Predictors of local recurrence after conservative surgery and whole-breast irradiation

Purpose To identify independent factors associated with increased risk of local recurrence (LR) in patients with breast cancer treated with conservative surgery and radiotherapy with or without systemic therapy.Methods and materials Between January 1997 and December 2001, 969 women were treated at the Radiation Oncology Department in Chieti. We retrospectively analyzed 802 of them who were treated with conservative surgery and whole breast irradiation with or without systemic therapy. Tangential fields delivering 50 Gy to the whole breast were used and a boost was added for a total dose of 60 Gy. χ²-test or Fisher’s exact test were used to identify independent significant factors that are predictive for LR. Kaplan–Meier method was used to calculate the 8-year rates of recurrence according to age, histologic findings, tumor size, number of positive nodes, margin status, receptor status and systemic therapy use: log-rank test was used to compare these curves. Cox proportional hazard model was used to obtain hazard ratios and 95% CI of LR for each covariate.Results Median follow-up time was 63.1 months. LR occurred in 33 (4.1%) of 802 patients. Percentage of LR was greater in <50 year-olds compared with 50–64 year-olds and ≥65 year-olds (9.8% versus 4.1 and 2.0%, respectively). LR was 18.8% in women with a tumor size >3 cm versus 3.5, 4.0, 5.5% in women with a tumor size of 0.1–1, 1.1–2, 2.1–3 cm, respectively. The 8-year LR rate calculated with Kaplan–Meier method was 6.54±1.51. Multivariate Cox regression analysis showed that independent significant factors that are predictive for LR were: age <50, tumor size >3 cm, positive margin or unknown status, and hormonal therapy alone versus chemotherapy or combined therapy.Conclusions Age and tumor size were the most important and statistically significant factors that correlated independently with higher rates of LR. Women <50 years old and with a tumor size >3 cm had a higher risk of LR. Also margin status and systemic therapy could influence LR risk.     

Late breast recurrence after lumpectomy and irradiation

For 276 patients with early breast cancer followed from 10-21 years after lumpectomy and radiotherapy, the recurrence rate in the treated breast was 15.6%, and 7.2% developed contralateral breast cancer. Only 63% of breast recurrences occurred within 5 years, and the remainder were "late failures," with 5 of the 43 recurrences observed after 10 years. The proportion of failures occurring late was greater for T1 than for T2 tumors (53% vs 25%). Twenty-six percent of early recurrences were inoperable, and an adverse impact of early recurrence on 10-year survival was clearly demonstrable. Late recurrences were all operable and did not appear to be associated with decreased survival. Only 16 of the 36 patients (44%) with operable breast recurrence ever developed metastatic disease, and 5 year survival following salvage therapy was 62%. Although the treated breast remains at continuous cancer risk even beyond 5 year, the prognosis of late recurrence appears quite similar to that of contralateral breast cancer. We do not consider the phenomenon of late recurrence to lend support to a policy of primary mastectomy, just as the existence of contralateral breast cancer does not justify routine "prophylactic" contralateral mastectomy.     

Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer

Background

Few studies have focussed on the prognosis of young women with local recurrence (LR) after breast-conserving therapy and the factors that can be used to predict their prognosis.

Methods

We studied the outcome and related prognostic factors in 124 patients with an isolated local recurrence in the breast following breast-conserving surgery and radiotherapy for early stage breast cancer diagnosed at the age of 40 years or younger.

Results

The median follow-up of the patients after diagnosis of LR was 7.0 years. At 10 years from the date of salvage treatment, the overall survival rate was 73% (95% CI, 63–83), the distant recurrence-free survival rate was 61% (95% CI, 53–73), and the local control rate (i.e. survival without subsequent LR or local progression) was 95% (95% CI, 91–99). In the multivariate analysis, the risk of distant metastases also tended to be higher for patients with LR occurring within 5 years after BCT, as compared to patients with LR more than 5 years after BCT (Hazard ratio [HR], 1.89; p = 0.09). A worse distant recurrence-free survival was also observed for patients with a LR measuring more than 2 cm in diameter, compared to those with a LR of 2 cm or smaller (HR, 2.88; p = 0.007), and for patients with a LR causing symptoms or suspicious findings at clinical breast examination, compared to those with a LR detected by breast imaging only (HR 3.70; p = 0.03).

Conclusions

These results suggest that early detection of LR after BCT in young women can improve treatment outcome.     

