DOI QR코드

DOI QR Code

Treatment results of breast cancer patients with locoregional recurrence after mastectomy

  • Jeong, Yuri (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Su Ssan (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gong, Gyungyub (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Hee Jin (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Sei Hyun (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Son, Byung Ho (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jong Won (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun Kyung (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Wook (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joo, Ji Hyeon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Seung Do (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2013.05.14
  • Accepted : 2013.08.06
  • Published : 2013.09.30

Abstract

Purpose: To analyze the results of locoregional and systemic therapy in the breast cancer patients with locoregional recurrence (LRR) after mastectomy. Materials and Methods: Seventy-one patients who received radiotherapy for isolated LRR after mastectomy between January 1999 and December 2009 were retrospectively reviewed. Among the 71 patients, 59 (83.1%) underwent wide excision and radiotherapy and 12 (16.9%) received radiotherapy alone. Adjuvant hormonal therapy was given to 45 patients (63.4%). Oncologic outcomes including locoregional recurrence-free survival, disease-free survival (DFS), and overall survival (OS) and prognostic factors were analyzed. Results: Median follow-up time was 49.2 months. Of the 71 patients, 5 (7%) experienced second isolated LRR, and 40 (56%) underwent distant metastasis (DM). The median DFS was 35.6 months, and the 3- and 5-year DFS were 49.1% and 28.6%, respectively. The median OS was 86.7 months, and the 5-year OS was 62.3%. Patients who received hormone therapy together showed better 5-year DFS and OS than the patients treated with locoregional therapy only (31.6% vs. 22.1%, p = 0.036; 66.5% vs. 55.2%, p = 0.022). In multivariate analysis, higher N stage at recurrence was a significant prognostic factor for DFS and OS. Disease free interval (${\leq}30$ months vs. >30 months) from mastectomy to LRR was also significant for OS. The patients who received hormone therapy showed superior DFS and showed trend to better OS. Conclusion: DM was a major pattern of failure after the treatment of LRR after mastectomy. The role of systemic treatment for LRR after mastectomy should be investigated at prospective trials.

