Accelerated partial breast brachytherapy after lumpectomy as salvage treatment for local recurrences after conservative treatment of breast cancer: Eighteen-year results of a nonrandomized comparison with mastectomy.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 109-109
Author(s):  
B. Guix ◽  
J. A. Lejarcegui ◽  
J. I. Tello ◽  
I. Guix ◽  
G. Zanon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Conservative Treatment ◽  
Distant Metastases ◽  
Low Risk ◽  
Hdr Brachytherapy ◽  
Total Mastectomy ◽  
Local Recurrences ◽  
Breast Brachytherapy

109 Background: To report the long-term results in a prospective group of patients (pts) treated for local recurrence after conservative treatment of breast cancer by a second conservative surgery or by total mastectomy. Methods: Between 12/1990 and 10/2004, 85 pts with <3 cm, low-risk local recurrence after conservative treatment for breast cancer were offered total mastectomy. 48 of them refused it and were treated by a second lumpectomy followed by HDR brachytherapy implant to the tumor bed+margin. 30 Gy in 12 fractions in 5 days were given. Pts treated by mastectomy had no further radiotherapy. Postmenopausal pts with negative receptors had no systemic tx. The rest of the pts had chemo or hormones. No pts were lost for follow-up. Results: All pts completed treatment. During the 17-year, 1-year minimum follow-up, in the second conservative group there were 8 pts who had regional (2 pts) or distant metastases (6 pts) as their first site of failure. Three of them experienced a differed local recurrence and 1 died from the disease. In the total mastectomy group, there were 2 local recurrences, 1 regional recurrence, and 5 distant metastases as first site of failure. One patient died from the disease. Actuarial results at 17-year for second conservative and total mastectomy were respectively: local control 84.2%-71.7%; disease free survival 65.4%-63.8%; and survival 90.7% and 88.2%. Cosmetic results were satisfactory in 89.4% treated conservatively. No patient experienced arm edema or grade 3-4 early or late complications. Between the 14 pts that were followed-up for at least 10-years, 13 of them were with their breast still in place. Conclusions: Second conservative treatment by HDR brachytherapy was a safe and effective method of treatment for small-size, low-risk, local recurrence after local excision in conservatively treated pts. APBI with wide margins probed to be enough treatment, without significant side-effects in previously intesively irradiated patients. Lumpectomy and partial breast brachytherapy can be conidered the treatment of choice in selected patients with low-risk recurrent breast tumors.

scholarly journals The role of postoperative radiotherapy after radical mastectomy in treatment of early breast cancer

2002 ◽  
Vol 10 (1) ◽  
pp. 7-12
Author(s):  
Jasmina Mladenovic ◽  
Nenad Borojevic
Keyword(s):  
Breast Cancer ◽  
Survival Rate ◽  
Adjuvant Chemotherapy ◽  
Local Recurrence ◽  
Postoperative Radiotherapy ◽  
Radical Mastectomy ◽  
Distant Metastases ◽  
Regional Lymph Nodes ◽  
Postoperative Irradiation

BACKGROUND: Radical or modified radical mastectomy was considered for many years the standard therapy for operable patients. Following radical mastectomy, postoperative irradiation of the chest wall and peripheral lymphatics is indicated in selected highrisk patients. Some studies on breast cancer patients who underwent radical mastectomy and received adjuvant chemotherapy tried to find out whether the addition of irradiation treatment to the chest wall and regional lymph nodes increases survival. The hypothesis in favor of irradiation is that chemotherapy can eliminate distant micrometastases, but is less effective against local and regional diseases, which are better controlled by radiotherapy. METHODS: In one year period, 110 patients with early stage of breast cancer were treated with radical mastectomy, and postoperative radiotherapy. Forty one patients had only postoperative radiotherapy, 27 received also adjuvant chemotherapy, 40 received adjuvant hormonal therapy and 2 patients received both adjuvant chemo and hormonotherapy. Postoperative irradiation was given on the regional lymph nodes (supra and infraclavicular, axillary and internal mammary nodes) with the tumor dose 48 Gy in 22 fractions over a period of four and a half weeks. All fields were treated with Cobalt 60. RESULTS After the median follow up of 67 months, 33 patients (30 %) had some kind of failure in form of local recurrence, distant metastases or both Locoregional relapse alone or associated with distant metastases occurred in 10 patients (9.1 %). Only 1.8 % of patients had local recurrence as the first failure. Distant metastases occurred in 32 patients (29.1%). After the end of follow up, 60 % patients are alive without evidence of disease while 16.4 % patients are alive with disease. The 5 year overall survival rate was 78.19% and 5 year disease free survival rate was 67.44%. CONCLUSION: Postoperative radiotherapy after radical mastectomy has important role in adjuvant treatment of early breast cancer in combination with adjuvant chemotherapy and hormonotherapy.

Early Detection of Local Recurrences in the Follow-Up of Primary Breast Cancer

1984 ◽  
Vol 70 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Stefano Ciatto ◽  
Marco Rosselli Del Turco ◽  
Paolo Pacini ◽  
Carla De Luca Cardillo ◽  
Paolo Bastiani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Distant Metastases ◽  
Small Sample ◽  
Biased Sampling ◽  
Breast Cancer Patients ◽  
Actuarial Survival ◽  
Local Recurrences ◽  
The Mean ◽  
Asymptomatic Phase

The results of physical examination (PE) in the detection of local recurrences (LR) from breast cancer are reviewed in the follow-up experience of 1139 breast cancer patients. A minimum follow-up time of 5 years was considered. LR accounted for 40 % of total first relapses and isolated (without distant metastases) LR represented about 1/3 of total relapses. The chest wall was the most frequent site of LR. The extent of LR was correlated with the probability of associated distant metastases detectable at the time of LR diagnosis, whereas no correlations were found with the presence or absence of subjective symptoms at diagnosis. The mean free interval from primary surgery was 3 months shorter for LR detected in asymptomatic phase than in the symptomatic phase. This difference increased to 5 months for recurrences detected in the first 2 years, when PE controls were repeated every 6 months whereas a smaller difference of 2 months was observed over 2 years with yearly controls. The mean and 5-year actuarial survival was better (75.5 vs. 64.9 months and 54 % vs. 40 %) for cases detected in the asymptomatic phase than in the symptomatic phase; however, the difference was not statistically significant for the small sample considered and could be even partially due to length biased sampling. On the basis of the reported results, PE should still be recommended as a follow-up test, although further studies are needed to assess its real impact on prognosis.

