The Implications of Local Recurrence of Breast Cancer as the First Site of Therapeutic Failure

Abstract

Sixty patients who had ipsilateral chest wall recurrence of breast cancer and no detectable distant metastases were evaluated retrospectively to determine the implications of chest wall recurrence as the first site of therapeutic failure. Mean time intervals between treatment of the primary breast cancer and discovery of local recurrence, between treatment of local recurrence and distant metastases, and between treatment of local recurrence and death in order and, respectively, in years for pathologic Stages I, II, and III patients were 6.2, 4.3 and 2.1; 4.2, 3.5, and 1.2; and 7.2, 6.0, and 2.5. Surgical resection resulted in the best local control. All patients eventually died of metastatic breast cancer, one as late as 23 years after treatment of the local recurrence. No Stage I patients recurred before two years. An arbitrary delay of two years before recommending breast reconstruction to avoid masking local recurrence seems unjustified for pathologic Stage I patients.

The Total Incidence of Loco-Regional Recurrence in a Randomized Trial of Breast Cancer Tnm Stage Ii the South Sweden Breast Cancer Trial

“…Even though we report all loco-regional recurrences during the observation time, which the CRC and NSABP studies do not, our figures are low (10, 1 I). from those of others in several reunlike Gilliland et al (12), whose findings suggested the loco-regional recurrence rate to be solely dependent on the initial stage of disease (l2), we found it to be related also to treatment: the recurrence rate in our postoperative radiotherapy subgroup was 7%), as compared with 17% in the subgroup without postoperative radiotherapy. This is also in accordance with earlier findings from the Manchester (I), CRC ( lo), and NSABP ( 1 1 ) trials although their loco-regional recurrence rates were much higher.…”

Invasive Breast Cancer after Mastectomy and Autologous Breast Reconstruction

“…In a study by Gilliland et al all patients with LR developed distant metastases between 1.2 and 4.2 years and all died of disease between 2.5 and 7.2 years [14]. Other reports with longer term follow-up of up to 10 years among patients with LR after mastectomy have reported overall survival rates of 18-42% [14,17] and 10-year disease-free survival of 7-17% after the diagnosis of LR [15,16]. In contrast, the MD Anderson experience of 23 patients with LR after SSM and IBR revealed 61% of patients alive with no evidence of disease at a median follow-up of 26 months [3].…”

“…In contrast, the MD Anderson experience of 23 patients with LR after SSM and IBR revealed 61% of patients alive with no evidence of disease at a median follow-up of 26 months [3]. However, survival after breast cancer has been consistently shown to be associated with stage and grade of the primary tumor [6,14,17,18], and therefore, distant relapse seen synchronously with LR can mostly be attributed to tumor biology rather than type of surgical treatment performed. However, not all local recurrences are equal.…”

“…Other reports of patients with recurrent breast cancer after mastectomy have shown that approximately 70% of LRs occur in the first 36 months [12,13], while 90% are detected within five years of initial diagnosis [14]. Although several studies have reported worse prognosis with LR after mastectomy than after breast conservation therapy [8,[14][15][16], this more adverse impact of LR on survival after mastectomy has not been supported by others [3]. In a study by Gilliland et al all patients with LR developed distant metastases between 1.2 and 4.2 years and all died of disease between 2.5 and 7.2 years [14].…”

“…Although several studies have reported worse prognosis with LR after mastectomy than after breast conservation therapy [8,[14][15][16], this more adverse impact of LR on survival after mastectomy has not been supported by others [3]. In a study by Gilliland et al all patients with LR developed distant metastases between 1.2 and 4.2 years and all died of disease between 2.5 and 7.2 years [14]. Other reports with longer term follow-up of up to 10 years among patients with LR after mastectomy have reported overall survival rates of 18-42% [14,17] and 10-year disease-free survival of 7-17% after the diagnosis of LR [15,16].…”