Local Relapse after Breast-Conserving Surgery and Radiotherapy (original) (raw)

Survival Benefit with Radiation Therapy in Node-Positive Breast Carcinoma Patients

Strahlentherapie und Onkologie, 2009

Background and Purpose: Postoperative radiation therapy (RT) has been the subject of discussion, especially in patients with one to three positive lymph nodes (≤ 3 pN+) in the axillary dissection. The authors investigated whether postoperative RT provides a survival benefit for pT1-2 pN+ breast cancer patients. Patients and Methods: Patients included were selected from the SEER database (NCI -Surveillance, Epidemiology and End Results, release 2000; n = 24,410) and the UZ Brussel database (1984-2002; n = 1,011) according to the following criteria: women aged 25-95, no previous cancer, unilateral pT1-pT2 breast tumors, total mastectomy (ME) or breast-conserving surgery (BCS), postoperative RT, and an axillary dissection showing at least one pathologic lymph node. Results: The overall survival (OS) of patients in the SEER and UZ Brussel databases who received postoperative RT was identical. However, patients in the SEER database who did not receive RT had a significantly worse outcome (p < 0.0001). After ME or BCS, all patients (SEER and UZ Brussel) who had ≥ 4 pN+ and received RT had comparable outcomes after 15 years. The 15-year OS in the subgroup with ME and ≤ 3 pN+ nodes was 57.0% and 46.6% (p = 0.0004) with RT (UZ Brussel) and without RT (SEER), respectively. For BCS and ≤ 3 pN+, the same significant difference in OS at 15 years was seen: 63.8% after RT (UZ Brussel) and 60.4% without RT (SEER; p = 0.0029). Conclusion: RT provides a survival benefit in patients with ≤ 3 or ≥ 4 pN+; the indication for postoperative RT should therefore be adapted in future consensus meetings.

Patterns of relapse in locally advanced breast cancer treated with neoadjuvant chemotherapy followed by surgery and radiotherapy

Journal of Cancer Research and Therapeutics, 2007

Aims: To define the clinical and pathological predictors of locoregional recurrence (LRR) in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NACT). Materials and Methods: We retrospectively reviewed the outcome of 141 patients with stage II to stage III carcinoma breast treated at Department of Radiotherapy, PGIMER, Chandigarh from 1998-2002. Mean age of the patients was 46 years, 49% of patients were premenopausal and 51% were postmenopausal. The tumor stage was T2 in 18%; T3 in 61% and T4 in 26% of the patients. NACT regimen given was FAC (5-fluorouracil, adriamycin and cyclophosphamide) in 85% and CMF (cyclophosphamide, methotrexate and 5-Fu) in 15% patients. Results: After NACT, surgery was possible in 95% patients. Conservative surgery was possible in 23% patients and mastectomy was done in 72% of patients. Pathological complete response (pCR) was seen in 18% patients and pathological partial response (pPR) in 69% of patients. Stable and progressive disease was seen in 6% and 7% of patients respectively. Adjuvant radiation therapy was given to 86% patients. Six percent patients developed progressive disease and 4% of patients did not turn up for radiation. Five year LRR was 6% and relapse free survival (RFS) was 94%. Thirty-two (23%) patients developed distant metastasis resulting in distant metastasis free survival of 77%. The factors that correlated positively with LRR on univariate analysis included tumor stage, stage and pathological nodal stage. However, on multivariate analysis, tumor stage and pathological nodal stage were significant. Factors that correlated for distant relapse were tumor stage, response to chemotherapy, type of surgery, extracapsular extension (ECE) and tamoxifen therapy. On multivariate analysis only ECE was the significant factor that correlated with distant relapse free survival. Conclusion: Thus, tumor stage and pathological nodal stage remains the most important predictor of LRR in LABC. Factors that correlated for distant relapse were tumor stage, response to chemotherapy, type of surgery and ECE and tamoxifen therapy.

Predictors of locoregional recurrence in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy, mastectomy, and radiotherapy

