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Breast Cancer Research and Treatment

, Volume 156, Issue 2, pp 391–400 | Cite as

Very low local recurrence rates after breast-conserving therapy: analysis of 8485 patients treated over a 28-year period

  • S. C. J. Bosma
  • F. van der Leij
  • E. van Werkhoven
  • H. Bartelink
  • J. Wesseling
  • S. Linn
  • E. J. Rutgers
  • M. J. van de Vijver
  • P. H. M. ElkhuizenEmail author
Epidemiology

Abstract

The purpose of this study was to study the impact of changes in clinical practice on outcome in patients treated with breast-conserving therapy (BCT) over a period of 28 years. Patients with early invasive breast cancer, who were treated with BCT at the Netherlands Cancer Institute between 1980 and 2008, were studied. Clinical characteristics, treatment and outcome were compared between groups (1980–1987; 1988–1998; 1999–2008). The main endpoint analyzed was ipsilateral breast tumor recurrence (IBTR). 8485 patients with a median follow-up of 9 years (IQR 6–14 years) were analyzed. The cumulative 5- and 10-year IBTR incidences were, respectively, 2 and 5 % for the whole cohort and 4 and 9 % in patients ≤40 years. Young age was a significant risk factor for IBTR in multivariable analysis. IBTR-free interval was better for patients who received a RT boost (HR 0.65) or systemic therapy (HR 0.52). In later years, patients less often received a boost and more often underwent adjuvant systemic treatment. 761 patients (9.0 %) underwent a re-excision; the tumor resection margins were tumor free for 85 %. In later years (1999–2008), 89 % of patients had a tumor-free margin. The margin status of invasive carcinoma did not influence IBTR, DM rate, or OS. Between 1980 and 2008, locoregional control after BCT remained stable with low IBTR rates, even in young patients. These good results were achieved under the policy of accepting close or focally positive margins, indicating this is a safe approach. The results of this study may help in lowering the re-excision rates, which are high in many centers.

Keywords

Breast cancer Breast-conserving therapy Tumor-free margins Local control 

Notes

Acknowledgments

We thank the Medical Registry staff and Stella Mook for providing baseline data.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

10549_2016_3732_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 23 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Radiation OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  2. 2.Statistics DepartmentThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Department of Medical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  5. 5.Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  6. 6.Department of SurgeryThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  7. 7.Department of PathologyAcademical Medical CenterAmsterdamThe Netherlands

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