Locoregional recurrence of breast cancer in patients treated with breast conservation surgery and radiotherapy following neoadjuvant chemotherapy.
OBJECTIVE
Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT.


METHODS
In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT.


RESULTS
During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p<0.0001) and 4.22 (p=0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p=0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p=0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR.


CONCLUSIONS
In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.
Center for Breast Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea; Department of Surgery, KyungHee University, Seoul, Korea.
Sun Young
SY
Min
Seung Ju
SJ
Lee
Kyung Hwan
KH
Shin
In Hae
IH
Park
So-Youn
SY
Jung
Keun Seok
KS
Lee
Jungsil
J
Ro
Seeyoun
S
Lee
Seok Won
SW
Kim
Tae Hyun
TH
Kim
Han-Sung
HS
Kang
Kwan Ho
KH
Cho
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies