Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer

Purposes: The study evaluates prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. Patients and methods: The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983–85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen.If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. Results: Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5–11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. Conclusions: Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.     

Early operable breast cancer

Opinion statement Early operable breast cancer is a potentially curable disease. However, a substantial number of patients are at risk for systemic recurrence and death. Breast conservation therapy (BCT) should be considered the preferred surgical option for most women with early operable breast cancer. Adjuvant systemic chemotherapy or hormonal therapy can substantially reduce, although not eliminate, the risk of recurrence and death. Neoadjuvant or primary systemic therapy (PST) in operable breast cancer slightly increases the number of women treated with breast conservation versus mastectomy. Although PST may identify women who are likely to have a better prognosis (those with a pathologic complete response), current PST strategies do not offer a survival advantage over standard adjuvant approaches. Early results of high-dose chemotherapy trials thus far have not shown any advantage over conventional dose therapy in high-risk patients with 10 or more positive lymph nodes. The role of adjuvant radiation therapy after mastectomy for all patients with high-risk early operable breast cancer is not fully defined.     

局部区域复发乳腺癌的治疗进展

和初治的乳腺癌相比,局部区域复发性患者的预后分析和挽救治疗策略选择存在更多的不确定性。本文首先分析了影响保乳手术和乳房切除术后局部-区域复发的高危因素以及相应的复发模式。以再次手术和包括完整复发灶及相应亚临床病灶的放射治疗为主要形式的局部治疗是综合治疗策略的基础,合理的局部治疗可以达到有效的局部疾病控制率并降低二次局部区域复发。虽然既往的前瞻性或回顾性资料对于全身治疗在局部-区域复发乳腺癌治疗中的价值始终没有确认,由多个国际乳腺癌研究组织联合发起的CALOR研究结果的公布第一次证实,在保留合理的内分泌治疗和靶向治疗的前提下,手术+放射治疗联合后续的全身化疗可以进一步提高无病生存率和总生存率,尤其在激素受体阴性的患者中获益更显著。所以结合原发病灶和复发灶的肿瘤标志物给予合理的全身治疗将成为局部区域复发患者综合治疗重要的组成部分。     

Current and future roles of neoadjuvant chemotherapy in operable breast cancer

Neoadjuvant chemotherapy was initially used only as treatment for locally advanced breast cancer. However, because breast cancer is considered to be a systemic disease in which distant micrometastases are already present at the time of the initial diagnosis, primary systemic therapy may be beneficial in the eradication of these micrometastatic lesions. Despite the fact that no survival benefit of neoadjuvant chemotherapy over adjuvant chemotherapy has yet been demonstrated, the clinical indication for neoadjuvant chemotherapy is being extended not only to stage T3/4 tumors but also to some stage T1/2 operable breast cancers. The current clinical benefits of the use of neoadjuvant chemotherapy are that (1) the safety of neoadjuvant chemotherapy is comparable with that of adjuvant chemotherapy, (2) neoadjuvant chemotherapy increases the possibility of the use of breast-conserving surgery, and (3) pathologic complete response may be a predictive indicator of better survival. Importantly, the response to neoadjuvant chemotherapy in vivo could provide a useful prediction of prognosis and help define strategies for an individual patient's future treatment with alternative chemotherapy regimens or molecular-targeting agents. Furthermore, the discovery of predictive markers for tumor response to neoadjuvant chemotherapy through the analysis of complementary DNA microarrays and proteomics may also help facilitate individualized chemotherapy, particularly by improving survival in patients with breast cancer with a poor prognosis. Herein we review the current status and future role of neoadjuvant chemotherapy in operable breast cancer in terms of its survival benefit and the potential for the individualization of adjuvant therapy for these patients.     

