Early ipsilateral breast tumor recurrences after breast conservation affect survival: an analysis of the National Cancer Institute randomized trial.
OBJECTIVE
To evaluate the effect of an ipsilateral breast tumor recurrence (IBTR) after breast-conservation therapy (BCT) on survival.


METHODS
One hundred twenty-one women were randomized to BCT. Patients with an IBTR were analyzed to determine survival. Analysis was performed with Kaplan-Meier estimates, log-rank tests, and time-dependent covariate Cox models.


RESULTS
At a median follow-up of 18.4 years, 27 patients had an IBTR. The median survival time after IBTR was 13.1 years. The 5-year survival rate was 91.8% (95% confidence interval [CI], 81.5-100%). The 10-year survival rate was 54.3% (95% CI, 35.8-82.6%). According to a Cox model with time-dependent covariates, the hazard ratio or relative risk of dying for those with an IBTR at <5.3 years after BCT relative to patients without an IBTR after BCT is 1.47 (95% CI, 1.02-2.12%; p = 0.04). The hazard ratio for those who relapse after 5.3 years is 0.59 (95% CI, 0.22-1.61%; p = 0.31). Age at randomization, original tumor size, and the presence of positive regional nodes at initial presentation were not found to be associated with decreased survival.


CONCLUSIONS
There seems to be a significant association of early IBTR after BCT with decreased survival. Local control should be maximized.
Brooks
Joseph P
JP
Radiation Oncology Branch, National Cancer Institute, Bethesda, MD, USA.
Danforth
David N
DN
Albert
Paul
P
Sciuto
Linda C
LC
Smith
Sharon L
SL
Camphausen
Kevin A
KA
Poggi
Matthew M
MM
D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000401:mortality*; D015412:Mastectomy, Segmental / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D015996:Survival Rate