Incidence and Patterns of Distant Metastases for Patients With Early-Stage Breast Cancer After Breast Conservation Treatment

doi:10.1016/j.clbc.2012.11.001

Clinical Breast Cancer

Volume 13, Issue 2, April 2013, Pages 88-94

https://doi.org/10.1016/j.clbc.2012.11.001 Get rights and content

Abstract

Background

Methods

A total of 1754 patients with stage I or II invasive carcinoma of the breast treated with BCT between 1977 and 2003 were identified. Patients were scored based on first site of metastasis: bone, brain, lung, liver, or other. Non–breast cancer deaths, contralateral breast cancer, and second malignancies were treated as competing risks events. Cumulative incidence functions for each competing event were calculated using competing risk methodology. Univariate analysis was performed to determine the hazard ratio (HR) associated with patient and tumor characteristics.

Results

The most common event was non–breast cancer death (16.5% at 15 years; 95% confidence interval [CI], 13.9%-19.4%). The most common exclusive first site of metastasis was bone (5.9% at 15 years). The 4 most common anatomic sites of distant metastases as the first exclusive event were bone (41.1%), lung (22.4%), liver (7.3%), and brain (7.3%).

Conclusion

The present study has demonstrated the site-specific risks of metastases. These data support current clinical practice of screening for site-specific metastatic disease after BCT based on concerning patient-specific signs or symptoms.

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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Original studyIncidence and Patterns of Distant Metastases for Patients With Early-Stage Breast Cancer After Breast Conservation Treatment

Abstract

Background

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Disclosure

Radiother Oncol

Eur J Cancer

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Surg Clin North Am

Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer

N Engl J Med

Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysisDanish Breast Cancer Cooperative Group

J Natl Cancer Inst Monogr

Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial

J Natl Cancer Inst Monogr

Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer

N Engl J Med

Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials

Lancet

Global cancer statistics

CA Cancer J Clin

Original study
Incidence and Patterns of Distant Metastases for Patients With Early-Stage Breast Cancer After Breast Conservation Treatment