title: Local relapse in primary breast cancer patients with unexcised positive surgical margins after lumpectomy, radiotherapy and chemoendocrine therapy.
abstract: BACKGROUND
  Inadequate surgical excision with residual involvement of resection margins by tumour after breast conservation results in increased local recurrence rates. To reduce this risk positive margins are, therefore, usually excised. Systemic treatment with tamoxifen or chemotherapy reduces local recurrence, along with radiotherapy. However, no studies to date have examined the correlation between chemoendocrine treatment, together with radiotherapy, and local relapse in patients with unexcised involved resection margins, having had breast conservation treatment.
  
  
  METHODS
  The histopathology reports were reviewed of 184 patients who were treated from June 1991 to August 1995 within our randomised study of neoadjuvant versus adjuvant chemoendocrine therapy with mitozantrone and methotrexate (2M) +/- mitomycin-C (3M) and tamoxifen, used concurrently with radiation following conservation surgical treatment. Histological resection margin was considered positive if ductal carcinoma in situ (DCIS) or invasive carcinoma was present microscopically less than 1 mm from the excision margin.
  
  
  RESULTS
  Although 38% of patients had unexcised microscopically involved margins, local relapse rate as first site of relapse was only 1.9% after a median follow up of 57 months. There was no difference in distant relapse (P = 0.2) and survival (P = 0.5) between the positive and negative margins groups.
  
  
  CONCLUSIONS
  The presence of positive unexcised margins does not have a significant effect on outcome in patients who are treated with chemoendocrine therapy together with radiotherapy. Further clinical trials are required.
authors.affiliation: Royal Marsden Hospital, Surrey, UK.
authors.forename: L
authors.initials: L
authors.lastname: Assersohn
authors.forename: T J
authors.initials: TJ
authors.lastname: Powles
authors.forename: S
authors.initials: S
authors.lastname: Ashley
authors.forename: A G
authors.initials: AG
authors.lastname: Nash
authors.forename: A J
authors.initials: AJ
authors.lastname: Neal
authors.forename: N
authors.initials: N
authors.lastname: Sacks
authors.forename: J
authors.initials: J
authors.lastname: Chang
authors.forename: U
authors.initials: U
authors.lastname: Querci della Rovere
authors.forename: N
authors.initials: N
authors.lastname: Naziri
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000532:radiotherapy; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018365:Neoplasm, Residual; D018709:Statistics, Nonparametric; D016019:Survival Analysis