Management of Isolated Locoregional Recurrences in Breast Cancer: A Review of Local and Systemic Modalities

Wadasadawala, Tabassum; Vadgaonkar, Rohit Avinash; Bajpai, Jyoti

doi:10.1016/j.clbc.2017.03.008

Cited by 35 publications

(27 citation statements)

References 89 publications

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“…Wadaswala et al reported a second recurrence ranging between 6% and 15% after salvage mastectomy and between 4% and 31% after second BCS . In our series, 17.8% developed a second recurrence, of which 20% after salvage mastectomy and 17.8% after second BCS.…”

Section: Discussionsupporting

confidence: 46%

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A retrospective analysis on 197 cases of breast cancer local recurrence: Biology, treatment, and prognosis

et al. 2019

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Many factors are associated with recurrence after primary breast-conserving surgery (BCS) and after primary mastectomy 1 ; a few data exist on risk factors affecting prognosis after surgery for recurrence.Mastectomy is considered the treatment of choice in patients with breast recurrence after BCS and whole-breast radiation therapy (RT); nevertheless, some authors advocate that in selected cases similar outcomes could be obtained with a second BCS followed by re-RT. 2,3 In this study, we analyzed how the tumor biology and treatment offered to patients at first recurrence affects long-term prognosis looking for independent risk factors for further recurrences. | MATERIAL S AND ME THODSThis is a retrospective study on 197 patients with operable locally BCR treated at Mauriziano Hospital and Candiolo Cancer Institute-FPO, IRCCS, Italy, between January 1996 and December 2016. LR was defined as IBTR (ipsilateral breast tumor recurrence) in patients who underwent BCS as primary surgery and CWR (chest wall recurrence) when mastectomy was performed for the primary tumor.Patients with isolated regional lymph node metastases, and those with distant metastases were not included. | RE SULTSThe histopathological features of the primary tumors, first and second recurrences are described in Table1.Among 157 patients who underwent BCS at primary surgery, 56 (35.7%) underwent a second BCS followed in 20% of cases by a second RT on a limited field and 101 (64.3%) underwent a salvage mastectomy followed in 4% of cases by chest wall RT. In all the 40 patients who underwent a mastectomy for the primary tumor, surgical removal of the recurrence was performed. In 60% of these cases, adjuvant RT was given (Figure 1). Thirty-five patients had a second recurrence, 18 (51.4%) were eligible for surgery; two patients received BCS, 8 CWR exeresis, and 8 mastectomy. Subsequent RT was performed in 4 cases after CWR exeresis. Among the 8 patients who received salvage mastectomy, one received adjuvant RT (Figure 2). Ten (18.7%) of the patients who underwent BCS at first recurrence developed a second recurrence, while 8 (7.9%) patients with salvage mastectomy at first recurrence developed a second recurrence.At multivariate analysis, the omission of RT at first recurrence (OR 4.6; 1.4-15.1, 95% IC, P = .011), the omission of CT at recurrence (OR3.7; 1.2-10.9, P = .0015), and the BCR high tumor grade (OR3.1;1.2-7.7 95% IC, P = .0013) were significantly associated with an increased rate of second recurrences.The development of a subsequent distant recurrence was detrimental on OS with a risk of BCR-related death of 41.4% (OR5.2-327.9, 95%IC), as were the omission of endocrine therapy (OR 6.8;1.1-40.5 IC 95%) and a recurrent tumor size >20 mm (OR7.2; 1.2-44.4 IC 95%). | D ISCUSS I ONRecurrences frequently show a more aggressive biology compared to primary tumors. In our study, at first and second recurrence a

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Section: Discussionsupporting

confidence: 46%

“…Many factors are associated with recurrence after primary breast‐conserving surgery (BCS) and after primary mastectomy; a few data exist on risk factors affecting prognosis after surgery for recurrence.…”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis on 197 cases of breast cancer local recurrence: Biology, treatment, and prognosis

et al. 2019

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“…A meta-analysis and systematic review based on randomized clinical trials, single-arm studies and retrospective analyses have proven the efficacy of sHT combined with RT in the treatment of LRBC [15]. This has been confirmed by several recent reviews [16][17][18][19][20]. Hyperthermia can also be combined with adjuvant re-RT after surgery of local recurrences in the case of "microscopic disease" upon R1 resection or high-risk situations due to close surgical margins [21][22][23].…”

Section: Introductionmentioning

confidence: 85%

Combined wIRA-Hyperthermia and Hypofractionated Re-Irradiation in the Treatment of Locally Recurrent Breast Cancer: Evaluation of Therapeutic Outcome Based on a Novel Size Classification

