Pattern of relapse after breast conserving therapy, a study of 1519 early breast cancer patients treated in the Central Region of Denmark 2000–2009

Abstract

Background: The continuous improvements in diagnosing and treatment of breast cancer are reflected in the ever changing pattern of recurrence. The aim of the study was to investigating recurrence pattern and prognostic factors of recurrence in a population-based cohort. Results: Median follow-up was 5.3 years (range 0.3-14.4). In total 183 women experienced breast cancer recurrence, 44 ipsilateral breast cancer recurrence, 13 regional recurrences, and 126 distant metastasis (DM). This corresponds to a cumulative risk of DM as first event at five and nine years of 6.5% and 12.6%, respectively. Further 42 women developed breast cancer in the contralateral breast. Disease-free survival (DFS) at five and nine years was 88% and 76%, respectively. Large tumor size (>20 mm), lymph node involvement, and vascular invasion were significantly associated with increased risk of DM. Margin width and age were not associated with risk of DM. Conclusion: Acceptable recurrence rates and DFS were observed. Patients with large tumors, lymph node involvement, and vascular invasion had an increased risk of DM.

The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial

“…In the hypofractionated arm the CTVp_breast volume receiving between 105 and 107% of the prescribed dose should be kept below 2% of the CTVp_breast volume. For both treatment arms, the volume receiving 107-110% dose should be <2 cm 3 . In the normofractionated arm, the dose constraints for the OAR were: maximum LADCA dose 20 Gy, heart V 20Gy 10% and V 40Gy 5%, ipsilateral lung V 20Gy 25% and mean lung dose (MLD) 18 Gy.…”

“…Adjuvant radiotherapy (RT) reduces loco-regional recurrence, distant failure and improves overall survival of early breast cancer patients [1][2][3]. On the other hand, adjuvant RT also increases the risk of heart-and lung-related toxicity compared to women not receiving RT [4,5].…”

Rethink radiotherapy – BIGART 2017

“…The indication for RT is primarily to avoid local recurrence. This is successfully achieved, but maybe because the true incidence of recurrence is on a rapid decline [162,163], which for some low-risk patient groups, make the indications for RT at all questionable [163,164]. On the other hand, there is still a prominent enhanced risk in the very young patients [161], which cannot be explained by differences in intrinsic subtypes or presence of BRCA mutations [165], but still is an issue with an unsolved etiology.…”

Intrinsic subtype characterization of local recurrences and new contralateral primary tumors in patients with low risk breast cancer. Influence of age and primary surgery

“…We have recently demonstrated that the local failure rate among early-stage node-negative breast cancer patients receiving no adjuvant systemic treatment was high among young patients ( 45 years) receiving breast conserving therapy (BCT) [1][2][3]. Furthermore, this outcome was associated with an increased risk of getting subsequent disseminated disease and cancer-related death [1].…”