J Breast Cancer.
2021 Jun;24(3):241-252. 10.4048/jbc.2021.24.e27.
The Italian Association of Radiotherapy and Oncology Recommendation for Breast Tumor Recurrence: Grades of Recommendation, Assessment, Development and Evaluation Criteria
- Bottero M
1 - Borzillo V2
- Pergolizzi S3
- Jereczek-Fossa BA4,5
- Ippolito E6
- Frezza GP7
- Fortunato L8
- Corvò R9
- Pappagallo GL10
- Arcangeli S11
- Magrini SM12
- D'Angelillo RM13
- Affiliations
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- 1Department of Radiation Oncology, Università degli Studi di Roma Tor Vergata, Rome, Italy
- 2Radiation Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale - Napoli, Italy
- 3Radiation Oncology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
- 4Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- 5Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- 6Radioterapia Oncologica, Università Campus Bio-Medico, Roma, Italy
- 7Department of Oncology, Radiation Oncology Unit, Ospedale Bellaria. Bologna, Italy
- 8Centro di Senologia Azienda Ospedaliera San Giovanni-Addolorata, Roma, Italy
- 9Department of Radiation Oncology, National Cancer Research Institute and University, Genova, Italy
- 10Private Epidemiologist, Silea TV, Italy
- 11Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan “Bicocca,” Milan, Italy
- 12Department of Radiation Oncology, University of Brescia, Brescia, Italy
- 13Radioterapia, Dipartimento di Biomedicina e prevenzione, Università degli Studi di Roma Tor Vergata, Roma, Italy
- KMID: 2517339
- DOI: http://doi.org/10.4048/jbc.2021.24.e27
Abstract
- Salvage mastectomy is currently considered the standard of care for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and postoperative radiotherapy (RT). Alternative treatment options for these patients, such as a second BCS followed by repeated RT, have been suggested. The panel of the Italian Association of Radiotherapy and Clinical Oncology developed clinical recommendations for second BCS followed by re-irradiation over mastectomy alone for women with IBTR using the Grades of Recommendation, Assessment, Development, and Evaluation methodology and the evidence to decision framework. The following outcomes were identified by the panel: locoregional control, metastasis-free survival, overall survival, and cancer-specific survival; acute and late toxicity, specific late toxicity, second locoregional tumor, and death related to treatment. An Embase and PubMed literature search was performed by two independent authors. Five retrospective observational studies were eligible for inclusion in the present analysis. According to the reports in the literature and our analysis, the advantages of second quadrantectomy and re-irradiation (re-QUART) outweigh its side effects, with overall good rates of survival and adequate toxicity without increasing costs. Given the very low level of evidence, the panel stated that a second BCS plus re-irradiation can be considered as an alternative to salvage mastectomy for selected patients with IBTR.
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