Prognostic Factors in 77 Curative Chest Wall Resections for Isolated Breast Cancer Recurrence

Abstract

BackgroundFull-thickness chest wall resection (CWR) is the preferred treatment for breast cancer (BC) patients with extensive isolated locoregional recurrence. It remains a challenge to select patients that will benefit most from this treatment. The aim of this study was to define prognostic factors in patients who undergo CWR with curative intent.MethodsBC patients who underwent a CWR with curative intent for recurrence of disease between 1986 and 2006 were included in this retrospective study. Twenty-two factors were studied in a univariate analyses, and multivariate stepwise Cox regression analyses was performed.ResultsSeventy-seven patients were included in this study. The 5-year overall survival was 25%. There was one postoperative death. Univariate analyses showed that three prognostic factors were significantly correlated with OS and disease-free survival: (1) interval between primary treatment and CWR (P = .02 and .004, respectively), (2) chemotherapy for recurrence (P = .05 and .05, respectively), and (3) resection specimen smaller than 150 cm2 (P = .03 and .009, respectively). An interval lasting >10 years between primary treatment and CWR remained statistically significantly correlated with better overall survival and disease-free survival after multivariate analyses.ConclusionsCWR is a safe treatment in patients who have isolated extensive BC recurrence. The best survival outcome was seen in patients after a disease-free interval of ≥10 years. Existing data show that adjuvant radiotherapy and adjuvant hormone therapy for estrogen-positive tumors improves overall survival. Neoadjuvant chemotherapy may be considered in individual patients.

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

“…Survival after second-IBTR ranges from a median of 33 months 19 to 80.7% at 5 years 20 . Treatment of post-mastectomy nodal or chest wall recurrences is associated with lasting local control of disease in about 50% of cases, but no series provide outcomes following a second-ILRR 6,21 .…”

Preoperative MRI in Patients with Locoregional Recurrent Breast Cancer

“…In these cases, a definite surgical resection is the essential factor for long-term survival. Several studies showed that in addition to a disease-free interval >2 years and extent of the regional recurrence (14,34), the radicality of an extensive resection had a benefit on prognosis, both after mastectomy (35,36) and after BCT in primary disease (12,13). Consequently, we may suggest that every fourth patient (25.6%) in the present study population profited from the MRI findings: by detection of either contralateral disease or additional lymph nodes and thoracic wall lesions resulting in improved treatment planning, more extensive surgery, and additional radiotherapy of occult lesions.…”

Surgical Management of the Radiated Chest Wall and Its Complications

“…[12-14] Loco-regional recurrence of breast cancer in the chest wall occurs in approximately 9% of patients undergoing breast conservation therapy. [14] Multi-modality treatment including chemotherapy, radiation, and surgery is typically employed.…”

“…[12-14] Loco-regional recurrence of breast cancer in the chest wall occurs in approximately 9% of patients undergoing breast conservation therapy. [14] Multi-modality treatment including chemotherapy, radiation, and surgery is typically employed. Although there is some controversy regarding the benefit of surgery compared with systemic therapy and radiation therapy in estrogen receptor-negative breast cancer, surgical resection is often carried out after radiation therapy has already been administered to the chest wall.…”