LOCAL RECURRENCE AFTER BREAST-CONSERVING THERAPY FOR INVASIVE BREAST-CANCER - HIGH-INCIDENCE IN YOUNG-PATIENTS AND ASSOCIATION WITH POOR SURVIVAL

Purpose: To study risk factors for local recurrence (LR) after breast- conserving therapy (BCT) for invasive breast cancer and, for patients with an LR, the mode of detection, location, treatment, influence of r adiation therapy, and impact on survival, Methods and Materials: 1360 patients (median age 52 years; range 24-88) with a total of 1393 pT1-2 NO-1 tumors treated with BCT between 1980-1994 were studied (median f ollow-up 52 months), The adequacy of radiation treatment of the patien ts developing LR was studied in a quality control study. The impact of LR on overall survival and distant metastasis was studied in a Cox re gression model with LR as a time-dependent covariate. Results: A total of 88 LR occurred with a 5- and 10-year LR risk of 8 and 12%, Age was the only significant risk factor, Compared to patients >65 years old, patients <45 years old and patients 45-65 Sears old had a relative ri sk (RR) of 4.09 and 2.41, respectively, of developing LR, Risk on LR w as found to increase gradually with younger age, Radiation therapy was considered adequate and did not play a role in influencing the LR rat e. Almost 65% of the LR were true or marginal recurrences, Of all LR, 80% appeared during the first 5 years and were detected with equal fre quency by the patient herself, the physician, and annual mammography, LR was a major predictor for distant metastasis (RR: 4.90; 3.15-7.62) and death (RR: 4.29; 2.93-6.28). Conclusion: Young age is a major risk factor for LR and there is a significant gradual increase in LR with decreasing age, LR is associated with a higher risk of distant metasta sis and death. Whether LR is the cause of or a marker for distant meta stasis remains unresolved. (C) 1998 Elsevier Science Inc.