不同放化疗模式治疗局部晚期乳腺癌的疗效分析

目的探讨不同治疗模式对局部晚期乳腺癌疗效的影响。方法回顾性分析278例T3～4、N0～3期乳腺癌的临床资料。其中82例患者先给予放疗,放疗后续行6周期化疗。另外196例患者均为先化疗者。在先行化疗的196例患者中,102例患者接受三明治疗法(即3周期化疗+放疗+3周期化疗),94例患者完成6周期化疗后行局部放疗。使用SPSS 10.0统计软件进行局部复发、远处转移及生存率的相关因素分析。结果3组治疗组间5年生存率无显著性差异,但化放夹心组较先化后放组局部复发率明显下降,而较先放后化组远处转移率降低,且不良反应较两者相比发生率低。结论三明治疗法可做为一种理想的乳腺癌术后辅助治疗选择。     

放化疗联合生物靶向治疗对乳腺癌早期改良根治术后患者远期生存率的影响

目的 分析放化疗联合生物靶向治疗对乳腺癌早期改良根治术后患者远期生存率的影响.方法 选取乳腺癌早期改良根治术患者86例,将其随机分为对照组与联合组,对照组患者术后行放化疗(多西紫杉醇结合顺铂化疗+三维适形放疗)辅助治疗,联合组在对照组基础上行生物靶向(曲妥珠单抗)治疗,对比两组患者术后并发症发生率及生活质量,比较两组患者术后1年、3年局部复发率、远处转移率、生存率.结果 联合组患者并发症发生率(4.65％)明显低于对照组(44.19％),差异显著(P<0.05);联合组术后生活质量各指标评分均高于对照组,差异明显(P<0.05);两组患者治疗后1年复发率、远处转移率、生存率比较均无明显差异(P>0.05);联合组术后3年远处转移率、复发率均低于对照组,但差异不明显(P>0.05).结论 乳腺癌早期改良根治术后患者实施放化疗联合生物靶向治疗可有效减少并发症提高其生活质量,远期生存率较好,可在临床上推广应用.     

Importance of timing of radiotherapy in breast conserving treatment for early stage breast cancer

This study reports on the treatment results in 508 patients with 514 AJCC stage I–II invasive breast carcinomas treated between July 1980 and July 1989. All patients underwent a lumpectomy with axillary lymph node dissection with postoperative irradiation. Adjuvant chemotherapy was given to premenopausal node-positive patients. Postmenopausal node-positive patients received adjuvant hormonal treatment. The median follow-up period was 68 months (range, 40–152 months). The 5-year survival rates were 92.6%, 81.4% and 65.5% for stage I, stage IIA and stage IIB, respectively. Distant metastases were the main cause of death. Locoregional failures occurred in 4.9%. Breast recurrences were detected in 17 patients (3.3%). In a Cox proportional hazards analysis, T-stage, pathological margins and interval between surgery and radiotherapy were identified as independent factors predictive of breast recurrence (p < 0.05). The results suggest that radiotherapy should be initiated early after surgery to maintain the breast recurrence rate as low as possible.     

乳腺癌根治术局部复发后影响预后的相关因素分析

目的研究乳腺癌根治术局部复发后影响预后的相关因素,探讨乳腺癌根治术后局部复发的最佳治疗方案。方法回顾性分析天津肿瘤医院1975年1月至2003年1月期间收治的1067例乳腺癌根治术后复发患者,采用χ2检验或秩和检验对患者年龄、绝经情况、原发瘤临床分期、腋窝淋巴结转移情况、无病间期、复发部位、胸壁复发灶数目及其最大直径、雌激素受体(ER)或孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达等临床病理特征以及不同治疗方案与局部复发治疗的近期疗效和远处转移率之间的关系进行单因素分析;使用Kaplan-Meier法及COX回归模型对乳腺癌根治术复发后影响5年生存率的相关因素进行单因素与多因素分析。结果对全部1067例病例进行随访,778例(72.9%)出现远处转移,复发后5年总生存率为42.4%。复发部位、胸壁复发灶数目及其最大直径、有无放射治疗、放射治疗范围、有无化疗、有无手术切除或切除活检等因素的不同亚组间局部控制率的差异有统计学意义(P0.050);腋窝淋巴结转移情况、无病间期、ER或PR表达、HER-2表达以及再治疗中有无化疗等因素的不同亚组间远处转移率的差异有统计学意义(P0.050);无病间期、复发部位、胸壁复发灶数目、ER或PR表达、HER-2表达、治疗方法等因素的不同亚组间5年总生存率的差异有统计学意义(P0.050);无病间期≤2年、复发部位多、治疗方案单一、局部控制率低及ER、PR均阴性是导致复发性乳腺癌预后差的独立因素(P0.050)。结论多部位复发、胸壁多发结节及胸壁复发灶最大直径3cm者局部控制不佳,局部扩大野放射治疗结合化疗和(或)手术是改善局部控制率的较好模式;有腋窝淋巴结转移、2年内复发、ER、PR均阴性以及HER-2阳性表达的乳腺癌复发后容易发生远处转移,复发再治疗中化疗能减少远处转移的发生;对于复发性乳腺癌采取综合治疗方案可以提高复发患者的生存率;无病间期长,多部位复发,ER或PR阴性者提示预后不良。     

