Question answered for the first time! Do her2+ breast cancers recur more often after

[Lani]

breast conserving surgery ie, lumpectomy + radiation therapy vs mastectomy

Hopefully, this is the beginning of other papers looking at whether other standard treatment recommendations also hold for her2+ breast cancer.

The Breast Journal
Volume 12 Page 431 - September 2006
doi:10.1111/j.1075-122X.2006.00297.x
Volume 12 Issue 5


ORIGINAL ARTICLE
The Impact of HER-2 Status on Local Recurrence in Women with Stage I–II Breast Cancer Treated with Breast-Conserving Therapy
Eleanor E. R. Harris, MD*, Wei-Ting Hwang, PhDâ€*, Eric A. Lee*, Keith A. Cengel, MD, PhD*, Michael D. Feldman, MD, PhD‡, Angela DeMichele, MD§, Gary Kao, MD, PhD*, and Lawrence J. Solin, MD*
Abstract: This study was undertaken to determine whether overexpression of the oncogene HER-2 is associated with an increase in local recurrence in women with early stage breast cancer treated with breast-conserving therapy (BCT). A retrospective review of the medical records of all women treated with stage I–II invasive breast cancer from 1991 through 2001 was performed. Of 596 eligible patients treated in that time period, immunohistochemical testing for HER-2 expression was performed in 352 patients (59%): 266 patients (76%) were HER-2 negative and 86 patients (24%) were HER-2 positive. Median follow-up was 5.4 years. The patient characteristics for the two groups were compared for age, pathologic T and N stage, number of positive nodes, estrogen receptor (ER) and progesterone receptor (PR) status, radiation treatment, and use of hormonal therapy or chemotherapy. There were no significant differences in any of these parameters between the two groups (all p ? 0.10). Local recurrence at 5 years was 2% in the HER-2-negative group and 0% in the HER-2-positive group (p = 0.15). There was no difference in local recurrence after BCT between HER-2-positive and negative breast cancers at 5 years. Therefore HER-2 overexpression does not appear to be a contraindication to BCT.

[Montana]

"Local recurrence at 5 years was 2% in the HER-2-negative group and 0% in the HER-2-positive group"

This seems to differ from other stats I remember seeing. Am I not understanding this correctly?

[Lani]

Figures for local recurrence with Breast conserving therapy with radiation therapy vs without usually quote a 40% decrease--but the absolute recurrence rates are only around 3-7% or so, as I recall.

I think their quoted recurrence rates were so low because their sample sizes were small.

[Becky]

Although a significant portion of recurrences are local and not distant. I will have to find my file but I believe that over 60% of recurrences are local.


Kind regards

Becky

[Lani]

and found articles showing higher recurrence rates for those <40 yrs old and decreasing with patients' age

Among other articles I came across this one again, which I had pointed out to Tom in case it could provide some solice. It shows at least that they are reexamining another long-held dogmatic position (perhaps rightly, perhaps wrongly, but at least they were reevaluating it!):

Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1416-21. Epub 2006 May 26. Links
Re-excision of margins before breast radiation-diagnostic or therapeutic?

Chism DB,
Freedman GM,
Li T,
Anderson PR.
Department of Radiation Oncology, North Shore Medical Center, Peabody, MA, USA.
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.
PMID: 16730133 [PubMed - in process]

Again, this does not differentiate by her2 status, age or LVI. Until such studies are done, we will be lumping the whole "fruit salad" together instead of discussing apples vs oranges vs plums.