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Locoregional Control of Clinically Diagnosed Multifocal or Multicentric Breast Cancer After Neoadjuvant Chemotherapy and Locoregional Therapy

Julia L. Oh, Mark J. Dryden, Wendy A. Woodward, Tse-Kuan Yu, Welela Tereffe, Eric A. Strom, George H. Perkins, Lavinia Middleton, Kelly K. Hunt, Sharon H. Giordano, Mary Jane Oswald, Delora Domain, Thomas A. Buchholz

From the Departments of Radiation Oncology, Surgical Oncology, Diagnostic Radiology, Pathology and Breast, Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to Julia L. Oh, MD, Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcolmbe Blvd, Unit 1202, Houston, TX 77030; e-mail: joh{at}mdanderson.org

Purpose The purpose was to assess whether patients with clinical multifocal or multicentric (MFMC) breast cancer determined by mammogram, ultrasound, or physical examination have inferior outcome compared with patients with clinical unicentric lesions.

Patients and Methods We retrospectively analyzed 706 consecutive patients with stages I-III breast cancer treated at the M.D. Anderson Cancer Center (Houston, TX) from 1976 to 2003 who received neoadjuvant anthracycline-based chemotherapy followed by breast conservation therapy (BCT), mastectomy alone, or mastectomy plus postmastectomy radiation therapy.

Results The mean follow-up was 66 months. At presentation, 97 of 706 patients had clinically MFMC disease (13.7%). The 5-year rate of locoregional failure was 10% for unicentric disease compared with 7% for MFMC disease (P = .78). Subset analyses of patients by treatment groups confirmed no statistical difference in locoregional control regardless of the type of locoregional treatment. Among patients with multifocal disease treated with BCT, there were no in-breast recurrences and one supraclavicular recurrence. Five-year disease-free survival and overall survival was equivalent between patients with MFMC and unicentric breast cancers.

Conclusion Patients with clinical MFMC breast cancer at the time of diagnosis treated with neoadjuvant chemotherapy followed by locoregional therapy have similar 5-year rates of locoregional control, disease-free survival, and overall survival as those with unicentric disease. Clinically detected MFMC disease did not predict for inferior outcome.

Presented in part at the 47th Annual Meeting of the American Society of Therapeutic Radiology and Oncology, Denver, CO, May 14-17, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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