SKIN RECURRENCES AFTER BREAST-CONSERVING THERAPY FOR EARLY-STAGE BREAST-CANCER

Purpose: To assess the frequency and prognosis of skin recurrences aft er breast-conserving therapy (BCT) compared with other breast recurren ces. Materials and Methods: From 1968 to 1986, 1,624 patients with uni lateral stage I or II breast cancer treated with BCT at the Joint Cent er for Radiation Therapy (Boston, MA) underwent gross tumor excision a nd received a dose of greater than or equal to 60 Gy to the tumor bed. Skin recurrences (58) were defined as breast recurrences without asso ciated parenchymal disease. An invasive breast recurrence with any par enchymal disease noted clinically or radiographically was scored as an other breast recurrence (OBR). Median follow-up for survivors was 137 months. Results: SR represented 8% (18 of 229) of all breast recurren ces and occurred in 1.1% of all patients. The outcome after local recu rrence was different for patients with SR and invasive OBR. Patients w ith SR more frequently had uncontrolled local failure (50%; 9 of 18) t han did patients with OBR (14%; 26 of 188) (P = .0007). Forty-four per cent (8 of 18) of patients with SR had distant metastasis simultaneous ly or within 2 months of the recurrence compared with 5% (9 of 188) of invasive OBR patients (P < .0001). for patients without distant metas tasis at the time of recurrence, the 5-year actuarial rate of developm ent of distant metastasis was 60% for SR patients compared with 39% fo r invasive OBR patients (P = .07), and the corresponding 5-year actuar ial survival rates beyond the time of local failure were 51% and 79%, respectively (P = .06). Conclusion: In contrast to other types of inva sive breast recurrence after breast-conserving therapy, skin recurrenc es are rare and are associated with a significantly higher rate of dis tant metastasis and uncontrolled local disease as well as a lower rate of survival. (C) 1998 by American Society of Clinical Oncology.