PURPOSE: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. METHODS AND MATERIALS: Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. RESULTS: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). CONCLUSIONS: On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.
PURPOSE: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. METHODS AND MATERIALS: Subjects were 2,264 women with pT1-3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer-specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. RESULTS: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age <45 years, 11.8% with Grade III, 11.3% with lymphovascular invasion (LVI), and 26.3% with ≥4 positive nodes. Corresponding rates in the negative margin cohort were 2.3%, 2.4%, 1.0%, and 2.4%, respectively. On Cox regression analysis of the entire cohort, close or positive margin, Grade III histology, ≥4 positive nodes, and lack of systemic therapy were significantly associated with higher LR risk. When close/positive margin cases were matched to negative margin controls, the difference in 5-year LR remained significant (4.25% vs. 0.7%, p < 0.001). CONCLUSIONS: On univariable analysis, subsets with close or positive margins, in combination with age <45 years, Grade III, LVI, and ≥4 positive nodes, have 5-year LR >10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.
Authors: Joerg Heil; Valerie Fuchs; Michael Golatta; Sarah Schott; Markus Wallwiener; Christoph Domschke; Peter Sinn; Michael P Lux; Christof Sohn; Florian Schütz Journal: Breast Care (Basel) Date: 2012-10 Impact factor: 2.860
Authors: Tae In Yoon; Jong Won Lee; Sae Byul Lee; Guiyun Sohn; Jisun Kim; Il Young Chung; Hee Jeong Kim; Beom Seok Ko; Byung Ho Son; Gyungyub Gong; Sung-Bae Kim; Su Ssan Kim; Seung Do Ahn; Minsung Chung; Sei Hyun Ahn Journal: Cancer Res Treat Date: 2017-04-14 Impact factor: 4.679
Authors: Maximilian Präger; Marion Kiechle; Björn Stollenwerk; Christoph Hinzen; Jürgen Glatz; Matthias Vogl; Reiner Leidl Journal: PLoS One Date: 2018-06-01 Impact factor: 3.240
Authors: Freya Schnabel; Susan K Boolbol; Mark Gittleman; Tami Karni; Lorraine Tafra; Sheldon Feldman; Alice Police; Neil B Friedman; Scott Karlan; Dennis Holmes; Shawna C Willey; Moshe Carmon; Kristen Fernandez; Stephanie Akbari; Jay Harness; Lisa Guerra; Thomas Frazier; Karen Lane; Rache M Simmons; Alison Estabrook; Tanir Allweis Journal: Ann Surg Oncol Date: 2014-03-05 Impact factor: 5.344