Local Recurrence After Breast-Conserving Therapy for Invasive Breast Cancer: High Incidence in Young Patients and Association with Poor Survival

• Published in: International journal of radiation oncology, biology, physics Vol. 40; no. 4; pp. 859 - 867
• Main Authors: Elkhuizen, Paula H.M, van de Vijver, Marc J, Hermans, Jo, Zonderland, Harmien M, van de Velde, Cornelis J.H, Leer, Jan-Willem H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1998; Elsevier
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Breast Neoplasms - epidemiology; Breast Neoplasms - mortality; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breast-conserving therapy; Cohort Studies; Combined Modality Therapy; Female; Gynecology. Andrology. Obstetrics; Humans; Incidence; Local recurrence; Lymphatic Metastasis; Mammary gland diseases; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - therapy; Risk factors; Survival Analysis; Time Factors; Tumors; Breast-conserving therapy; Local recurrence; Risk factors; Human; Parameter estimation; Relapse; Conservation; Malignant tumor; Radiotherapy; Mammary gland diseases; Treatment; Risk factor; Female; Diagnosis; Mammary gland; Survival curve
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/S0360-3016(97)00917-6

Purpose: To study risk factors for local recurrence (LR) after breast-conserving therapy (BCT) for invasive breast cancer and, for patients with an LR, the mode of detection, location, treatment, influence of radiation therapy, and impact on survival. Methods and Materials: 1360 patients (median age 52 years; range 24–88) with a total of 1393 pT1-2 N0-1 tumors treated with BCT between 1980–1994 were studied (median follow-up 52 months). The adequacy of radiation treatment of the patients developing LR was studied in a quality control study. The impact of LR on overall survival and distant metastasis was studied in a Cox regression model with LR as a time-dependent covariate. Results: A total of 88 LR occurred with a 5- and 10-year LR risk of 8 and 12%. Age was the only significant risk factor. Compared to patients >65 years old, patients <45 years old and patients 45–65 years old had a relative risk (RR) of 4.09 and 2.41, respectively, of developing LR. Risk on LR was found to increase gradually with younger age. Radiation therapy was considered adequate and did not play a role in influencing the LR rate. Almost 65% of the LR were true or marginal recurrences. Of all LR, 80% appeared during the first 5 years and were detected with equal frequency by the patient herself, the physician, and annual mammography. LR was a major predictor for distant metastasis (RR: 4.90; 3.15–7.62) and death (RR: 4.29; 2.93–6.28). Conclusion: Young age is a major risk factor for LR and there is a significant gradual increase in LR with decreasing age. LR is associated with a higher risk of distant metastasis and death. Whether LR is the cause of or a marker for distant metastasis remains unresolved.