Long-term prognosis of patients with isolated local recurrence following conservative surgery and radiotherapy for early breast cancer

We studied the long-term prognosis of 266 patients considered to have isolated local recurrence in the breast following conservative surgery and radiotherapy for early breast cancer. These recurrences occurred in a cohort of 7,000 patients with invasive breast cancer who were treated documented by eight departments of radiotherapy, two cancer institutes and one department of surgery in the Netherlands. The median time between the date of breast-conservative surgery and diagnosis of local recurrence was 3.6 years (range: 0.3-13.1 years). Seventy-eight recurrences (29%) occurred within two years of BCT, 127 (48%) between two and five years, and 61 (23%) more than five years after BCT. The median follow-up of the patients still alive after diagnosis of local relapse was 11.2 years.

 At 10 years from the date of salvage treatment, the overall survival rate for the 226 patients with invasive local recurrence was 39% (95% CI, 32-46), the distant recurrence-free survival rate was 36% (95% CI, 29-42), and the local control rate (i.e. survival without subsequent local recurrence or local progression) was 68% (95% CI, 62-75). Among patients with a local recurrence at or near the original tumour site a better distant disease-free survival was observed for patients with recurrences measuring 1 cm or less, compared to those with larger recurrences.

 We conclude that the long-term prognosis of patients with a local recurrence following conservative surgery and radiotherapy is poor. Lymph node status at the time of diagnosis of the primary tumour and location and size of breast cancer recurrence are predictors of this outcome. The latter finding suggests that follow-up directed at early detection of local recurrences might be worthwhile. However, it would require a large randomised study, comparing follow-up strategies with differing intensities, to confirm this.

Reference

Voogd AC, et al. "Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer",  Eur J Cancer. 2005 Nov;41(17):2637-44.

Adri C Voogd

Department of Epidemiology, Maastricht University, Maastricht, The Netherlands