乳腺癌药物治疗的现状与展望

术后辅助治疗能够提高乳腺癌病人的总生存率和无病生存率，含蒽环类药方案优于非蒽环类药方案，阿霉素为主方案中加入紫杉醇能进一步提高淋巴结阳性病人的生存率，化疗加用他莫昔芬（TAM）能进一步提高疗效，辅助化疗疗效与一定剂量强度相关，但强烈化疗联合造血干细胞 不能改善病人生存，新辅助化疗对Ⅲ期乳腺癌有效，合理应用内分泌治疗和化疗能改善晚期病人的生活质量，延长高质量的生存期。     

Survival in patients with metastatic recurrent breast cancer after adjuvant chemotherapy

BACKGROUND:

Population‐based studies have shown improved survival for patients diagnosed with metastatic breast cancer over time, presumably because of the availability of new and more effective therapies. The objective of the current study was to determine whether survival improved for patients who developed distant recurrence of breast cancer after receiving adjuvant therapy.

METHODS:

Adjuvant chemotherapy trials coordinated by the Eastern Cooperative Oncology Group that accrued patients between 1978 and 2002 were reviewed. Survival after distant disease recurrence was estimated for progressive time periods, and adjusted for baseline covariates in a Cox proportional hazards model.

RESULTS:

Of the 13,785 patients who received adjuvant chemotherapy in 11 trials, 3447 (25%) developed distant disease recurrence; the median survival after recurrence was 20 months (95% confidence interval, 19 months‐21 months). Factors associated with inferior survival included a shorter distant recurrence‐free interval (DRFI), estrogen receptor‐negative and progesterone receptor‐negative disease, the number of positive axillary lymph nodes present at the time of diagnosis, and black race (P < .0001 for all). When the time period of recurrence was added to the model, it was not found to be significantly associated with survival for the general population with disease recurrence. Survival improved over time only in those patients with hormone receptor‐negative disease with a DRFI ≤ 3 years, both among the 5 most recent and the entire trial data sets (P = .01 and P = .05, respectively).

CONCLUSIONS:

In contrast to reports from population‐based studies, no general improvement in survival was observed over the last 30 years for patients who developed distant disease recurrence after adjuvant chemotherapy after adjusting for DRFI. Improved survival for patients with hormone receptor‐negative disease with a short DRFI suggests a benefit from trastuzumab. Cancer 2013. © 2012 American Cancer Society.     

Long-term follow-up of axillary recurrences after negative sentinel lymph node biopsy: effect on prognosis and survival

As axillary recurrence (AR) after a negative sentinel lymph node biopsy (SLNB) is rare, the prognosis of these patients is unknown. Since treatment paradigms for patients with breast cancer are shifting toward less axillary surgery, the number of ARs might increase. In this study, we evaluated primary and salvage treatment as well as long-term survival of patients diagnosed with an AR. A retrospective analysis of the cancer registry of 16 breast cancer units in the Netherlands was used to identify patients who developed an AR after a negative SLNB performed between 2002 and 2004. Using local hospital records we recorded primary patient-, tumor-, and treatment-characteristics, as well as salvage treatment. We identified 54 patients with an AR, median 30 months (range 3–79) after SLNB. Eighteen patients (33 %) were initially treated with breast conserving therapy, 15 of whom received external beam radiation therapy (EBRT). Thirty-three patients (61 %) did not receive adjuvant systemic treatment. In 45 of the 54 (83 %) patients, a salvage axillary lymph node dissection was performed showing a median of three positive nodes (range 1–24). Nine patients (17 %) were not treated surgically: three were treated with salvage EBRT and six with salvage systemic therapy only. At time of detection of the AR, a total of 7 patients (13 %) had proven distant metastases. After a median follow-up of 47 months (range 3–118), the 5-year “post-recurrence” distant metastasis free survival was 50 % and overall survival was 58 %. Significant negative predictors of survival were negative estrogen receptor (ER) status and receiving adjuvant chemotherapy at initial treatment. AR following a negative SLNB is associated with a 58 % 5-year OS. Prognostic factors are ER? primary tumor and receiving adjuvant chemotherapy as a part of initial treatment, reflecting an aggressive phenotype. Adequate regional and systemic salvage therapy constitute a chance for long-term survival after AR.     

