BCT (breast conserving therapy) is now accepted as one of the standard therapeutic options for stage I, II breast cancers. However, especially in Korean breast cancer patients, many questions still remain to be answered in terms of the optimal indication, the extent of resection and the frequency and proper management of recurrence due to the lack of studies involving large numbers of patients. The aims of this study were to examine the pattern and the frequency of recurrence following BCT and to identify the risk factors of local recurrence and systemic relapse. In addition, the outcomes for the patients treated with a quadrantectomy and with a lumpectomy were compared with particular emphasis on the rate of local recurrence.

The medical records of 386 patients who underwent a BCT at Korea Cancer Center Hospital during the period from January 1986 to December 1996 were reviewed.

Among the 386 patients, 269 (69.7%) patients underwent a quadrantectomy and 117 (30.3%) patients underwent a lumpectomy with microscopic confirmation of margin status. Level I, II axillary dissection and whole breast irradiation, including electron beam boost to tumor site, were performed routinely. The axillar and supraclavicular areas were included in the irradiation field when 4 or more positive nodes were found. Systemic treatment (CMF or CAF:±tamoxifen) was done depending on the pathological stage and the hormone receptor status of the disease. During the period of follow up (median 66 months), 9 cases (2.3%) of local recurrence and 18 cases (4.7%) of systemic relapse were identified in 24 (6.2%) patients. Between the quadrantectomy and the lumpectomy groups, there were no significant differences in the frequencies of local recurrence (p=0.l79) and systemic relapse (p=0.266). Young age (≤40) (p=0.0l) and lymph node metastasis (p=0.000l) were proven to be risk factors of local recurrence. Large tumor size (>2 cm) (p=0.03) and lymph node metastasis (p=0.003) were risk factors of systemic relapse.

The rates of local recurrence were very low in both the quadrantectomy and the lumpectomy group compared with those in a Western series. These results show that a quadrantectomy or a lumpectomy with confirmation of margin status followed by radiation therapy can provide excellent results in terms of local control and survival in Korean breast cancer patients.