Prognosis after treatment for loco-regional recurrence after mastectomy orbreast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM)

The aim of this study was to investigate and compare the prognosis after tr eatment for loco-regional recurrences (LR) after (modified) radical mastect omy (MRM) or breast conserving therapy (BCT), in terms of overall survival and time to subsequent LR, in patients originally treated in two European r andomised trials. In EORTC trial 10801 and DBCG trial 82-TM, 1,807 patients with stage I and II breast cancer were randomised to receive MRM or BCT fr om 1980 to 1989. All patients with a LR in these trials were analysed for s urvival and time to subsequent LR after salvage treatment. Of these, 133 pa tients had their LR as a first event, the majority within 5 years after ini tial treatment. The prognostic significance for survival and time to subseq uent LR after salvage treatment was analysed in uni-, and multivariate anal yses for a number of original tumour- and recurrence-related variables. Aft er salvage treatment of LR after MRM or BCT, actuarial survival curves and the actuarial locoregional control curves were similar. The 5-year survival rates were 58% and 59% and the 5-year subsequent loco-regional control rat es 62% and 63%, respectively. In a multivariate analysis, pN category (P = 0.03), pT category (P = 0.01) and vascular invasion (P = 0.02) of the prima ry tumour were the only independent prognostic factors for survival, wherea s extensive LR (P < 0.001), interval less than or equal to 2 years (P < 0.0 02) and pN+ at primary treatment (P = 0.004) were significant predictive fa ctors for time to subsequent LR. The type of original treatment (MRM or BCT ) did not have any prognostic impact. It is concluded that the survival and time to subsequent LR after treatment for an early loco-regional recurrenc e after MRM or BCT was similar in these two European randomised trials. Thi s suggests that both after MRM and BCT an early LR is an indicator of a bio logically aggressive tumour; early loco-regional relapse carries a poor pro gnosis and salvage treatment only cures a limited number of patients, wheth er treated by MRM or BCT originally. (C) 1999 Elsevier Science Ltd. All rig hts reserved.