Primary chemotherapy for operable breast cancer: Incidence and prognostic significance of ipsilateral breast tumor recurrence after breast-conservingsurgery

Purpose: To determine the incidence and the prognostic value of ipsilateral breast tumor recurrence (IBTR) in patients treated with primary chemothera py and breast-conserving surgery. Patients and Method: Between January 1985 and December 1994, 257 patients w ith invasive T1 to T3 breast carcinoma were treated with primary chemothera py, lumpectomy, and radiation therapy. The median follow-up time was 93 mon ths. To evaluate the role of IBTR in metastase-free survival, a Cox regress ion multivariate analysis was performed using IBTR as a time-dependent cova riate. Results: The IBTR rates were 16% (+/- 2.4%) at 5 years and 21.5% (+/- 3.2%) at 10 years. Multivariate analysis showed that the probability of local co ntrol was decreased by the following independent factors: age less than or equal to 40 years, excision margin less than or equal to 2 mm, S-phase frac tion more than 4%, and clinical tumor size more than 2 cm at the time of su rgery. In patients with excision margins of more than 2 mm, the IBTR. rates were 12.7% at 5 years and 17% at 10 years. Nodal status, age less than or equal to 40 years, and negative estrogen receptor status were predictors of distant disease in the Cox multivariate model with fixed covariates. The c ontribution of IBTR was highly significant (relative risk = 5.34) when adde d to the model, whereas age:5 40 years was no longer significant. After IBT R, 31.4% (+/- 7.0%) of patients developed metastases at 2 years and 59.7% ( +/- 8.1 %) at 5 years. Skin involvement, size at initial surgery, and estro gen receptor status were predictors of metastases after IBTR. Conclusion: IBTR is a strong predictor for distant metastases. There are im plications for conservative surgery after downstaging of the tumor and ther apy at the time of IBTR. J Clin Oncol 19:3828-3835. (C) 2001 by American So ciety of Clinical Oncology.