Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jan 24, 2020; 11(1): 20-30
Published online Jan 24, 2020. doi: 10.5306/wjco.v11.i1.20
Ipsilateral breast tumor recurrence in early stage breast cancer patients treated with breast conserving surgery and adjuvant radiation therapy: Concordance of biomarkers and tumor location from primary tumor to in-breast tumor recurrence
Juhi M Purswani, Fauzia Shaikh, S Peter Wu, Jennifer Chun Kim, Freya Schnabel, Nelly Huppert, Carmen A Perez, Naamit K Gerber
Juhi M Purswani, Fauzia Shaikh, S Peter Wu, Nelly Huppert, Carmen A Perez, Naamit K Gerber, Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
Jennifer Chun Kim, Freya Schnabel, Department of Surgery, New York University School of Medicine, New York, NY 10016, United States
Author contributions: Purswani JM and Gerber NK designed the research; Purswani JM, Gerber NK and Wu SP performed the research; Purswani JM and Wu SP analyzed the data; Purswani JM, Gerber NK, Kim JC, Schnabel F, Huppert N and Perez CA wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of New York University School of Medicine on December 13, 2017. This is an exempt study, annual renewal is not required.
Informed consent statement: Patients were not required to give informed consent to the research study. The analysis used anonymized clinical data obtained after each subject agreed to treatment with written consent.
Conflict-of-interest statement: There are no financial disclosures, conflicts of interest, and/or acknowledgments for all the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Naamit K Gerber, MD, Assistant Professor, Department of Radiation Oncology, New York University School of Medicine, 160 E. 34th Street, New York, NY 10016, United States. naamit.gerber@nyumc.org
Received: March 23, 2019
Peer-review started: March 26, 2019
First decision: August 2, 2015
Revised: October 21, 2015
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 24, 2020
Abstract
BACKGROUND

Patients with an in-breast tumor recurrence (IBTR) after breast-conserving therapy have a high risk of distant metastasis and disease-related mortality. Classifying clinical parameters that increase risk for recurrence after IBTR remains a challenge.

AIM

To describe primary and recurrent tumor characteristics in patients who experience an IBTR and understand the relationship between these characteristics and disease outcomes.

METHODS

Patients with stage 0-II breast cancer treated with lumpectomy and adjuvant radiation were identified from institutional databases of patients treated from 2003-2017 at our institution. Overall survival (OS), disease-free survival, and local recurrence-free survival (LRFS) were estimated using the Kaplan Meier method. We identified patients who experienced an isolated IBTR. Concordance of hormone receptor status and location of tumor from primary to recurrence was evaluated. The effect of clinical and treatment parameters on disease outcomes was also evaluated.

RESULTS

We identified 2164 patients who met the eligibility criteria. The median follow-up for all patients was 3.73 [interquartile range (IQR) 2.27-6.07] years. Five-year OS was 97.7% (95%CI: 96.8%-98.6%) with 28 deaths; 5-year LRFS was 98.0% (97.2-98.8) with 31 IBTRs. We identified 37 patients with isolated IBTR, 19 (51.4%) as ductal carcinoma in situ and 18 (48.6%) as invasive disease, of whom 83.3% had an in situ component. Median time from initial diagnosis to IBTR was 1.97 (IQR: 1.03-3.5) years. Radiotherapy information was available for 30 of 37 patients. Median whole-breast dose was 40.5 Gy and 23 patients received a boost to the tumor bed. Twenty-five of thirty-two (78.1%) patients had concordant hormone receptor status, HER-2 receptor status, and estrogen receptor (ER) (P = 0.006) and progesterone receptor (PR) (P = 0.001) status from primary to IBTR were significantly associated. There were no observed changes in HER-2 status from primary to IBTR. The concordance between quadrant of primary to IBTR was 10/19 [(62.2%), P = 0.008]. Tumor size greater than 1.5 cm (HR = 0.44, 95%CI: 0.22-0.90, P = 0.02) and use of endocrine therapy upfront (HR = 0.36, 95%CI: 0.18-0.73, P = 0.004) decreased the risk of IBTR.

CONCLUSION

Among patients with early stage breast cancer who had breast conserving surgery treated with adjuvant RT, ER/PR status and quadrant were highly concordant from primary to IBTR. Tumor size greater than 1.5 cm and use of adjuvant endocrine therapy were significantly associated with decreased risk of IBTR.

Keywords: : Ipsilateral breast tumor recurrence, Breast conservation, Adjuvant radiation

Core tip: Distinguishing a new primary breast tumor from a true ipsilateral breast tumor recurrence (IBTR) based on clinical features alone is challenging among patients with early stage breast cancer treated with breast conserving surgery and adjuvant radiotherapy. Our aim was to describe primary and recurrent tumor characteristics in patients who experienced an IBTR. We retrospectively analyzed patients with isolated IBTR. Estrogen/progesterone receptor status from primary tumor to IBTR was highly associated, as was the concordance between the quadrant of primary to IBTR. Tumor size greater than 1.5 cm and use of adjuvant endocrine therapy decreased the risk of IBTR.