Risk factors for local recurrence after breast-conserving therapy

Background. Breast-conserving therapy has been widely accepted as a standard treatment for early breast cancer both in Western countries and in Japan. In Western countries, many studies have investigated the risk factors for local recurrence after breast-conserving therapy (BCT), but few such studies have been done in Japan. Methods. To determine the risk factors for local recurrence in 399 breast cancer patients (stage I and II, n = 396; stage III, n = 3) who had undergone BCT with or without postoperative radiation therapy, we evaluated their clinicopathological features by univariate and multivariate analyses. The patients were treated at Osaka National Hospital between February 1988 and December 1997. Results. Univariate analysis showed that a young age (≤45 years; P = 0.0005) was a significant risk factor for local recurrence, while radiation therapy (P = 0.0058) and adjuvant endocrine therapy (P = 0.0041) significantly reduced the risk of local recurrence. In patients with BCT, without radiation therapy a positive surgical margin significantly increased the risk of local recurrence (P = 0.0470). Multivariate analysis showed that a young age (P = 0.0285) was a significant independent risk factor for local recurrence, while radiation therapy (P = 0.0457) significantly decreased recurrence. In patients with a negative surgical margin, radiation therapy (P = 0.0158) and adjuvant endocrine therapy (P = 0.0421) significantly reduced the relative risk of local recurrence, to 0.160 and 0.366, respectively. In patients with a positive surgical margin, radiation therapy marginally significantly (P = 0.0756) reduced the relative risk of local recurrence, to 0.181, and adjuvant endocrine therapy significantly (P = 0.0119) reduced the risk, to 0.076. Conclusions. Young age and lack of radiation therapy or adjuvant endocrine therapy were risk factors for local recurrence in breast cancer patients treated with breast-conserving therapy, with surgical margin status also being a possible risk factor. Received: November 9, 1998 / Accepted: March 11, 1999     

Site-specific risk factors for local recurrence after rectal cancer surgery

BackgroundQuite few studies examined risk factors for local recurrence after rectal cancer surgery with respect to local recurrence sites.MethodsLocal recurrence sites were categorized into axial, anterior, posterior, and lateral (pelvic sidewall), and axial, anterior, and posterior type were combined as the “other” type of local recurrence. Among 76 patients enrolled into our prospective randomized controlled trial to determine the indication for pelvic autonomic nerve preservation (PANP) in patients with advanced lower rectal cancer (UMIN000021353), multivariate analyses were conducted to elucidate risk factors for either lateral or the “other” type of local recurrence.ResultsUnivariate analyses showed that tumor distance from the anal verge was significantly (p = 0.017), and type of operation (sphincter preserving operation (SPO) vs. abdominoperineal resection (APR)) was marginally (p = 0.065) associated with pelvic sidewall recurrence. Multivariate analysis using these two parameters showed that tumor distance from the anal verge was significantly and independently correlated with pelvic sidewall recurrence (p = 0.017). As for the “other” type of local recurrence, univariate analyses showed that depth of tumor invasion (p = 0.011), radial margin status (p < 0.001), and adjuvant chemotherapy (p = 0.037) were significantly associated, and multivariate analysis using these three parameters revealed that depth of tumor invasion (p = 0.004) and radial margin status (p < 0.001) were significantly and independently correlated with the “other” type of local recurrence.ConclusionRisk factors for local recurrence after rectal cancer surgery were totally different with respect to the intra-pelvic recurrent sites. Site-specific probability of local recurrence can be inferred using these risk factors.Trial registration numberUMIN000021353.     

Correlation between clinical features and prognosis of local recurrence after breast-conserving therapy

Background. In patients with early stage breast cancer who have breast-conserving therapy (BCT), the impact of local recurrence on the risk of distant metastasis is still controversial. Local recurrence after BCT is an uncommon event, so it is impossible to determine a standard treatment method by a clinical trial because not enough patients can be enrolled. Methods. Between February 1988 and December 1997, 399 patients with clinical stage I and II breast cancer underwent BCT in our department. Of these 399 patients, 22 developed local recurrence during this period. To assess the relationship between their clinical characteristics and prognosis, we performed a retrospective review of these 22 patients. Results. The 5-year overall survival rate after local recurrence was 66.7%. All four patients who had cutaneous or inflammatory type recurrence developed distant metasta-sis after salvage treatment. Of three patients with multiple recurrence, two developed disseminated disease after salvage treatment. Two of four patients treated by repeat lumpectomy developed further local recurrence after salvage lumpectomy. Conclusion. To improve prognosis in patients with multiple, cutaneous, or inflammatory recurrence, aggressive adjuvant systemic therapy may be required after salvage surgery. Received: May 13, 1999 / Accepted: September 22, 1999     

