Abstract
Results: Thirty-two cases (10.2%) treated with BCT developed an IBTR (12-year actuarial rate of 11%) and 2 cases (4.7%) developed a chest wall recurrence after mastectomy (12-year actuarial rate of 5%). Twenty-three (72%) of the IBTRs after BCT were classified as a TR/MM (12-year actuarial rate 7%) and 53% (17/32) were invasive. All local failures after mastectomy were invasive. The 12-year freedom from local failure and distant metastases, CSS, and overall survival after BCT versus mastectomy were 89% vs. 95% (p = 0.43), 98% vs. 100% (p = 0.98), 99% vs. 100% (p = 0.98), and 87% vs. 84% (p = 0.59), respectively. Increasing age (p 0.001) and the development of DM (p 0.001) on Cox multivariate analysis (MVA) was associated with reduced overall survival in all patients. On Cox univariate analysis (UVA), factors associated with IBTR for BCT patients were age less than 45 (p \0.001), pre-menopausal status (p = 0.002), and no mass detected on diagnostic mammogram (p = 0.079). Age less than 45 was associated with IBTR on MVA for patients treated with BCT. Chi-square test revealed age less than 45 (p 0.001), menopausal status (p = 0.055), no mass detected on mammogram (p = 0.029), and pathological tumor necrosis (p = 0.041) to be significant associated with TRMM. Fifty-seven patients (16%) developed secondary cancers (35 contralateral breast cancers [CBCA]). The 12-year actuarial rates of secondary cancers and CBCA for BCT versus mastectomy were 16.5% vs. 8.5% (p = 0.48) and 11.2% vs. 16%, respectively (p = 0.28). On UVA, age greater than 45 was associated with secondary malignancy (p = 0.009) and CBCA (p = 0.049). Conclusions: With long-term follow-up, BCT continues to provide equivalent outcome to mastectomy with regards to local control, DMFS, CSS and OS. The use of radiation therapy was not associated with the development of secondary malignancies (including CBCA).
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