This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elkhuizen, P. H. M. Articles by van de Vijver, M. J. Search for Related Content PubMed PubMed Citation Articles by Elkhuizen, P. H. M. Articles by van de Vijver, M. J.

High Local Recurrence Risk After Breast-Conserving Therapy in Node-Negative Premenopausal Breast Cancer Patients Is Greatly Reduced by One Course of Perioperative Chemotherapy: A European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group Study

From the Departments of Clinical Oncology, Surgery, Pathology, and Medical Statistics, Leiden University Medical Center, Leiden; Department of Pathology, the Netherlands Cancer Institute, Amsterdam, the Netherlands; and European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group (Data Center, Brussels, Belgium, and member institutions).

Address reprint requests to Marc J. van de Vijver, Department of Pathology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; email mvijver{at}nki.nl

PURPOSE: Patients with invasive breast cancer may develop a local recurrence (LR) after breast-conserving therapy (BCT). Younger age has been found to be an independent risk factor for LR. Within a group of premenopausal node-negative breast cancer patients, we studied risk factors for LR and the effect of perioperative chemotherapy (PeCT) on LR.

PATIENTS AND METHODS: The European Organization for Research and Treatment of Cancer (EORTC) conducted a randomized trial (EORTC 10854) to compare surgery followed by one course of PeCT (fluorouracil, doxorubicin, and cyclophosphamide) with surgery alone. From patients treated on this trial, we selected premenopausal patients with node-negative breast cancer who were treated with BCT to examine whether histologic characteristics and the expression of various proteins (estrogen receptor, progesterone receptor, p53, Ki-67, bcl-2, CD31, c-erbB-2/neu) are risk factors for subsequent LR. Also, the effect of one course of PeCT on the LR risk (LRR) was studied.

RESULTS: Using multivariate analysis, age younger than 43 years (relative risk [RR], 2.75; 95% confidence interval [CI], 1.46 to 5.18; P = .002), multifocal growth (RR, 3.34; 95% CI, 1.27 to 8.77; P = .014), and elevated levels of p53 (RR, 2.14; 95% CI, 1.13 to 4.05; P = .02) were associated with higher LRR. Also, PeCT was found to reduce LRR by more than 50% (RR, 0.47; 95% CI, 0.25 to 0.86; P = .02). Patients younger than 43 years who received PeCT achieved similar LR rates as those of patients younger than 43 years who were treated with BCT alone.

CONCLUSION: In premenopausal node-negative patients, age younger than 43 years is the most important risk factor for LR after BCT; this risk is greatly reduced by one course of PeCT. The main reason for administering systemic adjuvant treatment is to improve overall survival. The important reduction of LR after BCT is an additional reason for considering systemic treatment in young node-negative patients with breast cancer.

Presented at the European Cancer Conference ECCO 10, September 1999, Vienna, Austria.

This article has been cited by other articles:

				J. K. Kim, B. S. Kwak, J. S. Lee, S. J. Hong, H. J. Kim, B. H. Son, and S. H. Ahn Do Very Young Korean Breast Cancer Patients Have Worse Outcomes? Ann. Surg. Oncol., December 1, 2007; 14(12): 3385 - 3391. [Abstract] [Full Text] [PDF]

				H. Bartelink, J.-C. Horiot, P. M. Poortmans, H. Struikmans, W. Van den Bogaert, A. Fourquet, J. J. Jager, W. J. Hoogenraad, S. B. Oei, C. C. Warlam-Rodenhuis, et al. Impact of a Higher Radiation Dose on Local Control and Survival in Breast-Conserving Therapy of Early Breast Cancer: 10-Year Results of the Randomized Boost Versus No Boost EORTC 22881-10882 Trial J. Clin. Oncol., August 1, 2007; 25(22): 3259 - 3265. [Abstract] [Full Text] [PDF]

				B. Kreike, H. Halfwerk, P. Kristel, A. Glas, H. Peterse, H. Bartelink, and M. J. van de Vijver Gene expression profiles of primary breast carcinomas from patients at high risk for local recurrence after breast-conserving therapy. Clin. Cancer Res., October 1, 2006; 12(19): 5705 - 5712. [Abstract] [Full Text] [PDF]

				I. L. Wapnir, S. J. Anderson, E. P. Mamounas, C. E. Geyer Jr, J.-H. Jeong, E. Tan-Chiu, B. Fisher, and N. Wolmark Prognosis After Ipsilateral Breast Tumor Recurrence and Locoregional Recurrences in Five National Surgical Adjuvant Breast and Bowel Project Node-Positive Adjuvant Breast Cancer Trials J. Clin. Oncol., May 1, 2006; 24(13): 2028 - 2037. [Abstract] [Full Text] [PDF]

				A. C. Voogd and G. van Tienhoven Breast conservation in patients of 35 years or younger Ann. Onc., April 1, 2004; 15(4): 690 - 691. [Full Text] [PDF]

				H. Joensuu Primary chemotherapy of breast cancer followed by perioperative chemotherapy: feasible, but are there clinical benefits? Ann. Onc., October 1, 2003; 14(10): 1460 - 1462. [Full Text] [PDF]

				G. M. Freedman, A. L. Hanlon, B. L. Fowble, P. R. Anderson, and N. Nicoloau Recursive Partitioning Identifies Patients at High and Low Risk for Ipsilateral Tumor Recurrence After Breast-Conserving Surgery and Radiation J. Clin. Oncol., October 1, 2002; 20(19): 4015 - 4021. [Abstract] [Full Text] [PDF]

				F. A. Vicini and A. Recht Age at Diagnosis and Outcome for Women With Ductal Carcinoma-In-Situ of the Breast: A Critical Review of the Literature J. Clin. Oncol., June 1, 2002; 20(11): 2736 - 2744. [Abstract] [Full Text] [PDF]

				N. Q. Mirza, G. Vlastos, F. Meric, T. A. Buchholz, N. Esnaola, S. E. Singletary, H. M. Kuerer, L. A. Newman, F. C. Ames, M. I. Ross, et al. Predictors of Locoregional Recurrence Among Patients With Early-Stage Breast Cancer Treated With Breast-Conserving Therapy Ann. Surg. Oncol., April 1, 2002; 9(3): 256 - 265. [Abstract] [Full Text] [PDF]

				P. M. Ravdin Is Her2 of Value in Identifying Patients Who Particularly Benefit From Anthracyclines During Adjuvant Therapy? A Qualified Yes. J Natl Cancer Inst Monographs, December 1, 2001; 2001(30): 80 - 84. [Abstract] [Full Text] [PDF]

				J. A. van der Hage, C. J.H. van de Velde, J.-P. Julien, M. Tubiana-Hulin, C. Vandervelden, and L. Duchateau Preoperative Chemotherapy in Primary Operable Breast Cancer: Results From the European Organization for Research and Treatment of Cancer Trial 10902 J. Clin. Oncol., November 15, 2001; 19(22): 4224 - 4237. [Abstract] [Full Text]

				H. Bartelink, J.-C. Horiot, P. Poortmans, H. Struikmans, W. Van den Bogaert, I. Barillot, A. Fourquet, J. Borger, J. Jager, W. Hoogenraad, et al. Recurrence Rates after Treatment of Breast Cancer with Standard Radiotherapy with or without Additional Radiation N. Engl. J. Med., November 8, 2001; 345(19): 1378 - 1387. [Abstract] [Full Text] [PDF]