Breast Cancer Subtype Approximated by Estrogen Receptor, Progesterone Receptor, and HER-2 Is Associated With Local and Distant Recurrence After Breast-Conserving Therapy

2008 ◽  
Vol 26 (14) ◽  
pp. 2373-2378 ◽  
Author(s):  
Paul L. Nguyen ◽  
Alphonse G. Taghian ◽  
Matthew S. Katz ◽  
Andrzej Niemierko ◽  
Rita F. Abi Raad ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Breast Cancer Subtype ◽  
Distant Metastases ◽  
Breast Conserving Therapy ◽  
Luminal A ◽  
Luminal B ◽  
Cancer Subtype ◽  
Her 2

Purpose To determine whether breast cancer subtype is associated with outcome after breast-conserving therapy (BCT) consisting of lumpectomy and radiation therapy. Patients and Methods We studied 793 consecutive patients with invasive breast cancer who received BCT from July 1998 to December 2001. Among them, 97% had pathologically negative margins of resection, and 90% received adjuvant systemic therapy. No patient received adjuvant trastuzumab. Receptor status was used to approximate subtype: estrogen receptor (ER) or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 negative = luminal A; ER+ or PR+ and HER-2+ = luminal B; ER–and PR –and HER-2+ = HER-2; and ER–and PR –and HER-2–= basal. Competing risks methodology was used to analyze time to local recurrence and distant metastases. Results Median follow-up was 70 months. The overall 5-year cumulative incidence of local recurrence was 1.8% (95% CI, 1.0 to 3.1); 0.8% (0.3, 2.2) for luminal A, 1.5% (0.2, 10) for luminal B, 8.4% (2.2, 30) for HER-2, and 7.1% (3.0, 16) for basal. On multivariable analysis (MVA) with luminal A as baseline, HER-2 (adjusted hazard ratio [AHR] = 9.2; 95% CI, 1.6 to 51; P = .012) and basal (AHR = 7.1; 95% CI, 1.6 to 31; P = .009) subtypes were associated with increased local recurrence. On MVA, luminal B (AHR = 2.9; 95% CI, 1.3 to 6.5; P = .007) and basal (AHR = 2.3; 95% CI, 1.1 to 5.2; P = .035) were associated with increased distant metastases. Conclusion Overall, the 5-year local recurrence rate after BCT was low, but varied by subtype as approximated using ER, PR, and HER-2 status. Local recurrence was particularly low for the luminal A subtype, but was less than 10% at 5 years for all subtypes. Although further follow-up is needed, these results may be useful in counseling patients about their anticipated outcome after BCT.

scholarly journals Improved risk estimation of locoregional recurrence, secondary contralateral tumors and distant metastases in early breast cancer: the INFLUENCE 2.0 model

2021 ◽  
Author(s):  
Vinzenz Völkel ◽  
Tom A. Hueting ◽  
Teresa Draeger ◽  
Marissa C. van Maaren ◽  
Linda de Munck ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Locoregional Recurrence ◽  
Clinical Decision Making ◽  
Metastatic Breast ◽  
Distant Metastases ◽  
Time Dependent ◽  
Individual Risk ◽  
Primary Tumors ◽  
Statistical Approaches

Abstract Purpose To extend the functionality of the existing INFLUENCE nomogram for locoregional recurrence (LRR) of breast cancer toward the prediction of secondary primary tumors (SP) and distant metastases (DM) using updated follow-up data and the best suitable statistical approaches. Methods Data on women diagnosed with non-metastatic invasive breast cancer were derived from the Netherlands Cancer Registry (n = 13,494). To provide flexible time-dependent individual risk predictions for LRR, SP, and DM, three statistical approaches were assessed; a Cox proportional hazard approach (COX), a parametric spline approach (PAR), and a random survival forest (RSF). These approaches were evaluated on their discrimination using the Area Under the Curve (AUC) statistic and on calibration using the Integrated Calibration Index (ICI). To correct for optimism, the performance measures were assessed by drawing 200 bootstrap samples. Results Age, tumor grade, pT, pN, multifocality, type of surgery, hormonal receptor status, HER2-status, and adjuvant therapy were included as predictors. While all three approaches showed adequate calibration, the RSF approach offers the best optimism-corrected 5-year AUC for LRR (0.75, 95%CI: 0.74–0.76) and SP (0.67, 95%CI: 0.65–0.68). For the prediction of DM, all three approaches showed equivalent discrimination (5-year AUC: 0.77–0.78), while COX seems to have an advantage concerning calibration (ICI < 0.01). Finally, an online calculator of INFLUENCE 2.0 was created. Conclusions INFLUENCE 2.0 is a flexible model to predict time-dependent individual risks of LRR, SP and DM at a 5-year scale; it can support clinical decision-making regarding personalized follow-up strategies for curatively treated non-metastatic breast cancer patients.

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