diagnosis and relapse included: age, stage, receptor status, ploidy, adjuvant therapy, method of detection, and histology. Thetime to recurrence, family history, and BRCA mutation status were also compared. Pathology reports from mastectomyspecimens were reviewed and patients were retrospectively considered amenable to SBCS if the recurrence was �3 cm,confined to the biopsy site and adjacent tissue, without skin extension, and with �3 positive lymph nodes (LN). Prognosticfactors of SM patients were examined as predictors of localized recurrence or multicentric disease.

Results: Of the 146 patients definitively managed at IBTR, surgery was SM (n � 116) or SBCS (n � 30). One patient hadre-irradiation to the tumor bed with an interstitial implant after SBCS. Genetic testing was available in 64 patients, and 12patients had mutations in BRCA1/2. As of January 2004, the median length of follow-up was 20.3 years, with a medianfollow-up of 13.8 years after IBTR. Median time to IBTR was 4.9 years, and the median age at IBTR was 55 years. The SMand SBCS cohorts had no significant differences, except at IBTR the SM cohort had a greater tumor size (p � 0.049). Of theSM cohort, 65.5% were considered appropriate for SBCS based on our criteria for a localized recurrence with size �3cm, �3positive LN, and no skin extension. These inclusion criteria correlated with ER positive at diagnosis (p � 0.014), diploid atrecurrence (p � 0.028), and detection of IBTR by mammogram alone (p � 0.0003). Multicentric disease in the mastectomyspecimen was present in 28 patients (24%), and correlated with BRCA1/2 positive (p � 0.008), ER negative at diagnosis (p �0.043), LN positive at relapse (p � 0.032), and detection of IBTR by physical exam (p � 0.008). At 10 years, overall survivalwas 79.6% and distant DFS was 77.7%. Survival post IBTR was 64.5% at 10 years, with no significant difference (ns) betweenSM (65.7%) and SBCS (58.0%). Cause specific survival post IBTR was 71.3% at 10 years, 73.1% for SM and 61.1% for SBCS(p � ns). DM post IBTR was 30.3% at 10 years, 31.8% for SM and 23.9% for SBCS (p � ns). Only one patient in the SBCScohort subsequently developed a second IBTR, and was salvaged with mastectomy.

Conclusions: While mastectomy is the standard surgical salvage of IBTR after breast conservation therapy, roughly 2/3 of theSM cohort would have been candidates for SBCS based on our criteria. SBCS is feasible and prognostic factors for SBCS arerelated to favorable tumor biology and early detection. Patients with BRCA1/2 germline mutation may be less appropriate forSBCS, as multicentric disease was more common in this subset. Patients who underwent SBCS had comparable outcomes toSM, but remain at continued risk for a second IBTR. Current plans are underway for a multi-institutional prospective phase I/IIstudy evaluating SBCS with partial breast re-irradiation to the tumor bed for IBTR.

7 Salvage Treatment for Local Recurrence After Breast-Conserving Surgery Followed by Radiation as InitialTreatment for Mammographically-Detected Ductal Carcinoma In Situ of the Breast

E. S. Wai,1 L. Solin,2 A. Fourquet,3 F. A. Vincini,4 M. Taylor,5 B. Haffty,6 I. A. Olivotto,1 E. Strom,9 L. J. Pierce,8 L.Marks,7 H. Bartelink,10 W. Hwang2

1Radiation Oncology, BC Cancer Agency, Victoria, BC, Canada, 2University of Pennsylvania, Philadelphia, PA, 3InstitutCurie, Paris, France, 4William Beaumont Hospital, Royal Oak, MI, 5Mallinckrodt Institute of Radiology, WashingtonUniversity, St. Louis, OH, 6Yale University, New Haven , CT, 7Duke University, Durham , NC, 8University of Michigan,Ann Arbour, MI, 9M.D. Anderson, Houston, TX, 10Netherlands Cancer Institute, Amsterdam, Netherlands

Purpose/Objective: To determine the outcome after salvage treatment for local or local-regional recurrence for women initiallytreated for mammographically-detected ductal carcinoma in situ (DCIS) of the breast with breast-conserving surgery (BCS) plusdefinitive breast radiation treatment (RT).

Materials/Methods: We reviewed the records of 1003 patients from 10 institutions in North America and Europe, withmammographically-detected DCIS treated with BCS plus breast RT between 1973–1995. Ninety women with isolated localrecurrence (n � 85) or local-regional recurrence (n � 5) were identified. The median initial definitive RT dose was 60 Gy(range � 41.25–83 Gy), and no patient received adjuvant hormonal or chemotherapy, had prior or concurrent invasivecarcinoma of the ipsilateral or contralateral breast, or had a prior or concurrent malignancy (except non-melanoma skin cancer).Median follow-up after local recurrence was 5.6 years (range: 0.2–14.2 years).

Results: The histology of the local or local-regional recurrence was invasive ductal carcinoma (with or without associatedDCIS) (n � 51), DCIS (n � 33), invasive carcinoma NOS (not otherwise specified) (n � 1), invasive lobular carcinoma (n �1), angiosarcoma (n � 1), Paget’s disease with DCIS (n � 1), or unknown (n � 2). The method of detection was mammographyonly (n � 68), physical examination only (n � 8), both (n � 11), other (n � 2), or unknown (n � 1). The location of the localcomponent of recurrence was in-field or a marginal-miss (n � 64; 71%), elsewhere (n � 16; 18%), diffuse or multifocal (n �5), other (n � 1) or unknown (n � 4). The interval to recurrence was 5.0 years or less (n � 47), 5.1–10.0 years (n � 30), or10.1–15.0 years (n � 13).

Salvage surgery was mastectomy (with or without axillary staging) (n � 76), excision alone (n � 9), other (n � 3), orunknown (n � 2). Systemic therapy was hormones (generally tamoxifen) (n � 14), chemotherapy (n � 11), both (n � 3), none(n � 44), or unknown (n � 18).

Histology of the local recurrence and axillary lymph node status were associated with the development of metastatic disease.Metastatic disease developed in none of the 34 women with noninvasive local recurrence, 3 (6%) of the 48 women with invasivecarcinoma and negative axillary lymph nodes (pathologically node negative or clinically node negative without pathologicevaluation), and 4 (80%) of the 5 women with invasive carcinoma and pathologically positive axillary lymph nodes (2 patientswith unknown histology and 1 patient with angiosarcoma excluded from this analysis). For patients with an event after salvagetreatment, the first event was distant metastases (n � 7), contralateral breast cancer (n � 6), chest wall failure (n � 2), or secondmalignant neoplasm (n � 2).

The survival status at the time of last follow-up examination was alive with no evidence of disease (NED) (n � 77; 86%),alive with disease (n � 5; 6%), dead of disease (n � 3; 3%), dead NED (n � 2), and dead of unknown causes (n � 3). 10-yearactuarial overall survival after salvage treatment was 83%. 10-year actuarial freedom from distant metastasis was 91%.

Conclusions: These results demonstrate the efficacy of salvage treatment for local recurrence following breast conservationtreatment for mammographically-detected DCIS of the breast, particularly for patients who fail with DCIS alone or invasivecancer with negative nodes. Long-term, close follow-up after initial breast conservation treatment for DCIS is indicated, as earlylocal recurrence can be well salvaged.

S133Proceedings of the 46th Annual ASTRO Meeting