SIMULTANEOUS AND METACHRONEOUS BILATERAL BREAST-CARCINOMA - COMPARISON OF TREATMENT RESULTS

Background: A bilateral breast carcinoma is diagnosed either simultane ously or metachroneously in 2.7-9% of all breast cancer patients. In l iterature data it is not yet defined if survival prognosis of patients is influenced by the temporal sequence of contralateral cancer diagno sis. Patients and Methods: Therefore, we retrospectively (follow-up 5- 12 years) analyzed the medical records of 40/531 patients with a prima ry breast carcinoma (T1 - 4 NO - 3 MO) treated in 1977-1982 by postope rative irradiation (mastectomy/breast conserving surgery; 50 Gy, 2 Gy/ day 5x/weekly, chest wall/breast and regional lymph nodes) in whom a s imultaneous (n=10) or metachroneous (n=30) contralateral breast cancer was found. Comparing both groups of patients at the time of the first tumor diagnosis we observed no statistically differences with regard to age, therapeutic approaches, TNM-staging, and tumor histology. The contralateral carcinoma treated by surgery +/- radiotherapy demonstrat ed minor tumor stages (p < 0.05) and histologically more often carcino mas in situ (p < 0.02) in the simultaneously affected women compared t o the other group. Within all simultaneous tumors the second carcinoma was significantly proved to be more often lymph node negative (p < 0. 02) whereas in contralateral metachroneous carcinomas T-stage was mino r than in the primary (p < 0.02). Results: The 5- and 10-year overall- survival rates calculated since first diagnosis were 80% and 55% (meta static free-survival 83% and 60%) in metachroneously affected patients , respectively. In the other group 100% and 76% were alive after 5 and 8 years (metastatic free-survival 100% and 66%), respectively. Statis tical differences between both groups were not seen. Comparable distri butions of local recurrences (first/second tumor: simultaneous n-0/1, metachroneous n=8/3) and metastases (simultaneous n=3, metachroneous n =11)were found (n.s.). Conclusion: Conclusively, in consideration of t he small number of patients and in spite of minor differences between both groups with regard to the second tumor these results demonstrate that the temporal sequence of bilateral cancer diagnosis has no influe nce on overall-survival and prognosis of patients with bilateral breas t carcinoma.