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An analysis of relapsed breast cancer in patients previously treated with breast conserving surgery

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Abstract

Background

Recent advances in breast surgery have focused on breast conserving surgery in combination with radiotherapy. In the present study, we examine by retrospective analysis 105 patients with breast cancer who received breast conserving surgery for factors influencing disease free survival.

Methods

The analysis was performed on 105 patients with breast cancer who received breast conserving surgery in our department, including 38 patients without radiotherapy and 67 patients treated with radiotherapy. The disease-free survival of the patients was analyzed using the Kaplan-Meier method. The relapsed patients were assessed by examining pathological features and gene expression by immunohistochemical staining.

Results

There was no significant difference in the disease free survival at 5 years between patients without radiotherapy (89.6%) and with radiotherapy (94.5%). Relapse after breast conserving surgery was found in 6 patients including 4 patients without radiotherapy and 2 patients with radiotherapy. Local relapse and bone metastasis were found in 4 (3.8%) and 2 patients, respectively. Among the 4 local relapses, 1 patient had received radiotherapy and 3 patients had not. There was no significant difference between the type of relapse in terms of lymph node metastasis, hormone receptor, nuclear grade and intraductal component, but more vessel invasion was observed in the 2 cases with bone metastasis. The overexpression of apoptosis and angiogenesis genes such as p53, Bax, BcI-Xl, Bcl-2 and VEGF was not common in the relapsed patients, whereas the overexpression of drug resistance genes, either P-gp or MRP1, was found in the all patients.

Conclusions

Although radiotherapy may reduce the incidence of local relapse and increase disease free survival after breast conserving surgery, the development of an effective adjuvant chemotherapy based on drug resistance markers, is also required.

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Abbreviations

CMF:

Cyclophosphamide+methotrexate+5-fluorouracil

CAF:

Cyclophosphamide+adriamycin+5-fluorouracil

ACT:

Adriamycin + cyclophosphamide+paclitaxel

VEGF:

Vascular endothelial cell growth factor

P-gp:

P-glycoprotein

MRP1:

Multidrug resistance related protein 1

UFT:

Uracil-tegafur

5′-DFUR:

5′-deoxy-5-fluorouridine

References

  1. Hirose K, Tajima K, Hamajima N,et al: Effect of body size on breast cancer risk among Japanese woman.Int J Cancer 80:349–355, 1999.

    Article  PubMed  CAS  Google Scholar 

  2. Veronesi U, Volterrani F, Luini A,et al: Quandrantectomy versus lumpectomy for small size breast cancer.Eur J Cancer 26:671–673, 1990.

    Article  PubMed  CAS  Google Scholar 

  3. Van Dongen JA, Bartelink H, Fentiman IS,et al: Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC Trial 10801, breast conservation compared with mastecctomy in TNM stage I and II breast cancer.Eur J Cancer 28A:801–805, 1992.

    Article  PubMed  CAS  Google Scholar 

  4. Liljegren G, Holmberg L, Adami H-O,et al: Sector resection with or without postoperative radiotherapy for stage I breast cancer: Five-year results of a randomized trial.J Natl Cancer Inst 86:717–722, 1994.

    Article  PubMed  CAS  Google Scholar 

  5. Jacobson JA, Danforth DN, Cowan KH,et al: Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer.N Engl J Med 332:907–911, 1995.

    Article  PubMed  CAS  Google Scholar 

  6. Veronesi U, Salvadori B, Luini A,et al: Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomized trials on 1,973 patients.Eur J Cancer 31A:1574–1579, 1995.

    Article  PubMed  CAS  Google Scholar 

  7. Clark R, Whelan T, Levine M,et al: Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node negative breast cancer: an update.J Natl Cancer Inst 88:1659–1664, 1996.

    Article  PubMed  CAS  Google Scholar 

  8. The Japanese Breast Cancer Society: Results of questionnaries concerning breast cancer surgery in Japan. An update in 1998.Breast cancer 5:209, 1998.

    Article  Google Scholar 

  9. Kasumi F, Iwase T, Yoshimoto M,et al: Experience of quandrantectomy with axillary dissection without radiotherapy sustained by serial pathological examination for stage I breast cancer.J Cancer Res Clin Oncol 121:549–554, 1995.

    Article  PubMed  CAS  Google Scholar 

  10. Fortin A, Larochelle M, Laverdiere J,et al: Local failure is responsible for the decrease in survival for patients with breast cancer treated with conservative surgery and postoperative radiotherapy.J Clin Oncol 17:101–109, 1999.

    PubMed  CAS  Google Scholar 

  11. Kim R: Expression of the multidrug resistance gene in human tumors.Hiroshima J Med Sci 3:71–77, 1990.

    Google Scholar 

  12. Clahsen PC, van-de-Velde CJ, Duval C,et al: p53 protein accumulation and response to adjuvant chemotherapy in premenopausal wommen with nod-enegative early breast cancer.J Clin Oncol 16:470–479, 1998.

    PubMed  CAS  Google Scholar 

  13. Berardo MD, Elledge RM, de-Moor C,et al: bcl-2 and apoptosis in lymph node positive breast carcinoma.Cancer 82:1296–1302, 1998.

