ROLE OF CONSERVATION THERAPY FOR INVASIVE LOBULAR CARCINOMA OF THE BREAST

Background: Invasive lobular carcinoma (ILC) accounts for 5% to 10% of all invasive breast cancers, Although breast conservation therapy usi ng local excision and postoperative irradiation is a standard therapy for early invasive ductal breast cancer, the result of this strategy i n ILC is not well documented. We sought to determine the rate of locor egional recurrence after breast conservation therapy in patients with ILC. Methods: A retrospective review of 74 patients with ILC treated w ith breast conservation therapy at The University of Texas M. D. Ander son Cancer Center (n = 43) or The John Wayne Cancer Institute (n = 31) between 1977 and 1993 was performed. Results: The median age of patie nts was 60 years, and median follow-up was 56 months (range 1 to 207 m onths), Thirty-nine patients had American Joint Committee on Cancer st age I disease, 30 had stage II disease, and five had stage IIb disease . All patients underwent surgical resection and postoperative radiatio n therapy. Twelve patients received postoperative adjuvant chemotherap y, and 27 patients were treated with adjuvant hormonal therapy. The 5- year actuarial locoregional recurrence rate was 9.8%, and the median t ime to recurrence was 77 months (range 41 to 113 months). Patients wit h positive or close (less than or equal to 1 mm) surgical margins were at increased risk for local recurrence on univariate analysis (p = 0. 034). Of the nine patients with breast recurrence, six underwent salva ge therapy with total mastectomy and are disease free at the time of t his writing, two patients died of distant disease, and one is alive wi th local disease at the time of this report. The 5-year disease-specif ic survival rate was 93.7%. Conclusions: Breast conservation therapy f or ILC achieves locoregional control in the majority of patients, Howe ver, long-term follow-up of patients is important because many local r ecurrences following breast conservation therapy are late events.