AGE AS A PROGNOSTIC FACTOR FOR BREAST AND REGIONAL NODAL RECURRENCE FOLLOWING BREAST-CONSERVING SURGERY AND IRRADIATION IN STAGE-I AND STAGE-II BREAST-CANCER

Purpose: To evaluate the association between age and breast/regional n odal relapse following breast conserving surgery and irradiation. Meth ods and Materials: The results of treatment in 511 patients with 519 S tage I and II breast cancers treated at Mallinkrodt Institute of Radio logy and affiliated hospitals between 1958 and 1988 were reviewed. Res ults: Seventy women, of whom 96% had axillary dissections, were 39 yea rs of age or younger. These young patients were more likely to have ch emotherapy (p < 0.0001), and tumor bed reexcision (p < 0.01), and less likely to have an undissected axilla (p < 0.01), or estrogen receptor positive tumor (p = 0.02) than the older women (> 40 years). Although breast recurrence tended to appear earlier in the younger patients (1 2% at 5 years for those < 40 years vs. 6% at 5 years for those older), by 7 years the breast failure rate for the two groups was the same (1 2%), p = 0.13. In the 37 women 35 years of age or younger, the actuari al rate of breast recurrence was 9% at 7 years. Compared to other seri es in the literature, in which cancers were grossly excised without re gard to the microscopic margins of resection, and reexcision was not r outinely performed, young women treated with breast conserving surgery and irradiation at our institution frequently underwent reexcision of the tumor bed (57%), and had negative pathologic margins of resection (75%). Regional nodal relapse was in general uncommon, and not seen w ith increased frequency in the youngest cohort.Conclusion: Our experie nce suggests that young age is not a contraindication to breast conser ving surgery and irradiation. Although breast cancers in this cohort m ay have certain features rendering them prone to local failure, we bel ieve this risk can be mitigated by appropriate patient selection and o ptimal surgical resection.