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Local failure is responsible for the decrease in survival for patients with breast cancer treated with conservative
A Fortin1, M Larochelle, J Laverdière
1Department of Radiation Oncology, Hôtel-Dieu de Québec Hospital, Université Laval, Canada.
Summary
Local failure after breast-conserving surgery significantly increases mortality and distant metastasis risk. This local failure (LF) acts as both a marker and a potential source for new metastases, impacting patient survival.
Area of Science:
- Oncology
- Surgical Oncology
- Radiotherapy
Background:
- Breast-conserving surgery followed by radiotherapy is a standard treatment for early-stage breast cancer.
- Local failure (LF) after lumpectomy can impact patient outcomes.
- Understanding the role of LF in metastasis and survival is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the impact of local failure (LF) on survival in patients treated with lumpectomy and postoperative radiotherapy.
- To determine if LF serves as a marker for distant metastasis (DM) or as a cause of it.
Main Methods:
- Retrospective review of 2,030 patients treated with breast-conserving surgery between 1969 and 1991.
- Median follow-up of 6 years.
- Cox regression multivariate analysis using LF as a time-dependent covariate.
Main Results:
- Local control (LC) was achieved in 87% of patients at 10 years.
- Local failure (LF) was associated with significantly poorer 10-year survival (55% vs. 75%) and was a strong predictor of mortality (relative risk 3.6).
- LF significantly increased the risk of distant metastasis (DM) (relative risk 5.1), with a delayed peak incidence of DM compared to patients with LC.
Conclusions:
- Local failure (LF) is a significant predictor of increased mortality after breast-conserving surgery and radiotherapy.
- LF may act as a source for new distant metastases (DM), not just a marker for pre-existing occult disease.
- Distinct temporal patterns of DM in LF versus LC patients suggest different metastatic mechanisms, highlighting the importance of local control in breast cancer management.