Clinical outcome of isolated locoregional recurrence in patients with breast cancer according to their primary local treatment.
BACKGROUND
This study assessed the clinical outcome and prognostic factors in patients with breast cancer who presented with isolated locoregional recurrence (ILRR) as a first event.


METHODS
Between 1970 and 2008, 2960 patients with pT1-2, N0-3, M0 primary invasive breast cancer had either breast-conserving therapy (BCT) using lumpectomy and radiation therapy (RT) (group A = 1849 patients) or mastectomy without RT (group B = 1111 patients). Out of groups A and B, 117 and 103 patients, respectively, developed ILRR as a first event. Those 220 patients served as the basis for this study. A multivariate analysis was performed to estimate the clinical outcome of both groups, taking into account clinically relevant variables for the primary tumor and ILRR.


RESULTS
The median follow-up after ILRR was 83 months. The median disease-free interval (DFI) was 79 and 38 months for groups A and B, respectively. The overall survival (OS) for group A was 81% and 69% at 5 and 8 years, respectively. For group B, it was 61% and 46%, respectively. The distant metastasis-free survival (DMFS) for group A was 84% at 5 years and remained 84% at 8 years. The DMFS for group B was 60% at 5 years and 52% at 8 years. In multivariate analysis, initial local treatment (BCT vs. mastectomy without RT), pathologic T stage, locoregional recurrence site (local vs. regional), and DFI (≤ 4 years vs. > 4 years) were significant prognostic variables for both OS and DMFS.


CONCLUSIONS
Patients with breast cancer who developed ILRR after BCT as their initial local treatment have better clinical outcome compared with those who had mastectomy without RT.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Mina N
MN
Shenouda
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Betro T
BT
Sadek
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA; Statistics Section, Massachusetts General Hospital, Boston, MA.
Saveli I
SI
Goldberg
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Amany R
AR
Keruakous
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Brandon J
BJ
Croft
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Rita F
RF
Abi Raad
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA. Electronic address: ataghian@partners.org.
Alphonse G
AG
Taghian
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant
Breast cancer; Isolated locoregional recurrence; Local breast treatment; Long-term clinical outcome; Prognostic variables