Patterns of Care and Follow-up of Patients with an Ipsilateral Breast Tumor Event After Breast-Conserving Surgery: A Multicenter Retrospective Cohort Study in the Netherlands

PURPOSE: This study investigated patterns of care and oncological outcomes in patients with ipsilateral breast tumor events (IBTE) after prior breast-conserving surgery (BCS) treated with curative intent. METHODS: A retrospective cohort study was conducted on IBTE patients treated in 2016-2017 at 34 Dutch hospitals. Patient and characteristics, along with treatment details were collected and descriptive statistics were used for analysis. Overall survival (OS), disease-free survival (DFS) and breast cancer-specific survival (BCSS) were evaluated by using Kaplan-Meier analyses. RESULTS: Of the 486 IBTE patients, 75.1% were diagnosed more than 5 years after the primary tumor, 87.4% had invasive breast cancer, and 12.6% DCIS. Distinguishing true recurrences from second primaries was not possible. Among invasive IBTE, 70 (14.6%) had primary DCIS and 350 (72.8%) an invasive primary tumor. Most IBTEs (54.9%) were T1, grade II (46.5%), and ER/PR+/HER2- (61.7%). Seventy-two (14.8%) patients received neoadjuvant systemic therapy. Salvage mastectomy was performed in 435 (89.5%) patients, while 51 (10.5%) underwent repeat BCS; 60.8% of these received postoperative whole-breast re-irradiation. Among mastectomy patients, 411 (94.5%) had prior radiotherapy; 13.1% received repeat radiotherapy, either alone (24.1%) or with hyperthermia (75.9%). Adjuvant systemic therapy was administered to 64.9%. After a median follow-up of 37 months, 83 (17.4%) developed a subsequent event: 33 (39.8%) second IBTE, 9 regional recurrences, and 41 (49.4%) distant metastases. Three- and five-year OS was 89% and 72.5%, respectively. Three- and five-year DFS was 85.5% and 69.9%, respectively. Three- and five-year BCSS was 95.1% and 86%, respectively. CONCLUSIONS: Salvage mastectomy was the predominant treatment for IBTE, although repeat BCS with re-irradiation is increasingly performed in selected low-risk patients. Survival outcomes were favorable. The study highlights the need for tumor re-assessment and emphasizes the variability in IBTE management, underscoring the need for standardized treatment guidelines.

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Journal
Annals of Surgical Oncology
Published
2026-07-17
DOI
https://doi.org/10.1245/s10434-026-20080-x
Primary Topic
Breast Cancer Treatment Studies
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article
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article

Patterns of Care and Follow-up of Patients with an Ipsilateral Breast Tumor Event After Breast-Conserving Surgery: A Multicenter Retrospective Cohort Study in the Netherlands

Maurice J.C. van der Sangen, Coco J. E. F. Walstra, Grard A. P. Nieuwenhuijzen, Desirée H J G van den Bongard et al.
Annals of Surgical Oncology
Breast Cancer Treatment Studies
article

Patterns of Care and Follow-up of Patients with an Ipsilateral Breast Tumor Event After Breast-Conserving Surgery: A Multicenter Retrospective Cohort Study in the Netherlands

Maurice J.C. van der Sangen, Coco J. E. F. Walstra, Grard A. P. Nieuwenhuijzen, Desirée H J G van den Bongard, Lisca Wurfbain, Laura M. Tiels, W J Vles, A. M. Zeillemaker, M. S. Schlooz-Vries, J. Merkus, J. van Bastelaar, S. Schreurs, T. T. Frakking, L. M. van Roosendaal. L. Cornelissen, L. Daniels, E. van Dessel, E. van Bergen, N. Verheuvel, G. A. Gooiker, E. L. Postma, E. C. M. Zeestraten, A. Doeksen, J. C. van de Wetering, A. J. Maaskant-Braat, A. M. T. J. Raben, R. R. Dulfer, W. de Roos, L. H. Smit, J. E. Rutter, S. C. Hagenaars, A. E. Dassen, W. Truin, S. Stokmans, L. de Widt, C. A. Bargon, A. van Beurden, H. Peters, E. J. T. Luiten, S. Brookman, L. Outmani, S.den Besten, F. Aarts, H. A. P. Brokx, D. J. Evers, P. Jansen, S. van der Velden, L. de Rooij, A. C. Brink, D. J. P. van Uden, M Straver, S F Hardon, Marissa C. van Maaren, Robert-Jan Schipper, T. M. A. L. Klem, C. Willemien. Menke-van der Houven van Oordt, Birgit E. P. J. Vriens, Johanne G. Bloemen, G. J. Liefers, S. Jeuriens, Adri C. Voogd, B. M. D. Lemaire, L. B. Koppert, R. P. G.ten Broek, S. Muller
article en

Abstract

PURPOSE: This study investigated patterns of care and oncological outcomes in patients with ipsilateral breast tumor events (IBTE) after prior breast-conserving surgery (BCS) treated with curative intent. METHODS: A retrospective cohort study was conducted on IBTE patients treated in 2016-2017 at 34 Dutch hospitals. Patient and characteristics, along with treatment details were collected and descriptive statistics were used for analysis. Overall survival (OS), disease-free survival (DFS) and breast cancer-specific survival (BCSS) were evaluated by using Kaplan-Meier analyses. RESULTS: Of the 486 IBTE patients, 75.1% were diagnosed more than 5 years after the primary tumor, 87.4% had invasive breast cancer, and 12.6% DCIS. Distinguishing true recurrences from second primaries was not possible. Among invasive IBTE, 70 (14.6%) had primary DCIS and 350 (72.8%) an invasive primary tumor. Most IBTEs (54.9%) were T1, grade II (46.5%), and ER/PR+/HER2- (61.7%). Seventy-two (14.8%) patients received neoadjuvant systemic therapy. Salvage mastectomy was performed in 435 (89.5%) patients, while 51 (10.5%) underwent repeat BCS; 60.8% of these received postoperative whole-breast re-irradiation. Among mastectomy patients, 411 (94.5%) had prior radiotherapy; 13.1% received repeat radiotherapy, either alone (24.1%) or with hyperthermia (75.9%). Adjuvant systemic therapy was administered to 64.9%. After a median follow-up of 37 months, 83 (17.4%) developed a subsequent event: 33 (39.8%) second IBTE, 9 regional recurrences, and 41 (49.4%) distant metastases. Three- and five-year OS was 89% and 72.5%, respectively. Three- and five-year DFS was 85.5% and 69.9%, respectively. Three- and five-year BCSS was 95.1% and 86%, respectively. CONCLUSIONS: Salvage mastectomy was the predominant treatment for IBTE, although repeat BCS with re-irradiation is increasingly performed in selected low-risk patients. Survival outcomes were favorable. The study highlights the need for tumor re-assessment and emphasizes the variability in IBTE management, underscoring the need for standardized treatment guidelines.

Annals of Surgical Oncology
Radboud University Nijmegen (NL), Dutch Cancer Society (NL), Catharina Ziekenhuis (NL), Maastricht University (NL), Amsterdam Neuroscience (NL), Netherlands Comprehensive Cancer Organisation (NL), Amsterdam University Medical Centers (NL), Cancer Center Amsterdam (NL), Vrije Universiteit Amsterdam (NL), University of Twente (NL)
Good health and well-being
Openalex Percentile: Top 11%
Breast Cancer Treatment Studies
DOIOpen Access PDFOpenAlex
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