Despite modern surgical and irradiation techniques, approximately 1 in 10 women treated with lumpectomy and irradiation will experience recurrence of breast cancer in the ipsilateral breast (in-breast recurrence). Historically, this event has been managed definitively with mastectomy. However, many local recurrences are small and detected early, and even after a recurrence, long-term survival is achievable.¹ Thus, there has been an interest in examining the feasibility of subsequent breast-conserving therapy. Rates of second recurrence after lumpectomy alone for first recurrence are unacceptably high,^2,3 similar to those after lumpectomy alone for primary breast cancer. Fears of unacceptable toxic effects have prevented most investigators from pursuing lumpectomy with reirradiation of the whole breast; however, a number of groups reported their experience with a second lumpectomy with partial breast reirradiation (PBrI). Most studies used brachytherapy, and the largest study was the multi-institutional observational Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC-ESTRO) study.⁴ In this series, a 5-year second in-breast recurrence rate of 5.2% was reported, with a 5-year distant metastasis rate of 9.6% and overall survival of 88.7%. Regarding the cosmetic outcome, 48% of patients rated their cosmesis as excellent, with the remaining 52% rating it as fair or poor. Although these results are promising and comparable to clinical outcomes after mastectomy for in-breast recurrence, this study included a heterogeneous and incompletely defined patient population (eg, margin status was not reported). Thus, prospective data to better inform outcomes and patient selection are sorely needed.

尽管有现代手术和放射技术，大约十分之一接受乳房肿瘤切除术和放射治疗的女性会经历同侧乳房的乳腺癌复发（乳房内复发）。从历史上看，这一事件已通过乳房切除术得到明确处理。然而，许多局部复发很小并且早期发现，即使在复发后，也可以实现长期生存。¹因此，人们对研究后续保乳治疗的可行性产生了兴趣。单独乳房肿瘤切除术后第一次复发的第二次复发率高得令人无法接受，^{2 ,3}类似于原发性乳腺癌单独进行乳房肿瘤切除术后的那些。对不可接受的毒性作用的恐惧阻止了大多数研究人员进行乳房肿瘤切除术并重新照射整个乳房。然而，一些小组报告了他们进行第二次乳房部分切除术和部分乳房再照射 (PBrI) 的经验。大多数研究使用近距离放射治疗，最大的研究是多机构观察性 Groupe Européen de Curiethérapie 和欧洲放射治疗和肿瘤学会 (GEC-ESTRO) 研究。⁴在该系列中，报告了 5 年第二次乳房内复发率为 5.2%，5 年远处转移率为 9.6%，总生存率为 88.7%。关于美容效果，48% 的患者将其美容评价为优秀，其余 52% 的患者评价为一般或差。尽管这些结果是有希望的，并且与乳房切除术后乳房内复发的临床结果相当，但这项研究包括异质且定义不完整的患者群体（例如，未报告边缘状态）。因此，迫切需要前瞻性数据来更好地告知结果和患者选择。