Local and distant failures after limited surgery with positive margins andradiotherapy for node-negative breast cancer

Purpose: To determine the outcome of patients with positive margins after l umpectomy for breast cancer and to address the issue of the relationship be tween local recurrences and distant metastasis in the absence of chemothera py. Methods and Materials: Among 3697 patients with primary breast cancer, we r etrospectively analyzed 152 patients who had undergone conservative surgery with axillary dissection, had infiltrating carcinomas with positive margin s, were node-negative, and received radiotherapy without chemotherapy. One- third received hormonal therapy. Endpoints were local failure and distant m etastasis. Median follow-up was 72 months. Results: Five- and Ill-year recurrence-free survival were 0.80 and 0.71 res pectively for local recurrences, and 0.85 and 0.73 respectively for metasta sis. Infiltrating carcinoma on the margins was associated with early local relapse as opposed to intraductal carcinoma. Local and distant recurrences had similar patterns of yearly-event probabilities. Hazard of relapsing fro m metastasis was 2.5 times higher after a local recurrence. In the multivar iate analysis, negative estrogen receptors (ER-)(p = 0.0012), histologic mu ltifocality (p = 0.0028), and no hormonal therapy (p = 0.017) predicted loc al relapses, while ER- (p = 0.004) and pathologic grade (p 0.009) predicted metastasis. Hormonal therapy did not prevent early local recurrences. Conclusion: In this population, reexcision is advisable for local purposes and because the data support the hypothesis that local and distant recurren ces are tightly connected. (C) 2000 Elsevier Science Inc.