Recurrent Cancer After Breast-Conserving Surgery with Radiation Therapy
Objective: The purpose of our study was to determine the mammographic appearance, detection method, and stage of ipsilateral breast tumor recurrence in women treated with breast-conserving surgery and whole-breast radiation therapy for ductal carcinoma in situ (DCIS).
Materials and Methods: Following institutional review board approval, records of women treated with breast-conserving surgery and radiation therapy for DCIS who developed an ipsilateral breast tumor recurrence from 1981 to 2003 were reviewed retrospectively. Multiinstitutional database records showed 513 women were treated, of whom 42 (8.2%) developed local recurrence. Study criteria were fulfilled and complete records were available for 32 women. Mean age at initial diagnosis was 49 years (range, 26-73 years).
Results: Of the 32 patients included in our study, 31 (97%) recurrences were mammographically apparent. Twenty-nine (91%) of 32 were diagnosed exclusively by mammography. Mammographic findings at recurrence were calcifications in 24 (75%) of 32, mass in six (19%) of 32, and distortion in one (3%) of 32. The mean time to recurrence was 4.5 years. Twelve (40%) of 30 had the recurrence in a remote quadrant from the original cancer. Recurrences were DCIS in 17 (53%) of 32, DCIS with microinvasion in six (19%) of 32, invasive ductal cancer in three (9%) of 32, invasive lobular cancer in two (6%) of 32, and mixed DCIS and invasive cancer in four (13%) of 32. Six (67%) of nine patients with invasive cancer (excluding microinvasion) had tumors smaller than 1 cm. Ninety-one percent of recurrences were minimal cancers. All recurrences were stage 0 or 1.
Conclusion: Mammography successfully detected ipsilateral breast tumor recurrence, predominantly as calcifications or masses, after breast-conserving surgery with radiation therapy for DCIS in 97% of cases. The recurrences were located at variable distances from the lumpectomy site. Ninety-one percent of recurrences were minimal cancers and all were early stage, connoting excellent prognosis.
Women newly diagnosed with ductal carcinoma in situ (DCIS) of the breast face a perplexing array of treatment options ranging from mastectomy with hormonal therapy to lumpectomy alone. Although multiple randomized controlled trials have documented the equivalency of lumpectomy and radiation therapy to that of mastectomy in terms of survival for invasive breast cancer, DCIS is less well studied. Hence, clinical decisions regarding "best" treatment are based on nonuniform and nonrandomized trials.
Mastectomy for DCIS has been associated with a long-term local regional disease-free survival of 95% or greater. Although breast conservation surgery with whole-breast radiation therapy has proven to be effective, women electing this treatment are faced with the prospect of a local regional recurrence rate of approximately 1% per year. This decreases with the addition of tamoxifen in selected women. Although many consider mastectomy to be curative, a small percentage of patients (1-4%) will eventually develop chest wall recurrence. These recurrences are usually invasive carcinomas that are detected once they are palpable. Because the rate of local recurrence with lumpectomy and breast radiation is higher than with mastectomy, it is important for a woman electing this treatment path to understand not only the risk of recurrence but also the implications of a recurrence. We therefore reviewed our data of women experiencing a local recurrence after breast-conserving surgery and radiation therapy. We were particularly interested to observe the radiographic appearance, method of detection, location of recurrence, and, most important, the size and stage of recurrence that would provide information regarding prognosis after recurrence. This information should be helpful in guiding radiologists, oncologists, and patients facing treatment decisions and planning surveillance methods when breast conservation is chosen.
Objective: The purpose of our study was to determine the mammographic appearance, detection method, and stage of ipsilateral breast tumor recurrence in women treated with breast-conserving surgery and whole-breast radiation therapy for ductal carcinoma in situ (DCIS).
Materials and Methods: Following institutional review board approval, records of women treated with breast-conserving surgery and radiation therapy for DCIS who developed an ipsilateral breast tumor recurrence from 1981 to 2003 were reviewed retrospectively. Multiinstitutional database records showed 513 women were treated, of whom 42 (8.2%) developed local recurrence. Study criteria were fulfilled and complete records were available for 32 women. Mean age at initial diagnosis was 49 years (range, 26-73 years).
Results: Of the 32 patients included in our study, 31 (97%) recurrences were mammographically apparent. Twenty-nine (91%) of 32 were diagnosed exclusively by mammography. Mammographic findings at recurrence were calcifications in 24 (75%) of 32, mass in six (19%) of 32, and distortion in one (3%) of 32. The mean time to recurrence was 4.5 years. Twelve (40%) of 30 had the recurrence in a remote quadrant from the original cancer. Recurrences were DCIS in 17 (53%) of 32, DCIS with microinvasion in six (19%) of 32, invasive ductal cancer in three (9%) of 32, invasive lobular cancer in two (6%) of 32, and mixed DCIS and invasive cancer in four (13%) of 32. Six (67%) of nine patients with invasive cancer (excluding microinvasion) had tumors smaller than 1 cm. Ninety-one percent of recurrences were minimal cancers. All recurrences were stage 0 or 1.
Conclusion: Mammography successfully detected ipsilateral breast tumor recurrence, predominantly as calcifications or masses, after breast-conserving surgery with radiation therapy for DCIS in 97% of cases. The recurrences were located at variable distances from the lumpectomy site. Ninety-one percent of recurrences were minimal cancers and all were early stage, connoting excellent prognosis.
Women newly diagnosed with ductal carcinoma in situ (DCIS) of the breast face a perplexing array of treatment options ranging from mastectomy with hormonal therapy to lumpectomy alone. Although multiple randomized controlled trials have documented the equivalency of lumpectomy and radiation therapy to that of mastectomy in terms of survival for invasive breast cancer, DCIS is less well studied. Hence, clinical decisions regarding "best" treatment are based on nonuniform and nonrandomized trials.
Mastectomy for DCIS has been associated with a long-term local regional disease-free survival of 95% or greater. Although breast conservation surgery with whole-breast radiation therapy has proven to be effective, women electing this treatment are faced with the prospect of a local regional recurrence rate of approximately 1% per year. This decreases with the addition of tamoxifen in selected women. Although many consider mastectomy to be curative, a small percentage of patients (1-4%) will eventually develop chest wall recurrence. These recurrences are usually invasive carcinomas that are detected once they are palpable. Because the rate of local recurrence with lumpectomy and breast radiation is higher than with mastectomy, it is important for a woman electing this treatment path to understand not only the risk of recurrence but also the implications of a recurrence. We therefore reviewed our data of women experiencing a local recurrence after breast-conserving surgery and radiation therapy. We were particularly interested to observe the radiographic appearance, method of detection, location of recurrence, and, most important, the size and stage of recurrence that would provide information regarding prognosis after recurrence. This information should be helpful in guiding radiologists, oncologists, and patients facing treatment decisions and planning surveillance methods when breast conservation is chosen.
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