True Recurrences and New Primary Tumors Have Different Clinical Features in Invasive Breast Cancer Patients with Ipsilateral Breast Tumor Relapse After Breast-Conserving Treatment

Abstract

Ipsilateral breast tumor relapse (IBTR) after breast-conserving treatment (BCT) may represent two distinct types of lesion, including a true recurrence (TR) or a new primary tumor (NPT). The aim of this study was to ascertain the difference between TRs and NPTs and to show the clinical significance of classifying IBTR into these two types of recurrence. Patients (n = 2,075) with unilateral invasive breast cancer who underwent BCT between 1987 and 2005 at Saitama Cancer Center were analyzed. IBTR was classified into TR and NPT, which was based on all clinical and pathological features of both a primary tumor and IBTR that can be evaluated. IBTR-free survival and the risk factors were analyzed in order to compare the findings for TR and NPT. In addition, the salvage surgical methods for IBTR and overall survival after IBTR were analyzed. Sixty patients with IBTR were classified into 52 with TR and eight with NPT. IBTR-free survival was significantly shorter in the patients with TR than those with NPT. Young age, tumor size, a positive surgical margin, and omission of radiation therapy (RT) were significant risk factors for TR. Omission of RT was the only significant risk factor for NPT. In 27 patients who underwent a repeat lumpectomy for TR, four had a second IBTR. The overall survival after IBTR was worse in patients with TR than NPT. TR and NPT show quite different clinical features. Classifying IBTR into TR or NPT can therefore help to select the most appropriate treatment for IBTR.

New Primary Ipsilateral Metachronous Breast Tumor: A Case Report

“…TR and NPT have different natural histories, prognosis, and in turn different implications for therapeutic management [1, 2, 3, 4]. …”

“…However, as each case has different clinical relevance (evolution, prognosis and therapeutic management), it is necessary to distinguish in these patients between a true local recurrence (TR) of a previous tumor, and the appearance of a new primary tumor (NPT) [1, 2, 3, 4]. …”

Prise en charge de la récidive homolatérale d’un cancer du sein après traitement conservateur initial

“…Les deux facteurs le plus souvent pris en compte sont la localisation de la récidive par rapport à la première tumeur et le type histologique (c'est-à-dire canalaire, lobulaire, tubuleux… mais non in situ versus invasif) [37,48,58,71,89,110]. La différence entre vraie récidive et nouveau cancer repose actuellement sur des critères mal défi nis, non standardisés.…”

“…Les nouveaux cancers auraient pour la plupart des auteurs une survie (survie globale, survie spécifi que et survie sans métastase) meilleure que les « vraies RL » [48,58,71,110]. Dans l'étude de Huang et al [48], le risque de deuxième RL serait plus important pour les nouveaux cancers que pour les vraies RL, mais la prise en charge locale était signifi cativement diffé-rente : 94 % de MT en cas de nouveau cancer, 75 % en cas de vraie RL, avec 15 % de patientes sans traitement local lors de la RL.…”

Four types of Ipsilateral Breast Tumor Recurrence (IBTR) after breast‐conserving surgery: Classification of IBTR based on precise pathological examination

“…Several studies have attempted to classify the two distinct types of IBTR by using tumor location, histological subtype, surgical margin status of the primary tumor, estrogen receptor status and human epidermal growth factor receptor 2 (HER2) status. These studies demonstrated that patients with NP had significantly better survival rates than patients with TR . Although the importance of classifying IBTR is well known, IBTR is difficult to classify, especially the IBTR that occurs near the primary lumpectomy scar.…”