J Korean Surg Soc.  2009 Apr;76(4):215-220. 10.4174/jkss.2009.76.4.215.

Clinical Result and Prognosis of Locoregional Recurrent Carcinoma after Mastectomy

Affiliations
  • 1Department of Surgery, Keimyung University School of Medicine, Daegu, Korea. shkang9002@dsmc.or.kr

Abstract

PURPOSE: Despite the increasing use of breast-conserving therapy, modified radical mastectomy retains an important primary treatment of breast cancer. The aim of this study was to evaluate the survival of patients with isolated locoregional recurrence (LR) and the prognostic factors for LR after mastectomy.
METHODS
We retrospectively analyzed 76 patients who were treated for LR after mastectomy at our hospital between 1987 and 2002. These patients had only isolated LR. The following parameters were analyzed: primary tumor size, primary nodal status, stage, estrogen receptor status, treatment modalities for LR, disease free interval from primary operation and re-recurrence interval.
RESULTS
The median time to develop LR was 18.4 months and the median follow-up period from LR was 19.3 months (range 1.3~113 months). The 2-year overall survival rate from LR showed 46% and 5-year overall survival rate was 15%. Out of 76 patients, 47 patients (61.8%) developed re-recurrence and the median duration to re-recurrence was 9.6 months. The pattern of re-recurrence showed 45 patients with systemic recurrence and 2 patients with LR. The initial node status (P=0.041), the estrogen receptor status (P=0.009) and re-recurrence interval from LR (P=0.017) were statistically significant factors for survival. The primary tumor size, the stage, the disease free interval, and the treatment modalities for LR were not statistically significant.
CONCLUSION
The re-recurrence rate after isolated LR in patients with breast cancer showed 61.8% and these patients almost always had systemic recurrence. This study could not show the difference of survival according to the treatment modality for LR but the systemic treatment should be considered for the patients with unfavorable prognostic factors.

Keyword

Mastectomy; Locoregional recurrence; Prognosis

MeSH Terms

Breast Neoplasms
Estrogens
Follow-Up Studies
Humans
Mastectomy
Mastectomy, Modified Radical
Prognosis
Recurrence
Retrospective Studies
Survival Rate
Estrogens

Figure

  • Fig. 1 Overall survival after treatment of isolated locoregional recurrences according to nodal status.

  • Fig. 2 Overall survival after treatment of isolated locoregional recurrences according to estrogen receptor status.

  • Fig. 3 Overall survival after treatment of isolated locoregional recurrences according to re-recurrence interval.


Reference

1. Ahn SH, Yoo KY. Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996-2004. Breast Cancer Res Treat. 2006. 99:209–214.
2. Bedwinek J. Natural history and management of isolated local-regional recurrence following mastectomy. Semin Radiat Oncol. 1994. 4:260–269.
3. Tennvall-Nittby L, Tengrup I, Landberg T. The total incidence of loco-regional recurrence in a randomized trial of breast cancer TNM stage II. The South Sweden Breast Cancer Trial. Acta Oncol. 1993. 32:641–646.
4. Karrison TG, Ferguson DJ, Meier P. Dormancy of mammary carcinoma after mastectomy. J Natl Cancer Inst. 1999. 91:80–85.
5. Carreno G, Del Casar JM, Corte MD, Gonzalez LO, Bongera M, Merino AM, et al. Local recurrence after mastectomy for breast cancer: analysis of clinicopathological, biological and prognostic characteristics. Breast Cancer Res Treat. 2007. 102:61–73.
6. Son BH, Ahn SH, Kwak BS, Kim JK, Kim HJ, Hong SJ, et al. The recurrence rate, risk factors and recurrence patterns after surgery in 3700 patients with operable breast cancer. J Breast Cancer. 2006. 9:134–144.
7. Borner M, Bacchi M, Goldhirsch A, Greiner R, Harder F, Castiglione M, et al. Swiss Group for Clinical Cancer Research. First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. J Clin Oncol. 1994. 12:2071–2077.
8. Schuck A, Konemann S, Matthees B, Rube CE, Reinartz G, Hesselmann S, et al. Radiotherapy in the treatment of locoregional relapses of breast cancer. Br J Radiol. 2002. 75:663–669.
9. Lee JB, Kim DH, Min BW, Ryu KW, Um JW, Kim AR, et al. Factors influencing the recurrence of breast cancer following modified radical mastectomy. J Korean Breast Cancer Soc. 2001. 4:128–135.
10. Schwaibold F, Fowble BL, Solin LJ, Schultz DJ, Goodman RL. The results of radiation therapy for isolated local regional recurrence after mastectomy. Int J Radiat Oncol Biol Phys. 1991. 21:299–310.
11. Kennedy MJ, Abeloff MD. Management of locally recurrent breast cancer. Cancer. 1993. 71:2395–2409.
12. Katz A, Strom EA, Buchholz TA, Theriault R, Singletary SE, McNeese MD. The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys. 2001. 50:735–742.
13. Bedwinek JM, Lee J, Fineberg B, Ocwieza M. Prognostic indicators in patients with isolated local-regional recurrence of breast cancer. Cancer. 1981. 47:2232–2235.
14. Willner J, Kiricuta IC, Kolbl O. Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis. Int J Radiat Oncol Biol Phys. 1997. 37:853–863.
15. Karabali-Dalamaga S, Souhami RL, O'Higgins NJ, Soumilas A, Clark CG. Natural history and prognosis of recurrent breast cancer. Br Med J. 1978. 2:730–733.
16. Curcio LD, Chu DZ, Ahn C, Williams WL Jr, Paz IB, Riihimaki D, et al. Local recurrence in breast cancer: implications for systemic disease. Ann Surg Oncol. 1997. 4:24–27.
17. Son BH, Lee PC, Yoon HS, Kwak HS, Chang H, Ahn SH. Outcome of surgical excision for isolated locoregional recurrence of breast cancer. J Korean Surg Soc. 2000. 58:614–621.
18. Andry G, Suciu S, Vico P, Faverly D, Andry-t'Hooft M, Verhest A, et al. Locoregional recurrences after 649 modified radical mastectomies: incidence and significance. Eur J Surg Oncol. 1989. 15:476–485.
19. Dahlstrom KK, Andersson AP, Andersen M, Krag C. Wide local excision of recurrent breast cancer in the thoracic wall. Cancer. 1993. 72:774–777.
20. Son BH, Hong SH, Kang HJ, Yoon HS, Ahn SH. Pattern of secondary failure and prognostic factors for survival following surgical treatment of isolated locoregional recurrence after mastectomy of breast cancer. J Korean Surg Soc. 2003. 64:282–288.
21. Beck TM, Hart NE, Woodard DA, Smith CE. Local or regionally recurrent carcinoma of the breast: results of therapy in 121 patients. J Clin Oncol. 1983. 1:400–405.
22. Wapnir IL, Aebi S, Gelber S, Anderson SJ, Lang I, Robidoux A, et al. Progress on BIG 1-02/IBCSG 27-02/NSABP B-37, a prospective randomized trial evaluating chemotherapy after local therapy for isolated locoregional recurrences of breast cancer. Ann Surg Oncol. 2008. 15:3227–3231.
23. Gilliland MD, Barton RM, Copeland EM 3rd. The implications of local recurrence of breast cancer as the first site of therapeutic failure. Ann Surg. 1983. 197:284–287.
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