109 Background: To report the long-term results in a prospective group of patients (pts) treated for local recurrence after conservative treatment of breast cancer by a second conservative surgery or by total mastectomy. Methods: Between 12/1990 and 10/2004, 85 pts with <3 cm, low-risk local recurrence after conservative treatment for breast cancer were offered total mastectomy. 48 of them refused it and were treated by a second lumpectomy followed by HDR brachytherapy implant to the tumor bed+margin. 30 Gy in 12 fractions in 5 days were given. Pts treated by mastectomy had no further radiotherapy. Postmenopausal pts with negative receptors had no systemic tx. The rest of the pts had chemo or hormones. No pts were lost for follow-up. Results: All pts completed treatment. During the 17-year, 1-year minimum follow-up, in the second conservative group there were 8 pts who had regional (2 pts) or distant metastases (6 pts) as their first site of failure. Three of them experienced a differed local recurrence and 1 died from the disease. In the total mastectomy group, there were 2 local recurrences, 1 regional recurrence, and 5 distant metastases as first site of failure. One patient died from the disease. Actuarial results at 17-year for second conservative and total mastectomy were respectively: local control 84.2%-71.7%; disease free survival 65.4%-63.8%; and survival 90.7% and 88.2%. Cosmetic results were satisfactory in 89.4% treated conservatively. No patient experienced arm edema or grade 3-4 early or late complications. Between the 14 pts that were followed-up for at least 10-years, 13 of them were with their breast still in place. Conclusions: Second conservative treatment by HDR brachytherapy was a safe and effective method of treatment for small-size, low-risk, local recurrence after local excision in conservatively treated pts. APBI with wide margins probed to be enough treatment, without significant side-effects in previously intesively irradiated patients. Lumpectomy and partial breast brachytherapy can be conidered the treatment of choice in selected patients with low-risk recurrent breast tumors.
Risk factors for local recurrence after conservative treatment in stage I breast cancer. Definition of a subgroup not requiring radiotherapy