Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2017

01-02-2017 | Breast Oncology

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

Authors: Irene L. Wapnir, MD, Shari Gelber, MS, Stewart J. Anderson, PhD, Eleftherios P. Mamounas, MD, André Robidoux, MD, Miguel Martín, MD, Johan W. R. Nortier, MD, Charles E. Geyer Jr, MD, Alexander H. G. Paterson, MD, István Láng, MD, Karen N. Price, BS, Alan S. Coates, MD, Richard D. Gelber, PhD, Priya Rastogi, MD, Meredith M. Regan, ScD, Norman Wolmark, MD, Stefan Aebi, MD, On behalf of CALOR trial investigators

Published in: Annals of Surgical Oncology | Issue 2/2017

Login to get access

Abstract

Background

Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated.

Methods

In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome.

Results

The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had nodal ILRR, and one patient had chest wall ILRR. Among 64 patients whose primary surgery was mastectomy, 52 had chest wall/skin ILRR, and 12 had nodal ILRR. For 15 patients, a second ILRR developed a median of 1.6 years (range 0.08–4.8 years) after ILRR. All second ILRRs occurred for patients with progesterone receptor-negative ILRR. Death occurred for 7 (47 %) of 15 patients with a second ILRR and 19 (51 %) of 37 patients with a distant recurrence. As shown in the multivariable analysis, the significant predictors of survival after either a second ILRR or distant recurrence were chemotherapy for the primary cancer (hazard ratio [HR], 3.55; 95 % confidence interval [CI], 1.15–10.9; p = 0.03) and the interval (continuous) from the primary surgery (HR, 0.87; 95 % CI, 0.75–1.00; p = 0.05).

