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Mastectomy Offers Best Prognosis After Local Breast-Cancer Recurrence: Presented at SABCS

By Robert H. Carlson

SAN ANTONIO, TX -- December 13, 2001 -- Patients who have a local recurrence of breast cancer after breast-conserving surgery and radiotherapy can still have prolonged intervals free of disease, particularly when the local recurrence is treated with mastectomy.

In a retrospective study, researchers found that patients with the best prognosis after local recurrence of breast cancer were women who were treated with mastectomy, those who had a non-invasive local recurrence, those with longer intervals between initial surgery and local recurrence, and those whose disease recurred in the form of a non-lobular tumor.

The study was described on December 11^th at the 24^th Annual San Antonio Breast Cancer Symposium, in San Antonio, Texas, by Jay R. Harris, MD, a professor in radiation oncology at Harvard Medical School, in Boston, Massachusetts.

Dr. Harris said they studied the course of disease in 2,102 patients with early-stage breast cancer, defined as clinical stages I and II. They were all treated initially with breast-conserving surgery and radiotherapy.

Local recurrence was defined as any recurrence within the ipsilateral breast, with or without a simultaneous regional lymph node involvement or distant metastasis.

The final study population comprised 288 patients who had local recurrence of breast cancer.

These women had a median age of 45 years at the time of initial diagnosis, a median time from radiotherapy to local recurrence of 64.5 months (range one-220) and median follow-up after the local recurrence of 165 months (range 12-271).

Dr. Harris said local recurrence was non-invasive for 38 patients (13 percent of the 288), invasive for 225 (78 percent) and unknown for 25 (9 percent).

After local recurrence, 235 patients (82 percent) selected mastectomy with or without radiotherapy, 22 patients (8 percent) chose local breast-conserving excision with or without radiotherapy, and 31 patients (10 percent) selected no therapy. Systemic therapy was given to 46 percent at the time of local recurrence, Dr. Harris said.

Of the 288 local recurrences, 261 occurred in isolation, two occurred with simultaneous opposite breast failure, and 15 occurred with simultaneous ipsilateral regional-nodal failure.

"Among the 288 women, 59 percent were alive at 10 years," Dr. Harris said.

Those with invasive local recurrence had 8.5-times the risk of developing distant metastatic disease as did women with non-invasive disease, he said.

The researchers concluded that, in this study, mastectomy after local recurrence of breast cancer offered the best chance for prolonged survival.

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