Local recurrence after breast conservation therapy for early stage breast carcinoma - Detection, treatment, and outcome in 266 patients

BACKGROUND. Controversy exists concerning the roles of mammography and phys ical examination in the detection of local recurrence after conservation th erapy for breast carcinoma. In addition, the prognostic factors for and opt imal treatment of patients with local recurrence are uncertain. METHODS. At eight radiotherapy institutes, two cancer institutes, and one s urgical clinic in the Netherlands, regular follow-up of patients who underw ent breast conservation therapy between 1980 and 1992 identified 266 patien ts with local recurrence in the breast. These patients exhibited no clinica l signs of distant metastases at the time of diagnosis of the local recurre nce. Data on the method of detection were available for 189 patients (72%). Local recurrence was diagnosed by mammography alone in 47 cases (25%). Of all patients, 85% underwent salvage mastectomy, 8% underwent local excision , 4% received systemic treatment only, and 3% remained untreated. Specimens of the primary tumor were available for review from 238 of the 266 patient s (89%). RESULTS. Local recurrences detected by mammography alone were smaller than those detected by physical examination (P = 0.04). At 5 years from the date of salvage treatment, the overall survival rate for all 266 patients was 6 1% (95% confidence interval [CI], 55-67%), and the distant recurrence free survival rate was 47% (95% CI, 40-53%). For the 25 patients with noninvasiv e recurrence, these figures were 95% and 94%, respectively Skin involvement , the extent of recurrence (less than or equal to 10 mm vs. >10 mm), and bo th lymph node status and histologic grade of the primary disease were stron g predictors for distant metastases in patients with invasive recurrence. CONCLUSIONS. Patients with invasive local recurrence more than I cm in size are at a substantial risk for distant disease. The better distant disease free survival for patients with recurrence measuring 1 cm or less may indic ate that early detection can improve the treatment outcome. Recurrence with Skin involvement should be considered generalized disease. (C) 1999 Americ an Cancer Society.