Radiation Therapy for Locally Recurrent Breast Cancer

Siglin, Joshua; Champ, Colin E.; Vakhnenko, Yelena; Anné, Pramila R.; Simone, Nicole L.

doi:10.1155/2012/571946

Cited by 24 publications

(18 citation statements)

References 28 publications

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“…Notably, the majority of patient achieved very good local control after treatment of ILRR, with comparable rates of second-ILRR; 8.2% of the salvage mastectomy population and 12.5% in the repeat breast conserving surgery group. In-breast recurrences after repeat breast-conserving surgery ranges between 7% to 38% (36 to 120 month follow-up) 11, 18 . Gentilini et al found a higher second local failure rate than in our trial; 27% of 161 IBTR cases treated by repeat breast conservation 18 .…”

Section: Discussionmentioning

confidence: 99%

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

et al. 2016

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Purpose Isolated locoregional recurrences (ILRR) of breast cancer confer a significant risk of developing distant metastasis. Management practices and second-ILRR events in the CALOR trial are investigated. Methods 162 patients with ILRR were randomly assigned to receive post-operative chemotherapy, or no chemotherapy. Descriptive statistics characterize outcomes according to local therapy and the influence of hormone receptor status on subsequent recurrences. Competing risk regression models, Kaplan-Meier estimates, and Cox proportional hazards models evaluate associations between treatment, site of second recurrence and outcome. Results The median follow-up was 4.9 years. Of the 98 patients who received breast-conserving primary surgery (BCS), 89 had an ipsilateral-breast tumor recurrence (IBTR); salvage mastectomy was performed in 73 and repeat lumpectomy in 16. Another 8 had nodal-ILRR and 1 chest wall-ILRR. Among 64 whose primary surgery was mastectomy, 52 had chest wall/skin-ILRR and 12 nodal-ILRR. Fifteen patients developed a second-ILRR at a median time from ILRR of 1.6 years (range: 0.08–4.8). All second-ILRR occurred in patients with PR-negative ILRR. Seven (47%) of 15 patients with second-ILRR, and 19 (51%) of 37 with a distant recurrence have died. On multivariable analysis, chemotherapy for the primary cancer (HR 3.55, 95% CI 1.15–10.9, p=0.03) and time interval (continuous) from primary surgery (HR 0.87 95% CI 0.75–1.00, p=0.05) were significant predictors of survival following either a second-ILRR or distant recurrence. Conclusions Second-ILRRs represented about one-third of all recurrence events after ILRR and all were PR negative. These second-ILRRs, as well as distant metastases, portend an unfavorable outcome.

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Section: Discussionmentioning

confidence: 99%

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

et al. 2016

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“…Sexual well-being showed best results in the group of mastectomy ( Table 2). Despite these trends, there were no clinically important differences of questionnaire scores within (15) 53.8% (14) 42.3% (11) 3.6% (1) 51.4% (18) 34.3% (12) 14.3% (5) 44.2% (23) 38.5% (20) 17.3% (9) the groups. Higher satisfaction scores in most items were related to higher age (> 75 years) in every group, but even taking this into consideration there was still no evidence of significant differences.…”

Section: Resultsmentioning

confidence: 79%

Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

et al. 2020

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Purpose When ipsilateral breast-tumor recurrence (IBTR) following breast-conserving surgery (BCS) occurs, the cure of a potentially life-threatening disease is the main goal. If, however, this is diagnosed early, prognosis is still good and patient-reported outcomes become more important. Despite the fact that many patients would prefer a further BCS, international breast cancer guidelines still recommend mastectomy, mainly because previous radiation implies limited options. Our comparative study evaluates the long-term quality-of-life and outcome in patients with IBTR who received BCS plus intraoperative radiotherapy (IORT) versus mastectomy. Methods Patients with IBTR were retrospectively divided into three groups according to the local treatment: group 1 (n = 26) was treated with BCS + IORT; group 2 (n = 35) received a standard mastectomy; group 3 (n = 52) had a mastectomy with subsequent reconstruction. Outcomes were analyzed after a mean follow-up of 5 years after IBTR. Quality-of-life was evaluated by the validated questionnaire BREAST-Q in 50 patients who fulfilled the inclusion criteria. Results Quality-of-life scores varied within the groups, ranging from 51.4 to 91.3 (out of 100 points). We observed satisfactory scores in all items, with no statistical difference within the groups. Disease-free survival of all groups did not statistically differ, and overall mortality was very low (0.9%). The postinterventional complication rate was lower after BCS (19.2% versus 34.3% after mastectomy and 30.8% after mastectomy with reconstruction). Conclusion For patients with previous surgery and radiation who demand a second BCS in the recurrent situation, this surgical technique can be offered in combination with IORT. Our long-term results imply oncological safety, lower complication rate, and good patient satisfaction.

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“…Patients with IBTR without evidence of distant metastasis are treated with curative intent, aiming for local disease control through wide local excision or mastectomy, combined with selective use of (re)irradiation depending on previous treatments. Although lymph node staging is an integral component of primary breast cancer treatment, the optimal management of the lymph nodes in patients with IBTR has not been standardized.…”

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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Radiation Therapy for Locally Recurrent Breast Cancer

Cited by 24 publications

References 28 publications

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

Poor Prognosis After Second Locoregional Recurrences in the CALOR Trial

Breast-conserving surgery with intraoperative radiotherapy in recurrent breast cancer: the patient’s perspective

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

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