Local recurrence after conserving breast therapy: A retrospective study

Breast conservative therapy (BCT) is the preferred treatment for early breast cancer and carries low local recurrence (LR) rates. Proper follow up is mandatory and includes periodic clinical examination, mammography and ultrasound to detect early recurrence. This study aims at evaluating the results of breast conservative therapy especially as regard local recurrence.
Methods: Between January 2000 and July 2008, 241 consecutive female patients with early breast cancer were surgically treated by conservation surgery plus radiotherapy. Two patients had bilateral breast cancer and were subjected to preservation surgery on both sides in the same setting. The median age of patients was 48 years (range 23-76). Two hundred twenty four cases were treated by wide local excision and axillary clearance (level I&II) and 19 cases utilized the down staging policy which entails preoperative chemotherapy followed by preservation procedure. Patients were followed after surgery from one to 10 years (average 5.5yrs).
Those who developed suspicious lesions on mammography or ultrasound were subjected to magnetic resonance imaging (MRI) and then all suspicious lesions were subjected to biopsy and histopathologic examination.
Results: During follow-up, 62 out of 241 cases showed abnormal mammographic findings and were all subjected to magnetic resonance imaging (MRI) and then biopsy of all suspicious lesions.
Local recurrence was detected in 12 of them (4.9%). For 11 cases, LR was the only event and one case showed coincident LR and distant metastasis. The recurrences detected were true (n=7) or marginal (n=3), which arise within or adjacent to the excision area, respectively. Only
2 recurrences were located elsewhere in the breast (n=2).
In the present study, patients with large breasts were found to have a lower risk of local recurrence compared to patients with small breasts; highly statistically significant relation (p < 0.01). Statistically significant relation was also found between young age and the risk of LR (p < 0.05).
In the present study, patients with tumor size 2 cm, statistically significant relation (p=0.017). Statistically significant relation was also found between positive lymph nodes (+ve LNs) and the risk of LR (p < 0.01).
Four patients with LRs underwent salvage mastectomy, and the other 8 patients received wider local excision and adjuvant therapy.  No mortalities were detected in patients with LR.
In conclusion, breast conserving therapy is an appropriate primary therapy for early breast cancer, surgeons should be aware of the mammographic findings following such a surgery. Young age, breast size, tumor size and lymph status should be considered in planning optimal treatment for breast cancer. Detection of biological risk factors for types of LR would be fruitful to distinguish unfavorable LRs that need systemic therapy from favorable LRs which could be treated only locally.