Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial (original) (raw)
Related papers
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.
Locoregional recurrence in breast carcinoma patients
Ejso, 2009
Aims: To assess the risk of locoregional recurrence (LRR) after mastectomy and to identify predictive and treatment factors that affect the risk of LRR. Methods: The primary endpoint was local recurrence. Univariate and multivariate Cox regression analyses were carried out in the data from 1217 patients. Results: The median follow-up was 74 months, and 63 (5.2%) patients experienced a LRR in their follow-up period. In the multivariate analysis, age group (35 years vs. >35 years, p < 0.0001; Hazard Ratio [HR], 5.0; 95% Confidence Interval [95% CI], 3.0e8.3), tumour size (>2 cm vs. 2 cm, p ¼ 0.03; HR, 2.2; 95% CI, 1.2e4.7) and LVI (yes vs. no, p < 0.0001; HR, 3.2; 95% CI,1.9e5.2) were the independent prognostic factors for LRR. This analysis, in the final model, indicated that adjuvant radiotherapy and adjuvant tamoxifen were associated with a reduced risk of LRR by 90% and 75%, respectively, across the follow-up period, whereas age group remained as an important risk factor ( p ¼ 0.002; HR, 3.0; 95% CI, 1.5e6.2). Conclusions: Although adjuvant therapies reduce the risk of LRR, young age is an independent risk factor for LRR.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018
Purpose Isolated locoregional recurrence (ILRR) predicts a high risk of developing breast cancer distant metastases and death. The Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial investigated the effectiveness of chemotherapy (CT) after local therapy for ILRR. A report at 5 years of median follow-up showed significant benefit of CT for estrogen receptor (ER)-negative ILRR, but additional follow-up was required in ER-positive ILRR. Patients and Methods CALOR was an open-label, randomized trial for patients with completely excised ILRR after unilateral breast cancer. Eligible patients were randomly assigned to receive CT or no CT and stratified by prior CT, hormone receptor status, and location of ILRR. Patients with hormone receptor-positive ILRR received adjuvant endocrine therapy. Radiation therapy was mandated for patients with microscopically involved margins, and anti-human epidermal growth factor receptor 2 therapy was optional. End points were diseas...
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.
Clinical Oncology, 2005
Aims: Patients with invasive breast cancer submitted to conservative treatment must be followed for a long period of time to study locoregional control. In this study, we analysed the outcome and relationships between locoregional recurrence (LRR), distant metastases and survival. Materials and methods: A 15-year study, including 470 women with early breast cancer, stage I and II, who underwent breast conservative treatment. Tumour size, nodal status, age, menopausal status, histological grade and LRR were analysed for their ability to predict overall survival, disease-specific survival and distant disease-free survival. Results: With a median follow-up time of 6.6 years (3 months to 19.1 years), there were 19 LRR at their first site of recurrence and 53 distant metastases. Tumour size greater than 2 cm, positive lymph nodes and histological grade III were significantly related to lower overall and distant metastases-free survival. On multivariate analysis, nodal status, histological grade III and LRR (coded as a timedependent variable) were significantly related to overall, specific and distant metastases-free survival, whereas tumour size had only a borderline effect on specific and distant disease-free survival. Landmark analysis showed that women who presented an LRR within 2 years after surgery had significantly lower distant disease-free survival (hazard ratio [
Management of isolated locoregional recurrent breast cancer after mastectomy
International Journal of Radiation Oncology*Biology*Physics, 1989
Loco-regional recurrence (LRR) after adequate treatment of primary breast cancer poses a therapeutic challenge. Advances in the management of breast cancer have led to significant improvement in survival. With this advantage, it is observed that incidence of LRR has relatively decreased. Systemic involvement should be ruled out in patients presenting with loco-regionally recurrent disease, as isolated LRR deems a treatment with curative intent. Salvage mastectomy following Ipsilateral Breast Tumor Recurrence (IBTR) is a time tested treatment option and widely accepted. Second time breast conservation surgery with or without radiotherapy is an emerging alternative. Following second breast conservation, partial breast irradiation has been seen to improve local control. 5 year overall survival with second breast conservation and radiotherapy is in the range of 76% to 100% with acceptable toxicities. Isolated chest wall recurrences after mastectomy are difficult to manage. Multi-modality treatment has been adopted to treat chest wall recurrences, following which 5 year overall survival was observed to be in the range of 45% to 60%. Use of hyperthermia and photodynamic therapy in combination with conventional treatment options has been associated with better clinical outcomes. Systemic therapy in the form of chemotherapy and /or hormonal therapy in adjunct to adequate loco-regional treatment have shown to improve survival. Multi-modality treatment for isolated regional recurrences has been associated with better outcomes and 5 year survival rates are around 50%.All patients with LRR should be evaluated in multidisciplinary tumor board to individualize treatment based on expected risk benefit ratio of re-treatment.