Prognosis and Treatment of Loco-Regional Breast Cancer Recurrences: Critical Considerations on 120 Cases

Abstract

In the present study we report the long-term results for 120 female patients who underwent mastectomy for breast cancer, from 1955 to 1965, and in whom the first relapse was represented by a skin recurrence or a supraclavicular lymph node metastastis. Eighty-nine patients had been submitted only to local therapy, 11 had also undergone bilateral oophorectomy, and in the remaining 20 hormonal compounds had been administered in addition to local therapy. The disease-free interval between the first and the second relapse, and survival after the treatment of the first relapse were strictly related to the presence and the number of axillary lymph node metastases at the time of the mastectomy (N category). In fact, the median survival was 19.5 months for 63 cases with more than 3 metastatic lymph nodes, 29 months for 24 cases with 1–3 involved lymph nodes, and 59 months for 38 cases without axillary involvement. No significant difference in survival was observed in relation to chronological age and menopausal status of the patients or to the lenght of the disease-free interval. The association of endocrine therapies to local treatment of the recurrences also did not increase the survival rate in these cases. The present data indicate that the prognosis for patients with recurrent breast cancer is mainly related to the N category.

Fluorouracil, Doxorubicin, and Cyclophosphamide Followed by Tamoxifen as Adjuvant Treatment for Patients with Stage IV Breast Cancer with No Evidence of Disease

“…In the past, breast cancer patients who developed an isolated local recurrence were considered to have an unfavorable prognosis since the majority of these patients would eventually succumb to distant metastatic disease. Surgery, radiation therapy, or both were considered the treatment of choice for locoregional control, but treatment with these modalities conferred no benefit in terms of DFS for this patient population (4–8,17–19). For this reason, studies were begun to evaluate whether systemic therapy administered to patients in whom locoregional control had been achieved would improve DFS and decrease the incidence of distant metastases.…”

“…Only a limited amount of information exists on the natural history of the disease and the results of systemic therapy in patients with stage IV‐NED disease, and most of the studies have focused on the effect of local treatment on patient survival. Several studies have shown that approximately 30–40% of patients with a local or regional recurrence will develop systemic disease within 3 months (1–8) and that 50–80% of these patients will develop systemic disease within 2 years. The 5‐year survival rate ranges from 4% to 36% according to different retrospective studies (2,4,7,9).…”

“…Several studies have shown that approximately 30–40% of patients with a local or regional recurrence will develop systemic disease within 3 months (1–8) and that 50–80% of these patients will develop systemic disease within 2 years. The 5‐year survival rate ranges from 4% to 36% according to different retrospective studies (2,4,7,9). Only a few studies of systemic therapy for patients with a local or regional recurrence have been published (1,9–13).…”

Combined‐modality treatment for isolated recurrences of breast carcinoma

“…However, local treatment with these modalities does not improve DFS for this patient population. 4,8,[23][24][25] This suggests that many of these patients have micrometastases at the time of their first recurrence. Consequently, studies were initiated to assess whether adequate local treatment to achieve Stage IV-NED followed by systemic therapy would improve long-term outcome for these patients.…”

“…2,4,7,9 To our knowledge, few studies published to date have considered the role of adjuvant systemic treatment in patients with recurrent breast carcinoma who have been rendered Stage IV-NED with surgery and/or radiotherapy. We previously reported the results from three Phase II studies of doxorubicin-based chemotherapy for Stage IV-NED breast carcinoma in anthracycline-naïve patients that were conducted between 1974 and 1992.…”