OUTCOME OF TREATMENT FOR IPSILATERAL BREAST-TUMOR RECURRENCE IN EARLY-STAGE BREAST-CANCER

Introduction: The aims of the study were to assess the outcome among p atients with early breast cancer operated on with wide local excision who developed a subsequent ipsilateral breast tumor recurrence, and to identify risk factors for uncontrolled local disease. Uncontrolled lo cal disease (ULD) was defined as the appearance of clinically manifest invasive adenocarcinoma in the remaining breast or on the ipsilateral chest wall which could not be eradicated with salvage treatment durin g the period of follow-up (2-18 years). Patients and methods: Eighty-f ive patients in a cohort of 759 patients, treated for invasive Stage I -II breast cancer with breast-conserving surgery 1976-1985 in Stockhol m, with a subsequent ipsilateral breast tumor recurrence (IBTR) were r eviewed retrospectively. The majority of the patients were premenopaus al (58%), node negative (72%), and had received postoperative radiothe rapy (79%). Median follow-up time following breast-conserving surgery was 13 (9-19) years. Multivariate Cox's hazard regression was used in the statistical analysis to identify prognostic factors for ULD. Resul ts: The majority (n = 61) of the IBTR's were located in the original t umor quadrant and showed the same histopathological features as the pr imary tumor. Salvage mastectomy (n = 65) or reexcision (n = 14) were p erformed in 79 (93%) of the patients. Twenty-one patients developed UL D. Five years following the diagnosis of IBTR the disease-free surviva l was 59%, the cumulative incidence for ULD was 24%, and for death in breast cancer 34%. In the cohort of 759 patients, patients who receive d radiotherapy following the primary breast-conserving surgery had 1% cumulative incidence of ULD following the diagnosis of IBTR compared t o 4% among patients that received no postoperative radiotherapy. The c umulative incidence at 5 years of ULD following salvage mastectomy was 12% compared to 33% after salvage reexcision. Patients operated on wi th breast-conserving surgery with an original tumor size < 15 mm, who were treated with salvage mastectomy for IBTR, had in multivariate ana lysis the lowest relative risk for ULD. Adjuvant chemotherapy followin g IBTR treatment did not seem to improve local tumor control. Followin g the diagnosis of IBTR, 78% (n = 21) of the patients with ULD and/or regional recurrence (n = 27), died of a disseminated breast cancer in contrast to 10% (n = 6) among the remaining 58 patients. Conclusion: U ncontrolled local disease is an important outcome measure following br east-conserving surgery. In this cohort, salvage mastectomy provided a superior local control rate compared to salvage reexcision. A higher although not statistically significant rate of ULD was also seen in pa tients who had not received postoperative radiotherapy as part of thei r primary treatment.