Breast preservation in patients with local recurrence after breast-conserving therapy

Mastectomy is the current standard of care following in-breast local recurrence of breast cancer previously treated with breast-conserving surgery and whole-breast irradiation. Review of the limited world literature on repeat breast-conserving surgery suggests that the risk of secondary local in-breast recurrence may be too high in unselected patients following this approach. Rapid evolution of radiation therapy techniques has brought partial-breast irradiation (PBI) to the forefront as a potential local treatment for women with in-breast local recurrence following repeat breast-conserving surgery. This review gives an overview of the biological rationale for PBI; reviews techniques, potential benefits, and complications of PBI; and describes a new phase II national cooperative group trial evaluating PBI following repeat breast-conserving surgery. Mastectomy may not be necessary in all patients with in-breast local recurrence of breast cancer.