Breast Cancer Research and Treatment

, Volume 45, Issue 2, pp 181–192

Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer

  • Claus Kamby
  • Lisa Sengeløv
Article

Abstract

Purposes: The study evaluates prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. Patients and methods: The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983–85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen.If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. Results: Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5–11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. Conclusions: Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.

breast cancer local recurrence regional recurrence prognostic factors survival after recurrence 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Halversen K, Perez C, Kuske RR, Garcia DM, Simpson JR, Fineberg B: Isolated loco-regional recurrence of breast cancer following mastectomy: Radiotherapeutic management. Int J Radiat Oncol Biol Phys 19: 851–858, 1990Google Scholar
  2. 2.
    Kamby C: The pattern of metastases in human breast cancer. Cancer Treat Rev 17: 37–61, 1990Google Scholar
  3. 3.
    Kamby C, Andersen J, Ejlertsen B, Birkler NE, Rytter L, Zedeler K, Rose C: Pattern of spread and progression in relation to the characteristics of the primary tumour in human breast cancer. Acta Oncol 30: 301–308, 1991Google Scholar
  4. 4.
    Hietanen P, Miettinen M, Mäkinen J: Survival after first recurrence in breast cancer. Eur J Cancer 22: 913–919, 1986Google Scholar
  5. 5.
    Schwaibold F, Fowble BL, Solin LJ, Schultz DJ, Goodman L: The result of radiation therapy for isolated local regional recurrence after mastectomy. Int J Radiat Oncol Biol Phys 21: 299–301, 1991Google Scholar
  6. 6.
    Dahlstrøm KK, Andersson AP, Andersen M, Krag C: Wide local excision of recurrent breast cancer in the thoracic wall. Cancer 72: 774–777, 1993Google Scholar
  7. 7.
    Gilliland MD, Barton RM, Copeland EM: The implications of local recurrence of breast cancer as the first site of therapeutic failure. Ann Surg 197: 284–287, 1983Google Scholar
  8. 8.
    Rutqvist LE, Lax I, Fornander T, Johansson H: Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 22: 887–896, 1992Google Scholar
  9. 9.
    Kennedy MJ, Abeloff MD: Management of locally recurrent breast cancer. Cancer 71: 2395–2409, 1993Google Scholar
  10. 10.
    Kamby C, Dirksen H, Vejborg I, Daugaard S, Guldhammer B, Rossing N, Mouridsen HT: Incidence and methodological aspects of the occurrence of liver metastases in recurrent breast cancer. Cancer 59: 1524–1529, 1987Google Scholar
  11. 11.
    Cady B: Total mastectomy and partial axillary dissection. Surg Clin North Am 53: 313–318, 1973Google Scholar
  12. 12.
    Andersen KW, Mouridsen HT, Castberg T: Organization of the Danish adjuvant trials in breast cancer. Dan Med Bull 28: 102–106, 1981Google Scholar
  13. 13.
    Bloom HJG, Richardson WW: Histological grading and prognosis in breast cancer (a study of 1409 cases of which 359 have been followed for 15 years). Br J Cancer 11: 359–364, 1957Google Scholar
  14. 14.
    Scarff RW, Torloni H: Histological typing of breast tumors. p. 13. Geneva: World Health Organization, 1968Google Scholar
  15. 15.
    Rank F, Dombernowsky P, Jespersen NCB, Pedersen BV, Keiding N: Histological malignancy grading of invasive ductal breast carcinoma. A regression analysis of prognostic factors in low-risk carcinomas from a multicenter trial. Cancer 60: 1299–1305, 1987Google Scholar
  16. 16.
    Andersen JA, Blichert-Toft M, Klaergaard J, Andersen KW, Mouridsen HT: Prognostic significance of residual cancer tissue after diagnostic biopsy in breast carcinoma. Eur J Cancer 20: 765–770, 1984Google Scholar
  17. 17.
    Mouridsen HT, Rose C, Brincker H: Adjuvant systemic therapy in high-risk breast cancer: The Danish Breast Cancer Cooperative Group's trials of cyclophosphamide or CMF in premenopausal and tamoxifen in postmenopausal patients. Rec Results Cancer Res 96: 117–128, 1984Google Scholar
  18. 18.
