Local recurrence versus new primary: Clinical analysis of 82 breast relapses and potential applications for genetic fingerprinting

Bruce Haffty, Darryl Carter, Stuart D. Flynn, Diana B. Fischer, Douglas E. Brash, Jeffrey Simons, Anne Marie Ziegler, James J. Fischer

Research output: Contribution to journalArticle

77 Scopus citations

Abstract

Purpose: The purpose of this study was to perform a detailed clinical pathological analysis of breast relapses in patients treated with conservative surgery and radiation therapy in an effort to classify those relapses as true local recurrences or second primary tumors, and to assess the prognostic and therapeutic implications of such a classification system. Methods and Materials: Of 990 patients treated with conservative surgery and radiation therapy at our facilities prior to December 1987, 82 patients have experienced a relapse in the conservatively treated breast as the primary site of failure. Patients were classified as having new primary tumors if they fulfilled any one of the following criteria: a) breast relapse occurring at a site distinctly removed from the original tumor; b) histology of the breast relapse compared with the original tumor consistent with a new primary; or c) DNA flow cytometry converting from an aneuploid primary to a diploid relapse. Results: As of 2/92, with a median follow-up of 5.4 years from the time of breast relapse, the overall 5-year survival rate following breast relapse was 55%. Forty-seven patients were classified as true recurrences and 33 patients were classified as new primaries. Patients classified as true recurrences had a shorter median time to breast relapse than patients classified as new primaries (3.16 years vs.5.42 years, p <.05) and an inferior post breast recurrence survival rate compared to patients classified as new primaries (36% vs.89%, p <.05). Residual disease outside of the recurrent tumor bed was also noted to be more frequent in patients classified as true recurrences compared to patients classified as new primaries (48% vs.16%, p <.05). Conclusion: Based on the clinical and pathological criteria outlined, it appears that a significant portion of patients experiencing a relapse in the conservatively treated breast may have new primary tumors as opposed to true local relapses. Distinction between a true recurrence and a new primary tumor may have significant prognostic implications. Uncertainties associated with the clinical and pathological criteria are presented and further investigations with genetic fingerprinting techniques to establish the clonality of breast relapses are presented and discussed.

Original languageEnglish (US)
Pages (from-to)575-583
Number of pages9
JournalInternational journal of radiation oncology, biology, physics
Volume27
Issue number3
DOIs
StatePublished - Oct 20 1993

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Keywords

  • Conservative surgery and radiation therapy
  • Genetic fingerprinting
  • Local recurrence

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