Comparing Local Recurrence and Distant Metastasis Between Breast-Conserving Therapy with Radiotherapy and Total Mastectomy in Candidates for PET/CT Assessment

Background: This study aimed to compare the recurrence rate of breast cancerbetween women treated with breast-conserving therapy (BCT) with/withoutradiotherapy and those treated with total mastectomy using ۱۸F-fluorodeoxyglucosepositron emission tomography/computed tomography۱۸ (F-FDG PET/CT).Methods: The current study retrospectively included ۵۸۸ patients sufferingfrom breast cancer who had been referred to the PET/CT department of Masih-e-Daneshvari Hospital in Tehran between April ۲۰۱۳ and September ۲۰۱۹. Data ofall female patients with breast cancer were extracted from the recorded hospitalfiles. Based on the treatment plan, patients were divided into two groups: BCTwith/without radiotherapy (n=۱۶۸) and total mastectomy (n=۴۲۰). Local,locoregional, and distant metabolically active lesions were determined in۱۸ F-FDGPET/CT and compared between groups.Results: BCT and total mastectomy were comparable regarding local (۲۸.۵% vs.۲۵.۷%, P=۰.۲۰۰) and locoregional (۲۱.۴% vs. ۲۲.۸%, P=۰.۷۱۲) recurrence, whiledistant recurrence was significantly higher with total mastectomy (۸۸.۵% vs. ۶۴.۲%,P<۰.۰۰۱). Also, lymph node invasion (۴۲.۹% vs. ۶۰%m P<۰.۰۰۱) and positivePET/CT (۷۸.۵% vs. ۸۸.۵%, P=۰.۰۰۲) were significantly higher with total mastectomy.According to multivariate analysis, age, clinical stage, and positive margin areindependently correlated with the rate of distant metastasis.Conclusion: According to our analysis, breast-conserving therapy could be asuitable choice of surgery in selected patients since local and locoregionalrecurrence rate did not significantly differ between patients who underwent breastconservingsurgery compared to those who were treated with total mastectomy.Higher rate of distant metastasis in patients with total mastectomy seems to beinfluenced by many confounding variables such as age, higher stage of diagnosisand positive margin rather than type of surgery.

Keywords:

Breast cancer , recurrence , breast-conserving therapy , total mastectomy , ۱۸ F-FDG PET/CT