International Journal of Radiation Oncology*Biology*Physics, 2005

Purpose: To identify the clinical and pathologic factors predictive of locoregional recurrence (LRR) after neoadjuvant chemotherapy, mastectomy, and radiotherapy. Methods and Materials: We retrospectively reviewed the hospital records of 542 patients treated on six consecutive institutional prospective trials using neoadjuvant chemotherapy and postmastectomy radiotherapy. The clinical stage (American Joint Committee on Cancer, 1988) was Stage II in 17%, Stage IIIA in 30%, Stage IIIB in 43%, and Stage IV (ipsilateral supraclavicular disease) in 10%. All LRRs were considered events, irrespective of the timing to distant metastases. Results: The median follow-up was 70 months. The 5-year and 10-year actuarial LRR rate was 9% and 11%, respectively. The clinical factors associated with LRR included combined clinical stage, clinical T stage, ipsilateral supraclavicular nodal disease, chemotherapy response, physical examination size after chemotherapy, and no tamoxifen use (p < 0.04 for all factors). The pathologic predictors of LRR included the number of positive nodes, dissection of <10 nodes, multifocal/multicentric disease, lymphovascular space invasion, extracapsular extension, skin/nipple involvement, and estrogen receptor-negative disease (p < 0.05 for all factors). Multivariate Cox regression analysis revealed that five factors independently predicted for LRR: skin/nipple involvement, supraclavicular nodal disease, no tamoxifen use, extracapsular extension, and estrogen receptor-negative disease (hazard ratio, 2.1-2.8; p < 0.02 for all factors). The 10-year LRR rate was only 4% for patients with one or none of these five independent factors, 8% for those with two factors, and 28% for those with three or more factors (p < 0.0001). Conclusion: Although the long-term rate of LRR after neoadjuvant chemotherapy, mastectomy, and radiotherapy is low, we identified a number of factors that correlated independently with greater rates of LRR. Patients with three or more of these factors may benefit from research protocols investigating alternative treatment strategies.

Local recurrence after breast conservation therapy for early stage breast carcinoma

Cancer, 1999

Background: Breast conserving therapy (BCT) was the recommended modality for treating early stage (I-IIB) breast carcinoma. So, decreasing late morbidity of both chemotherapy and radiation therapy becomes one of our targets for the sake of expected long survival with good quality of life. Aim of the study: The aim of this study is the evaluation of the effect of adding boost dose of radiation therapy to the tumor bed in breast conserving therapy (BCT), significantly affect local recurrence & disease free survival (DFS). Patients and methods: Thirty seven patients were included in this study (age range from 35 to 70 years, mean age 53  3.84), all have an early stage breast carcinoma (stage I-II B) and treated surgically with breast conserving surgery (lumpectomy + axillary clearance level one and two lymphadenectomy), followed by adjuvant chemoradiotherapy without boost dose to tumor bed, using 3-D conformal radiation therapy this group (A) was, compared to a historical retrospective group (B), of 40 patients with the same criteria but with boost dose to tumor bed. Results: The 3-year disease free survival (DFS) was 78% in group A compared to 83% in group B (P> 0.05). On the other hand, boost dose of radiation decreases local recurrence as a cause of failure by about 5% (22% versus 17% in groups A & B respectively) P > 0.05. In group A most patients who achieved local failure were below the age of 45 years (82.6%) compared to 76.2% in group B, (P > 0.05). In group B, breast fibrosis as a late effect of radiation was 11% compared to 8.73% in group A (P  0.05) without statistically significant difference. Conclusion: In early stage breast cancer (I-IIB), giving a boost dose of radiation to tumor bed (12 Gy) insignificantly decreases local failure with improvement of 3years disease free survival on the sake of increasing grade III breast fibrosis as a late radiation toxicity. [Ahmad M. Alhosainy and Abd Elhafez M. Elshewael. The role of boost dose of radiation after whole breast irradiation in decreasing local recurrence in breast conserving therapy of early stage breast carcinoma. Cancer Biology 2015;5(3):185-190].

Patterns of failure in locally advanced female breast carcinoma treated with neoadjuvant chemotherapy followed by surgery and radiotherapy – A prospective study

Asian Journal of Medical Sciences

Background: The use of combined modality therapy including surgery, chemotherapy, and radiotherapy increases five survival rates in stage IIA and stage IIIB disease to 80% and 45%, respectively. Neoadjuvant chemotherapy (NACT) eradicates micro metastasis present in the body and also improves resectability. Aims and Objectives: The main aim of this study was to determine the locoregional recurrence and distant recurrence rates and thereby define clinical and pathological predictive factors for recurrence. Materials and Methods: This was a single institutional prospective study carried out in the Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata. From January 2017 to December 2019, according to inclusion and exclusions criteria, a total of 1183 histologically and/or cytologically proven breast carcinoma patients were included in this prospective study. Results: Breast conservative surgery was done in 16.5% of patients and the rest of the patients underwent modif...

