Open AccessBreast Conservation Surgery Achieving ≥ 2 mm Tumor‐Free Margins Results in Decreased Local‐Regional Recurrence Rates
Author(s) -
Kunos Charles,
Latson Larry,
Overmoyer Beth,
Silverman Paula,
Shenk Robert,
Kinsella Timothy,
Lyons Janice
Publication year - 2006
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/j.1075-122x.2006.00181.x
Subject(s) - medicine , breast cancer , hormonal therapy , radiation therapy , surgical margin , surgery , lymph node , chemotherapy , cancer , oncology
Whether cosmetically acceptable tumor‐free (≥2 mm) surgical margins reduce the local‐regional recurrence risk for patients treated with fractionated radiation therapy, chemotherapy, and hormonal therapy is unknown. The benefit of a minimum cosmetically acceptable tumor‐free margin remains speculative because no contemporary studies have investigated the extent of invasive disease infiltration within the breast beyond the primary tumor. To address these clinical issues, we conducted a retrospective study of 341 women diagnosed with stage I or II invasive breast cancer to determine the rate of local in‐breast, elsewhere in‐breast, and ipsilateral regional lymph node recurrences of breast cancer after conservation surgery achieving either tumor‐free (≥2 mm) or close (>0 mm to <2 mm) surgical margins followed by whole breast radiation therapy over a 6‐year period from January 1996 to December 2002. Women may have received adjuvant chemotherapy or hormonal therapy as clinically indicated. After a median follow‐up of 56 months from the completion of breast conservation surgery, 14 of the 341 women (4.1%) developed breast cancer recurrences. Crude ipsilateral recurrence rates were 1.8% (4 of 222) for tumor‐free (≥2 mm) versus 8.4% (10 of 119) for close (>0 mm to <2 mm) surgical margins (p = 0.007). The estimated 5‐year cumulative local recurrence rate was significantly less for women with tumor‐free margins (2.1%) as compared to close surgical margins (8.9%) (p = 0.004). Multivariate analyses identified negative estrogen receptor expression (p = 0.004), close surgical margins (p = 0.012), and the presence of angiolymphatic invasion (p = 0.040) as prognostic factors for local‐regional recurrences. Microscopically the extent of invasive disease infiltration beyond the primary tumor was on average 1 mm, with all measured invasive disease less than 1 cm. Based on our findings, cosmetically acceptable tumor‐free (≥2 mm) surgical margins significantly reduce local in‐breast and regional lymph node recurrences with fractionated radiation therapy, chemotherapy, and hormonal therapy.