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Method of Detection of Ipsilateral Breast Tumor Recurrence Following Breast Conserving Therapy is a Predictor of Distant Metastases. R Tuli MD PhD, JP Christodouleas MD MPH, L Roberts, SJ Deol, DA Frassica MD, RC Zellars MD, KY Usuki MD, KL Brill MD, AL Rosenberg MD. Background.

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Method of Detection of Ipsilateral Breast Tumor Recurrence Following Breast Conserving Therapy is a Predictor of Distant Metastases

R Tuli MD PhD, JP Christodouleas MD MPH, L Roberts, SJ Deol, DA Frassica MD,

RC Zellars MD, KY Usuki MD, KL Brill MD, AL Rosenberg MD


Background Following Breast Conserving Therapy is a Predictor of Distant Metastases

  • Current clinical guidelines suggest the method of detection (clinical vs. radiographic) of ipsilateral breast tumor recurrence (IBTR) following breast conserving therapy (BCT) does not influence survival

  • Controversy exists regarding the optimal surveillance of such patients

Purpose

  • We attempt to determine the prognostic significance of method of detection of IBTR on distant metastases (DM)-free survival

Author Disclosures: None


Methods Following Breast Conserving Therapy is a Predictor of Distant Metastases

  • IRB approved, retrospective single institution chart review of all newly diagnosed breast cancer patients

  • Treated with BCT between 1981 and 2007

  • We identified patients who subsequently developed IBTR

  • Charts reviewed for:

    • Demographics

    • Clinical presentation

    • Method of detection

    • Stage

    • Type of therapy

    • Histopathology

    • Margin status (primary and recurrent tumors)

  • All patients presenting with DM following BCT or a suspected new primary with different histology following BCT were excluded


Results Following Breast Conserving Therapy is a Predictor of Distant Metastases

  • Median follow-up from time of recurrence 27 months (1 to 231)

  • Median time from IBTR to DM was 151 months

  • 5-year DM-free survival following IBTR was 69.5%


Results Following Breast Conserving Therapy is a Predictor of Distant Metastases

  • Univariate analysis of pt/tumor characteristics on DM-free survival


Results Following Breast Conserving Therapy is a Predictor of Distant Metastases

  • Median DM-free survival for clinically and radiographically detected IBTRs was 54 months and > 231 months (median was not reached), respectively

  • On multivariate Cox regression analysis, clinically detected IBTRs remained a significant predictor of lower DM-free survival

  • Adjusted relative risk for clinically detected IBTRs was 2.2

Conclusions

  • Contrary to previous reports, clinical detection of local recurrence remains a significant risk factor for time to DM

  • In contrast, radiographic detection of such recurrences confers a higher DM-free survival

  • These results support the necessity for regular and timely radiographic evaluations following IBTR in patients previously treated with BCT


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