Sj. Dibiase et al., THE NUMBER OF POSITIVE MARGINS INFLUENCES THE OUTCOME OF WOMEN TREATED WITH BREAST PRESERVATION FOR EARLY-STAGE BREAST-CARCINOMA, Cancer, 82(11), 1998, pp. 2212-2220
BACKGROUND. There are conflicting reports regarding whether focally po
sitive surgical margins influence tumor control in breast-conservation
therapy. The authors have evaluated the relation between positive sur
gical margins on tumor control and whether the number of positive marg
ins affects tumor control in patients undergoing reexcision lumpectomy
. METHODS. From 1978 to 1994, 453 American Joint Committee on Cancer S
tage I/II breast carcinoma patients were treated at Thomas Jefferson U
niversity Hospital with breast conservation therapy. Patients underwen
t excisional biopsy and margin sampling with shaved biopsies of the tu
mor cavity. The entire breast received 45 grays (Gy) with a 20-Gy irid
ium-192 implant or an electron boost. Eighty-six patients had microsco
pically positive margins (19%), and the remainder had confirmed negati
ve margins. The median follow-up time was 45 months. RESULTS. Local tu
mor control rates for patients with negative margins at 5 and 10 years
were 94% and 87%, respectively, compared with 86% and 69%, respective
ly, for those patients with positive margins (P = 0.005). The disease
free survival rates for the negative margin group at 5 and 10 Fears we
re 91% and 82%, respectively, compared with 76% and 71%, respectively,
for the positive margin group (P = 0.001). Overall survival rates for
patients with negative margins at 5 and 10 years were 95% and 84%, re
spectively, compared with 87% and 78% respectively, for those with pos
itive margins (P = 0.047). When comparing the negative margin group wi
th the one positive margin group, there was no significant difference
in local tumor control (P = 0.12). However, women with two or more pos
itive margins had an inferior local tumor control compared with those
women with negative margins (P = 0.002). CONCLUSIONS. Patients with po
sitive margins have a higher risk for local failure and worse survival
when undergoing breast conservation therapy. Inferior local tumor con
trol was noted in those patients with two or more positive margins. (C
) 1998 American Cancer Society.