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

2010 ◽  
Vol 21 (3) ◽  
pp. 269-270
Author(s):  
S.B. Motwani ◽  
B.G. Haffty
Keyword(s):  
Breast Cancer ◽  
Breast Tumor ◽  
Tumor Recurrence ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Breast Conserving Therapy ◽  
Ipsilateral Breast ◽  
Node Negative ◽  
National Surgical Adjuvant Breast ◽  
Node Negative Breast Cancer ◽  
Bowel Project

scholarly journals 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

2009 ◽  
Vol 27 (15) ◽  
pp. 2466-2473 ◽  
Author(s):  
Stewart J. Anderson ◽  
Irene Wapnir ◽  
James J. Dignam ◽  
Bernard Fisher ◽  
Eleftherios P. Mamounas ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Breast Tumor ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Breast Conserving Therapy ◽  
Adjuvant Systemic Therapy ◽  
Ipsilateral Breast ◽  
Distant Disease ◽  
Node Negative ◽  
Node Negative Breast Cancer ◽  
Bowel Project

Purpose Locoregional failure (LRF) after breast-conserving therapy (BCT) is associated with increased risk of distant disease and death. The magnitude of this risk has not been adequately characterized in patients with lymph node-negative disease. Patients and Methods Our study population included 3,799 women randomly assigned to five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative disease (ie, B-13, B-14, B-19, B-20, and B-23) who underwent lumpectomy and whole breast irradiation with or without adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated, along with distant-disease–free interval (DDFI) and overall survival (OS) after these events. Cox models were employed to model mortality by using clinical and pathologic factors jointly with these events. Results Four hundred nineteen patients (11.0%) experienced LRF: 342 (9.0%) experienced IBTR, and 77 (2.0%) experienced oLRR. The 12-year cumulative incidences of IBTR and oLRR in patients treated with adjuvant systemic therapy were 6.6% and 1.8%, respectively. Overall, 37.1% of IBTRs and 72.7% of oLRRs occurred within 5 years of diagnosis. Older age, black race, higher body mass index (BMI), larger tumors, and occurrence of IBTR or oLRR were significantly associated with increased mortality. The 5-year OS after IBTR and oLRR were 76.6% and 34.9%, respectively. Adjusted hazard ratios for mortality associated with IBTR and oLRR were significantly higher in estrogen receptor (ER)–negative patients than in ER-positive patients (P = .002 and P < .0001, respectively). Patients with early LRF had worse OS and DDFI than those with later-occurring LRF. Conclusion Although LRF is uncommon in patients with node-negative breast cancer who are treated with lumpectomy, radiation, and adjuvant systemic therapy, those who do develop LRF have substantially worse OS and DDFI.

Prognosis After Ipsilateral Breast Tumor Recurrence and Locoregional Recurrences in Five National Surgical Adjuvant Breast and Bowel Project Node-Positive Adjuvant Breast Cancer Trials

2006 ◽  
Vol 24 (13) ◽  
pp. 2028-2037 ◽  
Author(s):  
Irene L. Wapnir ◽  
Stewart J. Anderson ◽  
Eleftherios P. Mamounas ◽  
Charles E. Geyer ◽  
Jong-Hyeon Jeong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Tumor ◽  
Tumor Recurrence ◽  
Ipsilateral Breast Tumor Recurrence ◽  
Ipsilateral Breast ◽  
Distant Disease ◽  
National Surgical Adjuvant Breast ◽  
Locoregional Failure ◽  
Node Positive ◽  
Bowel Project

Purpose Locoregional failure after breast-conserving surgery is associated with increased risk of distant disease and death. The magnitude of this risk in patients receiving chemotherapy has not been adequately characterized. Patients and Methods Our study population included 2,669 women randomly assigned onto five National Surgical Adjuvant Breast and Bowel Project node-positive protocols (B-15, B-16, B-18, B-22, and B-25), who were treated with lumpectomy, whole-breast irradiation, and adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated. Kaplan-Meier curves were used to estimate distant–disease-free survival (DDFS) and overall survival (OS) after IBTR or oLRR. Cox models were used to model survival using clinical and pathologic factors jointly with IBTR or oLRR as time-varying predictors. Results Four hundred twenty-four patients (15.9%) experienced locoregional failure; 259 (9.7%) experienced IBTR, and 165 (6.2%) experienced oLRR. The 10-year cumulative incidence of IBTR and oLRR was 8.7% and 6.0%, respectively. Most locoregional failures occurred within 5 years (62.2% for IBTR and 80.6% for oLRR). Age, tumor size, and estrogen receptor status were significantly associated with IBTR. Nodal status and estrogen and progesterone receptor status were significantly associated with oLRR. The 5-year DDFS rates after IBTR and oLRR were 51.4% and 18.8%, respectively. The 5-year OS rates after IBTR and oLRR were 59.9% and 24.1%, respectively. Hazard ratios for mortality associated with IBTR and oLRR were 2.58 (95% CI, 2.11 to 3.15) and 5.85 (95% CI, 4.80 to 7.13), respectively. Conclusion Node-positive breast cancer patients who developed IBTR or oLRR had significantly poorer prognoses than patients who did not experience these events.

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