International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: breastPredictors of reexcision findings and recurrence after breast conservation
Introduction
Several randomized trials have established the efficacy of breast-conserving surgery followed by radiation for Stage I and II breast cancer (1). However, outcome predictors for patients treated with breast conservation are important in defining optimal patient selection and surgical management. Various clinical and pathologic criteria have been proposed to have prognostic import for local recurrence, including patient age (5) margin status (6), extensive intraductal component (EIC) 10, 11, and lymphovascular invasion (3). The impact of systemic therapy 12, 13 and radiation dose 14, 15 has also been described.
In earlier work, we found margin status to be the most important predictor of local recurrence after breast conservation (16). However, many patients in that series had indeterminate margin status because of prevailing pathologic and surgical practices. This review updates results for previously reported patients and includes a larger number of patients with defined margin status using uniform criteria. The predictors of findings at reexcision are also examined.
Section snippets
Methods and materials
The records of 535 patients treated with breast-conserving radiotherapy (RT) at Stanford University or the Washington-Stanford Radiation Oncology Center between 1972 and 1996 for Stage I or II breast cancer were reviewed with Institutional Review Board approval. Clinical and pathologic data were recorded as previously described (16). Margin status was classified on the initial and reexcision specimens as positive when invasive or in situ disease was seen at an inked surgical margin, close when
Local recurrence
For the entire group of patients, the actuarial freedom from local recurrence (FFLR) at 6 years for patients with negative margins was 97% vs. 86% for close, positive, or indeterminate (non-negative) margins (p < 0.0001, Fig. 1). Excluding patients with indeterminate margin status, the FFLR was 97% vs. 87%, respectively. There was no significant difference in local recurrence rates among non-negative margins by type (Table 2). The actuarial FFLR for close margins was 78%, for indeterminate
Discussion
Breast-conserving surgery with radiation is an established treatment for early-stage breast cancer. The final pathologic margin status of the lumpectomy specimen is the most important factor determining local recurrence rates in the majority of reports. Although a “negative” inked surgical margin is advised, variation exists in general surgical practice and among cooperative group studies in terms of what is considered an acceptable margin in the setting of breast conservation.
Few studies have
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Do All Positive Margins in Breast Cancer Patients Undergoing a Partial Mastectomy Need to Be Resected?
2018, Journal of the American College of SurgeonsFocally positive margins in breast conserving surgery: Predictors, residual disease, and local recurrence
2017, European Journal of Surgical OncologyCitation Excerpt :The local recurrence risk for patients with focally positive margins is also unknown. This lack of knowledge exists since the focally positive margins have rarely been studied separately from the extensively positive margins except for a few small, retrospective studies more than 10 years ago.1,21–30 Low incidence of residual disease and local recurrences after focally positive margins after BCS could be an argument to omit re-excision.
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2017, The Breast: Comprehensive Management of Benign and Malignant DiseasesA study of margin width and local recurrence in breast conserving therapy for invasive breast cancer
2016, European Journal of Surgical OncologyComparison of margin status and lesional size between radioactive seed localized vs conventional wire localized breast lumpectomy specimens
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