Salvage mastectomy versus second conservative treatment for second ipsilateral breast tumor event: A propensity score-matched cohort analysis of the GEC-ESTRO Breast Cancer Working Group database.

Hannoun-Levi, Jean-Michel; Gal, Jocelyn; Van Limbergen, Erik; Chand, Marie-Eve; Schiappa, Renaud; Smanyko, Viktor; Kauer-Domer, Daniela; Pasquier, David; Lemanski, Claire; Racadot, Séverine; Houvenaeghel, Gilles; Guix, Benjamin; Belliere-Calandry, Aurélie; Loessl, Kristina; Polat, Bulent; Gutierrez, Cristina; Galalae, Razvan; Polgar, Csaba; Strnad, Vratislav (2021). Salvage mastectomy versus second conservative treatment for second ipsilateral breast tumor event: A propensity score-matched cohort analysis of the GEC-ESTRO Breast Cancer Working Group database. International journal of radiation oncology, biology, physics, 110(2), pp. 452-461. Elsevier 10.1016/j.ijrobp.2020.12.029

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PURPOSE

Second conservative treatment has emerged as an option for patients with second ipsilateral breast tumour event after conserving surgery and breast irradiation. We aimed to address the lack of evidence regarding second breast event treatment by comparing oncological outcomes after conservative treatment or mastectomy.

METHODS AND MATERIALS

Oncological outcomes were analysed using a propensity score-matched cohort analysis study on patients diagnosed with a second breast event between 01/1995 and 06/2017. Patient data were collected from 15 hospitals/cancer centres (7 European countries). Patients were offered mastectomy or lumpectomy plus brachytherapy. Propensity scores were calculated with logistic regression and multiple imputations. Matching (1:1) was achieved using the nearest neighbour method including 10 clinical/pathological data related to second breast event. The primary endpoint was 5-year overall survival from the salvage surgery date. Secondary endpoints were 5-year cumulative incidence of third breast event, regional relapse and distant metastasis, and disease-free and specific survivals. Complications and 5-year incidence of mastectomy were investigated in the conservative treatment cohort.

RESULTS

Among the 1327 analysed patients (mastectomy:945/conservative treatment:382), 754 were matched by propensity score (mastectomy:377/conservative treatment:377). Median follow-up was 75.4 months (95%CI 65.4-83.3) and 73.8 months [95%CI 67.5-80.8) for mastectomy and conservative treatment, respectively (p=0.9). In the matched analyses, no differences in 5-year overall survival and cumulative incidence of 3rd breast event were noted between mastectomy and conservative treatment (88% (95%CI 83.0-90.8) versus 87% (82.1-90.2); p=0.6 and 2.3% (95%CI 0.7-3.9) versus 2.8% (95%CI 0.8-4.7); p=0.4 respectively). Similarly, no differences were observed for all secondary endpoints. Five-year cumulative incidence of mastectomy was 3.1% (95%CI 1.0-5.1).

CONCLUSION

To our knowledge, this is the largest matched analysis between mastectomy and conservative treatment combining lumpectomy with brachytherapy for second breast event. Compared to mastectomy, conservative treatment does not seem to be associated with any differences in terms of oncological outcome. Consequently, conservative treatment could be considered a viable option for salvage treatment.

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