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Margin status and local recurrence after breast-conserving surgery
B Spivack1, M M Khanna, L Tafra
1Joyce Eisenberg Keefer Breast Center, Saint John's Hospital and Health Center, Santa Monica, Calif.
Objective:
To examine the effect of microscopic tumor at the margins on local recurrence after breast-conserving surgery for invasive carcinoma.
Design:
Retrospective review of patients treated with surgical resection followed by radiation therapy.
Setting:
A university-based radiation department and a community-based cancer referral center.
Patients:
A consecutive series of 272 women treated between 1982 and 1990.
Main Outcome Measure:
Local recurrence according to the histopathologic status of excised margins and the total dose of radiation.
Results:
During a mean follow-up period of 48 months, the overall rate of local recurrence was 6.3%. Local recurrence was more frequent (P = .0001) in patients with histologically positive margins (18.2%) than in those with unknown margins (7.1%) or negative margins (3.7%). In the 44 patients with positive margins, the local recurrence rate was 8.3% after radiation doses of 66 Gy or more compared with 21.9% following lower doses.
Conclusions:
Microscopic involvement of resection margins increases the risk of local recurrence following breast-conserving surgery for invasive carcinoma. Therefore, every effort should be made to achieve negative margins intraoperatively.