LOCAL AND DISTANT RECURRENCE AFTER CONSERVATIVE MANAGEMENT OF VERY LOW-RISK BREAST-CANCER ARE DEPENDENT EVENTS - A 10-YEAR FOLLOW-UP

Purpose: To determine the risk factors associated with recurrence afte r breast-conserving treatments, and the relationship between occurrenc e of a local recurrence and subsequent distant metastases. Methods and Materials: Among the 3697 patients with primary breast cancer treated at Institut Paoli-Calmettes Cancer Center, Marseille, between 1980 an d 1995, we retrospectively analyzed 756 patients who had been treated with conservative surgery with uninvolved margins of excision, were no de-negative, and had received uniform radiotherapy and no chemotherapy , One third of the patients received hormonal therapy via tamoxifen or surgical castration. The endpoints considered were local failures and distant metastases. All tumors mere reviewed by our pathologists. The median follow-up for the 700 survivors was 62 months. Results: In the multivariate analysis, histological multifocality (p = 0.0076), perit umoral vessel invasion (p = 0.0215), and young age (p = 0.0245) were a ssociated with an increased risk of local recurrences, whereas tumor s ize (p = 0.0013), young age (p = 0.003), and histological multifocalit y (p = 0.0414) were associated with an increased risk of distant metas tases, Local recurrences and distant metastases had similar yearly-eve nt probabilities. Median time to distant metastases was shorter after a local recurrence. Early timing of local recurrences did not mark a h igher risk of distant metastases, Hazard of relapsing from distant met astases was 4.4 times higher after a local recurrence. Conclusion: our results support the hypothesis that, in this subset of patients, loca l recurrences favor further dissemination of cancer cells. We are unab le to clearly identify a group who would benefit from more aggressive local therapy. (C) 1998 Elsevier Science Inc.