LONG-TERM RESULTS OF BREAST-CONSERVATION THERAPY FOR BREAST-CANCER

Objective This study was done to determine the long-term outcome of br east conservation therapy (BCT) for patients with early-stage breast c ancer during a period of treatment evolution at a single institution S ummary Background Data Breast cancer treatment has evolved from extens ive surgical extirpation of the breast to treatment options that conse rve the breast. Prospective and retrospective studies have confirmed t he efficacy of BCT and justify its use for many patients with early br east cancer, but there is no universally accepted consensus as to who benefits from more aggressive application of surgery or radiotherapy i n BCT. Prognostic variables for breast cancer and information on facto rs that contribute to local recurrence help predict BCT results. Conti nued analysis of BCT still is necessary to improve patient outcome. Me thods Eighty-five patients treated with BCT (lumpectomy with adjuvant radiation therapy) at the Medical College of Virginia from 1980 to 199 0 were identified. Clinicopathologic parameters and treatment details were analyzed for relationship to development of local recurrence, dis tant metastasis, and survival. Fisher's exact test was used for compar isons. Actuarial survival curves were plotted. The earlier treatment p eriod (1980-1985) was compared with the later treatment period(1985-19 90). Results Median follow-up was 5 years. Actuarial overall survival was 83% at 5 years (69% at 10 years), and 5-year distant metastasis-fr ee survival was 79%. The 5-year actuarial local recurrence rate was 6. 6% (crude rate 10.6%, 9/85). Young patients (age < 40 years) were foun d to be at increased risk for local recurrence (24% < 40 years vs. 6% greater than or equal to 40 years, p < 0.05). Tumor margins less than or equal to 3 mm were more frequently found, and lumpectomy site radia tion boost was used increasingly from 1986 to 1990. Almost half of all local recurrences occurred after 5 years. conclusions Survival and lo cal recurrence rates were comparable to other series. Young patients w ere found to be at increased risk for local recurrence. Negative micro scopic margins, even when close, can provide low local recurrence rate s when adjuvant radiation therapy is administered.