Ipsilateral breast tumor reappearance in patients treated with conservative surgery after primary chemotherapy. The role of surgical margins on outcome

Background and Objectives: To evaluate the ipsilateral breast tumor reappearance (IBTR) rate after breast conservative surgery (BCS) following primary chemotherapy (PC) and to assess whether positive margins affects IBTR rate and overall survival (OS). Methods: Three hundred nine women candidates for mastectomy received PC before surgery. One hundred ninety-five patients (63.1%) underwent BCS and 114 patients (36.9%) a modified radical mastectomy. Results: After a median follow-up of 41 months (range 7-90), 13 patients of the 195 treated with BCS had an IBTR (6.7%), 6 patients had a regional relapse (3.1%), 28 women had distant metastases (14.4%). Twenty-three patients died of breast cancer (11.8%). Twenty-four patients treated with BCS had positive margins (12.3%). At 3 years, the crude cumulative incidence of local recurrence was 4.7% in women with negative margins, and 13.3% in women with positive margins (P = 0.05). Cumulative incidence of distant metastases was similar in patients with positive and negative margins (P = 0.16) and there was no significant difference in terms of OS according to the margin status (P = 0.577). Conclusions: BCS after PC has an acceptable rate of IBTR. After a short follow-up, the presence of positive margins does not affect OS.