The significance of local recurrence of carcinoma of the breast

One hundred twenty-one patients with local or regional recurrence of carcinoma of the breast without evidence of distant metastases were treated with megavoltage radiation therapy. All patients had radical or modified radical mastectomy as their initial treatment. The 10 year survival probability of this group of patients is 26 %, with a local control probability of 46 %. Within this group of patients with recurrent disease, factors found to be associated with a poorer prognosis include peripheral nodal recurrence, advanced initial disease stage and short disease free interval. Contrary to expectation, patients with recurrence within the mastectomy scar (as opposed to chest wall recurrence wide of the scar) or a history of previous radiotherapy had poorer local control rates (although not statistically significant), without effect upon overall survival. Comprehensive radiation therapy (peripheral lymphatic plus chest wall) enhanced the local control rate for the entire group and the survival probability for patients with isolated chest wall recurrence compared with limited radiation therapy fields. (Five year survival probability: chest wall irradiation only = 27%; chest wall and peripheral lymphatic = 54%). Patients given systemic therapy at the time of local recurrence showed no survival benefit. Aggressive, comprehensive radiation therapy is indicated for locally recurrent breast cancer. More effective systemic therapy is needed, especially for higher risk patients.     

局部区域复发乳腺癌的治疗进展

和初治的乳腺癌相比,局部区域复发性患者的预后分析和挽救治疗策略选择存在更多的不确定性。本文首先分析了影响保乳手术和乳房切除术后局部-区域复发的高危因素以及相应的复发模式。以再次手术和包括完整复发灶及相应亚临床病灶的放射治疗为主要形式的局部治疗是综合治疗策略的基础,合理的局部治疗可以达到有效的局部疾病控制率并降低二次局部区域复发。虽然既往的前瞻性或回顾性资料对于全身治疗在局部-区域复发乳腺癌治疗中的价值始终没有确认,由多个国际乳腺癌研究组织联合发起的CALOR研究结果的公布第一次证实,在保留合理的内分泌治疗和靶向治疗的前提下,手术+放射治疗联合后续的全身化疗可以进一步提高无病生存率和总生存率,尤其在激素受体阴性的患者中获益更显著。所以结合原发病灶和复发灶的肿瘤标志物给予合理的全身治疗将成为局部区域复发患者综合治疗重要的组成部分。     

乳腺癌患者手术后局部复发的临床分析

目的探讨乳腺癌患者手术后局部复发的影响因素。方法回顾性分析2000年至2008年诊治的671例患者的临床病理资料,行Cox回归模型分析预后影响因素。结果手术后局部复发率为10．7％,Cox回归模型多因素分析显示,淋巴结状态、肿瘤分期、激素受体状态、术后规范化辅助治疗是影响手术后局部复发的重要因素,其中手术后规范化辅助治疗是其保护性因素。结论淋巴结状态、肿瘤分期、激素受体状态、术后规范化辅助治疗对患者的预后评估有重要意义,术后行规范化辅助治疗可降低局部复发。     

乳腺癌根治术局部复发后影响预后的相关因素分析

目的研究乳腺癌根治术局部复发后影响预后的相关因素,探讨乳腺癌根治术后局部复发的最佳治疗方案。方法回顾性分析天津肿瘤医院1975年1月至2003年1月期间收治的1067例乳腺癌根治术后复发患者,采用χ2检验或秩和检验对患者年龄、绝经情况、原发瘤临床分期、腋窝淋巴结转移情况、无病间期、复发部位、胸壁复发灶数目及其最大直径、雌激素受体(ER)或孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达等临床病理特征以及不同治疗方案与局部复发治疗的近期疗效和远处转移率之间的关系进行单因素分析;使用Kaplan-Meier法及COX回归模型对乳腺癌根治术复发后影响5年生存率的相关因素进行单因素与多因素分析。结果对全部1067例病例进行随访,778例(72.9%)出现远处转移,复发后5年总生存率为42.4%。复发部位、胸壁复发灶数目及其最大直径、有无放射治疗、放射治疗范围、有无化疗、有无手术切除或切除活检等因素的不同亚组间局部控制率的差异有统计学意义(P0.050);腋窝淋巴结转移情况、无病间期、ER或PR表达、HER-2表达以及再治疗中有无化疗等因素的不同亚组间远处转移率的差异有统计学意义(P0.050);无病间期、复发部位、胸壁复发灶数目、ER或PR表达、HER-2表达、治疗方法等因素的不同亚组间5年总生存率的差异有统计学意义(P0.050);无病间期≤2年、复发部位多、治疗方案单一、局部控制率低及ER、PR均阴性是导致复发性乳腺癌预后差的独立因素(P0.050)。结论多部位复发、胸壁多发结节及胸壁复发灶最大直径3cm者局部控制不佳,局部扩大野放射治疗结合化疗和(或)手术是改善局部控制率的较好模式;有腋窝淋巴结转移、2年内复发、ER、PR均阴性以及HER-2阳性表达的乳腺癌复发后容易发生远处转移,复发再治疗中化疗能减少远处转移的发生;对于复发性乳腺癌采取综合治疗方案可以提高复发患者的生存率;无病间期长,多部位复发,ER或PR阴性者提示预后不良。     

