310 I. J. Radiation Oncology l Biology l Physics Volume 45, Number 3 Supplement 1999

to 53 cm, and >3 cm) predicts for 5 year overall survival (100% versus 93% versus 67%, respectively; P=O.O8). Pathologic lymph node status at the time of recurrence (node positive versus node negative) predicts for 5 year overall survival (75% versus 87%; P=O.O2). Method of detection of recurrence (physical examination versus mammography versus both methods) predicts for 5 year overall survival (74% versus 94% versus 93%, respectively; P=O.Ol). Interval from diagnosis to recurrence (52 years versus >2 years) predicts for overall survival at 5 years (68% versus 89%; P=O.O019). Similarly, pathologic size of recurrence (51 cm. > 1 to 53 cm, and >3 cm) predicts for cause specific survival at 5 years (100% versus 93% versus 67%, respectively; P=O.O8). Pathologic lymph node status at the time of recurrence (node positive versus node negative) predicts for 5 year cause specific survival (75% versus 87%; P=O.O5). Method of detection of recurrence (physical examination versus mammography versus both methods) predicts for 5 year cause specific survival (74% versus 94% versus 93%. respectively; P=O.O2). Finally, interval from diagnosis to recurrence (52 years versus >2 years) is predictive of 5 year cause specific survival (68% versus 89%; P=O.O06). Prognostic factors which are not significant on univariate analysis for overall survival or cause specific survival are age at recurrence, skin involvement of the recurrence, pathologic lymph node status of the primary, hormones after recurrence, lymphvascular invasion in the recurrence, T stage of the recurrence, and location of the recurrence (all P~0.14). On multivariate analysis, interval from diagnosis to recurrence and method of detection were independent predictors of overall survival (P=O.O04 and 0.033, respectively).

Conclusions: This analysis provides long term data after salvage treatment for patients who experience local recurrence after breast conservation therapy. Prognostic variables of method of detection and interval from diagnosis to recurrence are identified as having independent prognostic significance. In view of the potential for long term survival, aggressive attempt at salvage treatment is warranted for the patient with local recurrence after breast conservation therapy.

2063 PREDICTING OUTCOME IN PATIENTS WITH LOCOREGIONALLY RECURRENT BREAST CARCINOMA AFTER MASTECTOMY

Ballo MT, Strom EA, Singletary SE. Theriault RL, Buchhola TA, McNeese MD

University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

Purpose: Patients presenting with locoregionally recurrent breast cancer after mastectomy have frequently been included in trials designed for metastatic disease. This report examines this group of atients treated with multi-modality therapy and describes a prognostic score predictive of locoregional control (LRC). overall survival (OS): and disease free survival (DFS).

Methods and Materials: One hundred-forty eight patients with locoregionally recurrent breast cancer after mastectomy were retrospectively evaluated. All patients were treated with definitive local irradiation and systemic therapy consisting of either tamoxifen, cytotoxic chemotherapy, or both, and excision of the recurrent tumor when possible. Patients with distant metastases were excluded, except for two patients with ipsilateral supraclavicular nodal metastases. Patients received comprehensive irradiation to the chest wall and regional lymphatics to a median dose of 45 Gy (range, 40-66 Gy), with a boost to a median dose of 60 Gy (range, 45-73 Gy) to areas of recurrence. Forty-eight patients (32%) were irradiated with palpable, gross disease that was unresponsive to systemic therapy and/or unresectable. The median follow-up time of surviving patients was 78 months.

Results: Overall actuarial LRC rates at 5- and 10 years were 68% and 55%, respectively. Five and lo-year actuarial OS and DFS rates were 50% and 35%. 39% and 29%, respectively. The following 2 factors were predictive on multivariate analysis of LRC, OS and DFS: clinically evident residual disease at the time of irradiation and interval from mastectomy to recurrence <24 months. Using these factors patients were subdivided into 3 distinct subgroups based upon having neither of the factors (prognostic score O-49 patients), 1 factor (prognostic score l-67 patients), or both factors (prognostic score 2-32 patients). The 5-year LRC according to prognostic score 0, 1: or 2 was 91%: 7370, and 16%, respectively (trend p<O.OOOl). The J-year OS according to prognostic score 0, 1, or 2 was 83%, 39%, and 23%: respectively (trend p<O.OOOl). The S-year DFS according to prognostic score 0, 1, or 2 was 73%, 29%, and 4%, respectively (trend p<O.OOOl). Within the prognostic score ~1 group OS was significantly improved if locoregional control was obtained (43% vs. 17% at 5 years, p=O.OOOS).

Conclusions: The use of prognostic grouping allows identification of three clinically distinct populations. The low-risk population (Score = 0) has a favorable 5-year survival (73%) and local disease control (91%) after multi-modality therapy, while the high-risk populations (Score = 1 or 2) clearly warrant therapeutic intensification. This information should be used as the basis for further clinical trials for the high-risk (prognostic score 2 1) patients. Aggressive therapy aimed at local control in addition to systemic control may ultimately translate into improved survival.

2064 LUMPECTOMY AS SALVAGE TREATMENT OF LOCAL RECURRENCE FOLLOWING BREAST CONSERVING MANAGEMENT: PROGNOSIS AND FACTORS PREDICTING LUMPECTOMY AS A REASONABLE ALTERNATIVE TO MASTECTOMY

Lee D’, Smith TE’, Ward BA’, Carter D3. Haffty BG’ Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA’; Department of Surgery’; Department of Pathology3

Purpose: Mastectomy (MAST) has been generally accepted as standard salvage treatment of local recurrence after conservative surgery and radiation therapy (CS + RT) of early stage breast cancer. However, many women wish to preserve the natural breast and have limited surgery (WLE) at the time of ipsilateral breast tumor relapse(IBTR). The purpose of this study is to review and compare outcome of WLE and MAST as salvage treatment and to identify factors which may identify patients who may be suitable candidates for WLE at the time of IBTR.

Materials and Methods: Of 1152 consecutive patients treated with CS + RT at Yale New Haven Hospital prior to 1990, 136 patients developed IBTR. Excluded from this analysis are 30 patients with either clinically metastatic disease and/or diffuse disease at the time of IBTR. A retrospective analysis of the records of the remaining 106 patients who had definitive surgical salvage therapy with curative intent by WLE or MAST was performed. To identify factors predicting WLE as a reasonable