Main Article Content
breast cancer, recurrence, breast-conserving therapy, total mastectomy, F18-FDG PET/CT
Background: This study aimed to compare the recurrence rate of breast cancer between women treated with breast-conserving therapy (BCT) with/without radiotherapy and those treated with total mastectomy using 18F-fluorodeoxyglucose positron emission tomography/computed tomography18 (F-FDG PET/CT).
Methods: The current study retrospectively included 588 patients suffering from breast cancer who had been referred to the PET/CT department of Masih-e-Daneshvari Hospital in Tehran between April 2013 and September 2019. Data of all female patients with breast cancer were extracted from the recorded hospital files. Based on the treatment plan, patients were divided into two groups: BCT with/without radiotherapy (n=168) and total mastectomy (n=420). Local, locoregional, and distant metabolically active lesions were determined in18 F-FDG PET/CT and compared between groups.
Results: BCT and total mastectomy were comparable regarding local (28.5% vs. 25.7%, P=0.200) and locoregional (21.4% vs. 22.8%, P=0.712) recurrence, while distant recurrence was significantly higher with total mastectomy (88.5% vs. 64.2%, P<0.001). Also, lymph node invasion (42.9% vs. 60%m P<0.001) and positive PET/CT (78.5% vs. 88.5%, P=0.002) were significantly higher with total mastectomy.
According to multivariate analysis, age, clinical stage, positive margin are independently correlated with the rate of distant metastasis.
Conclusion: According to our analysis, breast-conserving therapy could be a suitable choice of surgery in selected patients since local and locoregional recurrence rate did not significantly differ between patients who underwent breast-conserving surgery compared to those who were treated with total mastectomy. Higher rate of distant metastasis in patients with total mastectomy seems to be influenced by many confounding variables such as age, higher stage of diagnosis and positive margin rather than type of surgery.
2. Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288-300.
3. Harahap WA, Nindrea RD. Prognostic factors of local-regional recurrence in patients with operable breast cancer in Asia: a meta-analysis. Open Access Macedonian Journal of Medical Sciences. 2019;7(4):690.
4. López-Muñiz JIC, de la Cruz Merino L, Gregori JG, Dueñas EM, Oliveira M, Palmer MAS, et al. SEOM clinical guidelines in advanced and recurrent breast cancer (2018). Clinical and Translational Oncology. 2019;21(1):31-45.
5. De Cicco P, Catani MV, Gasperi V, Sibilano M, Quaglietta M, Savini I. Nutrition and breast cancer: a literature review on prevention, treatment and recurrence. Nutrients. 2019;11(7): 1514.
6. Maajani K, Jalali A, Alipour S, Khodadost M, Tohidinik HR, Yazdani K. The global and regional survival rate of women with breast cancer: a systematic review and meta-analysis. Clinical Breast Cancer. 2019;19(3):165-77.
7. Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine. 2005;353(17): 1784-92.
8. Newman EA, Guest AB, Helvie MA, Roubidoux MA, Chang AE, Kleer CG, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer. 2006;107(10):2346-51.
9. Van Laar C, Van Der Sangen MJC, Poortmans PMP, Nieuwenhuijzen GAP, Roukema JA, Roumen RMH, et al. Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients. European Journal of Cancer. 2013; 49(15): 3093-101.
10. Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. New England Journal of Medicine. 1995;333(22): 1456-61.
11. McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, 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(9935).
12.van der Sangen MJC, van de Wiel FMM, Poortmans PMP, Tjan-Heijnen VCG, Nieuwenhuijzen GAP, Roumen RMH, et al. Are breast conservation and mastectomy equally effective in the treatment of young women with early breast cancer? Long-term results of a population-based cohort of 1,451 patients aged? 40 years. Breast cancer research and treatment. 2011;127(1):207-15.
13. Mahmood U, Morris C, Neuner G, Koshy M, Kesmodel S, Buras R, et al. Similar survival with breast conservation therapy or mastectomy in the management of young women with early-stage breast cancer. International Journal of Radiation Oncology Biology Physics. 2012;83(5):1387-93.
14. Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, et al. European Organisation for Research and Treatment of Cancer Radiation Oncology and Breast Cancer Groups. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47-56.
15. Christiansen P, Al-Suliman N, Bjerre K, Møller S. Recurrence pattern and prognosis in low-risk breast cancer patients–data from the DBCG 89-A programme. Acta oncologica. 2008;47(4): 691-703.
16. Early Breast Cancer Trialists' Collaborative G. 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. The Lancet. 2011;378(9804):1707-16.
17. Early Breast Cancer Trialists' Collaborative G. 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 randomized trials. Obstetrical & Gynecological Survey. 2012;67(2):92-4.
18. Sedlmayer F, Sautter-Bihl ML, Budach W, Dunst J, Fastner G, Feyer P, et al. DEGRO practical guidelines: radiotherapy of breast cancer I. Strahlentherapie Und Onkologie. 2013;189(10): 825-33.
19.van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. Journal of the National Cancer Institute. 2000;92(14):1143-50.
20. Freedman G, Fowble B, Hanlon A, Nicolaou N, Fein D, Hoffman J, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. International Journal of Radiation Oncology Biology Physics. 1999;44(5):1005-15.
21. Touboul E, Buffat L, Belkacémi Y, Lefranc J-P, Uzan S, Lhuillier P, et al. Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. International Journal of Radiation Oncology Biology Physics. 1999;43(1):25-38.