High-risk CT features for detection of local recurrence after stereotactic ablative radiotherapy for lung cancer

Background and purpose

Early detection of local recurrences following stereotactic ablative radiotherapy (SABR) for lung cancer may allow for curative salvage treatment, but recurrence can be difficult to distinguish from fibrosis. We studied the clinical performance of CT imaging high-risk features (HRFs) for detecting local recurrence.

Materials and methods

Patients treated with SABR for early stage lung cancer between 2003 and 2012 who developed pathology-proven local recurrence (n = 12) were matched 1:2 to patients without recurrences (n = 24), based on baseline factors. Serial CT images were assessed by blinded radiation oncologists. Previously reported HRFs were (1) enlarging opacity at primary site; (2) sequential enlarging opacity; (3) enlarging opacity after 12-months; (4) bulging margin; (5) loss of linear margin and (6) air bronchogram loss.

Results

All HRFs were significantly associated with local recurrence (p < 0.01), and one new HRF was identified: cranio-caudal growth (p < 0.001). The best individual predictor of local recurrence was opacity enlargement after 12-months (100% sensitivity, 83% specificity, p < 0.001). The odds of recurrence increased 4-fold for each additional HRF detected. The presence of ?3 HRFs was highly sensitive and specific for recurrence (both >90%).

Conclusion

The systematic assessment of post-SABR CT images for HRFs enables the accurate prediction of local recurrence.     

Axillary recurrence after negative sentinel lymph node biopsy under local anesthesia in breast cancer

The procedure known as sentinel lymph node biopsy (SLNB) under local anesthesia (LA) allows surgical teams to avoid the uncertainties of frozen tissue examination and to perform axillary dissection on patients who have been informed of the risks of lymph node invasion prior to the procedure.     

三维适形放疗治疗直肠癌术后复发病例临床观察

目的：观察三维适形放疗治疗直肠癌术后复发病例的疗效。方法：选择直肠癌术后复发患者54例接受三维适形放疗，其中低分化腺癌4例，中分化腺癌37例，高分化腺癌7例，粘液腺癌6例。放疗总剂量在60－72GY／22－24F／每周4－5次，其毒性作用用血液学、生化试验、胃肠道和泌尿系统反应进行评价。观察有无放射性肠淡症状，监测血细胞。每3月复查MRCT1次，二年生每6月复查MR或CT1次。结果：迄2000年12月25日止共随访54例，随访到53例（98.1%），失访1例（1.9%）；中位随访时间为15.4个月，平均访时间为14.3个月（3－30个月）。疗效判定标准：按WHO制订标准，完全缓解5例，占9.3%；部分缓解27例，占50.0%。稳定15例，占27.8%；进展6例占11.1%。有效率为59.3%。一年生存率61.1%（33/54），症状缓解率92.6%（50／54）。放射性肠炎发生率约为5.6%。均未出现白细胞减少和肝、肾功能降低与尿频、尿急、尿痛和血尿。结论：三维适形放射治疗直肠癌术后复发患者具有明显的剂量分布优势，局部控制率和症状缓解率高，放射性肠炎发生率低。     

Breast cancer subtype approximations and loco-regional recurrence after immediate breast reconstruction

Background

A small but significant proportion of patients with breast cancer (BC) will develop loco-regional recurrence (LRR) after immediate breast reconstruction (IBR). The LRR also varies according to breast cancer subtypes and clinicopathological features.

