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Prognosis After Regional Nodal Recurrence in Patients With Stage I-II Breast Cancer Treated With Breast Conservation Therapy
Reviewer: Ryan Smith, MD
Last Modified: October 6, 2002
Presenter: Eleanor Harris
Presenter's Affiliation: University of Pennsylvania
Type of Session: Scientific
Regional nodal recurrences as first sites of failure are rare in early stage breast cancer treated with breast conservation therapy (BCT). They have been reported as first sites of failure in 1-3% of patients, with prognosis after this failure as very poor, with few long term survivors. However, this has been studied mainly in smaller patient populations and the prognostic factors related to these failures are poorly understood. This study attempts to document these failures and their outcomes in a larger patient population.
Materials and Methods
- 1358 patients comprised the study group
- All patients were required to have had an axillary dissection
- Median follow up was 8.4 years
- Median follow up in those patients with regional recurrence (RR) was 7.9 years
- 39 patients (2.9%) were noted to have RR and comprised those studied
- RR were noted to be more likely in younger patients, as the median age of those with RR was 45 years vs. those without RR (54 years)
- Those with RR had a much worse survival compared to those without RR.
- Axillary node only RR was noted in 21 patients (54%), supraclavicular node only failure in 20% of patients, and IMN only failure in 8% of patients.
- 85% of patients had some sort of systemic treatment with 33% having systemic treatment alone.
- 44% underwent resection and 20% had XRT, usually only if the recurrence was outside of the previously irradiated fields.
- For patients with RR only, OS was 67% at 5 years and 44% at 10 years
- For patients with local and regional recurrence (LRR), OS was 69% at 5 years and 26% at 10 years
- For patients with RR and distant metastases (DM), OS was 12% at 5 years and 12% at 10 years
- Axillary nodal RR were the only patients salvaged, at a rate of 63%. All other patients with any other site of failure were either alive with disease or died of their disease
- RR are uncommon, with an incidence of approximately 3%
- Patients with RR are usually younger
- Axillary node RR are more common and more salvageable
- Those patients with simultaneous DMs have a poor prognosis, though those with LRR or RR are salvageable
In previously published reports, patients with RR after BCT do very poorly, with few long term survivors. However, these patients are often sporadically reported from a smaller patient population. Also, patients with simultaneous DMs are often included in these analyses, which almost guarantees that the group as a whole will do poorly. This study demonstrates that many patients with RR do well. If those patients with simultaneous DMs are separated out, it is shown that it is not unreasonable to expect a 5 year survival upwards of 70%. In addition, all salvaged patients were those with axillary recurrences, many of which presumably had resection. It may be inferred, that if more aggressive treatment is used in other sites of regional recurrence (be it resection, aggressive XRT, combined with chemotherapy)it may be possible to achieve higher rates of salvage in these sites as well.
Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Ortho Biotech.