

Abstract

Introduction: Breast-conserving surgery (BCS) is the preferred modalityfor early breast cancer, yet there is a significant research gap in understandingthe feasibility of BCS in ipsilateral recurrent breast cancer(IRBC) post-radiotherapy. This systematic review aims to investigate theoutcomes of repeat BCS (rBCS) in managing IRBC, providing crucialinsights for clinicians and patients in evaluating treatment options.Methods: The PRISMA framework guided data collection from PubMedand Embase. A qualitative systematic approach involved descriptive andthematic analysis, examining patterns and consistencies in outcome findingsacross identified studies. Due to the nature of the research, no statisticalanalysis was conducted.Results: Four papers, employing a 95% confidence level, were included.Studies revealed a 2.103 risk ratio for second local recurrence (SLR) afterrBCS compared to mastectomy. Pooled data indicated SLR rates of15.7% 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 aprotective effect for SLR and a small OS benefit favoured rBCS. However,this came with overall evidence certainty. Other studies found a 5-year OSof 77 and 87% after rBCS, with oncological advantages for adjunctiveradiotherapy. Post-IBTR, 84% had a 5-year survival rate, while multivariateanalysis highlighted factors influencing SLR.Conclusion: This systematic review suggests that rBCS may be consideredin a subset of patients with IBCR after BCS and RT. Individual assessmentencompassing tumour-size and duration prior to relapse showsimportance approach feasibility. However, further research wouldimprove subject knowledge and aid in optimal patient selection.