Methods

We studied 1742 consecutive BC patients with IBR between 1997 and 2006. According to St Gallen conference consensus 2011, its BC approximations were applied to classify BC into five subtypes: estrogen receptor (ER) and/or progesterone receptor (PgR) positive, HER2 negative, and low Ki67 (<14%) [luminal A]; ER and/or PgR positive, HER2 negative and high Ki67(≥14%) [luminal B/HER2 negative]; ER and/or PgR positive, any Ki67 and HER2 positive [luminal B/HER2 positive]; ER negative, PgR negative and HER2 positive [HER2 positive/nonluminal]; and ER negative, PgR negative and HER2 negative [triple negative]. Cumulative incidences of LRR were compared across different subgroups by means of the Gray test. Multivariable Cox regression models were applied.

Results

Median follow up time was 74 months (range 3–165). The cumulative incidence of LRR was 5.5% (121 events). The 5-year cumulative incidence of LRR was 2.5% for luminal A; 5.0% for luminal B/HER2 negative; 9.8% for luminal B/HER2 positive; 3.8% for HER2 non luminal; and 10.9% for triple negative. On multivariable analysis, tumor size (pT) >2 cm, body mass index (BMI) ≥25, triple negative and luminal B/HER2 positive subtypes were associated with increased risk of LRR.

Conclusion

Luminal B/HER2 positive, triple negative subtypes and BMI ≥25 are independent prognostic factors for risk of LRR after IBR.     

Separate cavity margins excision as a complement to conservative breast cancer surgery

Background

Positive lumpectomy margins (LM) usually mandate re-excision. However, approximately half of these patients have no residual tumour in the re-excision specimen. The aim of this study was to investigate if separate cavity margin (CM) excision can safely reduce the need of re-operation.

Methods

Rate of re-operation for margin involvement and incidence of residual tumour in the re-excision specimen were retrospectively evaluated in 237 patients (group A) who underwent lumpectomy alone, and in 271 patients (group B) treated by lumpectomy and CM excision. Patients with positive LM (group A) or CM (group B) underwent re-excision.

Results

In the group A, 50/237 patients (21.1%) had LM+ and underwent re-excision. In the group B, 74/271 patients (27.3%) had LM+, but tumour was found within the CM specimen in 46 patients (17.0%), 24 LM+ and 22 LM−, and reached the CM cut edge in only 15 (5.5%), who finally underwent re-excision. Residual tumour was found in the re-excision specimen in 28/50 patients (56.0%) of the group A and in 7/15 patients (46.7%) of the group B.

Conclusions

Separate CM excision strongly decreases the rate of re-operation for involved margin. However, the finding of various combinations of LM and CM status and the evidence that CM excision does not improve the positive predictive value of margin involvement suggest prudent conclusions. Only long term follow up of patients treated according to the CM status can exclude that the reduced rate of re-operations allowed by this procedure would expose to an increased risk of local recurrence.     

Twelve-year clinical outcomes and patterns of failure with accelerated partial breast irradiation versus whole-breast irradiation: Results of a matched-pair analysis

Background and Purpose

To compare 12-year outcomes of accelerated partial breast irradiation (APBI) versus whole-breast irradiation (WBI) in patients treated with breast conservation.

Materials and Methods

A matched-pair analysis was performed using 199 patients receiving WBI and 199 patients receiving interstitial APBI. Match criteria included tumor size, age, nodal status, ER status, and the use of adjuvant hormonal therapy. Patterns of failure and efficacy of salvage treatments were examined.

Results

No differences were seen in the 12-year rates of local recurrence (3.8% vs. 5.0%, p = 0.40), regional recurrence (0% vs. 1.1%, p = 0.15), disease free survival (DFS) (87% vs. 91%, p = 0.30), cause-specific survival (CSS) (93% vs. 95%, p = 0.28), or overall survival (OS) (78% vs. 71%, p = 0.06) between the WBI and APBI groups, respectively. The rate of distant metastases was lower in the APBI group (10.1% vs. 4.5%, p = .05). Following LR, no difference in outcome was seen between the two groups with 5 year post-LR rates of DFS (80% vs. 86%, p = 0.55), CSS (88% vs. 75%, p = 0.77), and OS (88% vs. 75%, p = 0.77), respectively.

Conclusions

With 12-year follow-up, APBI produced outcomes equivalent to WBI. Following LR, patients treated with APBI also had similar failure patterns to those managed with WBI.     

Factors associated with breast cancer mortality after local recurrence

Purpose

We aimed to identify risk factors for mortality after local recurrence in women treated for invasive breast cancer with breast-conserving surgery.

