Objective: To evaluate our data concerning local and distant recurrences in order to identify predicting factors for local failure and increased risk of distant metastases.Materials and methods: Between January 1976 and December 1993, 562 patients with non-metastatic T1 (tumors ≤ 1 cm [n=213], > 1 cm [n=233]) or T2 (tumors less than or equal to 3 cm [n=116]) carcinoma of the breast underwent large tumorectomy [n=464] or quadrantectomy [n=98] with [n=528] or without [n=34] axillary dissection (N-: 396, 1-3 involved nodes: 100, > 3 involved nodes: 32). Radiotherapy consisted of 45 Gy to the entire breast via tangential fields. Patients with positive axillary lymph nodes or treated without axillary dissection received 45 Gy to the axillary and supra clavicular area. Patients with positive axillary nodes or inner and central tumor locations received 50 Gy to the internal mammary lymph node area. A booster dose was delivered to the primary site by iridium 192 implant in 301 patients (mean total dose: 15.2±0.06 Gy, min: 15, max: 25) or by electrons in 256 patients (mean total dose: 15 ± 0.1 Gy, min: 5, max: 20). The mean age was 53 ± 0.5 years (min: 25, max: 87) and 292 patients were post menopausal. Histological types were as follows: 493 infiltrating ductal carcinomas, 42 infiltrating lobular carcinomas, and 27 other histotypes. Grade distribution according to the SBR classification was as follows: 161 grade 1, 285 grade 2, 76 grade 3 and 40 non classified. The mean tumor size was 1.5 ± 0.03 cm (min: 0.2, max: 3). The intra ductal component of the primary tumor was extensive (EIC ≥ 25%) in 43 patients. Tumors were microscopically bifocal in 38 cases. Margins were assessed in the majority of cases by inking of the resection margins and were classified as positive in 13 cases, close (≤ 2 mm from the margin) in 22, negative (> 2 mm tumor-free margin) in 446, and indeterminate in 81. Vascular tumor emboli were observed in 40 patients. Hormonal therapy with tamoxifen for at least two years was administered in 199 patients and adjuvant systemic chemotherapy (at least 6 cycles) in 117 patients. The mean follow-up period from the beginning of the treatment was 85 ± 1.5 months.Results: There were 47 isolated local recurrences, 8 isolated axillary node recurrences, 40 isolated distant metastases, 2 local recurrences with synchronous axillary node recurrence, 7 local recurrences with synchronous metastases and 1 local recurrence with synchronous axillary node recurrence and distant metastases as first events. Over 40 pathologically evaluable local recurrences, 34 were classified as true local recurrences and 6 as new primary ipsilateral carcinomas. Eighty one patients had died (49 of breast carcinoma, 5 of other neoplastic diseases, 16 of other diseases and 11 of unknown causes). The five- and 10-year rates for specific survival were 94% and 82%, disease-free survival 86.5% and 77.5%, distant metastasis 8.5% and 13.5%, and local recurrence 7% and 13%, respectively. Mean intervals from the beginning of the treatment to the local recurrence and the distant metastases were 60 ± 6 months (median: 47, min: 6, max: 217) and 51 ± 5.3 months (median: 34, min: 6, max: 217), respectively. After local recurrence, salvage mastectomy was performed in 49 cases (86%) and 46 patients received systemic hormonal therapy and/or chemotherapy. After local recurrence, 5- year specific survival rate was 74 ± 7.5%. Multivariate analysis (multivariate generalization of the proportional hazards model) showed that independent factors influencing the local control were age (≤ 40 yr. vs > 40; RR: 3, 95% CI: 1.6-5.5, p=0.0003), menopausal status (pre vs post; RR: 2.9, 95% CI: 1.4-5.9, p=0.0029), focality (uni vs bifocal; RR: 3.1, 95% CI: 1.5-6.5, p=0.0029) and EIC (< 25% vs ≥ 25%; RR: 2.5, 95% CI: 1.2-4.8, p=0.01). However, the probability of distant metastatic spread was influenced by the number of involved axillary nodes (RR: 1.2, 95% CI: 1.09-1.25, p<0.0001), histological grading (1 vs 2 vs 3; RR: 2, 95% CI: 1.43-3.06, p=0.00013), isolated local recurrences (no vs yes; RR: 7, 95% CI: 4.30-11.2, p<0.0001) and vascular tumor emboli (no vs yes; RR: 2.3, 95% CI: 1.23-4.14, p=0.0087). Five-year specific survival after local recurrence was influenced only by caracteristics of the primary tumor: histological grading (RR: 8.6, 95% CI: 1.3-58, p=0.027) and axillary nodal status (RR: 2.75, 95% CI: 1.05-7.17, p=0.039).Conclusion: Isolated local recurrence increases the risk of distant metastases. In our series, predicting factors for local recurrence and distant metastases seem to differ. However, after local recurrence, the specific survival is influenced by histological grading and axillary nodal status of the primary tumor.