Risk factors in breast-conservation therapy.

PURPOSE To identify clinical and pathologic factors associated with an increased risk of local recurrence following breast-conservation therapy (BCT) to assess the safety of this procedure for all subgroups of patients. PATIENTS AND METHODS The study population consisted of 1,026 patients with clinical stage I and II breast cancer treated between 1979 and 1988 at the Netherlands Cancer Institute. The BCT regimen consisted of local excision and axillary lymph node dissection (ALND) followed by whole-breast irradiation to a total dose of 50 Gy in 2-Gy fractions and boost irradiation (mostly by iridium implant) of 15 to 25 Gy. RESULTS With a median follow-up duration of 66 months, the actuarial breast recurrence rate was 4% at 5 years, counting all breast recurrences. Univariate analysis showed seven factors to be associated with an increased risk of local recurrence; age, residual tumor at reexcision, histologic tumor type, presence of any carcinoma-in-situ component, vascular invasion, microscopic margin involvement, and whole-breast radiation dose. Three factors remained independently significant after proportional hazard regression analysis: age, margin involvement, and the presence of vascular invasion. When the analysis was repeated, but counting only those breast recurrences that occurred before regional or distant failures, only young age and vascular invasion were independent predictive factors. In the third analysis, factors predicting the necessity of local salvage treatment were analyzed. In this analysis, the possible bias in the former analysis caused by censoring actuarial methods was avoided. The results were the same as in the second analysis, showing young age and vascular invasion as the only independent predictive factors. Breast recurrence rates were 6% for patients less than 40 years of age and 8% for patients with tumors showing vascular invasion. In the absence of risk factors, the breast recurrence rate is only 1% at 5 years. CONCLUSION Slightly higher recurrence rates were found in patients less than 40 years of age and in patients with tumors showing vascular invasion. The role of margin involvement is uncertain.

Download Full-text

Abstract PD04-03: Is breast conservation therapy an option for young women with operable breast cancer? Local recurrence rates in young women following surgery: a single centre experience.

10.1158/0008-5472.sabcs12-pd04-03 ◽

2012 ◽

Cited By ~ 1

Author(s):

CR Lewis ◽

R Smith ◽

A Matthews ◽

E Choo ◽

C Lee

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Young Women ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Operable Breast Cancer ◽

Single Centre ◽

Recurrence Rates ◽

Single Centre Experience

Download Full-text

Differences in Risk Factors for Local and Distant Recurrence After Breast-Conserving Therapy or Mastectomy for Stage I and II Breast Cancer: Pooled Results of Two Large European Randomized Trials

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.6.1688 ◽

2001 ◽

Vol 19 (6) ◽

pp. 1688-1697 ◽

Cited By ~ 395

Author(s):

Adri C. Voogd ◽

Maja Nielsen ◽

Johannes L. Peterse ◽

Mogens Blichert-Toft ◽

Harry Bartelink ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Vascular Invasion ◽

