Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM)

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

“…However, when overlooking the available evidence for its effectiveness in primary breast cancer, it is our opinion that adjuvant systemic (re-)treatment should be considered in patients with unfavourable prognostic factors. Local recurrence at or near the site of the original tumour [22,[24][25][26], skin involvement [22,27], diffuse growth of recurrence [22,24], a short disease-free interval [3,4,8,12,13,15,20,[28][29][30] and an unfavourable initial tumour stage [22,31] have been found to be predictors of a poorer prognosis in more than one study. Patients with a recurrence remote from the primary tumour appear to have a better prognosis than those with a recurrence at or near the site of the primary tumour [22,[24][25][26].…”

“…In many studies, patients with a local recurrence within two or three years after the original treatment appeared to have a poorer overall and distant disease-free survival compared to those with a local recurrence occurring later [3,4,8,12,13,15,20,[28][29][30]. True recurrences tend to have a shorter interval from BCT than the recurrences that are considered to be new primary tumours.…”

“…Earlier studies reported 5-year survival rates ranging from 70% to 84% after salvage treatment for patients with local recurrence after BCT, which is equal or only slightly worse compared with those without local recurrence [5,[11][12][13]. More recent series, however, reported poorer 5-year survival rates, ranging from 55% to 68% after 5 years [3,14] and one study even reached the conclusion that the survival after treatment for an early loco-regional recurrence after modified radical mastectomy or BCT is similar [15]. The unfavourable prognostic effect of developing a local recurrence has been confirmed by other studies, that included local recurrence in a multivariate analysis as a time-dependent variable and showed it to be a strong independent predictor of the risk of developing distant metastatic disease [6,7,[16][17][18][19][20][21].…”

10 Breast-Conserving Therapy

“…Furthermore, loco-regional recurrences showed a negative impact on survival in axillary lymph node positive patients participating in NSABP trials (12). On the contrary, previous analysis of two randomized trials did not report a significant difference in survival between loco-regional recurrences after BCT and mastectomy (13). In addition, with the delivery of better systemic treatments to the patients such as chemotherapy, targeted therapy, and hormonal therapy and with the development of better radiotherapy devices and techniques, the expected rate of loco-regional recurrence decreased from 0.5-1% per year to less than 5% in 10 years.…”

Phase I Study and Biomarker Analysis of Lapatinib and Concurrent Radiation for Locally Advanced Breast Cancer

“…Yet, obtaining adequate local control is quite difficult with local failures seen in up to three-quarters of women treated with radiation alone and in about half of women treated with surgical excision followed by radiation [1][2][3][4]. Uncontrolled local-regional disease can adversely affect quality of life, making improved local control an important therapeutic goal [5].…”