Pathoanatomical Characteristics of Local Treatment Failure Following Breast-Conserving Therapy

Abstract

In recent years carcinoma of the breast has been treated increasingly frequently with forms of therapy allowing conservation of the breast. The key factor that has made it possible largely to abandon more radical surgical procedures is a completely new understanding of the biology of the breast [1]. According to this concept, in the majority of cases disseminated disease is already present when primary treatment is started. The patient’s fate is therefore determined not by what happens in the locoregional area, but by early metastasis to distant sites. The results of numerous prospective and retrospective studies are now available to show that removal of the primary tumor, with varying degrees of radicality, followed by radiation to the residual breast tissue can give survival rates comparable to those achieved with modified radical mastectomy [2, 9, 13]. Nevertheless locoregional clearance of the tumor process is important, Hayward’s studies have shown that inadequate control of the tumor in the breast region has a negative influence on the survival rates, especially in the case of a heavy tumor burden [7]. On the other hand, local recurrences can cause serious problems with treatment, as a result of fulminant tumor spread in the irradiated breast itself [8]. Thus it is important to find tumor characteristics that correlate with a high local relapse rate, in order to allow surgical or radiological treatment to be adapted in future to take account of the risk of relapse in the individual patient.