Therapy of isolated locoregional recurrent carcinoma of the breast

Gabriel, Lena; Schmidt, Marina; Juhasz-Böss, S; Melchior, Patrick; Heesen, Anika von; Schmidt, G.; Kranzhöfer, N; Solomayer, Erich‐Franz; Juhasz‐Böss, I.; Breitbach, G. P.

doi:10.1007/s00404-019-05220-x

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…However, some women will receive a second breast-conserving surgery, particularly if the initial treatment did not include adjuvant radiation. In some women who received radiation, re-irradiation to areas of the chest wall may be applied [ 1 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Prognosis after Local Recurrence in Patients with Early-Stage Breast Cancer Treated without Chemotherapy

et al. 2023

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Background: Many women with early-stage breast cancer are predicted to be at sufficiently low risk for recurrence that they may forego chemotherapy. Nevertheless, some low-risk women will experience a local recurrence, and for them the risk of death increases significantly thereafter. The utility of initiating chemotherapy at the time of local recurrence has not been adequately addressed. The purpose of this study is to identify, in a hospital-based series of patients with early-stage breast cancer who were not treated with chemotherapy, those factors which predict death post local recurrence. Methods: We identified 135 women who were diagnosed with early-stage breast cancer (node-negative, <5 cm) and who did not receive chemotherapy at diagnosis and who developed a local recurrence. They were diagnosed between 1987 and 2000 and treated at Women’s College Hospital. For each patient, we abstracted information on the initial cancer (age at diagnosis, tumour size, tumour grade, ER status, PR status, HER2 status, lympho-vascular invasion, type of surgery, use of radiotherapy, tamoxifen and chemotherapy), the time from initial diagnosis to local recurrence and treatment at recurrence. The Kaplan–Meier method was used to estimate the ten-year actuarial risk of breast cancer death post recurrence. A Cox proportional hazards model was used to estimate multivariate hazard ratios for the various factors. Results: Among the 135 women in the cohort, the mean time from initial diagnosis to local recurrence was 7.8 years (range: 0.3 to 22.6 years). A total of 38 of the 135 women (28.1%) died of breast cancer a mean of 5.3 years after experiencing the local recurrence (range: 0.3 to 17 years). The ten-year breast cancer survival post local recurrence was 71% and the 15-year survival was 65%. In a multivariate analysis, it was found that factors that were significantly associated with death after local recurrence were (1) PR-negative status, (2) young age at diagnosis (<40 years) and (3) time to local recurrence less than 2 years. Nine percent of women received chemotherapy at the time of local recurrence. Conclusions: For breast cancer patients with a low baseline risk of mortality, the risk of death after an isolated local recurrence is substantial. Systemic treatment at the time of local recurrence needs further study.

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Section: Discussionmentioning

confidence: 99%

Prognosis after Local Recurrence in Patients with Early-Stage Breast Cancer Treated without Chemotherapy

et al. 2023

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“…Breast cancer is the most common cancer affecting women worldwide. Despite advances in medical treatment, isolated locoregional breast cancer recurrences can still occur at a rate of 10–35% ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…1 , mucinous and DCIS subtype 2 ,. If multifocal/centric disease was present, the size measurement will be based on the largest lesion 3 ,.…”

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confidence: 99%

Axillary management of breast cancer patients with isolated chest wall recurrence after mastectomy

Lim¹,

Alcantara²,

Ng³

et al. 2023

Ann Transl Med

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Background: National Comprehensive Cancer Network (NCCN) guidelines on the axillary management of breast cancer patients with isolated chest wall recurrence after mastectomy are unclear. Though sentinel lymph node biopsy (SLNB) is possible and may be considered, there is limited data on its usefulness. We aimed to determine if axillary restaging surgery was required in this cohort of patients who developed operable isolated chest wall recurrences after mastectomy.Methods: Breast cancer patients treated at a tertiary institution from 1st September 2005 to 31st October 2017 and developed isolated chest wall invasive recurrences after mastectomy were retrospectively reviewed.We excluded patients with bilateral cancers, concurrent regional or distant metastases, patients without surgery for their chest wall recurrences and patients who were lost to follow-up. The demographics, pathological data and second recurrences were collected from a prospectively maintained database and compared between patients with axillary lymph node dissection (ALND), SLNB and no axillary operation.Results: Of the 1,841 patients who underwent mastectomy, 26 (1.4%) patients developed isolated chest wall recurrences. Twenty two eligible patients were analysed. The mean age at diagnosis of the recurrence was 54.7 years (range: 37-84). 1, 2 and 19 patients had ALND, SLNB and no axillary operation respectively.On mean follow-up of 38.3 months, no axillary recurrences were noted. Conclusions:In breast cancer patients with isolated chest wall recurrences after mastectomy, axillary restaging surgery can be safely omitted with no increased axillary recurrences on medium term follow-up.This finding could refine existing guidelines in the management of the axilla for patients with chest wall recurrences after mastectomy.

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Long-Term Oncologic Outcomes of Omitting Axillary Surgery in Breast Cancer Patients with Chest Wall Recurrence after Mastectomy

Lim,

Alcantara,

Allen

et al. 2024

Cancers

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Background: The management of the axilla in breast cancer patients with isolated chest wall recurrence (CWR) after mastectomy remains controversial. Although sentinel lymph node biopsy (SLNB) for restaging is feasible, its role is unclear. We aimed to determine if the omission of axillary restaging surgery in female patients with operable presumably isolated CWRs could result in an increased risk of second recurrences. Methods: In this retrospective multicentre study, patients who developed CWRs were reviewed. We excluded patients with suspected or concomitant regional/distant metastases, bilateral cancers and patients without CWR surgery. Patients’ demographics, pathological data and subsequent recurrences were collected from a prospective database and were compared between patients with axillary lymph node dissection (ALND) and/or SLNB versus no axillary operation at CWR. Findings: A total of 194 patients with CWRs were eligible. The median age at CWR was 56.0 (IQR 47.0–67.0) years old. At recurrence, 8 (4.1%), 5(2.6%) and 181 (93.3%) patients had ALND, SLNB and no axillary operation, respectively. Patients with no axillary surgery during CWR were associated with, at primary cancer, a lower incidence of ductal carcinoma in situ as diagnosis (p = 0.007) and older age (p = 0.022). Subsequent ipsilateral axillary (p = 0.768) and second recurrences (p = 0.061) were not statistically different between patients with and without axillary surgery at CWR on median follow-up of 59.5 (IQR 27.3–105) months. Interpretation: In patients without evidence of concomitant regional or distant metastasis at CWR diagnosis, omission of axillary restaging surgery was not associated with an increased ipsilateral axillary or second recurrences on long-term follow-up.

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Therapy of isolated locoregional recurrent carcinoma of the breast

Cited by 3 publications

References 25 publications

Prognosis after Local Recurrence in Patients with Early-Stage Breast Cancer Treated without Chemotherapy

Prognosis after Local Recurrence in Patients with Early-Stage Breast Cancer Treated without Chemotherapy

Axillary management of breast cancer patients with isolated chest wall recurrence after mastectomy

Long-Term Oncologic Outcomes of Omitting Axillary Surgery in Breast Cancer Patients with Chest Wall Recurrence after Mastectomy

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