Keywords

References

  1. Katz A, Strom EA, Buchholz TA, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol 2000;18:2817-27. https://doi.org/10.1200/JCO.2000.18.15.2817
  2. Wallgren A, Bonetti M, Gelber RD, et al. Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII. J Clin Oncol 2003;21:1205-13. https://doi.org/10.1200/JCO.2003.03.130
  3. Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast And Bowel Project randomized clinical trials. J Clin Oncol 2004;22:4247-54. https://doi.org/10.1200/JCO.2004.01.042
  4. Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 1999;17:1689-700.
  5. Aberizk 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 1986;58:1214-8. https://doi.org/10.1002/1097-0142(19860915)58:6<1214::AID-CNCR2820580607>3.0.CO;2-9
  6. Buchanan CL, Dorn PL, Fey J, et al. Locoregional recurrence after mastectomy: incidence and outcomes. J Am Coll Surg 2006;203:469-74. https://doi.org/10.1016/j.jamcollsurg.2006.06.015
  7. Kuo SH, Huang CS, Kuo WH, Cheng AL, Chang KJ, Chia-Hsien Cheng J. Comprehensive locoregional treatment and systemic therapy for postmastectomy isolated locoregional recurrence. Int J Radiat Oncol Biol Phys 2008;72:1456-64. https://doi.org/10.1016/j.ijrobp.2008.03.042
  8. Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J. Loco-regional recurrence after mastectomy in high-risk breast cancer: risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol 2006;79: 147-55. https://doi.org/10.1016/j.radonc.2006.04.006
  9. Ha SW, Yang MG, Chung WK, et al. Radiotherapy in locoregional recurrent breast carcinoma. J Korean Soc Ther Radiol 1988;6:203-10.
  10. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  11. Deutsch M. Radiotherapy for postmastectomy local-regional recurrent breast cancer. Am J Clin Oncol 2000;23:494-8. https://doi.org/10.1097/00000421-200010000-00013
  12. Schwaibold F, Fowble BL, Solin LJ, Schultz DJ, Goodman RL. The results of radiation therapy for isolated local regional recurrence after mastectomy. Am J Clin Oncol 1991;21:299-310.
  13. Magno L, Bignardi M, Micheletti E, Bardelli D, Plebani F. Analysis of prognostic factors in patients with isolated chest wall recurrence of breast cancer. Cancer 1987;60:240-4. https://doi.org/10.1002/1097-0142(19870715)60:2<240::AID-CNCR2820600221>3.0.CO;2-9
  14. Chen KK, Montague ED, Oswald MJ. Results of irradiation in the treatment of locoregional breast cancer recurrence. Cancer 1985;56:1269-73. https://doi.org/10.1002/1097-0142(19850915)56:6<1269::AID-CNCR2820560608>3.0.CO;2-Y
  15. Schmoor C, Sauerbrei W, Bastert G, Schumacher M. Role of isolated locoregional recurrence of breast cancer: results of four prospective studies. J Clin Oncol 2000;18:1696-708.
  16. Deutsch M, Parsons JA, Mittal BB. Radiation therapy for localregional recurrent breast carcinoma. Int J Radiat Oncol Biol Phys 1986;12:2061-5. https://doi.org/10.1016/0360-3016(86)90002-7
  17. Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure. Breast J 2002;8:81-7. https://doi.org/10.1046/j.1524-4741.2002.08202.x
  18. van Tienhoven G, Voogd AC, Peterse JL, et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 1999;35:32-8. https://doi.org/10.1016/S0959-8049(98)00301-3
  19. Kim H, Huh SJ, Park W, et al. Results of three-dimensional conformal radiation therapy for the treatment of a solitary sternal relapse of breast cancer. J Korean Soc Ther Radiol Oncol 2008;26:91-5. https://doi.org/10.3857/JKSTRO.2008.26.2.91
  20. Halverson KJ, Perez CA, Kuske RR, Garcia DM, Simpson JR, Fineberg B. Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys 1990;19:851-8. https://doi.org/10.1016/0360-3016(90)90004-4
  21. Haffty BG, Hauser A, Choi DH, et al. Molecular markers for prognosis after isolated postmastectomy chest wall recurrence. Cancer 2004;100:252-63. https://doi.org/10.1002/cncr.11915
  22. Waeber M, Castiglione-Gertsch M, Dietrich D, et al. Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: definitive results of a phase III randomized trial (SAKK 23/82) comparing tamoxifen with observation. Ann Oncol 2003;14:1215-21. https://doi.org/10.1093/annonc/mdg347
  23. Haylock BJ, Coppin CM, Jackson J, Basco VE, Wilson KS. Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy. Int J Radiat Oncol Biol Phys 2000;46:355-62. https://doi.org/10.1016/S0360-3016(99)00428-9
  24. Aebi S, Gelber S, Anderson SJ, et al. Chemotherapy prolongs survival for isolated local or regional recurrence of breast cancer: the CALOR trial (Chemotherapy as Adjuvant for Locally Recurrent breast cancer; IBCSG 27-02, NSABP B-37, BIG 1-02). Cancer Res 2012;72(24 Suppl):abstract no. S3-2.

Cited by

  1. Proportion and Clinical Outcomes of Postoperative Radiotherapy Omission after Breast-Conserving Surgery in Women with Breast Cancer vol.18, pp.1, 2013, https://doi.org/10.4048/jbc.2015.18.1.50
  2. Interstitial brachytherapy technique for chest wall refractory recurrence of breast cancer vol.7, pp.4, 2013, https://doi.org/10.5114/jcb.2015.53868
  3. Prognostic Factors for Distant Metastasis in Patients with Locoregional Recurrence after Mastectomy vol.18, pp.3, 2015, https://doi.org/10.4048/jbc.2015.18.3.279
  4. Chest wall recurrence in pT1-2N0-1 breast cancer patients after mastectomy without radiotherapy vol.169, pp.3, 2013, https://doi.org/10.1007/s10549-018-4707-0
  5. Salvage radiotherapy for second oligo-recurrence in patients with breast cancer vol.59, pp.1, 2013, https://doi.org/10.1093/jrr/rrx066
  6. Identifying Long-Term Survival Candidates among Patients with Isolated Locoregionally Recurrent Breast Cancer: Implications of the Use of Systemic Chemotherapy vol.23, pp.3, 2020, https://doi.org/10.4048/jbc.2020.23.e31
  7. Survival and Prognostic Factors for Breast Cancer Patients with Regional Oligo-Recurrence vol.23, pp.6, 2013, https://doi.org/10.4048/jbc.2020.23.e66