Repeat breast-conserving treatment of ipsilateral breast cancer recurrence: a nationwide survey amongst breast surgeons and radiation oncologists in the Netherlands

Coco J E F Walstra,Yvonne E Van Riet,Adri C Voogd,Maurice J C Vd Sangen,Marjolein L Smidt,Peter-Paul G Van Der Toorn,Robert-Jan Schipper,Grard A P Nieuwenhuijzen

doi:10.1007/s10549-021-06154-2

Abstract

BackgroundIn line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumour recurrence (IBTR) in selected patients. The conditions for the feasibility of a repeat BCT vary widely in literature. In clinical practice, many physicians have ongoing concerns about the oncological safety and possible toxicity of repeat BCT.AimTo investigate the attitude of Dutch breast surgeons and radiation oncologists towards repeat BCT and to report on their experiences with, objections against and perceived requirements to consider a repeat BCT in case of IBTR.Patients and methodsAn online survey consisting of a maximum of 26 open and multiple-choice questions about repeat BCT for IBTR was distributed amongst Dutch breast surgeons and radiation oncologists.ResultsForty-nine surgeons representing 49% of Dutch hospitals and 20 radiation oncologists representing 70% of Dutch radiation oncology centres responded. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. The most important factors to consider a repeat BCT for both groups were the patient’s preference to preserve the breast and surgical feasibility of a second lumpectomy. Arguments against a repeat BCT were based on the perceived unacceptable toxicity and cosmesis of a second course of radiotherapy. The technique of preference for re-irradiation would be partial breast irradiation (PBI) according to all radiation oncologists. Differentiating between new primary tumours (NPT) and true recurrences (TR) was reported to be done by 57.1% of breast surgeons and 60% of radiation oncologists. The most important reason to differentiate between NPT and TR was to establish prognosis and to consider whether a repeat BCT would be feasible.ConclusionAn increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient’s preference and with partial breast re-irradiation.

Highlights

After breast-conserving treatment (BCT) for breast cancer, women remain at risk of an ipsilateral breast tumour recurrence (IBTR) of approximately 0.5% per year [1]
The negative impact of a mastectomy compared to BCT on cosmetic outcome and quality of life (QoL) is well documented, at least after primary breast cancer treatment [2,3,4,5,6]
This study addresses the current attitude towards repeat BCT of both breast surgeons and radiation oncologists in the Netherlands

Summary

Introduction

After breast-conserving treatment (BCT) for breast cancer, women remain at risk of an ipsilateral breast tumour recurrence (IBTR) of approximately 0.5% per year [1]. It is even suggested to omit surgical nodal staging in patients with an IBTR, since the nodal status seems not to be an important prognostic factor [11] In line with this paradigm, a repeat BCT would be the step in minimizing surgical morbidity in patients with IBTR. In line with the paradigm to minimize surgical morbidity in patients with primary breast cancer, there is increasing evidence for the safety of a repeat breast-conserving treatment (BCT) of an ipsilateral breast tumour recurrence (IBTR) in selected patients. A repeat BCT was considered feasible in selected cases by 28.7% of breast surgeons and 55% of radiation oncologists. Conclusion An increasing number of Dutch breast cancer specialists is considering a repeat BCT feasible in selected cases, at the patient’s preference and with partial breast re-irradiation

Methods

Results

Conclusion