J Breast Cancer.  2011 Sep;14(3):191-197.

The Impact of Local and Regional Recurrence on Distant Metastasis and Survival in Patients Treated with Breast Conservation Therapy

• Lee JS
• Kim SI
• Park HS
• Lee JS
• Park S
• Park BW

Abstract

PURPOSE
We evaluated the effect of local recurrence (LR) and regional recurrence (RR) on distant metastasis and survival in patients treated with breast conservation therapy (BCT).
METHODS
We analyzed 907 patients who were treated for invasive breast cancer between 1993 and 2006. With 53 months of follow-up, 28 patients (3.1%) developed LR in the breast and 12 patients (1.3%) developed RR before distant metastasis. LR and RR were separated into four patterns to determine the prognostic relevance of recurrence site and time to recurrence: LR within 3 years (early LR), LR after 3 years (late LR), RR within 3 years (early RR), and RR after 3 years (late RR).
RESULTS
Early LR (hazard ratio [HR], 4.76; p=0.003) and early RR (HR, 18.16; p<0.001) were independent predictors of distant metastasis. In terms of overall survival, early LR (HR, 5.24; p=0.002), and early RR (HR, 18.80; p<0.001) were significantly related with poor survival. Patients with late LR/RR had a similar favorable prognosis compared with patients who never experienced LR/RR.
CONCLUSION
The result suggests that time to LR/RR following BCT is a significant predictor developing a distant metastasis and surviving.

Keyword

Breast conservation therapy; Distant metastasis; Local recurrence; Regional recurrence; Survival

MeSH Terms

Breast
Breast Neoplasms
Follow-Up Studies
Humans
Neoplasm Metastasis
Prognosis
Recurrence

Figure

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  Figure 1 Kaplan-Meier 5-year distant relapse free survival (A) and overall survival (B) estimate according to the patterns of local recurrence and regional recurrence. Early local recurrence (LR), local recurrence within 3 years; Late LR, local regional after 3 years; Early regional recurrence (RR), regional recurrence within 3 years; Late RR, regional recurrence after 3 years.

Reference

1. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002. 347:1233–1241.

2. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002. 347:1227–1232.

3. Arriagada R, Lê MG, Guinebretière JM, Dunant A, Rochard F, Tursz T. Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol. 2003. 14:1617–1622.

4. Harris EE, Hwang WT, Seyednejad F, Solin LJ. Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy. Cancer. 2003. 98:2144–2151.

5. Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure. Breast J. 2002. 8:81–87.

6. Fredriksson I, Liljegren G, Arnesson LG, Emdin SO, Palm-Sjövall M, Fornander T, et al. Local recurrence in the breast after conservative surgery--a study of prognosis and prognostic factors in 391 women. Eur J Cancer. 2002. 38:1860–1870.

7. Fourquet A, Campana F, Zafrani B, Mosseri V, Vielh P, Durand JC, et al. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys. 1989. 17:719–725.

8. Elkhuizen PH, Hermans J, Leer JW, van dE Vijver MJ. Isolated late local recurrences with high mitotic count and early local recurrences following breast-conserving therapy are associated with increased risk on distant metastasis. Int J Radiat Oncol Biol Phys. 2001. 50:387–396.

9. Lukens JN, Vapiwala N, Hwang WT, Solin LJ. Regional nodal recurrence after breast conservation treatment with radiotherapy for women with early-stage breast carcinoma. Int J Radiat Oncol Biol Phys. 2009. 73:1475–1481.

10. Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007. 356:2399–2405.

11. Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009. 27:2466–2473.

12. Fisher B, Anderson S, Fisher ER, Redmond C, Wickerham DL, Wolmark N, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991. 338:327–331.

13. Doyle T, Schultz DJ, Peters C, Harris E, Solin LJ. Long-term results of local recurrence after breast conservation treatment for invasive breast cancer. Int J Radiat Oncol Biol Phys. 2001. 51:74–80.

14. Monteiro Grillo I, Jorge M, Marques Vidal P, Ortiz M, Ravasco P. The effect of locoregional recurrence on survival and distant metastasis after conservative treatment for invasive breast carcinoma. Clin Oncol (R Coll Radiol). 2005. 17:111–117.

15. Cowen D, Jacquemier J, Houvenaeghel G, Viens P, Puig B, Bardou VJ, et al. Local and distant recurrence after conservative management of "very low-risk" breast cancer are dependent events: a 10-year follow-up. Int J Radiat Oncol Biol Phys. 1998. 41:801–807.

16. Voogd AC, van Tienhoven G, Peterse HL, Crommelin MA, Rutgers EJ, van de Velde CJ, et al. Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer. 1999. 85:437–446.

17. Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE Jr, Jeong JH, Tan-Chiu E, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006. 24:2028–2037.

18. Haffty BG, Reiss M, Beinfield M, Fischer D, Ward B, McKhann C. Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol. 1996. 14:52–57.

19. Whelan T, Clark R, Roberts R, Levine M, Foster G. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Investigators of the Ontario Clinical Oncology Group. Int J Radiat Oncol Biol Phys. 1994. 30:11–16.

20. Kurtz JM, Amalric R, Brandone H, Ayme Y, Jacquemier J, Pietra JC, et al. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer. 1989. 63:1912–1917.

21. Smith TE, Lee D, Turner BC, Carter D, Haffty BG. True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys. 2000. 48:1281–1289.

22. Fatouros M, Baltoyiannis G, Roukos DH. The predominant role of surgery in the prevention and new trends in the surgical treatment of women with BRCA1/2 mutations. Ann Surg Oncol. 2008. 15:21–33.

23. Roukos DH. Genetics and genome-wide association studies: surgery-guided algorithm and promise for future breast cancer personalized surgery. Expert Rev Mol Diagn. 2008. 8:587–597.