Conclusions

Second ILRRs represented about one third of all recurrence events after ILRR, and all were PR-negative. These second ILRRs and distant metastases portend an unfavorable outcome.
Appendix
Available only for authorised users
Literature
1.
Halverson KJ, Perez CA, Kuske RR, et al. Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis. Int J Radiat Oncol Biol Phys. 1992;23:285–91.CrossRefPubMed
2.
Fowble B, Solin LJ, Schultz DJ, et al. Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys. 1990;19:833–42.CrossRefPubMed
3.
Fisher B, Anderson S, Fisher ER, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991;338:327–31.CrossRefPubMed
4.
Veronesi U, Marubini E, Del Vecchio M, et al. Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst. 1995; 87:19–27.CrossRefPubMed
5.
Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24:2028–37.CrossRefPubMed
6.
Nielsen HM, Overgaard M, Grau C, et al. Locoregional recurrence after mastectomy in high-risk breast cancer–risk and prognosis: an analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol. 2006;79:147–55.CrossRefPubMed
7.
Anderson SJ, Wapnir I, Dignam JJ, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. J Clin Oncol. 2009;27:2466–73.CrossRefPubMedPubMedCentral
8.
Botteri E, Rotmensz N, Sangalli C, et al. Unavoidable mastectomy for ipsilateral breast tumour recurrence after conservative surgery: patient outcome. Ann Oncol. 2009;20:1008–12.CrossRefPubMed
9.
Kuerer HM, Arthur DW, Haffty BG. Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: the potential role of partial breast irradiation. Cancer. 2004;100:2269–80.CrossRefPubMed
10.
Schuck A, Könemann S, Matthees B, et al. Radiotherapy in the treatment of locoregional relapses of breast cancer. Br J Radiol. 2002;75:663–9.CrossRefPubMed
11.
12.
Hannoun-Levi J-M, Ihrai T, Courdi A. Local treatment options for ipsilateral breast tumour recurrence. Cancer Treat Rev. 2013;39:737–41.CrossRefPubMed
13.
Maaskant-Braat AJG, Voogd AC, Roumen RMH, et al. Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2013;138:13–20.CrossRefPubMed
14.
Aebi S, Gelber S, Anderson SJ, et al. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol. 2014;15:156–63.CrossRefPubMedPubMedCentral
15.
Kurtz JM, Jacquemier J, Amalric R, et al. Is breast conservation after local recurrence feasible? Eur J Cancer. 1991;27:240–4.CrossRefPubMed
16.
Salvadori B, Marubini E, Miceli R, et al. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg. 1999;86:84–7.CrossRefPubMed
17.
Ishitobi M, Komoike Y, Nakahara S, et al. Repeat lumpectomy for ipsilateral breast tumor recurrence after breast-conserving treatment. Oncology. 2011;81:381–6.CrossRefPubMed
18.
Gentilini O, Botteri E, Veronesi P, et al. Repeating conservative surgery after ipsilateral breast tumor reappearance: criteria for selecting the best candidates. Ann Surg Oncol. 2012;19:3771–6.CrossRefPubMed
19.
Kurtz JM. Factors influencing the risk of local recurrence in the breast. Eur J Cancer. 1991;28:660–6.CrossRef
20.
Ishitobi M, Okumura Y, Nishimura R, et al. Repeat lumpectomy for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery: the impact of radiotherapy on second IBTR. Breast Cancer. 2014;21:754–60.CrossRefPubMed
21.
van der Pol CC, van Geel AN, Menke-Pluymers MBE, et al. Prognostic factors in 77 curative chest wall resections for isolated breast cancer recurrence. Ann Surg Oncol. 2009;16:3414–21.CrossRefPubMedPubMedCentral
22.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 2012; 94:496–509.CrossRef
23.
Mamounas EP, Tang G, Liu Q. The importance of systemic therapy in minimizing local recurrence after breast-conserving surgery: the NSABP experience. J Surg Oncol. 2014;110:45–50.CrossRefPubMed
24.
Perez EA, Romond EH, Suman VJ, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014;32:3744–52.CrossRefPubMedPubMedCentral
25.
Hannoun-Levi J-M, Houvenaeghel G, Ellis S, et al. Partial breast irradiation as second conservative treatment for local breast cancer recurrence. Int J Radiat Oncol Biol Phys. 2004;60:1385–92.CrossRefPubMed
26.
Sedlmayer F, Zehentmayr F, Fastner G. Partial breast re-irradiation for local recurrence of breast carcinoma: benefit and long-term side effects. Breast. 2013;22:S141–S146.CrossRefPubMed
27.
Hannoun-Levi J-M, Resch A, Gal J, et al. Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: multicentric study of the GEC-ESTRO Breast Cancer Working Group. Radiother Oncol. 2013;108:226–31.CrossRefPubMed
28.
Trombetta M, Hall M, Julian TB. Long-term follow-up of breast preservation by re-excision and balloon brachytherapy after ipsilateral breast tumor recurrence. Brachytherapy. 2014;13:488–92.CrossRefPubMed
29.
Tanis E, van de Velde CJH, Bartelink H, et al. Locoregional recurrence after breast-conserving therapy remains an independent prognostic factor even after an event free interval of 10 years in early-stage breast cancer. Eur J Cancer. 2012;48:1751–6.CrossRefPubMed
30.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383:2127–35.CrossRef
31.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16.CrossRef
Metadata
Title
Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial
Authors
Irene L. Wapnir, MD
Shari Gelber, MS
Stewart J. Anderson, PhD
Eleftherios P. Mamounas, MD
André Robidoux, MD
Miguel Martín, MD
Johan W. R. Nortier, MD
Charles E. Geyer Jr, MD
Alexander H. G. Paterson, MD
István Láng, MD
Karen N. Price, BS
Alan S. Coates, MD
Richard D. Gelber, PhD
Priya Rastogi, MD
Meredith M. Regan, ScD
Norman Wolmark, MD
Stefan Aebi, MD
On behalf of CALOR trial investigators
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5571-y

Other articles of this Issue 2/2017

Annals of Surgical Oncology 2/2017 Go to the issue

Urologic Oncology

How Did We Obtain Complete Remission in Patients Who Had Metastatic Renal Cancer in the Era of Targeted Therapies?

Translational Research and Biomarkers

As a Novel Prognostic Marker, Cysteine/histidine-rich 1 (CYHR1) is a Therapeutic Target in Patients with Esophageal Squamous Cell Carcinoma

Melanomas

Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change

Translational Research and Biomarkers

Methylation of the Tumor Suppressor Genes HIC1 and RassF1A Clusters Independently From the Methylation of Polycomb Target Genes in Colon Cancer

Bone and Soft Tissue Sarcomas

Implications of Lymph Node Evaluation in the Management of Resectable Soft Tissue Sarcoma

Endocrine Tumors

Computed Tomography-Detected Central Lymph Node Metastasis in Ultrasonography Node-Negative Papillary Thyroid Carcinoma: Is It Really Significant?