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Correlating primary breast cancer size, growth and treatment delay with the risk of axillary metastases
251
Proceedings of the 36th Annual ASTRO Meeting
1015 MALE BREAST CARCINOMA - THE COLUMBIA-PRESBYTERIAN MEDICAL CENTER EXPERIENCE C.K. Tsang, M.D.1, M.K. Hayes, M.D.l, I.C. Hsu, M.D.l, J. O’Neil, M.S.2
Depts. of Radiation Oncology1 and Surgery2, Columbia-Presbyterian Medical Center, New York, N.Y. Purpose/Objective: To evaluate the Columbia-Presbyterian Medical Center experience in male breast cancer from 1980 to 1993 and compare it to the available literature. Materials and Methods: Charts of 44 male patients who underwent surgery, for primary breast cancer at Columbia-Presbyterian
Medical between
1980 and 1993 were retrospectively reviewed. Results: l/44 (2%) presented with Stage 0 disease. 13/44 (30%) presented with Stage I, 21144 (48 %) with Stage II, U44 (5%) with Stage III, and l/44 (2%) were diagnosed with Stage IV disease at pnsentation. In 6/44 (14%) patients, the stage was not able to be determined. All patients underwent mastectomy; 9 radical mastectomy, 29 mndified and radical mastectomy and 6 simple mastectomy. Median age at diagnosis was 70. Average age was 66.5 (range 38-91). 38144 (86%) patients had lymph node dissection. 18/38 (47)% had node positive disease. Median number of positive lymph nodes were 3.5 (range l-29). Twenty-six cases were infiltrating ductal carcinoma. Nine cases were inuaducti carcinoma. Hormonal status was known for 23 patients. In the 32 patients in whom follow-up was available, ER was found to be positive in 2O/23 (87%) patients. PR was positive in 9/L1(43%) patients, and negative in 12/21(57%) patients. There were a total of 7 relapse (22%) patients. Analysis of local failuns revealed 1 chest wall recurrence at 23 months after diagnosis, 1 ipsilateral axillary lymph node recurrence at 32 months. Five distant metastases occurred between 1 month and 11.5 years. Median time to relapse was 25 months. Four patients expired. Three deaths were breast cancer related, 1 non cancer related. With a median follow-up of 14.1 years, overall survival was 87.5% (range 1.2-13.3 years follow-up). Interestingly, 13/33 (29.5%) patients had one or more second primary malignancies including prostate (4). melanoma (3), colon (2), bladder (2), lung (l), basal cell (1). gas& (l), and larynx (1). This is in contrast to our female population where th&incidence of second malignancy is 5.5% ( p < 0.001 chi-square). Of the male bnzast carcinoma patients, 12 second primary cancers were diagnosed prior to the diagnoses. Three diagnoses were made subsequent to the diagnosis of breast cancer. Conclusion: When compared to the available literature on male breast carcinoma, our experience is in agreement with respect to histology, nodal
status and hormone status. In contrast to some series, 25/44 (57%) presented with early stage disease. However, the incidence of second malignancies is disconcerting at 29.5%. The absolute numbers an too small to make a specific comment regarding second tumor type. Although survival appears to be n&ted to breast can- in this small series, it seems appropriate to search for second malignancies in the male breast cancer population, and consider the possibility of breast cama in men with other malignancies.
1016 CORRELATING PRIMARY BREAST CANCER SIZE, GROWTH AND TREATMENT AXILLARY METASTASES ~~~er~p~gb~.D~J~~~~d~~~
,
-.,
(
MS:;,
. .,
. .
,Jane Lunceford,
Department of Radiation Oncol Cancer Center, Maryview Medi‘~&n!r~!~~o$~~!!#?
