Local and distant failures after limited surgery with positive margins and radiotherapy for node-negative breast cancer

Cowen, D.; Houvenaeghel, Gilles; Bardou, Valérie‐Jeanne; Jacquemier, Jocelyne; Bautrant, Eric; Conte, Michel; Viens, Patrice; Largillier, R.; Puig, Brigitte; Resbeut, M.; Maraninchi, D

doi:10.1016/s0360-3016(99)00553-2

Cited by 82 publications

(28 citation statements)

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“…In breast conservation, positive margins are associated with an increased long-term risk of cancer recurrence in the ipsilateral breast (Fourquet et al, 1989;Anscher et al, 1993;Pittinger et al, 1994;Dewar et al, 1995;Gage et al, 1996;Wazer et al, 1998;Freedman et al, 1999;Cowen et al, 2000) and, therefore, patients with positive margins, following BCS, require further surgery. In our series, the re-operation rate was 9.5% (two patients) but no histological evidence of residual tumour was found on the mastectomy specimen.…”

Section: Discussionmentioning

confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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Contrast-enhanced magnetic resonance imaging (MRI) was used to monitor the response of patients undergoing neoadjuvant chemotherapy for breast cancer with the aim of undergoing breast-conserving surgery (BCS). Patients were prospectively recruited to undergo MRI as well as conventional methods of clinical examination, mammography (MM) and ultrasonography (USS) and response was assessed by each of these methods. Thirty-two patients with primary breast cancer were recruited. Magnetic resonance imaging correlation with histopathological size (r ¼ 0.71) was superior to USS (r ¼ 0.65) and to MM where tumour size was not measurable following chemotherapy in 71% of patients. Magnetic resonance imaging had 87.5% sensitivity (95% CI ¼ 68 -97%) and 50% specificity (95% CI ¼ 16 -84%) for a PPV (positive predictive value) of 99.8% and NPV (negative predictive value) of 80% for the detection of residual invasive cancer. Magnetic resonance imaging displayed 80% sensitivity (95% CI ¼ 28.4 -99.5%) and 89% specificity (95% CI ¼ 71 -98%) to detect pathological pCR in the breast. Eighty-four per cent of recruited patients were identified as potentially suitable candidates for BCS following chemotherapy and of those choosing to accept BCS, breast conservation was achieved in 90.5%, or 65.6% of all patients. Of those who proceeded to BCS, 9.5% required a re-do mastectomy because of positive margins; however, no residual tumour was found on histological examination of mastectomy specimens. Magnetic resonance imaging appears to be superior to conventional methods for assessing pathological response and the low rate of re-operation for positive margins indicates a valuable role in aiding the decision to undergo BCS or mastectomy.

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Section: Discussionmentioning

confidence: 99%

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

et al. 2008

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“…Other groups have recently suggested that IBTR may be a cause of DM. 32,34,35 In the current study, we summarized the longterm follow-up results of BCT for Japanese women with breast cancer, and we focused on IBTR, particularly its incidence, risk factors, and predictive significance for subsequent DM. In Japan, BCT was adopted later than in western countries.…”

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confidence: 99%

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Komoike

Akiyama

Iino

et al. 2005

Cancer

162

103

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BACKGROUNDThe clinical features of ipsilateral breast tumor recurrence (IBTR) after breast conserving therapy (BCT) for early stage breast cancer were analyzed from long‐term follow‐up of BCT in Japan. The purpose of this study was to clarify risk factors of IBTR and the impact of IBTR on development of distant metastases in this ethnic group.METHODSPatients (N = 1901)with unilateral breast cancer ≤ 3 cm in diameter who underwent BCT at 18 Japanese major breast cancer treatment institutes from 1986 to 1993 were registered in this study. Survival rates, the incidences of IBTR and distant metastases, and annual rates of IBTR and distant metastases after primary operation were calculated by the Kaplan–Meier method. A Cox proportional hazards model was used to estimate the risks of IBTR and distant metastases. A Cox model was also used to estimate the risks of distant metastases after IBTR in the group of IBTR.RESULTSAt a median follow‐up time of 107 months, the 10‐year overall and disease‐free survival rates were 83.9% and 77.8%, respectively. The 10‐year cumulative rates of IBTR were 8.5% in the patients with postoperative irradiation and 17.2% in the patients without irradiation. The 10‐year cumulative distant metastasis rate was 10.9%. On multivariate analysis, young age, positive surgical margin, and omission of radiation therapy were significant predictors of IBTR. In addition, IBTR significantly correlated with subsequent distant metastases (hazard ratio, 3.93; 95% confidence interval, 2.676–5.771; P < 0.0001). Among patients who developed IBTR, initial lymph node metastases and short interval to IBTR were significant risk factors for subsequent distant metastasis.CONCLUSIONSYoung age, positive surgical margin, and omission of radiation therapy seemed to be important factors in relation to local control. The authors' results also indicated that IBTR is significantly associated with subsequent distant metastasis. Patients with positive nodal status at primary operation or with short interval from primary operation to IBTR are at especially high risk of distant metastasis. It remains unclear, however, whether IBTR is an indicator or a cause of subsequent distant metastases. Cancer 2006. © 2005 American Cancer Society.

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“…Achieving local tumour control is important as relapse often leads to removal of the breast and can result in uncontrolled local disease (Rutqvist, 1996). A causal relationship between local recurrence and distant metastasis has been suggested (Cowen et al, 2000), but the meta-analyses and individual clinical trials have so far yielded conflicting results about the survival advantage due to adjuvant RT ( Van de Steene et al, 2000).…”

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Trends in postoperative radiotherapy delay and the effect on survival in breast cancer patients treated with conservation surgery

et al. 2004

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The adequate timing of adjuvant radiotherapy (RT) in breast cancer has become a subject of increasing interest in recent years. A population-based study was undertaken to determine the influence of demographic and clinical factors on the postoperative RT delay in patients treated with breast-conserving surgery (BCS) and to assess the impact of delay on survival. In total, 7800 breast cancer patients treated with BCS and adjuvant RT between 1986 and 1998 in Yorkshire were included in the study. The median interval between surgery and the start of RT (S -RT interval) was 8 weeks (7 weeks for chemotherapy negative and 11 for chemotherapy positive patients). This interval increased substantially over time from 5 weeks during 1986 -1988, irrespective of patients' chemotherapy status, to 10 and 17 weeks among chemotherapy negative and chemotherapy positive patients, respectively, in 1997 -1998. The S -RT interval was also significantly influenced by travel time to RT centre, year and at which RT centre patient had the treatment (Po0.001). Overall, 5-year survival was 82%. Patients with S -RT intervals longer than 9 weeks had a trend towards an increased relative risk of death. This reached a statistical significance at 20 -26 weeks (RR 1.49, 95% CI (1.16 -1.92)). The findings of our study suggest that delaying the initiation of RT for 20 -26 weeks after surgery is associated with decreased survival in patients treated with conservation surgery.

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Local and distant failures after limited surgery with positive margins and radiotherapy for node-negative breast cancer

Cited by 82 publications

References 36 publications

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Using MRI to plan breast-conserving surgery following neoadjuvant chemotherapy for early breast cancer

Ipsilateral breast tumor recurrence (IBTR) after breast‐conserving treatment for early breast cancer

Trends in postoperative radiotherapy delay and the effect on survival in breast cancer patients treated with conservation surgery

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