Long-term results of local recurrence after breast conservation treatment for invasive breast cancer

Purpose: The outcome for women with a local failure after breast conservati on treatment is not well described in the literature. Because local recurre nce is a potentially salvageable event, this study was performed to evaluat e the outcome of patients with local recurrence after breast conservation s urgery and definitive radiation treatment. Methods and Materials: The study population consisted of 112 patients with ipsilateral breast tumor recurrence. There were 100 isolated local recurren ces and 12 local-plus-regional recurrences. There were 93 invasive local re currences and 19 DCIS (ductal carcinoma in situ) local recurrences. Local r ecurrences were detected by physical examination alone in 42 patients, mamm ography alone in 47 patients, and both modalities in 23 patients. All patie nts were initially treated with breast conservation treatment with or witho ut systemic therapy and subsequently treated at the time of local recurrenc e with salvage mastectomy with or without systemic therapy. The mean and me dian follow-up times after local recurrence were 49 and 44 months, respecti vely. Results: For the entire group of 112 patients, the overall survival at 10 y ears after local recurrence was 69%, the cause-specific survival was 71%, a nd the freedom from distant metastases was 47%. For the 93 patients with an invasive local recurrence, the overall survival at 10 years was 64%, cause -specific survival was 67%, and freedom from distant metastases was 44%. Fo r the 93 patients with an invasive local recurrence, interval from diagnosi s to local recurrence (less than or equal to2 years vs. 2.1-5 years vs. >5 years) predicted for overall survival at 5 years (65% vs. 84% vs. 89%; p = 0.03). Method of detection of local recurrence (physical examination vs. ma mmography vs. both methods) also predicted for 5-year overall survival (73% vs. 91% vs. 93%, respectively; p = 0.04). On multivariable analysis, inter val from diagnosis to local recurrence was an independent predictor of over all survival (p = 0.03). Method of detection of local recurrence (physical examination vs. mammography vs. both methods) was borderline in predicting for 5-year cause-specific survival (73% vs. 91% vs. 93%, respectively;p = 0 .06). Similarly, interval from diagnosis to local recurrence (less than or equal to2 years vs. 2.1-5 years vs. >5 years) was a borderline predictor of 5-year cause-specific survival (65% vs. 84% vs. 89%;p = 0.08). No factors that predicted for freedom from distant metastases were identified. There w ere three second locoregional failures on the chest wall. Two of the 19 pat ients with a DCIS local recurrence have died of metastatic breast cancer. D eath was probably not related to their local recurrence, but rather a resul t of persistent risk from an invasive primary cancer. Conclusions: This analysis provides long-term data after salvage treatment for patients who experience local recurrence after breast conservation trea tment. The variables of method of detection and interval from diagnosis to local recurrence are identified as having prognostic significance for overa ll and cause-specific survival. In view of the potential for long-term surv ival, aggressive attempt at salvage treatment is warranted for the patient with local recurrence after breast conservation treatment. Second local rec urrence after salvage mastectomy is an uncommon event. Although DCIS local recurrences may not in themselves cause an increase in the risk of mortalit y, the risk from the primary invasive cancer persists. (C) 2001 Elsevier Sc ience Inc.