Analysis of ipsilateral breast tumor recurrences after breast-conserving treatment based on the classification of true recurrences and new primary tumors

Komoike, Yoshifumi; Akiyama, Futoshi; Iino, Yuichi; Ikeda, Tadashi; Tanaka-Akashi, Sadako; Ohsumi, Shozo; Kusama, Mikio; Sano, Muneaki; Shin, Eisei; Suemasu, Kimito; Sonoo, Hiroshi; Taguchi, Tetsuya; Nishi, Tsunehiro; Nishimura, Reiki; Haga, Shunsuke; Mise, Kazuyuki; Kinoshita, Takayuki; Murakami, Shigeru; Yoshimoto, Masataka; Tsukuma, Hideaki; Inaji, Hideo

doi:10.2325/jbcs.12.104

Cited by 97 publications

(87 citation statements)

References 24 publications

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“…In addition, NP is associated more often than LR in the literature with contralateral breast cancer. The median times to relapse for cases of definite and likely LR (37 and 35 months, respectively) in our series were also shorter than for definite and likely NP (86 and 63 months, respectively), in keeping with results from previous series (20,(23)(24)(25) and supporting our attributions of IBTR.…”

Section: Discussionsupporting

confidence: 92%

“…Several studies have attempted to differentiate between true recurrences and new primaries (20,(23)(24)(25), from which common themes are apparent: the majority of IBTR are LR, which tend to occur earlier, metastasize earlier and more often, and have a shorter overall and disease-free survival than NP. In our series, 59 (39%) patients had metastatic disease at relapse, of whom 39/59 (66%) patients had LR, consistent with the reported association between LR and risk of distant relapse (21,26).…”

Section: Discussionmentioning

confidence: 99%

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5126 Ipsilateral breast tumour relapse: local recurrence versus new primary and the effect of whole breast radiotherapy on the rate of new primaries

Gujral¹,

Sumo²,

Owen³

et al. 2009

European Journal of Cancer Supplements

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Purpose: The justification for partial breast radiotherapy after breast conservation surgery assumes that ipsilateral breast tumor relapses (IBTR) outside the index quadrant are mostly new primary (NP) tumors that develop despite radiotherapy. We tested the hypothesis that whole-breast radiotherapy (WBRT) is ineffective in preventing NP by comparing development rates in irradiated and contralateral breasts after tumor excision and WBRT. Methods and Materials: We retrospectively reviewed 1,410 women with breast cancer who were entered into a prospective randomized trial of radiotherapy fractionation and monitored annually for ipsilateral breast tumor relapses (IBTR) and contralateral breast cancer (CLBC). Cases of IBTR were classified into local recurrence (LR) or NP tumors based on location and histology and were subdivided as definite or likely depending on clinical data. Rates of ipsilateral NP and CLBC were compared over a 15-year period of follow-up. Results: At a median follow-up of 10.1 years, there were 150 documented cases of IBTR: 118 (79%) cases were definite or likely LR; 27 (18%) cases were definite or likely NP; and 5 (3%) cases could not be classified. There were 71 cases of CLBC. The crude proportion of definite-plus-likely NP was 1.9% (27/1,410) patients compared with 5% (71/1,410) CLBC patients. Cumulative incidence rates at 5, 10, and 15 years were 0.8%, 2.0%, and 3.5%, respectively, for definite-plus-likely NP and 2.4%, 5.8%, and 7.9%, respectively for CLBC, suggesting a difference in the rates of NP and CLBC. Conclusions: This analysis suggests that WBRT reduces the rate of ipsilateral NP tumors. The late presentation of NP has implications for the reporting of trials that are testing partial breast radiotherapy. Ó 2011 Elsevier Inc.Breast cancer, Ipsilateral, Contralateral, Relapse, Radiotherapy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

5126 Ipsilateral breast tumour relapse: local recurrence versus new primary and the effect of whole breast radiotherapy on the rate of new primaries

Gujral¹,

Sumo²,

Owen³

et al. 2009

European Journal of Cancer Supplements

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“…Their definition according to clinical and histological criteria remains a wild dream. All authors agree on a basic definition of a new primary that is, an ipsilateral breast tumour recurrence with a different histological type from its primary tumour (Haffty et al, 1993;Touboul et al, 1999;Smith et al, 2000;Huang et al, 2002;Komoike et al, 2005). Our series showed a good concordance of the histological type in the ipsilateral breast tumour recurrence.…”

Section: Discussionsupporting

confidence: 78%

Are ipsilateral breast tumour invasive recurrences in young (⩽40 years) women more aggressive than their primary tumours?

