Classifying local disease recurrences after breast conservation therapy based on location and histology

Abstract

BACKGROUND To distinguish true local recurrences (TR) from new primary tumors (NP) and to assess whether this distinction has prognostic value in patients who develop ipsilateral breast tumor recurrences (IBTR) after breast‐conserving surgery and radiotherapy. METHODS Between 1970 and 1994, 1339 patients underwent breast‐conserving surgery at The University of Texas M. D. Anderson Cancer Center for ductal carcinoma in situ or invasive carcinoma. Of these patients, 139 (10.4%) had an IBTR as the first site of failure. For the 126 patients with clinical data available for retrospective review, we classified the IBTR as a TR if it was located within 3 cm of the primary tumor bed and was of the same histologic subtype. All other IBTRs were designated NP. RESULTS Of the 126 patients, 48 (38%) patients were classified as NP and 78 (62%) as TR. Mean time to disease recurrence was 7.3 years for NP versus 5.6 years for TR (P = 0.0669). The patients with NP had improved 10‐year rates of overall survival (NP 77% vs. TR 46%, P = 0.0002), cause‐specific survival (NP 83% vs. TR 49%, P = 0.0001), and distant disease‐free survival (NP 77% vs. TR 26%, P < 0.0001). Patients with NP more often developed contralateral breast carcinoma (10‐year rate: NP 29% vs. TR 8%, P = 0.0043), but were less likely to develop a second local recurrence after salvage treatment of the first IBTR (NP 2% vs. TR 18%, P = 0.008). CONCLUSIONS Patients with NP had significantly better survival rates than those with TR, but were more likely to develop contralateral breast carcinoma. Distinguishing new breast carcinomas from local disease recurrences may have importance in therapeutic decisions and chemoprevention strategies. This is because patients with new carcinomas had significantly lower rates of metastasis than those with local disease recurrence, but were more likely to develop contralateral breast carcinomas. Cancer 2002;95:2059–67. © 2002 American Cancer Society. DOI 10.1002/cncr.10952

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

“…Most authors have also proposed that location would help distinguish the two -with ipsilateral breast tumour recurrences occurring away from the index quadrant more prone to be new primaries (Fisher et al, 1986;Haffty et al, 1993;Smith et al, 2000;Huang et al, 2002). This was confirmed in our series where ipsilateral breast tumour recurrences that had conserved their IBTR vs primary breast cancer B Sigal-Zafrani et al primary tumours' histological types tended to arise more often in the index quadrant than others.…”

“…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.…”

“…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.…”

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

“…A similarly low rate of chest wall recurrence (4%) was reported by Salvadori et al and also may be the result of the inclusion of patients with initial Stage I and Stage II disease. 6 Huang et al 11 found that the rate of local recurrence after mastectomy was significantly higher in patients with a true local recurrence at the site of the initial breast-conserving surgery compared with patients with recurrent tumors detected elsewhere in the breast (18% vs. 2%).…”

“…3,4,[6][7][8][9][10][11][12][13][14][15][16][17] These studies demonstrated that a second local recurrence in the form of a chest wall recurrence occurs in approximately 2-32% of patients. Thus, mastectomy after in-breast local recurrence does not necessarily eliminate the risk of subsequent secondary local recurrences at the chest wall.…”