True recurrence vs. new primary ipsilateral breast tumor relapse

An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management

Tanya E. Smith, Daesung Lee, Bruce C. Turner, Darryl Carter, Bruce G. Haffty

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study was to classify all ipsilateral breast tumor relapses (IBTR) in patients treated with conservative surgery and radiation therapy (CS+RT) as either new primary tumors (NP) or true local recurrences (TR) and to assess the prognostic and therapeutic implications of this classification.Methods and Materials: Of the 1152 patients who have been treated at Yale-New Haven Hospital before 1990, 136 patients have experienced IBTR as their primary site of failure. These relapses were classified as either NP or TR. Specifically, patients were classified as NP if the recurrence was distinctly different from the primary tumor with respect to the histologic subtype, the recurrence location was in a different location, or if the flow cytometry changed from aneuploid to diploid. This information was determined by a detailed review of each patient's hospital and/or radiotherapy record, mammograms, and pathologic reports.Results: As of 2/99, with a mean follow-up of 14.2 years, the overall ipsilateral breast relapse-free rate for all 1152 patients was 86% at 10 years. Using the classification scheme outlined above, 60 patient relapses were classified as TR, 70 were classified as NP and 6 were unable to be classified. NP patients had a longer mean time to breast relapse than TR patients (7.3 years vs. 3.7 years, p <0.0001) and were significantly younger than TR patients (48.9 years vs. 54.5 years, p <0.01). Patients developed both TR and NP at similar rates until approximately 8 years, when TR rates stabilized but NP rates continued to rise. By 15 years following original diagnosis, the TR rate was 6.8% compared to 13.1% for NP. Of the patients who had been previously tested for BRCA1/2 mutations, 17% (8/52) had deleterious mutations. It is noteworthy that all patients with deleterious mutations had new primary IBTR, while patients without deleterious mutations had both TR and NP (p = 0.06). Ploidy was evenly distributed between TR and NP but NP had a significantly lower S phase fraction (NP 13.1 vs. TR 22.0, p <0.05). The overall survival following breast relapse was 64% at 10 years and 49% at 15 years. With a mean follow-up of 10.4 years following breast relapse, patients with NP had better 10-year overall survival (TR 55% vs. NP 75%, p <0.0001), distant disease-free survival (TR 41% vs. NP 85%, p <0.0001), and cause-specific survival (TR 55% vs. NP 90%, p <0.0001).Conclusion: It appears that a significant portion of patients who experience ipsilateral breast tumor relapse following conservative surgery and radiation therapy have new primary tumors as opposed to true local recurrences. True recurrence and new primary tumor ipsilateral breast tumor relapses have different natural histories, different prognoses, and, in turn, different implications for therapeutic management. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)1281-1289
Number of pages9
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume48
Issue number5
DOIs
StatePublished - Dec 1 2000
Externally publishedYes

Fingerprint

prognosis
Natural History
breast
tumors
histories
Breast Neoplasms
Recurrence
Neoplasms
Therapeutics
mutations
Breast
radiation therapy
Mutation
Radiotherapy
surgery
New Haven (CT)
therapy
Survival

Keywords

  • BRCA1
  • Conservative surgery
  • Ipsilateral breast tumor recurrence
  • Local recurrence
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

True recurrence vs. new primary ipsilateral breast tumor relapse : An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. / Smith, Tanya E.; Lee, Daesung; Turner, Bruce C.; Carter, Darryl; Haffty, Bruce G.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 48, No. 5, 01.12.2000, p. 1281-1289.