Prognostic factors for death after an isolated local recurrence in patients with early-stage breast carcinoma

Cancer, 2002

BACKGROUNDThe authors analyzed the outcome of patients with early-stage breast carcinoma after an isolated local recurrence, taking into account initial tumor characteristics and the type of initial treatment and local salvage treatment.The authors analyzed the outcome of patients with early-stage breast carcinoma after an isolated local recurrence, taking into account initial tumor characteristics and the type of initial treatment and local salvage treatment.METHODSOne hundred five patients were studied who presented with a breast tumor measuring ≤ 25 mm and who subsequently developed an isolated local recurrence (breast or chest wall) as the first tumor event. A second series included 335 patients who developed distant metastases as the first event. Cox models that took into account potential prognostic factors were used to estimate the risk of death. First, survival rates were compared after an isolated local recurrence and after a diagnosis of distant metastases; and, second, effects of initial treatments and local or systemic treatments of local recurrences were analyzed.One hundred five patients were studied who presented with a breast tumor measuring ≤ 25 mm and who subsequently developed an isolated local recurrence (breast or chest wall) as the first tumor event. A second series included 335 patients who developed distant metastases as the first event. Cox models that took into account potential prognostic factors were used to estimate the risk of death. First, survival rates were compared after an isolated local recurrence and after a diagnosis of distant metastases; and, second, effects of initial treatments and local or systemic treatments of local recurrences were analyzed.RESULTSThe 10-year survival rate was 56% (95% confidence interval, 45–65%) after an isolated local recurrence compared with 9% (95% confidence interval, 7–13%) after distant metastasis as the first event. Three independent prognostic factors for the risk of death after local recurrence were identified: histologic tumor grade, patient age at the time of diagnosis with the primary tumor, and disease free interval until recurrence. The type of initial treatment and local salvage treatment did not influence the risk of death. Systemic treatments of local recurrence had different effects according to the patient's menopausal status. In premenopausal patients, ovarian suppression and chemotherapy significantly decreased the risk of death. In postmenopausal women, systemic treatments did not affect the risk of death.The 10-year survival rate was 56% (95% confidence interval, 45–65%) after an isolated local recurrence compared with 9% (95% confidence interval, 7–13%) after distant metastasis as the first event. Three independent prognostic factors for the risk of death after local recurrence were identified: histologic tumor grade, patient age at the time of diagnosis with the primary tumor, and disease free interval until recurrence. The type of initial treatment and local salvage treatment did not influence the risk of death. Systemic treatments of local recurrence had different effects according to the patient's menopausal status. In premenopausal patients, ovarian suppression and chemotherapy significantly decreased the risk of death. In postmenopausal women, systemic treatments did not affect the risk of death.CONCLUSIONSIsolated local recurrences in patients with early-stage breast carcinoma carry a moderately good prognosis. The outcome of patients is not affected by the type of initial treatment or local salvage treatment. After a local recurrence, ovarian suppression or chemotherapy had a beneficial effect in premenopausal patients. Cancer 2002; 94:2813–20. © 2002 American Cancer Society.DOI 10.1002/cncr.10572Isolated local recurrences in patients with early-stage breast carcinoma carry a moderately good prognosis. The outcome of patients is not affected by the type of initial treatment or local salvage treatment. After a local recurrence, ovarian suppression or chemotherapy had a beneficial effect in premenopausal patients. Cancer 2002; 94:2813–20. © 2002 American Cancer Society.DOI 10.1002/cncr.10572

Clinical Outcome of Isolated Locoregional Recurrence in Patients With Breast Cancer According to Their Primary Local Treatment

Clinical Breast Cancer, 2014

The long-term clinical outcome was studied for 220 patients with breast cancer who developed isolated locoregional recurrence. Based on a multivariate analysis including multiple pathologic and clinical parameters, the results suggest that patients who had breast-conserving surgery and radiation therapy for their primary tumor have a significantly better clinical outcome compared with those who had mastectomy with no radiation therapy. Introduction: This study assessed the clinical outcome and prognostic factors in patients with breast cancer who presented with isolated locoregional recurrence (ILRR) as a first event. Materials and Methods: Between 1970 and 2008, 2960 patients with pT1-2, N0-3, M0 primary invasive breast cancer had either breast-conserving therapy (BCT) using lumpectomy and radiation therapy (RT) (group A ¼ 1849 patients) or mastectomy without RT (group B ¼ 1111 patients). Out of groups A and B, 117 and 103 patients, respectively, developed ILRR as a first event. Those 220 patients served as the basis for this study. A multivariate analysis was performed to estimate the clinical outcome of both groups, taking into account clinically relevant variables for the primary tumor and ILRR. Results: The median follow-up after ILRR was 83 months. The median disease-free interval (DFI) was 79 and 38 months for groups A and B, respectively. The overall survival (OS) for group A was 81% and 69% at 5 and 8 years, respectively. For group B, it was 61% and 46%, respectively. The distant metastasisefree survival (DMFS) for group A was 84% at 5 years and remained 84% at 8 years. The DMFS for group B was 60% at 5 years and 52% at 8 years. In multivariate analysis, initial local treatment (BCT vs. mastectomy without RT), pathologic T stage, locoregional recurrence site (local vs. regional), and DFI (4 years vs. > 4 years) were significant prognostic variables for both OS and DMFS. Conclusion: Patients with breast cancer who developed ILRR after BCT as their initial local treatment have better clinical outcome compared with those who had mastectomy without RT.