LOCAL RECURRENCE IN BREAST-CANCER - IMPLICATIONS FOR SYSTEMIC-DISEASE

Background: Recurrence in breast carcinoma follows a pattern of growth marked by local, regional, or widespread dissemination. Local recurre nce may be the harbinger of systemic disease or failure of local contr ol. Delineation of these processes may have implications in treatment. Methods: A retrospective review found 1,171 patients with stages I an d II breast cancer from 1978 to 1990 treated at the City of Hope Medic al Center. Results: Twenty-seven percent (n = 313) of patients develop ed recurrences. These were classified as local, including chest wall a nd regional nodes (n = 40), local and distant (n = 63), and distant (n = 210). Mean follow-up was 60 months. Multivariate analysis demonstra tes tumor size was not different between the three groups, but the pre sence of positive lymph nodes was: local = 51%, local and distant = 78 %, and distant = 64%. The disease-free interval was longest in the loc al group (42 months) versus the local and distant group (23 months) an d distant group (39 months). Median survival was calculated from the t ime of recurrence: local = 90 months, local and distant = 26 months, a nd distant = 16 months. Conclusions: A group of patients with local re currence have improved survival and do not develop distant disease. Th is group may benefit from aggressive surgical treatment to control loc al disease. These data suggest that a subset of breast tumors can act locally aggressive without metastatic potential.