Research output: Contribution to journalArticle

@article{98d8168ce6444eebae7bbb535c191b42,
title = "True recurrence vs. new primary ipsilateral breast tumor relapse: An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management",
abstract = "Purpose: The purpose of this study was to classify all ipsilateral breast tumor relapses (IBTR) in patients treated with conservative surgery and radiation therapy (CS+RT) as either new primary tumors (NP) or true local recurrences (TR) and to assess the prognostic and therapeutic implications of this classification.Methods and Materials: Of the 1152 patients who have been treated at Yale-New Haven Hospital before 1990, 136 patients have experienced IBTR as their primary site of failure. These relapses were classified as either NP or TR. Specifically, patients were classified as NP if the recurrence was distinctly different from the primary tumor with respect to the histologic subtype, the recurrence location was in a different location, or if the flow cytometry changed from aneuploid to diploid. This information was determined by a detailed review of each patient's hospital and/or radiotherapy record, mammograms, and pathologic reports.Results: As of 2/99, with a mean follow-up of 14.2 years, the overall ipsilateral breast relapse-free rate for all 1152 patients was 86{\%} at 10 years. Using the classification scheme outlined above, 60 patient relapses were classified as TR, 70 were classified as NP and 6 were unable to be classified. NP patients had a longer mean time to breast relapse than TR patients (7.3 years vs. 3.7 years, p <0.0001) and were significantly younger than TR patients (48.9 years vs. 54.5 years, p <0.01). Patients developed both TR and NP at similar rates until approximately 8 years, when TR rates stabilized but NP rates continued to rise. By 15 years following original diagnosis, the TR rate was 6.8{\%} compared to 13.1{\%} for NP. Of the patients who had been previously tested for BRCA1/2 mutations, 17{\%} (8/52) had deleterious mutations. It is noteworthy that all patients with deleterious mutations had new primary IBTR, while patients without deleterious mutations had both TR and NP (p = 0.06). Ploidy was evenly distributed between TR and NP but NP had a significantly lower S phase fraction (NP 13.1 vs. TR 22.0, p <0.05). The overall survival following breast relapse was 64{\%} at 10 years and 49{\%} at 15 years. With a mean follow-up of 10.4 years following breast relapse, patients with NP had better 10-year overall survival (TR 55{\%} vs. NP 75{\%}, p <0.0001), distant disease-free survival (TR 41{\%} vs. NP 85{\%}, p <0.0001), and cause-specific survival (TR 55{\%} vs. NP 90{\%}, p <0.0001).Conclusion: It appears that a significant portion of patients who experience ipsilateral breast tumor relapse following conservative surgery and radiation therapy have new primary tumors as opposed to true local recurrences. True recurrence and new primary tumor ipsilateral breast tumor relapses have different natural histories, different prognoses, and, in turn, different implications for therapeutic management. Copyright (C) 2000 Elsevier Science Inc.",
keywords = "BRCA1, Conservative surgery, Ipsilateral breast tumor recurrence, Local recurrence, Radiation therapy",
author = "Smith, {Tanya E.} and Daesung Lee and Turner, {Bruce C.} and Darryl Carter and Haffty, {Bruce G.}",
year = "2000",
month = "12",
day = "1",
doi = "10.1016/S0360-3016(00)01378-X",
language = "English (US)",
volume = "48",
pages = "1281--1289",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - True recurrence vs. new primary ipsilateral breast tumor relapse

T2 - An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management

AU - Smith, Tanya E.

AU - Lee, Daesung

AU - Turner, Bruce C.

AU - Carter, Darryl

AU - Haffty, Bruce G.

PY - 2000/12/1

Y1 - 2000/12/1

N2 - Purpose: The purpose of this study was to classify all ipsilateral breast tumor relapses (IBTR) in patients treated with conservative surgery and radiation therapy (CS+RT) as either new primary tumors (NP) or true local recurrences (TR) and to assess the prognostic and therapeutic implications of this classification.Methods and Materials: Of the 1152 patients who have been treated at Yale-New Haven Hospital before 1990, 136 patients have experienced IBTR as their primary site of failure. These relapses were classified as either NP or TR. Specifically, patients were classified as NP if the recurrence was distinctly different from the primary tumor with respect to the histologic subtype, the recurrence location was in a different location, or if the flow cytometry changed from aneuploid to diploid. This information was determined by a detailed review of each patient's hospital and/or radiotherapy record, mammograms, and pathologic reports.Results: As of 2/99, with a mean follow-up of 14.2 years, the overall ipsilateral breast relapse-free rate for all 1152 patients was 86% at 10 years. Using the classification scheme outlined above, 60 patient relapses were classified as TR, 70 were classified as NP and 6 were unable to be classified. NP patients had a longer mean time to breast relapse than TR patients (7.3 years vs. 3.7 years, p <0.0001) and were significantly younger than TR patients (48.9 years vs. 54.5 years, p <0.01). Patients developed both TR and NP at similar rates until approximately 8 years, when TR rates stabilized but NP rates continued to rise. By 15 years following original diagnosis, the TR rate was 6.8% compared to 13.1% for NP. Of the patients who had been previously tested for BRCA1/2 mutations, 17% (8/52) had deleterious mutations. It is noteworthy that all patients with deleterious mutations had new primary IBTR, while patients without deleterious mutations had both TR and NP (p = 0.06). Ploidy was evenly distributed between TR and NP but NP had a significantly lower S phase fraction (NP 13.1 vs. TR 22.0, p <0.05). The overall survival following breast relapse was 64% at 10 years and 49% at 15 years. With a mean follow-up of 10.4 years following breast relapse, patients with NP had better 10-year overall survival (TR 55% vs. NP 75%, p <0.0001), distant disease-free survival (TR 41% vs. NP 85%, p <0.0001), and cause-specific survival (TR 55% vs. NP 90%, p <0.0001).Conclusion: It appears that a significant portion of patients who experience ipsilateral breast tumor relapse following conservative surgery and radiation therapy have new primary tumors as opposed to true local recurrences. True recurrence and new primary tumor ipsilateral breast tumor relapses have different natural histories, different prognoses, and, in turn, different implications for therapeutic management. Copyright (C) 2000 Elsevier Science Inc.