Correlation between clinical features and prognosis of local recurrence after breast-conserving therapy

Background. In patients with early stage breast cancer who have breast-conserving therapy (BCT), the impact of local recurrence on the risk of distant metastasis is still controversial. Local recurrence after BCT is an uncommon event, so it is impossible to determine a standard treatment method by a clinical trial because not enough patients can be enrolled. Methods. Between February 1988 and December 1997, 399 patients with clinical stage I and II breast cancer underwent BCT in our department. Of these 399 patients, 22 developed local recurrence during this period. To assess the relationship between their clinical characteristics and prognosis, we performed a retrospective review of these 22 patients. Results. The 5-year overall survival rate after local recurrence was 66.7%. All four patients who had cutaneous or inflammatory type recurrence developed distant metasta-sis after salvage treatment. Of three patients with multiple recurrence, two developed disseminated disease after salvage treatment. Two of four patients treated by repeat lumpectomy developed further local recurrence after salvage lumpectomy. Conclusion. To improve prognosis in patients with multiple, cutaneous, or inflammatory recurrence, aggressive adjuvant systemic therapy may be required after salvage surgery. Received: May 13, 1999 / Accepted: September 22, 1999     

Radiotherapy in breast cancer.

This review focuses on four aspects of radiotherapy in the treatment of breast cancer. The most controversial area is the treatment of ductal carcinoma in situ. Recent studies exploring breast-conserving surgery with and without radiation are outlined. Although no consensus exists on the recent studies, the emergence of ductal carcinoma in situ as a cancer with both significant pathologic subtypes and significant differences in clinical presentation is clear. Concerning the role of radiation in invasive breast cancer, all reports indicate continuation of the earlier observed success. Predictors for recurrence, the diagnosis of recurrence, and the relationship of an apparent isolated local recurrence with the eventual development of distant metastatic disease are reviewed. The outcome of treatment with breast-conserving surgery in radiation in unusual situations is also presented, including patients with silicone prostheses, those presenting with an axillary mass and occult breast disease, and those with multiple primary tumors in the same breast. The clinical evidence continues to support radiation delivered after mastectomy in patients who are at high risk for locoregional recurrence. Systemic adjuvant chemotherapy alone does not appear to prevent many of these recurrences. With the improved local control following treatment with both adjuvant systemic therapy and comprehensive postoperative radiation, preliminary reports are also documenting advantages in terms of disease-free survival.     

Neoadjuvant Therapy of Breast Cancer

Primary systemic therapy is defined as the first systemic treatment a patient receives after cancer is diagnosed, and indicates that subsequent therapies are intended. It is also known as preoperative, induction, or neoadjuvant systemic therapy. Because of high tumor regression rates, primary systemic chemotherapy has become part of the standard of multidisciplinary care for patients with locally advanced and inflammatory breast cancer. An expert panel has reviewed all large randomized clinical trials of primary systemic chemotherapy versus adjuvant systemic therapy in operable breast cancer and concluded that both result in equivalent disease-free, local recurrence-free, and overall survival rates when compared head to head. However, the rate of successful breast-conserving surgery is statistically significantly increased in patients who receive primary chemotherapy; thus, primary systemic therapy is a reasonable alternative for patients with operable breast cancer who are deemed to be appropriate candidates for mastectomy but who desire breast-conserving surgery, or for those patients who desire less extensive breast-conserving surgery. The addition of taxanes or trastuzumab to primary systemic chemotherapy results in a significant increase in the overall and complete clinical response rates and in pathologic complete response (pCR) rates. A poor response to primary systemic chemotherapy is a predictor of poor prognosis and of a high risk of recurrence, irrespective of the type of surgery performed. In contrast, a pCR of the tumor or of cytologically documented axillary lymph node disease correlates strongly with both prolonged disease-free survival and overall survival, and occurs in 6–31% of patients, depending on the breast cancer subtype, the particular chemotherapy regimen used, and on the definition of what constitutes a pCR that is used by the particular group. Thus, pCR may be regarded as one major goal of primary systemic chemotherapy. Emerging data suggest that the achievement of pCR is associated with an excellent long-term outcome, regardless of the therapy regimen that results in pCR. If this association of pCR with outcome, regardless of the therapy regimen resulting in pCR, is confirmed, the application of newer gene- or protein-based technologies to predict at diagnosis which patients will achieve pCR in response to various biologic therapies and chemotherapies will have important clinical implications. In addition, the ability of pCR to predict an excellent long-term outcome may, with further study, become routinely applicable to the study of novel anticancer agents in the adjuvant setting, perhaps ultimately allowing us to avoid the need to perform large expensive trials with many years of follow-up.     

