Risk factors for ipsilateral breast tumor recurrence and uncontrolled local disease

Sammanfattning: The aims of the study were to assess intrinsic and treatment related risk factors for ipsilateral breast tumor recurrence (IBTR) and uncontrolled local disease (ULD) following breast-conserving surgery of early-stage invasive breast cancer. In a cohort of 759 women with T1-T2 tumors risk factors were evaluated. The majority of the patients (88%) had received postoperative irradiation to the breast. A continuous 1-1.5% yearly increase in IBTR was seen. Three independent risk-factors for IBTR were identified, age <50 years, no postoperative irradiation and positive lymph nodes. Radiotherapy reduced the IBTR-rate, but the effect decreased with time. Node-negative women >50 years constituted a low risk-group for IBTR having a cumulative risk at 10 years of 9% without radiation and 5% with breast radiation. In a case-control study "nested" within the cohort, biological markers were assessed. Sub-groups of patients with low and high risk for IBTR were identified, namely women >50 years with proliferative index mib-1 <30%, who had an odds-ratio of 0.2 and patients <50 years with tumors showing both c-erbB-2 and waf-1-immunoreactivity with an odds-ratio of 6.7. Salvage mastectomy among patients with IBTR provided a superior local control rate compared to reexcision. A higher although not statistically significant rate of ULD was also seen in patients who had not received postoperative radiotherapy as part of their primary treatment. In postmenopausal, node-negative breast cancer patients treated with breast-conserving surgery and radiotherapy, the addition of tamoxifen was evaluated in a population of 432 women, who constituted a separate stratum of the Stockholm Adjuvant Tamoxifen Trial. An improved event-free survival and a reduced rate of ipsi and contralateral breast tumor recurrences was accomplished in patients allocated to tamoxifen. Mammograms from 69 patients with invasive breast cancer, operated on with breast-conserving surgery between 1987-1990 were blindly reevaluated for prediction of IBTR. The study cohort was divided into two groups of 34 and 35 patients, respectively. Each group was matched according to age, the time at risk and to presence or absence of IBTR. The mammographic reinterpretation correctly predicted an IBTR in 81%. Mammographic characteristics, such as diffuse microcalcifications, multifocality, solitary densities of stellate type near the nipple and/or solitary densities with spicula in the vicinity of the retroareolar region, correlated with the ability of the tumor to recur locally.