MAMMARY RECURRENCES FOLLOWING CONSERVATIV E SURGERY AND RADIATION-THERAPY FOR EARLY BREAST-CANCER - RISK-FACTORS, SITE OF RECURRENCE, EVOLUTION

The identification of factors associated with breast recurrence as fir st event (62 cases, 10%) following conservative surgery and radiation therapy are drawn out from a serie of 618 mammary carcinomas of clinic al size less than 40 mm, stade I and II (UICC), with a median follow u p of 8 years. The most powerful predictive characteristic associated w ith the likehood of breast recurrence is multiple foci of invasion (42 .9% vs 8.9, P = 0.0001, relativ risk [RR]: 6). After this rarely cited feature, young age, less than 40 years (20% vs 7.3%, P = 0.0001, RR: 2.8), extensive in situ carcinoma more than 25% (19.2% vs 8.7%, P = 0. 003, RR: 2.5) were found also persistant in the Cox model, but not his tologic size more than 25 mm (18.9% vs 9.1%, P = 0.01, RR: 2.3). The s ite of recurrence was studied on the 54 salvage mastectomy done. A hig h rate of recurrence at distance of the initial site was found: 37% wh ose more than half 22%, were multicentric. No significant difference i n the mean delay of appearence was noted between recurrence near or at distance of the initial cancer (mean delay 52 months vs 64 months). F rom the recurrence the evolution is not very favourable: excluding sim ultaneous metastases found at the preoperative investigation, ten case s, mammary recurrence is followed by a metastatic syndrome in 36% of c ases against 17% without it (P = 0.01, RR: 1.9). Metastatic evolution is not significantly linked with the time, early or late, of the mamma ry recurrence (54.5% before 5 years vs 39% after) but with the associa tion of a controlateral cancer (P = 0.03). Locally ten of the 54 maste ctomy presented a thoracic recurrence, often in case of multicentric b reast recurrence (P = 0.05) and not significantly when skin or aerola were invaded by carcinoma.