Postoperative radiotherapy in gastric cancer

Surgeons in Poland are very skeptical about the positive role of adjuvant irradiation in patients with gastric cancer. A retrospective study of 21 patients with operable gastric cancer referred for irradiation to Cancer Centre in Warsaw between December 1984 and December 1991 was performed. Patients were qualified to receive adjuvant treatment because of bad prognostic factors—nonradical surgery (10 patients), infiltration of entire thickness of gastric wall (13 patients), and metastases in regional lymph nodes (9 patients). All patients were in good condition. They were treated by either telecobalt 60 unit or linear accelerator using 9–15 MeV photons. The total dose to the gastric bed and lymphatic was 46–50 Gy in 25 to 28 fractions, 5 days a week. The tolerance of treatment was good. None of these patients received 5-FU either during irradiation or as maintenance therapy. We have obtained more than 50% overall survival rate at 3 years. Median survival was 27 months and median recurrent-free interval 27 months. Local recurrence was found in four patients, distant metastases in five patients. In the group of 10 patients with nonradical surgery, 5 are alive without evidence of disease from 2 up to 7 years after treatment. Our preliminary results and good tolerance of treatment seem to support the beneficial role of adjuvant radiotherapy after gastrectomy in patients with risk factors of locoregional cancer recurrence. © 1995 Wiley-Liss, Inc.     

Radiation therapy as an adjunct to primary surgery in early stage breast cancer: biological and clinical rationale.

In spite of the widespread use of adjuvant endocrine and cytotoxic chemotherapy, a substantial proportion of patients with early-stage breast cancer eventually develop a distant disease recurrence. Local control also remains a clinically significant problem in subsets of patients. Whether improved local control through the use of postoperative radiation therapy would prevent distant dissemination has been much debated for several decades. Studies on the long-term outcome of systemically untreated breast cancer patients indicate that breast cancer in many patients is a local disease that can be cured by surgery or radiotherapy. Randomized trials of breast screening have also shown that a delay in effective local treatment is associated with an increased incidence of distant dissemination and death from to the disease. Data from individual randomized trials and overviews of postoperative radiation therapy have indicated that radiation therapy as an adjunct to primary surgery is associated with a decrease in distant dissemination and breast cancer death. This benefit may be translated into a substantial overall survival benefit, provided that the treatment technique avoids long-term cardiac side effects. In many of the older radiation therapy trials, such effects appear to have balanced the benefit in terms of a reduced incidence of distant disease among the patients allocated to radiotherapy.     

The significance of local recurrence of carcinoma of the breast

One hundred twenty-one patients with local or regional recurrence of carcinoma of the breast without evidence of distant metastases were treated with megavoltage radiation therapy. All patients had radical or modified radical mastectomy as their initial treatment. The 10 year survival probability of this group of patients is 26 %, with a local control probability of 46 %. Within this group of patients with recurrent disease, factors found to be associated with a poorer prognosis include peripheral nodal recurrence, advanced initial disease stage and short disease free interval. Contrary to expectation, patients with recurrence within the mastectomy scar (as opposed to chest wall recurrence wide of the scar) or a history of previous radiotherapy had poorer local control rates (although not statistically significant), without effect upon overall survival. Comprehensive radiation therapy (peripheral lymphatic plus chest wall) enhanced the local control rate for the entire group and the survival probability for patients with isolated chest wall recurrence compared with limited radiation therapy fields. (Five year survival probability: chest wall irradiation only = 27%; chest wall and peripheral lymphatic = 54%). Patients given systemic therapy at the time of local recurrence showed no survival benefit. Aggressive, comprehensive radiation therapy is indicated for locally recurrent breast cancer. More effective systemic therapy is needed, especially for higher risk patients.     

