Identification of patients at high risk for local recurrence after conservative surgery and radiation therapy for stage I or II breast cancer
R. T. Osteen, J. L. Connolly, A. Recht, B. Silver, S. J. Schnitt and J. R. Harris
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115.
The extent of excision prior to radiation for breast cancer is
controversial. Three hundred evaluable patients with invasive ductal
carcinoma received radiation therapy after gross tumor excision. The median
follow-up was 70 months. Local recurrence was related to the presence of an
extensive intraductal component (EIC) in addition to the invasive ductal
carcinoma. From operative notes and pathology reports, patients with an EIC
were categorized as having discrete masses with the extent of disease
confirmed histologically or as having one of five criteria in which the
final pathologic findings revealed more intraductal disease than was
evident grossly or by frozen section. After ten years of follow-up, the
local failure rate of patients without an EIC (193) was 3% compared with
35% for those with an EIC (107). Eight-year recurrence rates were 18% for
clearly defined tumors and 71% for tumors in which the intraductal
component was detectable only histologically.
