Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer

Touboul, E.; Buffat, Laurent; Belkacémi, Yazid; Lefranc, Jean‐Pierre; Uzan, Serge; Lhuillier, Pierre; Faivre, Corinne; Huart, Judith; Lotz, Jean‐Pierre; Antoine, Martine; Pene, F.; J, Blondon; Izrael, V.; Laugier, A; Schlienger, M.; Housset, M.

doi:10.1016/s0360-3016(98)00365-4

Cited by 238 publications

(132 citation statements)

References 79 publications

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“…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). In addition, NP is associated more often than LR in the literature with contralateral breast cancer.…”

Section: Discussionsupporting

confidence: 89%

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: 89%

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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“…Short DFI was reported to be highly correlated with subsequent DM. 21,25,26,31,[41][42][43][44] These risk factors appear to reflect the inherent aggressive characteristics of primary tumors. 38,39 Thus the risk of developing DM would be predetermined before treatment, with local recurrence being a manifestation of this risk.…”

Section: Figurementioning

confidence: 99%

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Komoike

Akiyama

Iino

et al. 2005

Cancer

156

102

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BACKGROUNDThe clinical features of ipsilateral breast tumor recurrence (IBTR) after breast conserving therapy (BCT) for early stage breast cancer were analyzed from long‐term follow‐up of BCT in Japan. The purpose of this study was to clarify risk factors of IBTR and the impact of IBTR on development of distant metastases in this ethnic group.METHODSPatients (N = 1901)with unilateral breast cancer ≤ 3 cm in diameter who underwent BCT at 18 Japanese major breast cancer treatment institutes from 1986 to 1993 were registered in this study. Survival rates, the incidences of IBTR and distant metastases, and annual rates of IBTR and distant metastases after primary operation were calculated by the Kaplan–Meier method. A Cox proportional hazards model was used to estimate the risks of IBTR and distant metastases. A Cox model was also used to estimate the risks of distant metastases after IBTR in the group of IBTR.RESULTSAt a median follow‐up time of 107 months, the 10‐year overall and disease‐free survival rates were 83.9% and 77.8%, respectively. The 10‐year cumulative rates of IBTR were 8.5% in the patients with postoperative irradiation and 17.2% in the patients without irradiation. The 10‐year cumulative distant metastasis rate was 10.9%. On multivariate analysis, young age, positive surgical margin, and omission of radiation therapy were significant predictors of IBTR. In addition, IBTR significantly correlated with subsequent distant metastases (hazard ratio, 3.93; 95% confidence interval, 2.676–5.771; P < 0.0001). Among patients who developed IBTR, initial lymph node metastases and short interval to IBTR were significant risk factors for subsequent distant metastasis.CONCLUSIONSYoung age, positive surgical margin, and omission of radiation therapy seemed to be important factors in relation to local control. The authors' results also indicated that IBTR is significantly associated with subsequent distant metastasis. Patients with positive nodal status at primary operation or with short interval from primary operation to IBTR are at especially high risk of distant metastasis. It remains unclear, however, whether IBTR is an indicator or a cause of subsequent distant metastases. Cancer 2006. © 2005 American Cancer Society.

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Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer

Cited by 238 publications

References 79 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?

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

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