Late breast recurrence after lumpectomy and irradiation

For 276 patients with early breast cancer followed from 10-21 years after lumpectomy and radiotherapy, the recurrence rate in the treated breast was 15.6%, and 7.2% developed contralateral breast cancer. Only 63% of breast recurrences occurred within 5 years, and the remainder were "late failures," with 5 of the 43 recurrences observed after 10 years. The proportion of failures occurring late was greater for T1 than for T2 tumors (53% vs 25%). Twenty-six percent of early recurrences were inoperable, and an adverse impact of early recurrence on 10-year survival was clearly demonstrable. Late recurrences were all operable and did not appear to be associated with decreased survival. Only 16 of the 36 patients (44%) with operable breast recurrence ever developed metastatic disease, and 5 year survival following salvage therapy was 62%. Although the treated breast remains at continuous cancer risk even beyond 5 year, the prognosis of late recurrence appears quite similar to that of contralateral breast cancer. We do not consider the phenomenon of late recurrence to lend support to a policy of primary mastectomy, just as the existence of contralateral breast cancer does not justify routine "prophylactic" contralateral mastectomy.     

Therapeutic strategy for postoperative recurrence in patients with non-small cell lung cancer

Postoperative recurrence occurs in approximately half of patients with non-small cell lung cancer (NSCLC), even after complete resection. Disease recurrence after surgical resection reduces the patient’s life expectancy sharply. The prognosis after postoperative recurrence is considered to largely depend on both the mode of first recurrence (distant, locoregional or combined) and the treatment modality: (1) The majority of cases of postoperative recurrence involve distant metastasis with or without locoregional recurrence. Platinum-based systemic chemotherapy is practically accepted as the treatment for these diseases on the basis of evidence for original stage IV disease. The advent of both pemetrexed and molecular-targeted drugs has improved the survival of nonsquamous NSCLC and changed the chemotherapeutic algorithm for NSCLC; (2) Among patients with distant metastatic recurrence without locoregional recurrence at the primary tumor site, the metastasis is often limited in both organ and number. Such metastases are referred to as oligometastases. Local therapy, such as surgical resection and radiotherapy, has been suggested to be the first-line treatment of choice for oligometastatic recurrence; and (3) While locoregional recurrence is likely to cause troublesome symptoms, it is a potentially limited disease. Therefore, providing local control is important, and radiation is usually beneficial for treating local recurrence. In order to obtain better control of the disease and provide treatment with curative intent in patients with limited disease, the administration of concurrent platinum-based chemoradiotherapy is recommended according to the results of originally nonresectable stage IIIA and IIIB disease.     

Two cases with long-term disease-free survival after resection and radiotherapy for solitary brain metastasis from breast cancer with extensive nodal metastases

Two rare cases, each with a solitary brain metastasis from breast cancer with extensive nodal metastases as the first site of distant metastasis, were locally treated with surgery and irradiation. The outcome of the two treated cases indicated an excellent and non-recurrent post-therapeutic survival period of more than 3 and 8 years, respectively. In a 50-year-old woman (Case 1), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with doxorubicin and tegafur-uracil (UFT) and hormonal therapy with tamoxifen for left breast cancer. The brain metastasis was treated twice surgically followed by radiotherapy. One year and 6 months later, local recurrence of the brain metastasis appeared and was treated surgically again. No other treatment was done thereafter. Since then, no other distant or lymph node metastasis occurred, and to date her outcome has been non-eventful for 8 years and 5 months. In a 63-year-old woman (Case 2), a solitary brain metastasis was found to have developed after standard radical mastectomy and adjuvant chemotherapy with cyclophosphamide, epirubicin and fluorouracil (CEF) for right breast cancer. The brain metastasis was treated locally with surgery and irradiation of 50 Gy. She thereafter received no further treatments. Since then neither distant metastases nor local recurrence have developed, and to date the post-treatment outcome has been uneventful for 37 months. Our findings suggest that patients who developed a solitary brain metastasis as the first site of distant metastasis from breast cancer have a chance of achieving long-term disease-free survival when treated with aggressive local therapy, even in the presence of extensive lymph node metastases at the primary surgery site for breast cancer.