Outcome at 8 Years After Breast-Conserving Surgery and Radiation Therapy for Invasive Breast Cancer: Influence of Margin Status and Systemic Therapy on Local Recurrence

Abstract

Pathologic margin status and the use of adjuvant systemic therapy are the most important factors associated with LR among patients treated with breast-conserving surgery and radiation therapy.

Multicentre randomised controlled trial examining the cost-effectiveness of contrast-enhanced high field magnetic resonance imaging in women with primary breast cancer scheduled for wide local excision (COMICE)

“…[3][4][5][6] Ideally, the tumour, along with a margin of at least 10 mm of normalappearing tissue, is resected to attempt to remove any microscopic cancer. The minimum cosmetically acceptable tumour-free margin in relation to the risk of local or distant recurrence has been debated in many studies.…”

“…2 Local recurrence after conservation surgery usually results from growth of residual cancer adjacent to the excised primary tumour or from multicentric disease. [3][4][5][6] Complete local excision, confirmed histologically, is essential to ensure that the risk of local recurrence is minimal. It is now recognised that for patients with multicentric disease detected prior to surgery, breast conservation surgery may still be appropriate if all clinically and radiologically apparent abnormalities are removed, clear margins of resection are achieved, and there is no extensive intraductal component present.…”

The impact of margin status on local recurrence following breast conserving therapy for invasive carcinoma in Manitoba

“…Horiguchi et al, 1999). No difference between positive and negative margins was found in the 1 mm margin study but the numbers were small (Assersohn et al,, tege Park et al, 2000) and the third study demonstrated increased local recurrence for diffusely positive versus any other margin (Schnitt et aL,1994). Two of these studies also compared focally positive versus negative margins.…”

“…Based on the Milan quadrantectomy data, Veronesi also reported ahazard ratio for distant disease of 4.62 in patients with local rectrrence (Veronesi et al, 1995). Decreased (Fortin, Larochelle, Laverdiere, Lavertu, & Tremblay, 1999 (Borger et al, 1994;Park et al, 2000) and the presence of DCIS (Borger et a1.,1994; Luu, Otis, Reed, Garb, & Frank, 1999;Tartter et al', 2000). (Holland, Veling, Mravunac, & Hendriks, 1985).…”

“…Two of these studies also compared focally positive versus negative margins. Focally positive margins were associated with increased local recurrence, although the results were intermediate between negative and diffusely positive (Gage et aI., 1996;Park et al, 2000). A fourth study included categories of focally and diffusely positive margins but did not analyze them individually (Smitt ef al, 1995).…”