Breast relapse following primary radiation therapy for early breast cancer. II. Detection, pathologic features and prognostic significance.

In order to define better the nature of breast relapse following primary radiation therapy for early-stage invasive breast cancer, we examined the clinical patterns, methods of detection, histopathology and prognosis in 25 patients. Eighty-eight percent of these relapses occurred in the vicinity of the original tumor at an average of 33 months after treatment. Twelve percent occurred in a location distinctly separate from the primary tumor area at an average of 75 months after treatment. In 14 patients breast relapse was detected by physical examination (PE) alone, in 6 patients by mammography alone and in 5 patients by both. In eight of the patients whose relapses were detected by PE alone, mammography was not performed; mammograms were negative in the other six. In 89% of the patients who presented with a new abnormality on physical examination, the recurrence consisted predominantly or exclusively of invasive carcinoma. In contrast, in all six patients who presented with only a new mammographic abnormality, the recurrence consisted predominantly or exclusively of intraductal carcinoma. Eighteen of these patients underwent salvage mastectomy, 3 were inoperable on clinical grounds and 4 refused mastectomy. Only 1 of the 18 patients who underwent mastectomy had a significant complication related to the surgery. Twenty-one of these 25 patients (84%) are alive without further recurrence up to 67 months (mean 24 months) after breast relapse. We conclude that (1) physical examination and mammography are both important for the detection of breast relapses: (2) secondary (salvage) surgery can be performed without significant complications; and (3) a breast relapse does not have the same grave prognosis as a local (chest wall) recurrence after mastectomy.