AB - Purpose: The purpose of this study was to classify all ipsilateral breast tumor relapses (IBTR) in patients treated with conservative surgery and radiation therapy (CS+RT) as either new primary tumors (NP) or true local recurrences (TR) and to assess the prognostic and therapeutic implications of this classification.Methods and Materials: Of the 1152 patients who have been treated at Yale-New Haven Hospital before 1990, 136 patients have experienced IBTR as their primary site of failure. These relapses were classified as either NP or TR. Specifically, patients were classified as NP if the recurrence was distinctly different from the primary tumor with respect to the histologic subtype, the recurrence location was in a different location, or if the flow cytometry changed from aneuploid to diploid. This information was determined by a detailed review of each patient's hospital and/or radiotherapy record, mammograms, and pathologic reports.Results: As of 2/99, with a mean follow-up of 14.2 years, the overall ipsilateral breast relapse-free rate for all 1152 patients was 86% at 10 years. Using the classification scheme outlined above, 60 patient relapses were classified as TR, 70 were classified as NP and 6 were unable to be classified. NP patients had a longer mean time to breast relapse than TR patients (7.3 years vs. 3.7 years, p <0.0001) and were significantly younger than TR patients (48.9 years vs. 54.5 years, p <0.01). Patients developed both TR and NP at similar rates until approximately 8 years, when TR rates stabilized but NP rates continued to rise. By 15 years following original diagnosis, the TR rate was 6.8% compared to 13.1% for NP. Of the patients who had been previously tested for BRCA1/2 mutations, 17% (8/52) had deleterious mutations. It is noteworthy that all patients with deleterious mutations had new primary IBTR, while patients without deleterious mutations had both TR and NP (p = 0.06). Ploidy was evenly distributed between TR and NP but NP had a significantly lower S phase fraction (NP 13.1 vs. TR 22.0, p <0.05). The overall survival following breast relapse was 64% at 10 years and 49% at 15 years. With a mean follow-up of 10.4 years following breast relapse, patients with NP had better 10-year overall survival (TR 55% vs. NP 75%, p <0.0001), distant disease-free survival (TR 41% vs. NP 85%, p <0.0001), and cause-specific survival (TR 55% vs. NP 90%, p <0.0001).Conclusion: It appears that a significant portion of patients who experience ipsilateral breast tumor relapse following conservative surgery and radiation therapy have new primary tumors as opposed to true local recurrences. True recurrence and new primary tumor ipsilateral breast tumor relapses have different natural histories, different prognoses, and, in turn, different implications for therapeutic management. Copyright (C) 2000 Elsevier Science Inc.

KW - BRCA1

KW - Conservative surgery

KW - Ipsilateral breast tumor recurrence

KW - Local recurrence

KW - Radiation therapy

UR - http://www.scopus.com/inward/record.url?scp=0034565272&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034565272&partnerID=8YFLogxK

U2 - 10.1016/S0360-3016(00)01378-X

DO - 10.1016/S0360-3016(00)01378-X

M3 - Article

VL - 48

SP - 1281

EP - 1289

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 5

ER -