Second conservative treatment for local recurrence breast cancer: a GEC-ESTRO oncological outcome and prognostic factor analysis.

Hannoun-Levi, J M; Gal, J; Polgar, C; Strnad, V; Loessl, K; Polat, B; Kauer-Domer, D; Schiappa, R; Gutierrez, C (2023). Second conservative treatment for local recurrence breast cancer: a GEC-ESTRO oncological outcome and prognostic factor analysis. International journal of radiation oncology, biology, physics, 117(5), pp. 1200-1210. Elsevier 10.1016/j.ijrobp.2023.06.075

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OBJECTIVE

For ipsilateral second breast tumor event (2ndIBTE), second conservative treatment (2ndCT) combining lumpectomy plus accelerated partial breast re-irradiation (APBrI) represents a curative option. The aim of this study was to analyze oncological prognostic factors for 2ndIBTE patients treated with 2ndCT.

MATERIAL AND METHODS

An analysis of clinical practices was conducted across 7 academic hospitals/cancer centers in 6 European countries based on the XXXX database. Patients presenting a 2ndIBTE occurring after conservative surgery (lumpectomy+axillary evaluation) and irradiation performed for the primary tumor, underwent a 2ndCT with brachytherapy based APBrI. The main outcome was 5-year cumulative incidence (CI) rate of second local relapse (2ndLR). All analyzed patients were classified according to risk groups for GEC-ESTRO APBI (APBI) and molecular classification (Mol.) and time interval between first and second breast surgery (TIS1S2). Finally, we combined GEC-ESTRO APBI, molecular and TIS1S2 risk groups, leading to the definition of a new score (named "TAM") specifically designed for 2ndIBTE oncological outcome analysis.

RESULTS

From 07/1994 and 01/2021, a total of 508 patients received a 2ndCT. At the time of 2ndIBTE, median age was 64.6 years [56.2-72.6]. With a median follow-up of 60.9 months [56.2-72.6], 5-year 2ndLR CI rate was 4% [95%CI 2-6]. Five-year distant metastasis disease CI rate was 7% [95%CI 4-10]. Five-year disease-free and overall survival rates were 89% [95%CI 86-93] and 91% [95%CI 88-94] respectively. In multivariate analysis, TAM score was an independent prognostic factor for all the oncological items (p<0.001) except disease specific survival (p=0.07) and overall survival (p=0.09). G≥3 late toxicity rate was 12.1%.

CONCLUSION AND RELEVANCE

This analysis of 2ndCT combining lumpectomy with APBrI for 2ndIBTE confirmed the excellent oncological results obtained after 2ndCT. Furthermore, GEC-ESTRO TAM score appears to be an important prognostic factor, assisting patients and physicians in the decision-making process.

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