Breast Conservation ◽

Breast Conserving Therapy ◽

Distant Recurrence ◽

Extensive Intraductal Component ◽

Distant Disease ◽

Increased Risk ◽

Intraductal Component

PURPOSE: Risk factors for local and distant recurrence after breast-conserving therapy and mastectomy were compared to define guidelines for the decision making between both treatments. PATIENTS AND METHODS: The data of two randomized clinical trials for stage I and II breast cancer patients were pooled. The total number of patients in the study was 1,772, of whom 879 underwent breast conservation, and 893, modified radical mastectomy. Representative slides of the primary tumor were available for histopathologic review in 1,610 cases (91%). RESULTS: There were 79 patients with local recurrence after breast-conservation and 80 after mastectomy, the 10-year rates being 10% (95% confidence interval [CI], 8% to 13%) and 9% (95% CI, 7% to 12%), respectively. Age no more than 35 years (compared with age >60: hazard ratio [HR], 9.24; 95% CI, 3.74 to 22.81) and an extensive intraductal component (HR, 2.52; 95% CI, 1.26 to 5.00) were significantly associated with an increased risk of local recurrence after breast-conserving therapy. Vascular invasion was predictive of the risk of local recurrence, irrespective of the type of primary treatment (P < .01). Tumor size, nodal status, high histologic grade, and vascular invasion were all highly significant predictors of distant disease after breast-conserving therapy and mastectomy (P < .01). Age no more than 35 years and microscopic involvement of the excision margin were additional independent predictors of distant disease after breast-conserving therapy (P < .01). CONCLUSION: Age no more than 35 years and the presence of an extensive intraductal component are associated with an increased risk of local recurrence after breast-conserving therapy. Vascular invasion causes a higher risk of local recurrence after mastectomy as well as after breast-conserving therapy and should therefore not be used for deciding between the two treatments.

Download Full-text

Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316293 ◽

2020 ◽

pp. bjophthalmol-2020-316293

Author(s):

Puneet Jain ◽

Paul T Finger ◽

Maria Fili ◽

Bertil Damato ◽

Sarah E Coupland ◽

...

Keyword(s):

Local Recurrence ◽

Local Excision ◽

External Beam Radiotherapy ◽

Staging System ◽

Primary Treatment ◽

Excision Biopsy ◽

Conjunctival Melanoma ◽

Recurrence Rates ◽

Increased Risk ◽

Eighth Edition

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.

Download Full-text

Risk factors and management of local recurrence following breast conservation surgery

World Journal of Surgery ◽

10.1007/bf00348195 ◽

1994 ◽

Vol 18 (1) ◽

pp. 76-80 ◽

Cited By ~ 12

Author(s):

Robert T. Osteen

Keyword(s):

Risk Factors ◽

Local Recurrence ◽

Breast Conservation ◽

Breast Conservation Surgery ◽

Conservation Surgery

Download Full-text

Intraoperative Evaluation of Lumpectomy Margins by Imprint Cytology With Histologic Correlation

Archives of Pathology & Laboratory Medicine ◽

10.5858/2002-126-0846-ieolmb ◽

2002 ◽

Vol 126 (7) ◽

pp. 846-848 ◽

Cited By ~ 4

Author(s):

Andrew J. Creager ◽

Jo Ann Shaw ◽

Peter R. Young ◽

Kim R. Geisinger

Keyword(s):

Predictive Value ◽

Community Hospital ◽

Frozen Section ◽

Breast Conservation ◽

Hospital Setting ◽

Breast Conservation Therapy ◽

Imprint Cytology ◽

Recurrence Rates ◽

Cytologic Examination ◽

Initial Surgery

Abstract Background.—Several well-controlled studies have demonstrated significantly increased local recurrence rates in patients with low-stage breast carcinoma treated with breast conservation therapy in whom focally positive margins were not reexcised. Imprint cytology is a rapid technique for evaluating surgical margins intraoperatively, thus allowing reexcisions to be performed during the initial surgery. The large majority of studies on the use of intraoperative imprint cytologic examination of breast conservation therapy margins have been performed at university-based academic centers. Objective.—To evaluate the utility of intraoperative imprint cytologic evaluation of breast conservation therapy margins in a community hospital setting. Methods.—We retrospectively reviewed the intraoperative imprint cytology margins of 141 lumpectomy specimens that had been obtained from 137 patients between May 1997 and May 2001. Results.—We evaluated 758 separate margins. On a patient basis, the sensitivity was 80%, the specificity was 85%, the positive predictive value was 40%, the negative predictive value was 97%, and the overall accuracy was 85%. There were no cytologically unsatisfactory margins. Conclusions.—Imprint cytology is an accurate, simple, rapid, and cost-effective method for determining the margin status of breast conservation therapy specimens intraoperatively in the community hospital setting. This method allows a survey of the entire surface area of the lumpectomy specimen, which is not practical using frozen section evaluation.

Download Full-text