Local and distant relapses in relation to age following breast-conserving surgery and irradiation in premenopausal patients with breast cancer

Ipsilateral Breast Tumor Recurrence Following Breast-Conserving Surgery for Early-Stage Invasive Cancer

“…The development of distant metastases subsequent to an isolated IBTR (pattern C) has been correlated with the interval to failure, young age, initial T2 tumor size, initial positive axillary nodes, and the extent of the recurrence (17,19,53,55,56,63,67). Sixty percent of patients whose IBTR appears within 2 years of initial treatment have been reported to develop distant metastases compared with 27 -38% after 2 years (49,53).…”

“…Factors that correlate with an earlier pattern of IBTR and therefore reflect a greater likelihood of subsequent distant metastases include young age, a recurrence in the vicinity of the original primary, the presence of skin involvement, a diffuse recurrence, high histologic grade, and the presence of lymphatic or vascular invasion (19,50,54,57,68,69). Factors that correlate with a later pattern of IBTR and therefore fewer subsequent distant metastases include initial T1 primary tumor size, axillary node-negative and location of the recurrence distinct from the original primary (54,58,62).…”

“…Six to 14% percent of all patients who develop an IBTR will have simultaneous distant metastases (pattern B) (19,24,(50)(51)(52)(53)(54)(55)(56)(57). Factors which correlate with this pattern of failure are not well defined but would logically include those that are associated with an increased risk of initial distant metastases, i.e., large primary tumor size and positive axillary nodes.…”

“…In several series IBTR rates have been reported in the range of 24-43% at 8 to 10 years in women 5 35 years of age treated with conservative surgery and radiation (11,(15)(16)(17)(18)(19). This increased risk has been attributed to a greater prevalence of primary tumors with an extensive intraductal component or adverse histopathologic factors such as high nuclear or histologic grade or tumor necrosis (16, 20 -22).…”