title: Outcomes and predictive factors for salvage therapy after local--regional recurrence following neoadjuvant chemotherapy and breast conserving therapy.
abstract: BACKGROUND
  There are few data addressing local-regional recurrence (LRR) and salvage therapies in patients treated with neoadjuvant chemotherapy (NCT) compared to those treated with surgery first. We characterize the clinical course and predictive features of salvage treatment for LRR after breast conserving therapy (BCT) analyzed by initial treatment.
  
  
  METHODS
  We identified 1,589 patients who underwent BCT; 1,141 (72 %) patients underwent initial surgery, and 448 (28 %) received NCT. Kaplan-Meier and Cox regression analyses were performed to analyze factors associated with overall survival (OS), local control (LC) of recurrence, and distant metastasis-free survival (DMFS) following LRR.
  
  
  RESULTS
  56 patients had a LRR, for a crude recurrence rate of 3 %. For patients with potentially curable recurrence (excluding distant metastases within 3 months of LRR), the 5-year OS, LC, and DMFS rates were 52, 77, and 69 %. On multivariate analysis, initial pathologically negative node status and use of surgery for salvage were significant factors associated with higher OS. Additionally, older age was associated with higher LC rates after salvage. Estrogen receptor-positive disease and surgery for LRR were associated with reduced risk of distant metastases; regional recurrence and use of initial adjuvant chemotherapy were associated with increased risk of distant metastases. For each of these endpoints, the addition of NCT to the multivariate model did not approach significance.
  
  
  CONCLUSIONS
  LRR is an uncommon event after BCT and many patients with LRR remain curable (5-year OS >50 %). Our data indicate that NCT does not compromise salvage after LRR, providing further assurance that this strategy is safe for appropriately selected breast cancer patients.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Weksberg
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Litton
authors.forename: Eric A
authors.initials: EA
authors.lastname: Strom
authors.forename: Ruchita R
authors.initials: RR
authors.lastname: Shah
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mittendorf
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000401:mortality*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate