Management of locoregional recurrence of breast cancer

Abstract

The locoregional recurrence of breast cancer is not a sign of distant metastases, and a substantial proportion of cases are cured by salvage therapy. Patients with locoregional recurrence should not be treated with palliative intent as if they have visceral metastases. The recommended treatment for ipsilateral breast recurrence after breast conservative therapy is a mastectomy. For patients who suffer from isolated chest wall recurrence after mastectomy, a surgical approach is recommended. Neoadjuvant chemotherapy is considered for patients with unresectable disease in order to render the disease resectable. For patients with isolated chest wall recurrence who have received no prior radiotherapy, postoperative radiotherapy involving the chest wall and regional lymph nodes is recommended. Patients with isolated axillary lymph node recurrence should be treated with axillary dissection or resection. Although the effectiveness of systemic therapy for patients with locoregional recurrence is unclear, there is a trend toward treating patients with supraclavicular lymph node recurrence with radiotherapy plus systemic therapy. Pain relief and the eradication of other distressing symptoms resulting from inoperable disease are achieved in two-thirds to three-quarters of patients by radiotherapy with or without systemic therapy. New anti-cancer agents and molecular target therapies should be evaluated with the objective of improving the treatment outcome of patients with locoregional recurrence. A combination of approaches is required for treatment of patients with locoregional recurrence, and a multidisciplinary tumor board should be organized at each institute.

Symptom Management in Metastatic Breast Cancer

“…When this occurs, local recurrence should be treated aggressively with surgery and/or radiation with or without systemic therapy [52]. For example, if the initial treatment was breast-conserving surgery, a mastectomy or surgical resection may be performed, if possible.…”

Locoregional and Distant Recurrence Patterns in Young versus Elderly Women Treated for Breast Cancer

“…LRRs can occur in different tissue sites including the ipsilateral breast, chest wall, axillary, supraclavicular, and internal mammary lymph nodes. A local recurrence within the breast may require a complete mastectomy, as salvage treatment, while a chest wall recurrence may need excisional surgery along with radiation with or without systemic therapy [ 6 ]. Preventing a LRR is an important factor driving improvements in the treatment of primary breast tumors, but current guidelines for deciding lumpectomy versus mastectomy are based on potential cosmetic outcome, history of collagen vascular diseases and prior radiation, and patient and physician preference.…”

Clinicopathological Features and Prognostic Factors Affecting Survival Outcomes in Isolated Locoregional Recurrence of Breast Cancer: Single-Institutional Series

“…The incidence of ILRR of breast cancer is approximately 10–13% within 10 years after BCS, and 3–8% after mastectomy plus postoperative radiotherapy [ 7 , 8 ]. Despite local treatment, ILRR has been associated with an increased risk of distant metastasis and poor prognosis [ 2 , 3 , 6 , 14 , 15 ].…”

“…Isolated locoregional recurrence (ILRR) of breast cancer after breast-conserving surgery (BCS) or mastectomy is associated with an increased risk of distant metastases and a poor prognosis [ 1 – 6 ]. The incidence of ILRR is approximately 10–13% after BCS and 3–8% after mastectomy [ 7 , 8 ]. For patients with recurrence, salvage mastectomy has been the predominant local treatment modality for most patients with operable ILRR but second BCS might be considered in some patients, particularly those with small and late recurrence [ 9 – 11 ].…”