    Rose C, Mouridsen HT, Thorpe SM: Anti-oestrogen treatment of postmenopausal breast cancer patients with high risk of recurrence: 72 months of life table analysis and steroid hormone receptor status. World J Surg 9: 765–774, 1985Google Scholar
  19. 19.
    Overgaard M, Christensen Juul J, Johansen H, Nybo-Rasmussen A, Brincker H, Van der Kooy P, Frederiksen PL, Lauersen F, Panduro J, Sørensen NE, Gadeberg CC, Hjelm-Hansen M, Overgaard J, West Andersen K, Zedeler K: Postmastectomy irradiation in high-risk breast cancer patients. Present status of the Danish Breast Cancer Cooperative Group trials. Acta Oncol 27: 707–714, 1988Google Scholar
  20. 20.
    Bartolucci AA: Estimation and comparisons of proportions. In: Buyse ME, Staquet MJ, Sylvester RJ and EORTC (eds) Cancer Clinical Trials-Methods and Practice. Oxford University Press, Oxford, 1984, pp 337–360Google Scholar
  21. 21.
    Peto R, Pike MC, Armitage P, Breslow E, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG: Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35: 1–39, 1977Google Scholar
  22. 22.
    Cox DR: Regression models and life tables. J Roy Stat Soc B 34: 187–195, 1972Google Scholar
  23. 23.
    Georg SL: Identification and assessment of prognostic factors. Semin Oncol 15: 462–471, 1988Google Scholar
  24. 24.
    Recht A, Hayes DF, Eberlein TJ, Sadowsky NL: Local-regional recurrence after mastectomy or breast-conserving therapy. In: Harris JR, Lippman ME, Morrow M, Hellman S (eds) Diseases of the Breast. Lippincott-Raven, Philadelphia-New York, 1996, pp 649–769Google Scholar
  25. 25.
    Bedwinek JM, Fineberg B, Lee J, Ocwieza M: Analysis of failures following local treatment of isolated local-regional recurrence of breast cancer. Int J Radiat Oncol Biol Phys 7: 581–585, 1981Google Scholar
  26. 26.
    Bedwinek JM, Lee J, Fineberg B, Ocwieza M: Prognostic indicators in patients with isolated local-regional recurrence of breast cancer. Cancer 47: 2232–2235, 1981Google Scholar
  27. 27.
    Aberizck WJ, Silver B, Henderson IC, Cady B, Harris JR: The use of radiotherapy for treatment of isolated locoregional recurrence of breast carcinoma after mastectomy. Cancer 58: 1214–1218, 1986Google Scholar
  28. 28.
    Janjan NA, McNeese MD, Buzdar AU, Montague ED, Oswald MD: Management of locoregional breast cancer. Cancer 58: 1552–1556, 1986Google Scholar
  29. 29.
    Chen K K-Y, Montague E, Oswald MJ: Results of irradiation in the treatment of locoregional breast cancer recurrence. Cancer 56: 1269–1273, 1985Google Scholar
  30. 30.
    Beck TM, Hart NE, Woodard DA, Smith CE: Local or regional recurrent carcinoma of the breast: Results of therapy in 121 patients. J Clin Oncol 1: 100–404, 1983Google Scholar
  31. 31.
    Donegan WL, Perez-Mesa CM, Watson FR: A biostatistical study of locally recurrent breast carcinoma. Surg Gyn Obstet 122: 529–540, 1966Google Scholar
  32. 32.
    Olson CE, Ansfield FJ, Richards MJS, Ramirez G, Davis HL: Review of local soft tissue recurrence of breast cancer irradiated with and without actinomycin-D. Cancer 39: 1981–1983, 1977Google Scholar
  33. 33.
    Renolleau P, Merviel P, Clough KB, Asselain B, Campana F, Durand JC: Isolated axillary recurrences after conservative treatment of breast cancer. Eur J Cancer 32A: 617–621, 1996Google Scholar
  34. 34.
    Berstock DA, Houghton J, Haybittle J, Baum M: The role of radiotherapy following total mastectomy for patients with early breast cancer. World J Surg 9: 667–670, 1985Google Scholar
  35. 35.
    Patanaphan V, Salazar OM, Poussin-Rosillo H: Prognosticators in recurrent breast cancer. A 15-year experience with irradiation. Cancer 54: 228–234, 1984Google Scholar
  36. 36.
    Borner M, Bacchi M, Goldhirsch A Greiner R, Harder F, Castiglione M, Jungi WF, Thürlimann B, Cavalli F, Obrecht JP, Levyraz S, Alberto P, Adam H, Varini M, Loehnert T, Senn HJ, Metzger U, Brunner K, for the 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 12: 2071–2077, 1994Google Scholar

Copyright information

© Kluwer Academic Publishers 1997

Authors and Affiliations

  • Claus Kamby
    • 1
  • Lisa Sengeløv
    • 2
  1. 1.Finsen CentreRigshospitaletDenmark
  2. 2.Department of OncologyCopenhagen University Hospital in HerlevDenmark

Personalised recommendations