Treatment results and predictors of local recurrences after breast conserving therapy in early breast carcinoma.

Purpose: The aim of this study was to access the influence of several factors on local control (LC) and overall survival (OS) in patients with early breast cancer after breast-conserving therapy.

Patients And Methods: 122 early breast cancer patients with tumor (T) up to 3 cm and breast-conserving surgery followed by radiotherapy, chemotherapy, or hormonal therapy were retrospectively analysed. Factors considered to carry possible significance in relation with local recurrence were classified into 3 groups that included characteristics of the patient, of the tumor and the non-surgical treatment methods applied.

Results: With a median follow-up of 63.5 months (range 52.4-127 months) LC was achieved in 116 (95.1%) patients. The median time to local recurrence was 30.3 months (range 6.6-117.1 months). Of all the factors examined in the 3 groups, a negative statistical impact on LC was found only in high-risk node-negative patients (tumor size over 2 cm, high grade of malignancy, and absence of steroid receptors (SR); p=0.02). Ten-year OS was 95.8%, with statistical significance favoring stage I patients (98.5% versus 87.5% for stage I and II, respectively; p%0.05). Ten-year recurrencefree survival was 89.4%. Postponement of radiotherapy after chemotherapy did not change significantly either LC or OS (p >0.46). Adjuvant chemotherapy was administered to 22 (83.3%) node-positive patients, but only to 1 (12.5%) of node-negative high-risk patients. This resulted in unsatisfactory OS for the latter group of patients (90.2% versus 73.4%; p <0.000).

Conclusion: In high-risk node-negative early breast cancer patients, the occurrence of early local recurrences and distant metastasis defines an aggressive disease behavior. Chemotherapy administration and its timing in relation with the delivery of radiotherapy constitutes an issue of future research for this group of patients.