Long-term results from a series of patients managed with breast conservation surgery and hypofractionated radiotherapy in Christchurch: What is the recurrence rate and how do we detect recurrences.

Aims: Hypofractionated radiation treatment (HFRT) following breast conservation surgery (BCS) has similar efficacy to conventionally fractionated radiation treatment (CFRT). This study updates outcomes for patients treated with HFRT in Christchurch, New Zealand, and reports on the pattern, timing and method of detection of recurrences to inform follow-up practice.

Methods: Between 2004 and 2006, 273 women with early breast cancer were treated with HFRT (42.5 Gray (Gy) in 16 fractions). Details of demographics, tumour characteristics, treatments, any recurrence (local, nodal or distant), follow-ups and date of death were collected. The primary endpoint was local recurrence rate (LRR); secondary endpoints were local recurrence-free survival (LRFS) and overall survival (OS).

Results: With a median follow-up of 12.9 years, 17 women developed a local recurrence. LRR at 5 and 10 years were 3.1% and 5.3%, respectively. Five-year LRFS was 91.7% and ten-year LRFS was 83.5%. The OS at five years was 93.7% and at ten years was 87.7%. For the 41 patients with a first recurrence at any site, 75.6% were symptomatic, 22% were screen detected with radiology and 2.4% were incidental findings. None of the first recurrences were detected when asymptomatic on clinical examination in follow-up clinics.

Conclusions: The rate of local recurrence following HFRT for BCS is low. No asymptomatic recurrence was detected by routine clinic follow-up. The utility of regular clinical examination for the detection of recurrence is low and this should inform follow-up strategies.