Abstract P1-16-01: Effect of margin width on local recurrence in invasive lobular carcinoma treated with multimodality therapy
Authors: Sagara Yasuaki , Barry William T , Vaz-Luis Ines , Aydogan Fatih , Brock Jane E , Winer Eric P , Golshan Mehra , Metzger-Filho Otto 
Published: May 2015

Background: Recent consensus guideline on margins for breast conserving surgery recommends the use of no ink on tumor as the standard for an adequate margin. Current recommendation extends to invasive lobular carcinoma (ILC), however the data in this subset is limited by small numbers. In the present analysis we sought to evaluate the influence of margin status on outcomes in ILC and mixed tumors.

Methods: We performed retrospective cohort study and reviewed 809 eligible patients diagnosed with ILC (337 with pure ILC; 472 with mixed ILC) with Stage I –III treated at Dana Farber/Brigham and Women’s Cancer Center (DFBWCC) between May 1997 and Dec 2007. Clinico-pathologic data was extracted following the Clinical Research Information Systems (CRIS) Database procedures and manually reviewed to confirm inclusion and details of margin status. Margin status was defined using the last ASCO/ASTRO/SSA consensus guidelines criteria. Analysis results were considered to be statistically significant when the two-tailed p-value was &lt;0.05.

Results: Breast conservation was performed in 399 patients (49%). Margin status at the initial attempt for breast conservation was defined as follows: 180 (45%) negative, 64 (16%) positive, 71 (18%) ≤ 1mm margin, and 84 (21%) close margins (&gt; 1 and &lt; 3 mm). Following initial lumpectomy, 102 (25%) patients underwent additional surgery (96 re-excisions and 6 mastectomies) and residual invasive disease was found in 40 patients. Whole-breast radiation therapy was performed in 376 patients (96%). In multivariate models adjusted for classic clinico-pathologic factors, tumor size (HR= 1.8 95% CI 1.0 to 3.3, p=0.05), multifocality (HR= 2.0 95% CI 1.1 to 3.6, p= 0.02) and ILC subtype (HR= 2.0 95% CI 1.0 to 3.7, p=0.04) were correlated with positive margins, while year of diagnosis, age and pre-surgical MRI findings were not statistically significant.

With 72 months median follow-up, 12 ipsilateral breast cancers (3.1%), 5 other locoregional (1.2%) and 15 distant (3.8%) recurrences were observed after definitive breast conserving therapy. The incidence of locoregional recurrence (LRR) was 4.3% and similar for ILC and mixed ILC (p=0.76). In univariate analysis positive surgical margin was associated with LRR (HR=5.1, p= 0.03) and disease-free survival (DFS) (HR=8.9, p≤ .001), but due to limited number of cases and events this could not be adjusted for other clinico-pathologic prognostic factors in a mulitvariate model. Close surgical margins, margins within 1mm and multifocality were not associated with increased LRR or worse DFS. Re-excision did not impact on DFS for patients with close margin (p= 0.57) and within 1 mm margin (p= 0.85). By contrast, significant improvement of DFS following re-excision was observed in patients with positive margin (p= 0.01).

Conclusions: Following lumpectomy, local recurrence rates for ILC patients with close surgical margin and ≤ 1mm margin are low and equivalent to those in patients with negative margins. This study supports the validity of using no ink on tumor as the standard for an adequate margin for patients diagnosed with pure or mixed ILC treated with multimodality therapy.

Citation Format: Yasuaki Sagara, William T Barry, Ines Vaz-Luis, Fatih Aydogan, Jane E Brock, Eric P Winer, Mehra Golshan, Otto Metzger-Filho. Effect of margin width on local recurrence in invasive lobular carcinoma treated with multimodality therapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-16-01.