Abstract
The aims of the study were to assess intrinsic and treatment related risk
factors for ipsilateral breast tumor recurrence (IBTR) and uncontrolled
local disease (ULD) following breast-conserving surgery of early-stage
invasive breast cancer.
In a cohort of 759 women with T1-T2 tumors risk factors were evaluated.
The majority of the patients (88%) had received postoperative irradiation
to the breast. A continuous 1-1.5% yearly increase in IBTR was seen.
Three independent risk-factors for IBTR were identified, age <50 years,
no postoperative irradiation and positive lymph nodes. Radiotherapy
reduced the IBTR-rate, but the effect decreased with time. Node-negative
women >50 years constituted a low risk-group for IBTR having a cumulative
risk at 10 years of 9% without radiation and 5% with breast radiation.
In a case-control study "nested" within the cohort, biological markers
were assessed. Sub-groups of patients with low and high risk for IBTR
were identified, namely women >50 years with proliferative index mib-1
<30%, who had an odds-ratio of 0.2 and patients <50 years with tumors
showing both c-erbB-2 and waf-1-immunoreactivity with an odds-ratio of
6.7.
Salvage mastectomy among patients with IBTR provided a superior local
control rate compared to reexcision. A higher although not statistically
significant rate of ULD was also seen in patients who had not received
postoperative radiotherapy as part of their primary treatment.
In postmenopausal, node-negative breast cancer patients treated with
breast-conserving surgery and radiotherapy, the addition of tamoxifen was
evaluated in a population of 432 women, who constituted a separate
stratum of the Stockholm Adjuvant Tamoxifen Trial. An improved event-free
survival and a reduced rate of ipsi and contralateral breast tumor
recurrences was accomplished in patients allocated to tamoxifen.
Mammograms from 69 patients with invasive breast cancer, operated on with
breast-conserving surgery between 1987-1990 were blindly reevaluated for
prediction of IBTR. The study cohort was divided into two groups of 34
and 35 patients, respectively. Each group was matched according to age,
the time at risk and to presence or absence of IBTR. The mammographic
reinterpretation correctly predicted an IBTR in 81%. Mammographic
characteristics, such as diffuse microcalcifications, multifocality,
solitary densities of stellate type near the nipple and/or solitary
densities with spicula in the vicinity of the retroareolar region,
correlated with the ability of the tumor to recur locally.