Notter

Thomsen

Nitsche³

et al. 2020

Cancers

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Effective tumor control in patients suffering from unresectable locally recurrent breast cancer (LRBC) in pre-irradiated areas can be achieved by re-irradiation combined with superficial hyperthermia. Using this combined modality, total re-irradiation dose and toxicity can be significantly reduced compared to conventionally fractionated treatment schedules with total doses of 60–66 Gy. Applying contact-free, thermography-controlled water-filtered infrared-A superficial hyperthermia, immediately followed by hypofractionated re-irradiation, consisting of 4 Gy once per week up to a total dose of 20 Gy, resulted in high overall response rates even in large-sized tumors. Comparability of clinical data between different combined Hyperthermia (HT)/Radiotherapy (RT) treatment schedules is impeded by the highly individual characteristics of this disease. Tumor size, ranging from microscopic disease and small lesions to large-sized cancer en cuirasse, is described as one of the most important prognostic factors. However, in clinical studies and analyses of LRBC, tumor size has so far been reported in a very heterogeneous way. Therefore, we suggest a novel, simple and feasible size classification (rClasses 0–IV). Applying this classification for the evaluation of 201 patients with pre-irradiated LRBC allowed for a stratification into distinct prognostic groups.

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“…Ipsilateral breast tumour recurrence (IBTR) has an unfavourable prognosis, with a significant risk of subsequent local, regional and distant recurrence as well as poor survival. The 5‐year overall survival rate for patients with IBTR ranges between 45 and 80 per cent. Primary nodal status, size of IBTR, and the disease‐free interval (DFI) between the primary breast cancer and IBTR diagnosis are known prognostic factors for the development of further recurrences.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of repeat sentinel lymph node biopsy in patients with ipsilateral breast tumour recurrence

Poodt

Vugts

Schipper

et al. 2019

British Journal of Surgery

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Background: Ipsilateral breast tumour recurrence (IBTR) has an unfavourable prognosis, with a significant subsequent risk of distant recurrence. Repeat sentinel lymph node biopsy (rSLNB) has recently been demonstrated to be technically feasible and useful in tailoring adjuvant treatment plans in patients with IBTR. The prognostic impact of rSLNB in patients with IBTR remains unclear. This study analysed the risk of distant recurrence after IBTR, and evaluated the prognostic impact of rSLNB and other patient and tumour characteristics on distant recurrence-free survival. Methods: Data were obtained from the SNARB (Sentinel Node and Recurrent Breast Cancer) study. Cox proportional hazards analyses were performed to assess the prognostic effect of tumour, patient and treatment factors on distant recurrence-free survival.Results: Of the 515 included patients, 230 (44⋅7 per cent) had a tumour-negative rSLNB and 46 (8⋅9 per cent) a tumour-positive rSLNB. In 239 patients (46⋅4 per cent) the rSLNB procedure was unsuccessful. After a median follow-up of 5⋅1 years, 115 patients (22⋅3 per cent) had developed a recurrence. The overall 5-year distant recurrence-free survival rate was 84⋅2 (95 per cent c.i. 80⋅7 to 87⋅7) per cent. An interval of less than 2 years between primary breast cancer treatment and ipsilateral recurrence (P = 0⋅018), triple-negative IBTR (P = 0⋅045) and absence of adjuvant chemotherapy after IBTR (P = 0⋅010) were independently associated with poor distant recurrence-free survival. The association between the outcome of rSLNB and distant recurrence-free survival was not statistically significant (P = 0⋅682). Conclusion:The outcome of rSLNB is not an important prognostic factor for distant recurrence, and its value as a staging tool in patients with IBTR seems disputable.Members of the SNARB study group are co-authors in this study and are listed in Appendix S1 (supporting information)

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Management of Isolated Locoregional Recurrences in Breast Cancer: A Review of Local and Systemic Modalities

Cited by 35 publications

References 89 publications

A retrospective analysis on 197 cases of breast cancer local recurrence: Biology, treatment, and prognosis

A retrospective analysis on 197 cases of breast cancer local recurrence: Biology, treatment, and prognosis

Combined wIRA-Hyperthermia and Hypofractionated Re-Irradiation in the Treatment of Locally Recurrent Breast Cancer: Evaluation of Therapeutic Outcome Based on a Novel Size Classification

Prognostic impact of repeat sentinel lymph node biopsy in patients with ipsilateral breast tumour recurrence

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