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More Local Recurrences Seen in Breast Cancer Patients Treated With Irradiation: Presented at ASBS
By Carole Bullock
NEW YORK -- May 9, 2008 -- The median time to local recurrence was more than twice as long for breast cancer patients who received radiation therapy than for patients who did not receive radiation, according to research presented here at the 9th Annual Meeting of the American Society of Breast Surgeons (ASBS).
This longer time to local recurrence seen in women who receive radiation therapy gives more time for the breast cancer tumours to become invasive and more difficult to find, said researcher Lisa E. Guerra, MD, Surgery Fellow, Kenneth Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, during a poster presentation on May 3.
"During this prolonged time period, there is more time for a local recurrence to progress to invasion," explained Dr. Guerra.
Follow-up with magnetic resonance imaging should be considered, she urged.
In a prospective database analysis of 878 conservative patients treated for ductal carcinoma in situ (DCIS), the rate of invasive tumours was 35% in the 551 patients who had excision only and 53% among 327 patients who had excision plus radiation therapy (P = .04).
Percentage rates for DCIS were 65% for excision-alone and 47% for excision plus radiation (P = .04).
Dr. Guerra and colleagues took into account 26 factors, including nuclear grade, size, and margin width in an attempt to identify the most relevant predictors for recurrences.
"Prolonged time to recurrence was the only statistically significant factor," Dr. Guerra said.
"It is widely thought that local recurrences after conservative treatment for DCIS are equally distributed between invasive and noninvasive DCIS recurrences. We analysed our data to see if this was true," she said.
They found that median time to recurrence was 23 months for the excision-alone group and 58 months for irradiated patients (P = .01). Furthermore, the tumours tended to be at or near the primary tumour in 92% of the excision-only group and 80% of the excision plus radiation group (P = .03).
Researchers also noted more breast scarring among irradiated cancer patients, making diagnosis by palpation and mammography more difficult.
In an interview, Dr. Guerra concluded, "The prospective database, which includes more patient factors than analysed in prior randomised trials, demonstrates that there are patients who can safely be treated with excision alone, with an absolute local recurrence risk that lies well within the 'standard' recurrence risk described by randomised trial data, even comparing our excision-alone group of patients to radiation therapy patients."
[Presentation title: Invasive Local Recurrence Increased After Radiation Therapy for DCIS. Poster 29]
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