Sigal‐Zafrani

Antoni

et al. 2007

Br J Cancer

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The characteristics of ipsilateral breast tumour recurrences (IBTRs) relative to those of their primary tumours (PTs) remain scarcely studied. Of 70 young (p40 years) premenopausal women with IBTRs, we studied a series of 63 with paired histological data. Median follow-up since IBTR was 10 years. Rates of histological types, grades or hormonal receptors were not significantly different in PTs and in IBTRs. The concordance between IBTRs and their PTs was good for histological types. IBTRs with conserved histological types tended to occur more locally, but not significantly sooner than others. These IBTRs had good concordance for hormone receptors. In discordant cases there were as many losses as appearances of the receptors. The concordance was weak for grades, with equivalent numbers of IBTRs graded lower as higher than their PTs. The 10-year overall survival rate was 70%. Neither the conservation of histological type, location, nor of the two combined were associated with deaths. Early (o2 years) IBTRs, tended to be associated with poorer survival (HR ¼ 2.24 (0.92 -5.41); P ¼ 0.08). IBTRs did not display features of higher aggressiveness than PTs. Neither clinical nor histological definition of a true recurrence could be established other than the conservation of the histological type. British Journal of Cancer (2007) Breast-conserving treatments of early stage breast cancer exposes the patient to the risk of ipsilateral breast tumour recurrence (IBTR). The most important prognostic factor for local recurrence is the young age of the patient (Vrieling et al, 2003) and this remains true among young (o40 years old), premenopausal women treated either by surgery first (Bollet et al, 2007) or by neoadjuvant chemotherapy (Oh et al, 2006). Many questions remain unanswered concerning the real nature of these ipsilateral breast tumour recurrences. We shall examine how different they are from primary tumours and whether there are clinical or histological factors to help distinguish between a re-growth of malignant cells not removed by surgery and not killed by radiotherapy (also called a true recurrence, TR) and a de novo malignancy arising from mammary epithelial cells of residual breast tissues (also known as new primary tumours, NP) (Haffty et al, 1993). Some have implied that ipsilateral breast tumour recurrences should display features of, at least as much aggressiveness (differentiation (Huang et al, 2002), ploidy (Haffty et al, 1993) and percentage of invasiveness (Haffty et al, 1993;Smith et al, 2000;Huang et al, 2002)) to qualify as true recurrences. We shall see whether biological evidence can be found to support this definition. Finally, we shall investigate whether the characteristics of ipsilateral breast tumour recurrences are associated with prognosis. PATIENTS AND METHODSOut of a previously described series of 209 premenopausal women, younger than 40 years old, treated at the Institut Curie between 1985 and 1995 for early breast cancers (clinical T1-2, N0-1 ; Sobin and Wittekind, 2002) with primary brea...

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“…Regular check-ups for IBTR may be necessary after 10 years. Regarding the characteristics of IBTR, 68.6% occurred within or adjacent to the original tumor bed, which is similar to existing observations (16,24,25). Of note, IBTR was salvaged with partial mastectomy in 48.6%.…”

Section: ------------------------------------------------------------supporting

confidence: 85%

Impact of radiation therapy on breast-conserving therapy for breast cancer in Japanese women: A retrospective analyses of multi-institutional experience. Kansai Breast Cancer Radiation Therapy Study Group

Mitsumori

Hiraoka²,

Inaji

et al. 2009

Oncol Rep

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Abstract. Whole breast radiation therapy (RT) after breastconserving surgery is sometimes omitted in Japan; however, its impact on the outcome has not been properly evaluated. A multi-institutional retrospective study was conducted to clarify the impact of RT on local control after breast-conserving therapy (BCT). Data were collected from 3576 patients from 37 participating hospitals, of whom 1763 were eligible for analyses. Five hundred and five patients had ipsilateral breast tumor recurrence (IBTR) and 1258 patients did not. Details of IBTR were available for 245 of 505 patients who had IBTR, the location of IBTR was within or adjacent to the original tumor bed in 168 patients (68.6%). IBTR was salvaged with partial mastectomy in 119 patients (48.6%). Second recurrence in the ipsilateral breast was observed in 27 patients (11.0%). Univariate analyses demonstrated that administration of RT, the resection margin status, hormone responsiveness, T stage, N stage and stage were significantly related to IBTR. Multivariate analysis demonstrated that administration of RT, T stage and N stage were significantly correlated to IBTR. Among them, administration of RT had the largest impact on RT and it decreased the risk of IBTR by 77.3%. Omission of RT had the most significant impact on IBTR. RT should be given as a standard component of BCT.

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Analysis of ipsilateral breast tumor recurrences after breast-conserving treatment based on the classification of true recurrences and new primary tumors

Abstract: TR and NP show clinically quite different features; time to occurrence, characteristics of the original tumor, prognosis and risk factor profile for IBTR were all different. Classifying IBTR as TR or NP can provide clinically significant data for the management of IBTR.

Cited by 97 publications

References 24 publications

5126 Ipsilateral breast tumour relapse: local recurrence versus new primary and the effect of whole breast radiotherapy on the rate of new primaries

5126 Ipsilateral breast tumour relapse: local recurrence versus new primary and the effect of whole breast radiotherapy on the rate of new primaries

Are ipsilateral breast tumour invasive recurrences in young (⩽40 years) women more aggressive than their primary tumours?

Impact of radiation therapy on breast-conserving therapy for breast cancer in Japanese women: A retrospective analyses of multi-institutional experience. Kansai Breast Cancer Radiation Therapy Study Group

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