Anti-Tumor Treatment Local treatment options for ipsilateral breast tumour recurrence Jean-Michel Hannoun-Levi a,⇑ , Tarik Ihrai b , Adel Courdi a a Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France b Department of Surgical Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, Nice, France article info Article history: Received 3 January 2013 Received in revised form 4 February 2013 Accepted 7 February 2013 Keywords: Breast cancer Local recurrence Conservative treatment abstract Purpose: In case of ipsilateral breast tumour recurrence (IBTR), radical mastectomy represents the treat- ment option frequently proposed. A second conservative treatment (2ndCT) has been proposed using either lumpectomy alone or associated with a re-irradiation of the tumor bed. However, in both clinical situations, the proof level of such therapeutic approaches remains low, based on cased-series or retro- spective studies (level C). Material and methods: In order to assess the different strategies of local treatment proposed in case of IBTR, a PubMed literature review was performed using the following keywords: breast cancer, ipsilateral recurrence, mastectomy, radiation therapy, brachytherapy. Four different salvage options were analyzed: (a) salvage mastectomy alone; (b) salvage mastectomy with postoperative re-irradiation; (c) 2ndCT with surgery alone; (d) 2ndCT with re-irradiation. Results: The rate of second local recurrence is about 10% [3–32%], about 25% [7–36%] and about 10% [2– 26%], after salvage mastectomy, salvage lumpectomy alone or combined with a re-irradiation of the tumor bed respectively. Results: However, the 5-year overall survival rates after salvage mastectomy and 2ndCT seem to be equivalent (75%) mainly influenced by distant metastatic progression. Conclusion: In terms of Evidence Based Medicine, different options can be discussed such as Phase III or II randomized trials comparing salvage mastectomy versus 2ndCT, retrospective studies based on a matched-pair analysis or observatory studies. Those study designs need to be carefully analyzed to be able to propose new treatment options for women who experience an IBCR. Ó 2013 Elsevier Ltd. All rights reserved. Introduction Breast cancer represents the most frequent cancer among wo- men with an estimated 1.38 million new cancer cases diagnosed in 2008 (23% of all cancers), and ranks second overall (10.9% of all cancers). 1 It is now the most common cancer both in developed and developing regions with around 690,000 new cases estimated. The risk of breast cancer recurrence for a given subject depends on a variety of factors, including patient age, inherited susceptibility, tumour characteristics, type of treatment for original tumour (e.g., surgery and/or radiation therapy) and other lifestyle factors such as obesity and alcohol consumption. In the 1980s and the 1990s, the ipsilateral breast tumour recurrence rates (IBTR) were reported to be 8–19% in the 10 years following the initial diagnosis and treatment. 2 In the early 21st century, the local recurrence rates after completion of adjuvant therapy are still about 10% and 20% at 10 and 15 years, respectively. 3 The concept of breast conservative treatment (BCT) as the man- agement of primary breast cancer was brought out by Veronesi et al. 4 at the Cancer Institute of Milan at the end of the 70s. From the beginning, the Italian team considered the BCT based on the association of a conservative surgery with a post-operative radia- tion therapy (RT) of the whole breast. Veronesi et al. 5 reported with a twenty-year follow-up, the results of a randomized trial confirm- ing that the long-term survival rate among women who undergo BCT was equivalent to that among women who undergo radical mastectomy. At the same time, Fisher et al. 6 highlighted the critical role of adjuvant RT in case of conservative surgery. Regarding the local treatment strategy for IBTR after BCT, salvage radical mastec- tomy is currently considered as the gold-standard local treatment. However, in regards to the conservative treatment philosophy for primary breast cancer, is radical mastectomy still the unique sal- vage treatment in case of IBTR? We propose to analyze the litera- ture focusing on the different local salvage therapeutic options applied in case of IBTR. 0305-7372/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ctrv.2013.02.003 ⇑ Corresponding author. Address: Department of Radiation Therapy, Antoine Lacassagne Cancer Center, 33 Avenue de Valombrose, 06189 NICE CEDEX, France. Tel./fax: +33 492 031 570. E-mail addresses: jean-michel.hannoun-levi@nice.unicancer.fr (J.-M. Hannoun-Levi), tarik.irhai@nice.unicancer.fr (T. Irhai), adel.coudi@nice.unicancer.fr (A. Courdi). Cancer Treatment Reviews 39 (2013) 737–741 Contents lists available at SciVerse ScienceDirect Cancer Treatment Reviews journal homepage: www.elsevierhealth.com/journals/ctrv