Local Recurrences and Distant Metastases After Conservative Breast Cancer Treatments: Partly Independent Events

Veronesi, Umberto; Marubini, Ettore; Vecchio, Marcella Del; Manzari, Antonia; Andreola, Salvatore; Greco, Marco; Luini, Alberto; Merson, M.; Saccozzi, R; Rilke, F; Salvadori, B

doi:10.1093/jnci/87.1.19

Cited by 456 publications

(271 citation statements)

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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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“…20 The relative risk of breast carcinomaassociated death is estimated to increase by a factor of 3.4 to 4.6 in patients who develop a local in-breast recurrence compared with patients who do not. 20,21 This fact is likely related to the biology of disease rather than a cause of subsequent distant metastases, although this remains a controversial area of discussion. 22 The overall survival of patients with in-breast local recurrences at 5 years reportedly ranges from 52-84% (Table 1); virtually all deaths appear to occur in patients with an invasive recurrence.…”

Section: Survival After Mastectomy For In-breast Local Recurrencementioning

confidence: 99%

“…Patients with an early local recurrence are reported to subsequently develop distant metastases approximately 50% of the time. 21 Veronesi et al 21 found that the risk of developing distant metastases for patients with a local recurrence in the first year after surgery was 6.6 that of patients in whom a local recurrence developed Ͼ 3 years after the completion of initial conservative therapy. 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%).…”

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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“…The rationale for partial breast radiotherapy (PBRT) after breast conservation surgery for early breast cancer includes the assumption that most ipsilateral breast tumor relapses (IBTR) developing outside the index quadrant are new primary (NP) tumors that are not prevented by radiotherapy (1)(2)(3). Several phase I and II studies evaluating accelerated PBRT have reported promising early results, with few local tumor relapses, while maintaining excellent cosmetic outcomes and minimum toxicity (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

Gujral

Sumo

Owen³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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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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Local Recurrences and Distant Metastases After Conservative Breast Cancer Treatments: Partly Independent Events

Cited by 456 publications

References 0 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

Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

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