Alexandrova Elena, Sergieva Sonya, Kostova Petia, Mihaylova Iglika, Katzarov Dimitar, Milev Angel
Specialized Hospital for Active Treatment in Oncology, Department of Thoracic Surgery, Sofia, Bulgaria.
J BUON. 2015 Jul-Aug;20(4):1001-8.
To classify ipsilateral in-breast cancer recurrences (IBCR) in patients treated with conservative surgery and radiation therapy, either as new primary tumor (NP) or true recurrence (TR) and to assess the prognostic and therapeutic importance of this classification.
The records of 107 patients treated for local tu- mor recurrence after breast-conserving therapy (BCT) at the National Cancer Center, Sofia, between March 1999 and May 2011 were retrospectively analysed. The patients'primary tumors were up to 2 cm in size. For their primary tumors all patients underwent quadrantectomy, axillary lymph node dissection and postoperative radiotherapy (RT) up to 50 Gy. In cases with nodal metastasis additional RT has been used. Adjuvant chemotherapy and hormonotherapy have been used according to the clinical indications and depending of the patient's condition. Every attempt was made to define a tumor as a TR or NP, based on the changes in location and histology. (99m)Tc-MIBI SPECT-CT was used to localize the site of recurrence.
Forty-four (41.1%) of the relapses were TR and 63 (58.9%) NPs. Out of 63 relapses defined as NPs, 54 (85.7%) changed the location and 49 (68.3%) had a different histology. The age of patients with TR and with NP did not differ significantly at the time of diagnosis of the primary tumor (TR 48.8±10.45 years vs NP 50.8±10.56; p<0.330), but those who developed TR were significantly younger than those with NP at the time of recurrence (TR 53 years, 66±11.1 vs NP 58.15+10.6; p<0.05). Recurrences defined as NPs, developed after a significantly longer period of time in comparison to the TRs (7.4±2.6 years vs 4.8±2.2 years; p<0.0001). Five-year overall survival of patients with TR was significantly lower compared to patients with NP (31.8% vs 96.7% p=0.0001).
Recurrences developing after BCT represent different clinical events, having different origin, prognosis and, therefore, requiring different type of treatment. It seems that a significant part of the recurrences that develop in the residual parenchyma, following BCT, are new carcinomas.
对接受保乳手术和放射治疗的患者同侧乳腺内癌复发（IBCR）进行分类，分为新发原发性肿瘤（NP）或真性复发（TR），并评估该分类的预后和治疗重要性。
回顾性分析1999年3月至2011年5月在索菲亚国家癌症中心接受保乳治疗（BCT）后局部肿瘤复发的107例患者的记录。患者的原发性肿瘤最大为2 cm。所有患者的原发性肿瘤均接受了象限切除术、腋窝淋巴结清扫术和术后放疗（RT），剂量高达50 Gy。对于有淋巴结转移的病例，采用了额外的RT。根据临床指征并依据患者情况使用辅助化疗和激素治疗。基于位置和组织学的变化，尽一切努力将肿瘤定义为TR或NP。使用（99m）Tc-MIBI SPECT-CT定位复发部位。
44例（41.1%）复发为TR，63例（58.9%）为NP。在定义为NP的63例复发中，54例（85.7%）改变了位置，49例（68.3%）组织学不同。TR组和NP组患者在原发性肿瘤诊断时的年龄无显著差异（TR为48.8±10.45岁，NP为50.8±10.56岁；p<0.330），但复发时发生TR的患者比发生NP的患者明显年轻（TR为53岁，66±11.1岁，NP为58.15+10.6岁；p<0.05）。与TR相比，定义为NP的复发发生时间明显更长（7.4±2.6年对4.8±2.6年；p<0.0001）。TR组患者的5年总生存率明显低于NP组患者（31.8%对96.7%，p=0.0001）。
BCT后发生的复发代表不同的临床事件，具有不同的起源、预后，因此需要不同类型的治疗。似乎BCT后在残留实质内发生的复发中，很大一部分是新发癌。
