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Outcome at 8 Years After Breast-Conserving Surgery and Radiation Therapy for Invasive Breast Cancer: Influence of Margin Status and Systemic Therapy on Local Recurrence

From the Joint Center for Radiation Therapy; Departments of Radiation Oncology and PathologyBeth Israel Deaconess Medical Center; Department of Radiation Oncology, Brigham and Women’s Hospital; and the Division of Biostatistics and Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.

Address reprint requests to Catherine Park, MD, Joint Center for Radiation Therapy, 330 Brookline Ave, Boston, MA 02215; email CPark{at}jcrt.harvard.edu

PURPOSE: To examine the relationship between pathologic margin status and outcome at 8 years after breast-conserving surgery and radiation therapy.

PATIENTS AND METHODS: The study population comprised 533 patients with International Union Against Cancer/American Joint Committee on Cancer clinical stage I or II breast cancer who had assessable margins, who received at least 60 Gy to the primary tumor bed, and who had more than 8 years of potential follow-up. Each margin was scored (according to the presence of invasive or in situ disease that touched the inked surgical margin) as one of the following: negative, close, focally positive, or extensively positive. Outcome at 8 years was calculated using crude rates of first site of failure. A polychotomous logistic regression analysis was performed. Median follow-up time was 127 months.

RESULTS: At 8 years, patients with close margins and those with negative margins both had a rate of local recurrence (LR) of 7%. Patients with extensively positive margins had an LR rate of 27%, whereas patients with focally positive margins had an intermediate rate of LR of 14%. In the polychotomous logistic regression model, margin status and the use of systemic therapy were the only two variables that had significant effects on the risk ratio of LR to remaining alive and free of disease. Among the 45 patients with focally positive margins who received systemic therapy, the crude LR rate was 7% at 8 years (95% confidence interval, 1% to 20%).

CONCLUSION: Pathologic margin status and the use of adjuvant systemic therapy are the most important factors associated with LR among patients treated with breast-conserving surgery and radiation therapy.

Presented in part at the Fortieth Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Phoenix, AZ, October 25-29, 1998, and the Twenty-First Annual San Antonio Breast Cancer Symposium, San Antonio, TX, December 9-12, 1998.

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