DELAY WITH THE RISK OF
M.S.‘, Deborah Kuban, M.D.‘, Raymond Wu, Ph.D.‘, James
’ ’ Medicai School, Norfolk, VA 23507’ and Martha W. Davis
PURPOSE: To introduce a new concept of correlating primary breast cancer size and risk of pathologically proven axillary metastases using mathematical modeling of retrospective clinical data. Practical clinical implications of this correlation, including the increased risk of axillary nodal metastases attributable to treatment delay, will be presented. MATERIALS AND METHODS: Recently published data have become available correlating the size of primary breast cancer with percent risk of pathologically confirmed axillq nodal metastases’: AJCTSNo. of Patients AJC Tumor Size Ranee Ave. AJC Tumor Sk j6 Positive Axillac: Tla 3% 96 0- 5mm 2.5 mm 17% Tlb 6- 10mm 8.0 mm 156 Tic 11 -2Omm 15.5 mm 32% 357 T2 44% 330 21-50mm 35.5 mm RESULTS: Analysis of these data was performed revealing a linear relation between the natural log of the AJC tumor size (the average AJC tumor size in each T substage) and the percent positive axilkuy dissections, with correlation coefficient r = 0.993. This linear relation is described in the equation: In Y = (0.0624)X - 1.4734, where Y = tumor size (in cm) and X = percent positive axillary dissections. Solving for X in the range of tumor sizes in Tla reveals an estimated risk of axillary me&stases of: approximately 0% for tumors s 0.2 cm, 4.3% for 0.3 cm tumors, 8.9% for 0.4 cm tumors and 12.5% for 0.5 cm tumors. Using the preceding equation and the known exponential relation between tumor growth and time, Yz = y,ewhmT, we derived a second equation. This second equation determines the increased risk of axillary nodal metastases .attributable to an n day delay in treatment (n) by solving for a change in X (AX), given a known primary breast cancer doubling time (DT). This second equation is: AX = (ll.l08)n/DT. The estimated increased risk of axillary nodal metastases attributable to delay in definitive treatment, given a primary breast cancer doubling time of 130 days, is calculated to be: 0.09% for one day, 0.60% for seven days an4 2.56% for 30 days.
Proceedings of the 36th Annual ASTRO Meeting
1015 MALE BREAST CARCINOMA - THE COLUMBIA-PRESBYTERIAN MEDICAL CENTER EXPERIENCE C.K. Tsang, M.D.1, M.K. Hayes, M.D.l, I.C. Hsu, M.D.l, J. O’Neil, M.S.2
Depts. of Radiation Oncology1 and Surgery2, Columbia-Presbyterian Medical Center, New York, N.Y. Purpose/Objective: To evaluate the Columbia-Presbyterian Medical Center experience in male breast cancer from 1980 to 1993 and compare it to the available literature. Materials and Methods: Charts of 44 male patients who underwent surgery, for primary breast cancer at Columbia-Presbyterian
Medical between
1980 and 1993 were retrospectively reviewed. Results: l/44 (2%) presented with Stage 0 disease. 13/44 (30%) presented with Stage I, 21144 (48 %) with Stage II, U44 (5%) with Stage III, and l/44 (2%) were diagnosed with Stage IV disease at pnsentation. In 6/44 (14%) patients, the stage was not able to be determined. All patients underwent mastectomy; 9 radical mastectomy, 29 mndified and radical mastectomy and 6 simple mastectomy. Median age at diagnosis was 70. Average age was 66.5 (range 38-91). 38144 (86%) patients had lymph node dissection. 