title: Prognosis after local recurrence after conservative surgery and radiation for early-stage breast cancer.
abstract: OBJECTIVE
  To determine the long-term prognosis of patients who develop a local recurrence (LR) after conservative surgery (CS) and radiation therapy (RT) for early-stage invasive breast cancer.
  
  
  METHODS
  Between 1970 and 1987, 2102 patients with clinical Stage I-II breast cancer were treated with CS+RT. LR was defined as any recurrence within the ipsilateral breast with or without simultaneous regional nodal or distant metastasis. Patients were at risk for a LR until the first of distant metastases, second nonbreast malignancy, or death (DF/S/D). The final study population comprised 341 patients with LR. The median time to LR was 72 months. The median follow-up time after LR was 85 months. A proportional hazards model of time from LR to DF/S/D was done to investigate the influence of factors at initial diagnosis and at LR on subsequent outcome.
  
  
  RESULTS
  The actuarial freedom from DF/S/D 5 years after LR was 65% and the survival was 81%. Variables significantly associated with time to DF/S/D were: LR histology (invasive vs. ductal carcinoma in situ, hazard ratio [HR] = 4.1, p < 0.0001); local therapy for LR (none vs. mastectomy or unknown, HR = 3.2, p < 0.0001; and CS +/- RT vs. mastectomy or unknown, HR = 2.0, p = 0.02); time to LR (< or =2 years vs. >5 years, HR = 2.6, p < 0.0001; and 2-5 years vs. >5 years, HR = 1.8, p = 0.006); and age at initial diagnosis (> or =60 vs. <60, HR = 1.6, p = 0.01).
  
  
  CONCLUSIONS
  Many patients with LR after CS+RT have prolonged distant disease-free survival, particularly those able to be treated with mastectomy. Patients with a noninvasive LR, longer interval to LR, or age <60 had a longer time to distant failure, second malignancy, or death than other patients.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Galper
authors.forename: Emily
authors.initials: E
authors.lastname: Blood
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gelman
authors.forename: Anthony
authors.initials: A
authors.lastname: Abner
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
authors.forename: Anita
authors.initials: A
authors.lastname: Kohli
authors.forename: Julia S
authors.initials: JS
authors.lastname: Wong
authors.forename: Darrell
authors.initials: D
authors.lastname: Smith
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bellon
authors.forename: James
authors.initials: J
authors.lastname: Connolly
authors.forename: Stuart
authors.initials: S
authors.lastname: Schnitt
authors.forename: Eric
authors.initials: E
authors.lastname: Winer
authors.forename: Barbara
authors.initials: B
authors.lastname: Silver
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D016879:Salvage Therapy; D013997:Time Factors