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Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Isolated locoregional recurrences (ILRRs) of breast cancer confer a significant risk for the development of distant metastasis. Management practices and second ILRR events in the Chemotherapy as Adjuvant for LOcally Recurrent breast cancer (CALOR) trial were investigated.

Methods

In this study, 162 patients with ILRR were randomly assigned to receive postoperative chemotherapy or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to evaluate associations between treatment, site of second recurrence, and outcome.

Results

The median follow-up period was 4.9 years. Of the 98 patients who received breast-conserving primary surgery 89 had an ipsilateral-breast tumor recurrence. Salvage mastectomy was performed for 73 patients and repeat lumpectomy for 16 patients. Another eight patients had nodal ILRR, and one patient had chest wall ILRR. Among 64 patients whose primary surgery was mastectomy, 52 had chest wall/skin ILRR, and 12 had nodal ILRR. For 15 patients, a second ILRR developed a median of 1.6 years (range 0.08–4.8 years) after ILRR. All second ILRRs occurred for patients with progesterone receptor-negative ILRR. Death occurred for 7 (47 %) of 15 patients with a second ILRR and 19 (51 %) of 37 patients with a distant recurrence. As shown in the multivariable analysis, the significant predictors of survival after either a second ILRR or distant recurrence were chemotherapy for the primary cancer (hazard ratio [HR], 3.55; 95 % confidence interval [CI], 1.15–10.9; p = 0.03) and the interval (continuous) from the primary surgery (HR, 0.87; 95 % CI, 0.75–1.00; p = 0.05).

Conclusions

Second ILRRs represented about one third of all recurrence events after ILRR, and all were PR-negative. These second ILRRs and distant metastases portend an unfavorable outcome.

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Acknowledgments

The CALOR trial was supported in part by Public Service Grants U10-CA-180868, U10-CA-189867, U10-CA-180822, and U24-CA-75362 from the National Cancer Institute, Department of Health and Human Services. The International Breast Cancer Study Group is supported in part by the Swiss Group for Clinical Cancer Research (SAKK), Frontier Science and Technology Research Foundation, Australia and New Zealand Breast Cancer Trials Group, Swedish Cancer Society, Cancer Research Switzerland/Oncosuisse, Cancer Association of South Africa, Foundation for Clinical Research of Eastern Switzerland (OSKK). Spanish participation was funded by Grupo Español de Investigación en Cáncer de Mama (GEICAM), and Dutch participation by BOOG, the Dutch Breast Cancer Trialists’ Group.

Disclosure

None of the authors have any conflicts of interest to report.

Author information

Authors and Affiliations

  1. NRG Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Irene L. Wapnir MD

  2. IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Frontier Science and Technology Research Foundation, Boston, MA, USA

    Shari Gelber MS & Karen N. Price BS

  3. NRG Oncology and Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    Stewart J. Anderson PhD

  4. NRG Oncology and University of Florida Health Cancer Center at Orlando Health, Orlando, FL, USA

    Eleftherios P. Mamounas MD

  5. NRG Oncology and Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada

    André Robidoux MD

  6. GEICAM, Instituto de Investigacion SanitariaGregorio Marañon, Universidad Complutense, Madrid, Spain

    Miguel Martín MD

  7. BOOG, Dutch Breast Cancer Trialists’ Group, Leids Universitair Medisch Centrum, Leiden, Netherlands

    Johan W. R. Nortier MD

  8. NRG Oncology and Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA

    Charles E. Geyer Jr MD

  9. NRG Oncology and Tom Baker Cancer Centre, Calgary, Alberta, Canada

    Alexander H. G. Paterson MD

  10. IBCSG and National Institute of Oncology, Budapest, Hungary

    István Láng MD

  11. IBCSG, Bern, Switzerland and University of Sydney, Sydney, Australia

    Alan S. Coates MD

  12. IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard TH Chan School of Public Health, Harvard Medical School, and Frontier Science and Technology Research Foundation, Boston, MA, USA

    Richard D. Gelber PhD

  13. NRG Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Priya Rastogi MD

  14. IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Meredith M. Regan ScD

  15. NRG Oncology and the Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA

    Norman Wolmark MD

  16. IBCSG, Luzerner Kantonsspital, Lucerne and University of Berne, Switzerland and Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland

    Stefan Aebi MD

Authors
  1. Irene L. Wapnir MD
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  2. Shari Gelber MS
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  3. Stewart J. Anderson PhD
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  4. Eleftherios P. Mamounas MD
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  5. André Robidoux MD
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  6. Miguel Martín MD
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  7. Johan W. R. Nortier MD
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  8. Charles E. Geyer Jr MD
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  9. Alexander H. G. Paterson MD
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  10. István Láng MD
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  11. Karen N. Price BS
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  12. Alan S. Coates MD
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  13. Richard D. Gelber PhD
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  14. Priya Rastogi MD
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  15. Meredith M. Regan ScD
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  16. Norman Wolmark MD
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  17. Stefan Aebi MD
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Consortia

On behalf of CALOR trial investigators

Corresponding author

Correspondence to Irene L. Wapnir MD.

Additional information

Members of the Chemotherapy as Adjuvant for the LOcally Recurrent (CALOR) Breast Cancer Collaborative Group are listed in the Supplementary Appendix.

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Supplementary material 1 (DOCX 46 kb)

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Wapnir, I.L., Gelber, S., Anderson, S.J. et al. Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial. Ann Surg Oncol 24, 398–406 (2017). https://doi.org/10.1245/s10434-016-5571-y

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  • DOI: https://doi.org/10.1245/s10434-016-5571-y

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