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The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy

1994; Wiley; Volume: 74; Issue: 6 Linguagem: Inglês

10.1002/1097-0142(19940915)74

1097-0142

Stuart J. Schnitt, Anthony Abner, Rebecca Gelman, James L. Connolly, Abram Recht, Rosemary B. Duda, Timothy J. Eberlein, Kathleen Mayzel, Barbara Silver, Jay R. Harris,

Breast Lesions and Carcinomas

CancerVolume 74, Issue 6 p. 1746-1751 ArticleFree Access The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy Stuart J. Schnitt M. D., Corresponding Author Stuart J. Schnitt M. D. Department of Pathology, Beth Israel Hospital and Harvard Medical School, Boston Breast Evaluation Center, Dana-Farber Cancer Institute, BostonDepartment of Pathology, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215===Search for more papers by this authorAnthony Abner M. D., Anthony Abner M. D. Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this authorRebecca Gelman Ph. D., Rebecca Gelman Ph. D. Division of Biostatistics, Dana-Farber Cancer Institute and Harvard School of Public Health, BostonSearch for more papers by this authorJames L. Connolly M. D., James L. Connolly M. D. Department of Pathology, Beth Israel Hospital and Harvard Medical School, Boston Breast Evaluation Center, Dana-Farber Cancer Institute, BostonSearch for more papers by this authorAbram Recht M. D., Abram Recht M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this authorRosemary B. Duda M. D., Rosemary B. Duda M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Division of Surgical Oncology, Beth Israel Hospital and Harvard Medical School, BostonSearch for more papers by this authorTimothy J. Eberlein M. D., Timothy J. Eberlein M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Departments of Surgery (Division of Surgical Oncology), Brigham and Women's Hospital and Harvard Medical School, BostonSearch for more papers by this authorKathleen Mayzel M. D., Kathleen Mayzel M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Faulkner Breast Center, Faulkner Hospital, Jamaica Plain, MassachusettsSearch for more papers by this authorBarbara Silver B. A., Barbara Silver B. A. Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this authorJay R. Harris M. D., Jay R. Harris M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this author Stuart J. Schnitt M. D., Corresponding Author Stuart J. Schnitt M. D. Department of Pathology, Beth Israel Hospital and Harvard Medical School, Boston Breast Evaluation Center, Dana-Farber Cancer Institute, BostonDepartment of Pathology, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215===Search for more papers by this authorAnthony Abner M. D., Anthony Abner M. D. Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this authorRebecca Gelman Ph. D., Rebecca Gelman Ph. D. Division of Biostatistics, Dana-Farber Cancer Institute and Harvard School of Public Health, BostonSearch for more papers by this authorJames L. Connolly M. D., James L. Connolly M. D. Department of Pathology, Beth Israel Hospital and Harvard Medical School, Boston Breast Evaluation Center, Dana-Farber Cancer Institute, BostonSearch for more papers by this authorAbram Recht M. D., Abram Recht M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this authorRosemary B. Duda M. D., Rosemary B. Duda M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Division of Surgical Oncology, Beth Israel Hospital and Harvard Medical School, BostonSearch for more papers by this authorTimothy J. Eberlein M. D., Timothy J. Eberlein M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Departments of Surgery (Division of Surgical Oncology), Brigham and Women's Hospital and Harvard Medical School, BostonSearch for more papers by this authorKathleen Mayzel M. D., Kathleen Mayzel M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Faulkner Breast Center, Faulkner Hospital, Jamaica Plain, MassachusettsSearch for more papers by this authorBarbara Silver B. A., Barbara Silver B. A. Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this authorJay R. Harris M. D., Jay R. Harris M. D. Breast Evaluation Center, Dana-Farber Cancer Institute, Boston Joint Center for Radiation Therapy, Harvard Medical School, BostonSearch for more papers by this author First published: 15 September 1994 https://doi.org/10.1002/1097-0142(19940915)74:6 3.0.CO;2-YCitations: 379AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Background. The relationships among the involvement of tumor at the final margins of resection, the presence of an extensive intraductal component (EIC), and the risk of local recurrence are important considerations in patients treated with conservative surgery and radiation therapy for early stage breast cancer but have not been defined adequately. Methods. Between 1982 and 1985, 885 patients were treated for clinical Stage I or II invasive breast cancer. The study population was limited to 181 patients with an infiltrating ductal carcinoma who received a radiation dose to the surgical site of 60 Gy or greater, whose final microscopic margins of resection were evaluable, and who had at least 5 years of follow-up. A positive margin was defined as tumor present at the inked margin of resection, a close margin as tumor within 1 mm of the inked margin, and a negative margin as no tumor within 1 mm of the inked margin. A focally positive margin was defined as tumor at the margin in three or fewer low-power fields. In 157 patients (87%), the tumor was evaluable for the presence or absence of an EIC. The median follow-up was 86 months. Results. In 12 of 181 patients (7%), a recurrence developed at or near the primary site (true recurrence/marginal miss [TR/MM]) within 5 years. The 5-year rate of TR/MM (with 95% confidence intervals) among patients with negative, close, focally positive, and more than focally positive margins was 0% (0-4%), 4% (0-20%), 6% (1-17%) and 21% (10-37%), respectively. Patients with positive margins also were more likely to have a distant failure within 5 years (14%, 8%, 25%, and 32% in the four groups, respectively). However, patients with positive margins more often had positive axillary lymph nodes than patients with negative or close margins (59% vs. 38%, P < 0.02). The 5-year rate of TR/MM was 20% for patients with an EIC-positive tumor and 7% for patients with an EIC-negative tumor. However, among the 127 patients with an EIC-negative tumor, the 5-year rate of TR/MM was less than 10% in all margin groups. Among the 30 patients with an EIC-positive tumor, the 5-year rate of TR/MM was 0% when margins were negative or close but 50% when margins were more than focally positive. Conclusions. These results provide support for the use of breast-conserving surgery and breast irradiation in all patients with uninvolved margins, whether the tumor is EIC-positive or EIC-negative. This study suggests that breast-conserving therapy (including a radiation boost to the primary site) also may be a reasonable option for some patients with an EIC-negative tumor and margin involvement. References 1 Veronesi U, Volterrani F, Luini A, Sacozzi R, Del Vecchio M, Zucali R, et al. Quadrantectomy versus lumpectomy for small size breast cancer. 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