Original studyIncidence and Patterns of Distant Metastases for Patients With Early-Stage Breast Cancer After Breast Conservation Treatment
Introduction
Breast conservation treatment (BCT), consisting of breast conservation surgery followed by definitive radiation therapy (RT), has been shown to be effective for early-stage breast cancer. Six large randomized trials have shown equivalent survival outcomes of BCT compared with mastectomy.1, 2, 3, 4, 5, 6 In addition, BCT has the potential advantage of improved cosmesis. Despite multimodality treatment, approximately 20% to 30% of women with early-stage breast cancer still experience distant metastases.7, 8, 9, 10 Breast cancer remains the leading cause of cancer-related deaths worldwide among women, largely secondary to the impact of distant metastases.11
Patterns of metastatic failure by specific anatomic site are not well described in the literature. In addition, methods to predict which patients will experience metastases and at which sites remain limited. Predicting the incidence of metastases at specific sites could allow physicians to more accurately identify patients for specific screening and prevention methods and to better tailor individualized clinical management.
The current analysis was performed to examine the incidence and patterns of the development of metastases at specific sites—including brain, lung, bone, and liver—in women with early-stage breast cancer who were treated with BCT. This study aims to identify patient and tumor characteristics as well as other prognostic factors associated with the development of metastases.
Section snippets
Methods
The study cohort was derived from the 1902 consecutive women with invasive carcinoma of the breast treated with breast conservation surgery followed by definitive RT at the Hospital of University of Pennsylvania between 1977 and 2003. All women had unilateral invasive carcinoma of the breast at presentation. Patients with a contralateral breast or a nonbreast second malignancy (excluding nonmelanoma skin cancers) diagnosed before or during radiation were excluded from analysis (n = 134). One
Results
Table 1 lists the patient and tumor characteristics. Median age was 54 years (mean, 54 years; range, 21–89 years). Most patients had node-negative disease (66.1%) with negative margins at the primary tumor resection (59.5%). Adjuvant chemotherapy was given in 20.4% of patients, hormonal therapy was given in 19.7% of patients, and both chemotherapy and hormonal therapy were administered in 16.1% of patients.
The 5-, 10-, and 15-year cumulative incidence of each competing event is shown in Table 2
Discussion
These results document the incidence and patterns of distant metastases and confirm that BCT has favorable results in women with early-stage invasive breast carcinoma through 15 years after treatment. Nonetheless, a significant number of distant metastases do occur at least 15 years after BCT, indicating that physicians should be mindful of any patient symptoms that could indicate new metastatic disease even many years after definitive treatment. A number of patient and tumor characteristics as
Conclusion
This study reports the 15-year incidence of specific metastatic sites (brain, lung, bone, and liver) in a large cohort of women with early-stage breast cancer treated with BCT at a single institution and followed prospectively. Distant metastasis is a frequent, incurable outcome after BCT and can occur at least up to 15 years after primary treatment. We have added to the expanding knowledge of patient and tumor characteristics and treatment modalities associated with the development of
Disclosure
The authors have stated that they have no conflicts of interest.
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