18/38 (47)% had node positive disease. Median number of positive lymph nodes were 3.5 (range l-29). Twenty-six cases were infiltrating ductal carcinoma. Nine cases were inuaducti carcinoma. Hormonal status was known for 23 patients. In the 32 patients in whom follow-up was available, ER was found to be positive in 2O/23 (87%) patients. PR was positive in 9/L1(43%) patients, and negative in 12/21(57%) patients. There were a total of 7 relapse (22%) patients. Analysis of local failuns revealed 1 chest wall recurrence at 23 months after diagnosis, 1 ipsilateral axillary lymph node recurrence at 32 months. Five distant metastases occurred between 1 month and 11.5 years. Median time to relapse was 25 months. Four patients expired. Three deaths were breast cancer related, 1 non cancer related. With a median follow-up of 14.1 years, overall survival was 87.5% (range 1.2-13.3 years follow-up). Interestingly, 13/33 (29.5%) patients had one or more second primary malignancies including prostate (4). melanoma (3), colon (2), bladder (2), lung (l), basal cell (1). gas& (l), and larynx (1). This is in contrast to our female population where th&incidence of second malignancy is 5.5% ( p < 0.001 chi-square). Of the male bnzast carcinoma patients, 12 second primary cancers were diagnosed prior to the diagnoses. Three diagnoses were made subsequent to the diagnosis of breast cancer. Conclusion: When compared to the available literature on male breast carcinoma, our experience is in agreement with respect to histology, nodal
status and hormone status. In contrast to some series, 25/44 (57%) presented with early stage disease. However, the incidence of second malignancies is disconcerting at 29.5%. The absolute numbers an too small to make a specific comment regarding second tumor type. Although survival appears to be n&ted to breast can- in this small series, it seems appropriate to search for second malignancies in the male breast cancer population, and consider the possibility of breast cama in men with other malignancies.
1016 CORRELATING PRIMARY BREAST CANCER SIZE, GROWTH AND TREATMENT AXILLARY METASTASES ~~~er~p~gb~.D~J~~~~d~~~
,
-.,
(
MS:;,
. .,
. .
,Jane Lunceford,
Department of Radiation Oncol Cancer Center, Maryview Medi‘~&n!r~!~~o$~~!!#?
DELAY WITH THE RISK OF
M.S.‘, Deborah Kuban, M.D.‘, Raymond Wu, Ph.D.‘, James
’ ’ Medicai School, Norfolk, VA 23507’ and Martha W. Davis
PURPOSE: To introduce a new concept of correlating primary breast cancer size and risk of pathologically proven axillary metastases using mathematical modeling of retrospective clinical data. Practical clinical implications of this correlation, including the increased risk of axillary nodal metastases attributable to treatment delay, will be presented. MATERIALS AND METHODS: Recently published data have become available correlating the size of primary breast cancer with percent risk of pathologically confirmed axillq nodal metastases’: AJCTSNo. of Patients AJC Tumor Size Ranee Ave. AJC Tumor Sk j6 Positive Axillac: Tla 3% 96 0- 5mm 2.5 mm 17% Tlb 6- 10mm 8.0 mm 156 Tic 11 -2Omm 15.5 mm 32% 357 T2 44% 330 21-50mm 35.5 mm RESULTS: Analysis of these data was performed revealing a linear relation between the natural log of the AJC tumor size (the average AJC tumor size in each T substage) and the percent positive axilkuy dissections, with correlation coefficient r = 0.993. This linear relation is described in the equation: In Y = (0.0624)X - 1.4734, where Y = tumor size (in cm) and X = percent positive axillary dissections. Solving for X in the range of tumor sizes in Tla reveals an estimated risk of axillary me&stases of: approximately 0% for tumors s 0.2 cm, 4.3% for 0.3 cm tumors, 8.9% for 0.4 cm tumors and 12.5% for 0.5 cm tumors. Using the preceding equation and the known exponential relation between tumor growth and time, Yz = y,ewhmT, we derived a second equation. This second equation determines the increased risk of axillary nodal metastases .attributable to an n day delay in treatment (n) by solving for a change in X (AX), given a known primary breast cancer doubling time (DT). This second equation is: AX = (ll.l08)n/DT. The estimated increased risk of axillary nodal metastases attributable to delay in definitive treatment, given a primary breast cancer doubling time of 130 days, is calculated to be: 0.09% for one day, 0.60% for seven days an4 2.56% for 30 days.