A Systematic Review Ot Treatment For The Ipsilateral Breast Tumour Recurrence After Breast-Conserving Therapy

Purpose:Whether the repeat breast-conserving therapy is considered as the feasible therapy for the ipsilateral breast tumour recurrence(IBTR)after breast-conserving therapy and what about the overall survival and quality of life of IBTR patients,there are not any definite answers to these problems.Thus,we searched related articles referring to the evidence-based medicine research method,and synthesized the results to expand the sample capacity in order to evaluate the patients outcome and quality of life after the repeat breast-conserving therapy.Methods:This literature search was performed in Cochrane Library,PubMed and Embase according to the strategy,and the key words are breast cancer,conserving therapy,mastectomy,recurrence,expired on December 31,2018.There were three different treatment options:(1)salvage mastectomy(2)repeat breast-conserving surgery alone(3)repeat breast-conserving surgery followed by re-radiotherapy in the studies,and we extracted the data of follow-up,overall survival rate,distance metastasis free survival rate and local control rate to calculate the weighted estimates and tested the date by Chi-square significance test.Finally,we evaluated the toxicity and cosmesis of patients underwent repeat breast-conserving surgery followed by re-radiotherapy.Results:We included 22 related articles,which contain salvage mastectomy group in 6 articles with the sample capacity of 706 patiens,repeat breast-conserving surgery alone group in 5 articles with the sample capacity of 340 patiens and repeat breast-conserving surgery followed by re-radiotherapy group in 16 articles including 5 survival and local control studies with the sample capacity of 201 patiens and 15 toxicity and cosmesis studies with the sample capacity of 201 patiens.The 5-year overall survival rates of salvage mastectomy group,repeat breast-conserving surgery alone group and repeat breast-conserving surgery followed by re-radiotherapy group are 79.15%,75.17%,89.05%respectively(P<0.001).The 5-year distance metastasis free survival rates of three groups are 64.58%,61.63%,82.59%(P<0.001),and there are significant statistical differences in the 5-year overall survival rates and distance metastasis free survival rates among three groups.The s-year local control rates of repeat breast-conserving surgery alone group and repeat breast-conserving surgery followed by re-radiotherapy group are 56.79%,72.64%respectively(p<0.001)with significant statistical differences.Since there were many patients with different side effects been counted repeatedly in some articles,we could not calculate the weighted estimates of every grade of the toxicity.There was no toxicity of grade 4 in all the studies,and the incidence of grade 3 toxicity was approximately no more than 5.5%.The outcomes of cosmesis in patients underwent repeat breast-conserving surgery followed by re-radiotherapy were "excellent" in 63 patients(33.7%),"good,in 61 patients(32.6%),"moderate/fair" in 41 patients(24.6%),"acceptable" in 16 patients(8.6%),"unacceptable" in 1 patient(0.5%).Conclusions:Based on the limited studies and date in the treatment for the ipsilateral breast tumour recurrence(IBTR)after breast-conserving therapy,the rates of overall survival,distance metastasis free survival and local control in the repeat breast-conserving surgery followed by re-radiotherapy group were better than the salvage mastectomy group or repeat breast-conserving surgery alone group,with a low toxicity and a satisfying cosmesis.Thus we supposed that repeat breast-conserving surgery followed by re-radiotherapy seemed to be a feasible alternative to salvage mastectomy in case of IBTR,in selected patients.