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• W2103806939 abstract "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. As a result, controversy exists regarding the optimal surveillance of such patients. Herein, we attempt to determine the prognostic significance of method of detection of IBTR on distant metastases (DM)-free survival. With IRB approval, a retrospective single institution chart review of all newly diagnosed breast cancer patients treated between 1981 and 2007 was conducted to identify women treated with breast conserving surgery. Of these, all patients who received adjuvant radiation therapy (RT) and subsequently developed IBTR were identified. Charts were reviewed for demographics, clinical presentation, method of detection, stage, type of therapy, histopathology, and margin status for both the primary and recurrent tumors. All patients presenting with DM following BCT or a suspected new primary with different histology following BCT were excluded. A total of 1733 patients were treated with breast conserving surgery. Of these, 199 (11%) developed IBTR. 157/199 patients received adjuvant RT following breast conserving surgery and subsequently developed IBTR. Median follow-up for this cohort from the time of recurrence was 27 months (range, 1 to 231). Of all IBTRs, 86% occurred within the initial tumor bed. 65% of IBTRs were detected radiographically, whereas 35% were detected clinically. The main outcome was time to DM. Median time from IBTR to DM was 151 months. 5-year DM-free survival following IBTR was 69.5%. Univariate analysis revealed the type of IBTR management, younger age, lymph node positivity at initial diagnosis, higher initial T stage, shorter time to IBTR, histology of recurrence (invasive > mixed invasive and DCIS > DCIS), and method of detection (clinical > radiographic) of IBTR were significant predictors of lower DM-free survival. On multivariate Cox regression analysis, clinically detected IBTRs remained a significant predictor of lower DM-free survival. Median DM-free survival for clinically and radiographically detected IBTRs was 54 months and >231 months (median was not reached), respectively. Adjusted relative risk for clinically detected IBTRs was 2.2. Contrary to previous reports, clinical detection of local recurrence remains a significant risk factor for time to development of distant metastases. 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." @default.
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• W2103806939 date "2008-09-01" @default.
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• W2103806939 title "Method of Detection of Ipsilateral Breast Tumor Recurrence Following Breast Conserving Therapy is a Predictor of Distant Metastases" @default.
• W2103806939 doi "https://doi.org/10.1016/j.ijrobp.2008.06.491" @default.
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