Local recurrence following breast-conserving treatment in women aged 40years or younger: Trends in risk and the impact on prognosis in a population-based cohort of 1143 patients

Laar, Charlotte van; Sangen, M.J.C. van der; Poortmans, Philip; Nieuwenhuijzen, Grard A. P.; Roukema, Jan A.; Roumen, R. M. H.; Tjan-Heijnen, Vcg; Voogd, Adri C.

doi:10.1016/j.ejca.2013.05.030

Cited by 101 publications

(69 citation statements)

References 28 publications

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“…This was associated with a reduced risk of local and distant recurrences and death. Multiple studies have shown that improved locoregional control was associated with increased adjuvant systemic therapy [10,11,23,24], although it may also be due to improved patient selection and local treatment [25].…”

Section: Discussionmentioning

confidence: 99%

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Bosma

Leij

Werkhoven

et al. 2016

Breast Cancer Res Treat

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The purpose of this study was to study the impact of changes in clinical practice on outcome in patients treated with breast-conserving therapy (BCT) over a period of 28 years. Patients with early invasive breast cancer, who were treated with BCT at the Netherlands Cancer Institute between 1980 and 2008, were studied. Clinical characteristics, treatment and outcome were compared between groups (1980-1987; 1988-1998; 1999-2008). The main endpoint analyzed was ipsilateral breast tumor recurrence (IBTR). 8485 patients with a median follow-up of 9 years (IQR 6-14 years) were analyzed. The cumulative 5- and 10-year IBTR incidences were, respectively, 2 and 5 % for the whole cohort and 4 and 9 % in patients ≤40 years. Young age was a significant risk factor for IBTR in multivariable analysis. IBTR-free interval was better for patients who received a RT boost (HR 0.65) or systemic therapy (HR 0.52). In later years, patients less often received a boost and more often underwent adjuvant systemic treatment. 761 patients (9.0 %) underwent a re-excision; the tumor resection margins were tumor free for 85 %. In later years (1999-2008), 89 % of patients had a tumor-free margin. The margin status of invasive carcinoma did not influence IBTR, DM rate, or OS. Between 1980 and 2008, locoregional control after BCT remained stable with low IBTR rates, even in young patients. These good results were achieved under the policy of accepting close or focally positive margins, indicating this is a safe approach. The results of this study may help in lowering the re-excision rates, which are high in many centers.

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Section: Discussionmentioning

confidence: 99%

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Bosma

Leij

Werkhoven

et al. 2016

Breast Cancer Res Treat

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“…Several reports have demonstrated that patients with late IBTR have a better prognosis than those with early IBTR [3,4,5,6,8,9,10,11,12,13,14,15,16]. However, distant recurrence after late IBTR is not rare.…”

Section: Discussionmentioning

confidence: 99%

“…According to these studies, the time interval from initial surgery to IBTR (disease-free interval) was one of the most important predictors of disease recurrence after IBTR [3,4,5,6,8,9,10,11,12,13,14,15,16]. Patients with IBTR >5 years after breast-conserving surgery have a better prognosis than patients with earlier IBTR [8,13,15,16]. However, it is not rare for patients with IBTR >5 years after initial surgery to develop systemic recurrence [6,13,16].…”

Section: Introductionmentioning

confidence: 99%

Distant Recurrence Risk after Late Ipsilateral Breast Tumor Recurrence: Results of a Retrospective, Single-Institution Study

Ishitobi

Okuno²,

Kittaka³

et al. 2015

Oncology

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Objectives: There is limited information regarding risk factors for distant recurrence in patients with late ipsilateral breast tumor recurrence (IBTR). Methods: Late IBTR was defined as IBTR occurring >5 years after the initial surgery. Seventy-eight patients with late IBTR were reviewed to examine the risk factors of distant recurrence. Results: The negative estrogen receptor and positive HER2 statuses of IBTR were significantly correlated with poorer distant disease-free survival (p = 0.03 and 0.02, respectively). Multivariate analyses demonstrated that the HER2 status of IBTR was an independent predictive factor of distant recurrence (p = 0.04). Conclusions: The results of our retrospective, single-institution study revealed that the HER2 status of IBTR was an independent predictive factor of distant recurrence in patients with late IBTR.

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“…This question has been addressed in several studies attempting to differentiate between true recurrences and new primaries [25,26,27,28], from which the following conclusions can be derived: The majority of IBTRs are true recurrences, which tend to occur earlier and in the same quadrant as the initial tumor, metastasize earlier and more often and result in a shorter OS and disease-free survival (DFS) than new primaries. Further retrospective studies [29,30,31] evaluating IBTRs showed that there are subgroups of patients with improved rates of OS, DFS, and second local recurrence. Based on these retrospective studies, selection criteria for patients who may be candidates for a second breast-conserving approach are summarized in table 1.…”

Section: Therapy Of Ipsilateral Breast Tumor Recurrencementioning

confidence: 99%

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

et al. 2015

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Patients with isolated locoregional breast cancer recurrences should be treated with curative intent. Mastectomy is regarded as the standard of care for patients with ipsilateral breast tumor recurrence. In a selected group of patients, partial breast irradiation after second breast-conserving surgery is a viable alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory, especially in patients who had not been irradiated previously. In case of re-irradiation, the largest experience exists for multi-catheter brachytherapy. Prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. In patients with resectable locoregional breast cancer recurrences after mastectomy, multi-modal therapy comprising complete resection, radiation therapy in previously unirradiated patients, and systemic therapy results in 5-year disease-free and overall survival rates of 69% and 88%, respectively. In radiation-naive patients with unresectable, isolated locoregional recurrences, radiation therapy is mandatory. In selected patients with previous irradiations and unresectable locoregional recurrences, a second irradiation as part of an individual treatment concept can be applied. The increased risk of severe toxicity should always be weighed up against the potential clinical benefit. A combination therapy with hyperthermia can further improve the treatment results.

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Local recurrence following breast-conserving treatment in women aged 40years or younger: Trends in risk and the impact on prognosis in a population-based cohort of 1143 patients

Cited by 101 publications

References 28 publications

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

Distant Recurrence Risk after Late Ipsilateral Breast Tumor Recurrence: Results of a Retrospective, Single-Institution Study

Current Treatment of Isolated Locoregional Breast Cancer Recurrences

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