Re-excision of margins before breast radiation-diagnostic or therapeutic?

Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1416-21. doi: 10.1016/j.ijrobp.2006.02.017. Epub 2006 May 26.

Abstract

Purpose: To identify factors in breast cancer patients that predict the pathologic results of re-excision for close or positive margins and to determine the effect on local control.

Methods and materials: We divided 1,044 patients with Stage I-II breast cancer with a close (< or =2 mm) or positive margin after initial excision into three groups. Group 1 included 199 patients without additional excision, Group 2 included 546 patients with re-excision found to be free of cancer, and Group 3 included 299 patients with re-excision and residual cancer. All patients were treated with radiotherapy with a median follow-up of 6.7 years.

Results: The 10-year local control rate was 95% for Group 1 and 94% for Groups 2 and 3 (p = 0.788). Of the 846 patients, 65% had no residual disease on re-excision and 35% did have residual tumor. The factors significantly associated with positive re-excision findings were initial positive margins, positive nodes, Stage T2 tumor, and an extensive intraductal component. The 10-year local control rate was 95% for Group 2 vs. 91% for Group 3 (p = 0.038).

Conclusion: The low recurrence rates seen in this study suggest that selected patients with non-negative margins, particularly those with a low risk of having residual disease at re-excision, may be treated with radiotherapy.

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy
  • Breast Neoplasms / surgery*
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Intraductal, Noninfiltrating / radiotherapy
  • Carcinoma, Intraductal, Noninfiltrating / surgery*
  • Chi-Square Distribution
  • Combined Modality Therapy / methods
  • Female
  • Humans
  • Logistic Models
  • Mastectomy, Segmental
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm, Residual
  • Reoperation