Prognosis following local recurrence in the conservatively treated breast cancer patient

Haffty, Bruce G.; Fischer, Dennis; Beinfield, Malcolm; McKhann, Charles F.

doi:10.1016/0360-3016(91)90774-x

Cited by 155 publications

(71 citation statements)

References 17 publications

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“…Short DFI was reported to be highly correlated with subsequent DM. 21,25,26,31,[41][42][43][44] These risk factors appear to reflect the inherent aggressive characteristics of primary tumors. 38,39 Thus the risk of developing DM would be predetermined before treatment, with local recurrence being a manifestation of this risk.…”

Section: Figurementioning

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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Section: Figurementioning

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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“…3,4,[6][7][8][9][10][11][12][13][14][15][16][17] These studies demonstrated that a second local recurrence in the form of a chest wall recurrence occurs in approximately 2-32% of patients. Thus, mastectomy after in-breast local recurrence does not necessarily eliminate the risk of subsequent secondary local recurrences at the chest wall.…”

Section: Local Recurrence Risk After Mastectomy For In-breast Local Rmentioning

confidence: 99%

“…18 Several series published to date also have shown that patients with a recurrence elsewhere in the breast have significantly less risk of developing distant metastases and dying of breast carcinoma compared with patients with local recurrence near the site of initial surgery. 11,15,17 Clarke et al found that survival after local recurrence is worse in patients presenting with dermal involvement or lymph node involvement. 12 Cajucom et al 16 found that the size of the local recurrence and the number of lymph nodes with metastases at the time of mastectomy were statistically significant factors related to overall survival.…”

Section: Survival After Mastectomy For In-breast Local Recurrencementioning

confidence: 99%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

Self Cite

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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“…Early detection of locoregional relapse has a beneficial effect on survival (Clark et al, 1985;Recht et al, 1989;Fowble et al, 1990;Kurtz et al, 1990;Haffty et al, 1991;Dalberg et al, 1998). However, it is uncertain whether routine clinical examination contributes to this early detection.…”

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confidence: 99%

Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature

2007

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Multiple guidelines exist for the follow-up of breast cancer, with no agreement on frequency or duration. The contribution of routine clinical examination for the detection of potentially treatable relapse, and the impact this has on survival, is unknown. In this study, we systematically review the literature to establish the proportion of potentially treatable locoregional relapses and new contralateral breast cancers detected by clinical examination, mammography and patient self-examination. We analyse whether method of detection of relapse influences outcome. The methods used were systematic review of the literature. MEDLINE, EMBASE, CancerLit, Web of Sciences and EBM reviews were the data sources for the systematic review. All studies with information on proportion of relapses detected by clinical examination, mammography and self-examination were included. A total of 30 -40% of potentially treatable relapses are detected by patient self-examination. In studies published before 2000, 15% of such relapse is mammographically detected with 46% detected by routine clinical examination. In those published after 2000, 40% are mammographically detected with 15% detected on routine clinical examination. Patients with ipsilateral breast relapse detected clinically appear to do less well than those with relapse detected by self-examination or mammography. Routine clinical surveillance is responsible for detection of fewer potentially treatable relapses in more modern cohorts as experience with mammography increases. There is no evidence to suggest that clinical examination confers a survival advantage compared with other methods of detection. The data in this analysis suggest that a review of the guidelines on follow-up after breast cancer should be undertaken.

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Prognosis following local recurrence in the conservatively treated breast cancer patient

Cited by 155 publications

References 17 publications

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

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

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature

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