Experimental Design

Our prospective cohort study included 267 women who were treated with breast-conserving surgery at Women’s College Hospital from 1987 to 1997 and who later developed local recurrence. Clinical information and tumour receptor status were abstracted from medical records and pathology reports. Patients were followed from the date of local recurrence until death or last follow-up. Survival analysis used a Cox proportional hazards model.

Results

Among the 267 women with a local recurrence, 97 (36.3%) died of breast cancer within 10 years (on average 2.6 years after the local recurrence). The actuarial risk of death was 46.1% at 10 years from recurrence. In a multivariable model, predictors of death included short time from diagnosis to recurrence [hazard ratio (hr) for <5 years compared with ≥10 years: 3.40; 95% confidence interval (ci): 1.04 to 11.1; p = 0.04], progesterone receptor positivity (hr: 0.35; 95% ci: 0.23 to 0.54; p < 0.001), lymph node positivity (hr: 2.1; 95% ci: 1.4 to 3.3; p = 0.001), and age at local recurrence (hr for age >45 compared with age ≤45 years: 0.61; 95% ci: 0.38 to 0.95; p = 0.03).

Conclusions

The risk of death after local recurrence varies widely. Risk factors for death after local recurrence include node positivity, progesterone receptor negativity, young age at recurrence, and short time from diagnosis to recurrence.     

Partial breast irradiation as second conservative treatment for local breast cancer recurrence

PURPOSE: Mastectomy is the treatment of reference for local relapse after breast cancer (BC). The aim of this study was to document the feasibility and the results of associating lumpectomy with partial breast irradiation by interstitial brachytherapy (IB) as local treatment for an isolated ipsilateral BC local recurrence (LR). METHODS AND MATERIALS: Between 1975 and 1996 at Marseille and Nice Cancer Institutes, 4026 patients received lumpectomy and radiotherapy (RT) (50-80 Gy) for a localized breast cancer of which 473 presented a LR. Among these patients, 69 (14.6%) received a second lumpectomy followed by IB, which delivered 30 Gy (Nice, n = 24) or 45-50 Gy (Marseille, n = 45) with 3 to 8 (192)Ir wires in 1 or 2 planes on the 85% isodose. RESULTS: Median age at LR was 58.2 years, median follow-up since primary BC was 10 years, and median follow-up after the second conservative treatment was 50.2 months (range, 2-139 months). Immediate tolerance was good in all cases. Grade 2 to 3 long-term complications (LTC) according to IB dose were 0%, 28%, and 32%, respectively, for 30 Gy, 45 to 46 Gy, and 50 Gy (p = 0.01). Grade 2 to 3 LTC according to total dose were 4% and 30%, respectively, for total doses (initial RT plus IB) < or = 100 Gy or >100 Gy (p = 0.008). Logistic regression showed that the only factor associated with Grade 2 to 3 complications was higher IB doses (p = 0.01). We noted 11 second LRs (LR2), 10 distant metastases (DM), and 5 specific deaths. LR2 occurred either in the tumor bed (50.8%) or close to the tumor bed (34.3%) or in another quadrant (14.9%). Kaplan-Meier 5-year freedom from (FF) LR2 (FFLR2), FFDM, and DFS were 77.4%, 86.7%, and 68.9%, respectively. Overall 5-year survival (OS) was 91.8%. Univariate analysis showed the following factors associated with a higher FFLR2: (1) number of wires used for IB (3-4 vs. 5-8 wires, p = 0.006), (2) IB doses (30-45 Gy vs. 46-60 Gy, p = 0.05), (3) number of planes (1 vs. 2, p = 0.05), (4) interval between primary breast cancer and LR (< 36 months vs. > or =36 months, p = 0.06). Multivariate analysis showed two factors associated with better local control: (1) number of wires (5-8 wires, p = 0.013) and (2) interval between primary breast cancer and LR > or =36 months (p = 0.039). The multivariate analysis showed two factors associated with better FFDM: (1) absence of initial axilla involvement (p = 0.019) and (2) relapse in a different location (p = 0.04). These two factors were also associated with a higher OS. CONCLUSION: Our experience showed that second conservative treatments for local relapse were feasible and gave results comparable to standard mastectomy. We recommend delivering IB doses of at least 46 Gy in 2 planes when initial radiotherapy delivered 50 Gy. The study gives enough information to encourage a Phase III trial that compares radical mastectomy to conservative procedures for localized breast cancer recurrences.