When can a second conservative approach be considered for ipsilateral breast tumour recurrence?

Background: Mastectomy is considered the treatment of choice in patients with ipsilateral breast tumour recurrence (IBTR) after breast-conserving surgery (BCS). Patients and methods: One hundred and sixty-one patients with invasive IBTR who underwent a second conservative approach were retrospectively evaluated in order to describe prognosis, determine predictive factors of outcome and select the subset of patients with the best local control. Results: Fifty-seven patients (35.4%) relapsed after IBTR. Thirty-four patients (21.1%) had further in-breast recurrences and four patients (2.5%) had skin relapses. Five years cumulative incidence of local relapse was 31.4%. Twenty-four patients (17.8%, 5 years cumulative incidence) died during the follow-up. At the multivariate analysis, recurrent tumour size > 2 cm was found to affect local-disease-free survival [hazard ratio (HR): 2.8, 95% confidence interval (CI) 1.2-6.2], whereas Ki-67 >= 20% and time to relapse <= 48 months were associated with disease-free survival (HR: 1.7, 95% CI 1.0-3.1, and HR: 2.1, 95% CI 1.2-3.6, respectively). Absence of oestrogen receptors affected overall survival (HR: 2.5, 95% CI 1.1-6.0). Among 64 patients with recurrent tumour <= 2 cm and time to IBTR > 48 months, eight (12.8%, 5 years cumulative incidence) had further local relapses. Conclusions: Some patients with IBTR might receive a second BCS, especially when a good local control can be estimated (small recurrent tumour, late relapse), also taking into account patients' preference.