    Article  PubMed  CAS  Google Scholar 

  14. Veronesi U, Banfi A, Del-Vecchiko M,et al: Comparison of Halstead mastectomy with qaudrantectomy, axillary dissection, and radiotherapy in early breast cancer; Long-term results.Eur J Cancer Clin Oncol 22:1085–1089, 1986.

    Article  PubMed  CAS  Google Scholar 

  15. Fisher B, Anderson S, Redmond CK,et al: Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer.N Engl J Med 333:1456–1461, 1995.

    Article  PubMed  CAS  Google Scholar 

  16. Salvadori B, Marubini E, Miceli R,et al: Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery.Br J Surg 86:84–87, 1999.

    Article  PubMed  CAS  Google Scholar 

  17. Dexter DW, Reddy RK, Geles KG,et al: Quantitative reverse transcriptase-polymerase chain reaction measured expression of MDR1 and MRP in primary breast carcinoma.Clin Cancer Res 4:1533–1542, 1998.

    PubMed  CAS  Google Scholar 

  18. Peley G, Bezzegh A, Besznyak I,et al: Correlation of biochemical tumor markers with conventional pathological features in primary breast cancer.Int J Biol Makers 14:49–51, 1999.

    CAS  Google Scholar 

  19. Daidone MG, Luisi A, Veneroni S,et al: Clinical studies of Bcl-2 and treatment benefit in breast cancer patients.Endocr Relat Cancer 6:61–68, 1999.

    Article  PubMed  CAS  Google Scholar 

  20. Obermair A, Kucera E, Mayerhofer K,et al: Vascular endothelial growth factor (VEGF) in human breast cancer: correlation with disease-free survival.Int J Cancer 74:455–458, 1997.

    Article  PubMed  CAS  Google Scholar 

  21. Buzzoni R, Bonadonna G, Valagussa P,et al: Adjuvant chemotherapy with doxorubicin plus cyclophosphamide, methotrexate, and fluorouracil in the treatment of resectable breast cancer with more than three positive axillary nodes.J Cin Oncol 9:2134–2140, 1991.

    CAS  Google Scholar 

  22. Mechetner E, Kyshtoobayeva A, Zonis S,et al: Levels of multidrug resistance (MDR1) P-glycoprotein expression by human breast cancer correlate with in vitro resistance to taxol and doxorubicin.Clin Cancer Res 4:389–398, 1998.

    PubMed  CAS  Google Scholar 

  23. Filipits M, Suchomel R W, Dekan G,et al: MRP and MDR1 gene expression in primary breast carcinomas.Clin Cancer Res 2:1231–1237, 1996.

    PubMed  CAS  Google Scholar 

  24. Gianni, L, Munzone E, Capri G,et al: Paclitaxel in metastatic breast cancer patients: a trial of two doses by a 3-hour infusion in patients with disease recurrence after prior therapy with anthracyclines.J Natl Cancer Inst 87:1169–1175, 1995.

    Article  PubMed  CAS  Google Scholar 

  25. Seidman AD, Hudis CA, Albanel J,et al: Dose-dense therapy with weekly 1-hour paclitaxel infusions in the treatment of metastatic breast cancer.J Clin Oncol 16:3353–3361, 1998.

    PubMed  CAS  Google Scholar 

  26. Wolmark N, Dignam J, Margolese R,et al: The role of radiotherapy and tamoxifen in the management of node negative invasive breast cancer-1.0 cm treated with lumpectomy: Preliminary results of NSABP protocol B-21.Proc Am Soc Clin Oncol 19:70a (abstr 271), 2000.

    Google Scholar 

  27. Group EBCTCG: Polychemotherapy for early breast cancer: An overview of the randomized trials.Lancet 352:930–942, 1998.

    Article  Google Scholar 

  28. Budman D, Berry D, Cirrincone C,et al: Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer.J Natl Cancer Inst 90:1205–1211, 1998.

    Article  PubMed  CAS  Google Scholar 

  29. Henderson IC, Berry D, Demetri G: Improved disease-free and overall survival from the addition of sequential paclitaxel but not from the escalation of adriamycin dose level in the adjuvant chemotherapy of patients with node-positive primary breast cancer.Proc Am Soc Clin Oncol 17:101a (abstr 390A), 1998.

    Google Scholar 

  30. Ohi Y, Kim R, Toge T: Overcoming of multidrug resistance by introducing the apoptosis gene, bcl-Xs, into MRP-overexpressing drug resistant cells.Int J Oncol, 16:959–969, 2000.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Japan

    Ryungsa Kim, Naoki Nishimoto, Akihiko Osaki, Jun Kojima & Tetsuya Toge

  2. Department of Pathology, Hiroshima University, Japan

    Satoshi Fujii & Kouki Inai

Authors
  1. Ryungsa Kim
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  2. Naoki Nishimoto
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  3. Akihiko Osaki
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  4. Jun Kojima
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  5. Satoshi Fujii
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  6. Kouki Inai
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  7. Tetsuya Toge
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Kim, R., Nishimoto, N., Osaki, A. et al. An analysis of relapsed breast cancer in patients previously treated with breast conserving surgery. Breast Cancer 8, 146–152 (2001). https://doi.org/10.1007/BF02967494

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  • DOI: https://doi.org/10.1007/BF02967494

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