Prognosticators in recurrent breast cancer. A 15-year experience with irradiation

Abstract

After initial surgery, 133 breast cancer patients, who did not receive postoperative radiation or chemotherapy, were subsequently irradiated for recurrences in the Department of Radiation Oncology, University of Maryland Hospital. All patients have been followed for a minimum of 5 years after the treatment of recurrences. An extensive analysis was done in search of prognosticators for outcome in recurrent breast cancer. Traditional prognostic factors, such as the initial axillary status, primary surgical procedure, initial menopausal status, time and site of recurrences, distant metastases and radiation dose and field issues, were investigated. No correlation was found between the initial axillary status and the overall prognosis after recurrence. The main prognosticators were: the size of the initial breast tumor, the radiation treatment for recurrences, and the presence of, or time to, distant metastases. Initial T1–T2 breast tumors were associated with a delayed onset of recurrences and a lower incidence of chest wall relapses; in turn, both the latter situations yielded the best outcome. Radiation doses of more than 4000 rad in 4 weeks delivered with locoregional fields achieved a local control rate of 72%, and the best 5‐year postrecurrence survival (57%). In 52% of the recurrent breast cancer patients, distant metastases were discovered; 70% of them occurred within 2 years from recurrence. The overall postrecurrence 5‐year survival for the entire series was 40%. Both the results achieved with radiation therapy and the need for a logical strategy to approach the problem of breast cancer recurrences are discussed. The situation for a large proportion of these patients is not hopeless, and many are salvagable. Combined modality approaches could offer the best possibilities of survival. However, the importance of radiation therapy in the management of these patients cannot be denied or ignored.

Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer

“…The course of primary breast cancer is known to depend on factors such as age, menstrual status, body size parameters, histological and biochemical characteristics of the primary tumor [1][2][3][4][5][6]. However, little is known about the influence of these factors on the course of the disease after recurrence [4].…”

“…However, little is known about the influence of these factors on the course of the disease after recurrence [4]. The dissemination of the primary tumor to the brain is associated with a median survival of a few months [7][8][9].…”

High dose chemotherapy and autologous blood stem cell support in women with breast carcinoma and isolated supraclavicular lymph node metastases

“…In the current series, the addition of radiation therapy to the SCN improved EFS but did not appear to have an impact on OS. Although data from the NAABMTR did not show that the use of radiation therapy in the posttransplantation period was associated with an improved outcome,21 our data suggest that when possible, posttransplantation radiation therapy should be delivered to patients with isolated SCN metastases.…”

“…It occurs in approximately 13% of patients experiencing locoregional failure (chest wall and axillary, supraclavicular, or internal mammary lymph nodes) 20. Although the disease free interval from the time of primary breast carcinoma diagnosis has been found to predict OS in patients with locoregional recurrence,20, 21 survival from the time of first appearance of SCN metastases appears unchanged for women presenting with de novo involvement or as a site of initial failure 4. The median survival of such patients as reported by Kiricuta et al4 was approximately 24 months and was similar to patients with MBC at other sites 4, 20.…”

Sensitivity of locally recurrent rat mammary tumour cell lines to syngeneic polymorphonuclear cell, macrophage and natural killer cell cytolysis

“…Often regional relapse indicates a poor 5-or 10-year prognosis because systemic disease occurs shortly after diagnosis (Recht et al, 1985; KarabaliDalamaga et al, 1978;Patanaphan et al, 1984;Pearlman & Jochimsen, 1979). Also sensitivity to treatment regimens are frequently different in recurrent tumours compared to the original primary tumour.…”