SAN ANTONIOBreast-conserving treatment of early-stage breast
cancer confers a low risk of locoregional recurrence that does not
adversely affect survival, but early local recurrence increases the
likelihood of metastatic disease, M.D. Anderson investigators
reported at a poster session of the 22nd Annual San Antonio Breast
Among 1,338 breast-conservation patients followed a median of 8
years, 6.8% had a locoregional recurrence. Ten-year disease-specific
survival was 93% in patients who had only locoregional recurrence vs
48% in patients who had local recurrence followed by metastatic
recurrence (see Table).
Overall, breast conservation is associated with a low rate of
local and regional recurrence, and the patients have excellent
long-term survival, said Kelly Hunt, MD, assistant professor of
surgical oncology, M.D. Anderson Cancer Center. However,
patients who have early recurrence are at increased risk for
development of systemic recurrence, and they require close follow-up
and consideration of aggressive treatment strategies.
The 1,338 patients in the cohort had 1,369 breast cancers treated by
means of breast-conserving surgery between 1955 and 1994. All but 54
of the tumors were stages 0-II. In all cases, lumpectomy was the
primary surgical treatment, and axillary node dissection was
performed in association with 1,075 of the tumors. In 96% of cases,
treatment included adjuvant breast irradiation.
During follow-up, 93 locoregional recurrences were documented, along
with 162 metastatic recurrences without locoregional recurrence, and
60 cases of locoregional and metastatic recurrence.
The 5-year disease-specific survival ranged from 89% (stage III) to
100% (stage 0), and 10-year disease-specific survival ranged from 85%
(stage II) to 98% (stage 0).
For patients with stage 0 disease, disease-free survival was 94% and
88% at 5 and 10 years. Stages I-III breast cancers were associated
with disease-free survival of 76% to 82% at 5 years and 65% to 68% at
A separate analysis showed favorable results with breast-conserving
surgery in patients who had large primary tumors, defined as 4 cm or
greater. During a median follow-up of 6.5 years, six locore-gional
recurrences were documented in association with 114 large tumors.
Dr. Hunt and her colleagues did a second evaluation of the same
patient population, focusing on 135 patients who had locoregional
recurrences with (42 patients) or without (93 patients) systemic
recurrence. Clinical characteristics and treatment strategies did not
differ between the two patient groups.
Development of metastatic disease was associated with a shorter time
to loco-regional recurrence, a median of 3.4 years vs 5.7 years for
patients who did not have systemic recurrences (P = .003).
Systemic recurrence was associated with significantly lower survival.
At 5 years, disease-specific survival was 97% in patients who had
only locoregional recurrence vs 71% in those who had metastatic
recurrence. Ten-year disease-specific survival was 93% with
locoregional recurrence and 48% with metastatic recurrence (P < .001).