Local recurrence in the breast after conservative surgery—a study of prognosis and prognostic factors in 391 women

Fredriksson, Irma; Liljegren, Göran; Arnesson, Lars-Gunnar; Emdin, SO; Palm-Sjövall, M; Fornander, Tommy; Holmqvist, Marit; Holmberg, Lars; Frisell, Jan

doi:10.1016/s0959-8049(02)00219-8

Cited by 72 publications

(58 citation statements)

References 27 publications

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“…The same applied to the conservation of histological type and features of equal or lesser differentiation. On the other hand, we confirmed the notion that early recurrences, that is occurring within the first 2 years, are associated with more deaths than late ones (Fourquet et al, 1989;Fisher et al, 1991;Whelan et al, 1994;Veronesi et al, 1995;Haffty et al, 1996;Fredriksson et al, 2002). In our study the group of patients with early recurrences had primary tumours significantly more proliferating and ipsilateral breast tumour recurrences with a higher degree of nuclear polymorphism than the group of patients with late recurrences.…”

Section: Discussionsupporting

confidence: 89%

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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Section: Discussionsupporting

confidence: 89%

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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“…Similarly, in what to our knowledge is the largest series to date evaluating survival after in-breast local recurrence, which involved 391 patients from Sweden with a median follow-up of 95 months, the 5-year overall survival rate was significantly lower (68%) in patients presenting with a local in-breast recurrence in the same quadrant as the initial tumor within 2 years after the completion of initial therapy compared with patients in whom a recurrence developed Ͼ 2 years after the completion of initial therapy (97%). 26 …”

Section: Survival After Mastectomy For In-breast Local Recurrencementioning

confidence: 99%

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

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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“…Rates of local recurrence in the preserved breast vary between 2% and 10% after 5 years and between 5% and 15% at 10 years [1][2][3][4][5][6][7][8][9][10]. Considering the growing number of patients who have undergone BCT and the risk of local recurrence also extending after more than 10 years of follow-up, the number of patients experiencing a local recurrence is expected to increase considerably in the future.…”

Section: Introductionmentioning

confidence: 99%

Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer

Voogd

Oost

Rutgers

et al. 2005

European Journal of Cancer

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We have studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years. At 10 years from the date of salvage treatment, the overall survival rate for the 226 patients with invasive local recurrence was 39% (95% CI, 32-46), the distant recurrence-free survival rate was 36% (95% CI, 29-42), and the local control rate (i.e., survival without subsequent local recurrence or local progression) was 68% (95% CI, 62-75). Among patients with a local recurrence at or near the original tumour site a better distant disease-free survival was observed for patients with recurrences measuring 1 cm or less, compared to those with larger recurrences. This suggests, though does not prove, that early detection of local recurrence can improve the treatment outcome but might as well point towards a different biologic behaviour, facilitating early detection.

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Local recurrence in the breast after conservative surgery—a study of prognosis and prognostic factors in 391 women

Cited by 72 publications

References 27 publications

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

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

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

Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer

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