survival after a local relapse in the breast

survival after a local relapse in the breast

survival based on how quickly the breast relapse occurs

Local Relapse after Breast Conservation

As noted elsewhere a certain number of women (4 - 20%) may get a relapse or recurrence in the breast after having a lumpectomy and radiation. In general the treatment for this requires a mastectomy and further breast radiation is usually not given (see NCCN) though a second lumpectomy may be an option (see study from Yale.) Most of these women are still cured. The survival is related to how quickly the cancer grows back (those that recur quickly, within the first 2 years, do worse.) Those women whose relapse is non-invasive (DCIS) almost always do well. Some of the studies are noted below,

Long-term results of local recurrence after breast conservation treatment for invasive breast cancer Todd Doyle, et al. International Journal of Radiation Oncology*Biology*Physics, 2001: 51:1 : 74-80

The study population consisted of 112 patients with ipsilateral breast tumor recurrence. Local recurrences were detected by physical examination alone in 42 patients, mammography alone in 47 patients, and both modalities in 23 patients. All patients were initially treated with breast conservation treatment with or without systemic therapy and subsequently treated at the time of local recurrence with salvage mastectomy with or without systemic therapy.

Results: For the entire group of 112 patients, the overall survival at 10 years after local recurrence was 69%, the cause-specific survival was 71%, and 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%. For the 93 patients with an invasive local recurrence, interval from diagnosis to local recurrence (2 years vs. 2.1–5 years vs. >5 years) predicted for overall survival at 5 years (65% vs. 84% vs. 89%;). Method of detection of local recurrence (physical examination vs. mammography vs. both methods) also predicted for 5-year overall survival (73% vs. 91% vs. 93%, respectively; ).

Local recurrence after breast conservation therapy for early stage breast carcinoma . Detection, treatment, and outcome in 266 patients. Adri C. Voogd, Ph.D.^{, et al.}

At eight radiotherapy institutes, two cancer institutes, and one surgical clinic in the Netherlands, regular follow-up of patients who underwent breast conservation therapy between 1980 and 1992 identified 266 patients with local recurrence in the breast. These patients exhibited no clinical signs of distant metastases at the time of diagnosis of the local recurrence. Data on the method of detection were available for 189 patients (72%). Local recurrence was diagnosed by mammography alone in 47 cases (25%). Of all patients, 85% underwent salvage mastectomy, 8% underwent local excision, 4% received systemic treatment only, and 3% remained untreated. Specimens of the primary tumor were available for review from 238 of the 266 patients (89%).

Local recurrences detected by mammography alone were smaller than those detected by physical examination. At 5 years from the date of salvage treatment, the overall survival rate for all 266 patients was 61%, and the distant recurrence free survival rate was 47%.. For the 25 patients with noninvasive recurrence, these figures were 95% and 94%, respectively. Skin involvement, the extent of recurrence (

10 mm vs. >10 mm), and both lymph node status and histologic grade of the primary disease were strong predictors for distant metastases in patients with invasive recurrence.

CONCLUSIONS

Patients with invasive local recurrence more than 1 cm in size are at a substantial risk for distant disease. The better distant disease free survival for patients with recurrence measuring 1 cm or less may indicate that early detection can improve the treatment outcome. Recurrence with skin involvement should be considered generalized disease. Cancer 1999;85:437-46.