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Regional Nodal Recurrence after Treatment for Breast Cancer

  • Local-Regional Evaluation and Therapy (A Kong, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Regional nodal recurrence (RNR) after breast cancer treatment is historically rare but associated with worse survival outcomes. The management of primary breast cancer has changed significantly, with less completion axillary dissection (ALND) and increased use of genomic testing, neoadjuvant therapy, and regional nodal irradiation. This review examines the incidence, risk factors, presentation, treatment, and prognosis of RNR in the context of modern breast cancer treatment.

Recent Findings

The rate of RNR recurrence is low (< 3%) in modern studies. Tumor biology and nodal burden play an important role in both risk of RNR and outcome. Combined locoregional and systemic therapy appears to provide the best outcome in the absence of systemic recurrence. Chemotherapy provides a survival benefit in estrogen receptor–negative patients only.

Summary

RNR remains rare despite decreased ALND for node-positive disease. Treatment planning should be individualized based on tumor biology, prior treatment, and site and extent of recurrence.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Moossdorff M, Van Roozendaal L, Strobbe L, Aebi S, Cameron D, Dixon J, et al. Maastricht Delphi consensus on event definitions for classification of recurrence in breast cancer research. J Natl Cancer Inst. 2014;106(12):dju288. https://doi.org/10.1093/jnci/dju288.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five national surgical adjuvant breast and bowel project protocols of node-negative breast cancer. J Clin Oncol. 2009;27(15):2466–73. https://doi.org/10.1200/JCO.2008.19.8424.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Falato C, Taylor SK, Szulkin R, Nordblom A, Eriksson L, Sofiadis A, et al. Prognosis in patients diagnosed with loco-regional failure of breast cancer: 34 years longitudinal data from the Stockholm-Gotland cancer registry. Breast Cancer Res Treat. 2018;172(3):703–12. https://doi.org/10.1007/s10549-018-4936-2.

    Article  PubMed  Google Scholar 

  4. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97(2):116–26. https://doi.org/10.1093/jnci/djh297.

    Article  PubMed  Google Scholar 

  5. • Tseng YD, Uno H, Hughes ME, Niland JC, Wong YN, Theriault R, et al. Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database. Int J Radiat Oncol Biol Phys. 2015;93(3):622–30. https://doi.org/10.1016/j.ijrobp.2015.07.006The authors used the NCCN Breast Cancer Database to examine time to isolated locoregional recurrence after mastectomy. They found that patients with triple-negative breast cancer had the highest risk among subtypes. Post-mastectomy radiation was shown to reduce the risk of recurrence, but its effect varied by subtype with the greatest effect in patients with luminal A tumors and a nonsignificant reduction in those with triple-negative tumors.

  6. Wapnir IL, Anderson SJ, Mamounas EP, Geyer CE, Jeong JH, Tan-Chiu E, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol. 2006;24(13):2028–37. https://doi.org/10.1200/JCO.2005.04.3273.

    Article  PubMed  Google Scholar 

  7. •• Giuliano AE, Ballman K, Mc Call L, Beitsch P, Whitworth PW, Blumencranz P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: Long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264(3):413–20. https://doi.org/10.1097/SLA.0000000000001863This 10-year update of the randomized controlled trial comparing completion ALND versus SLNB only for 1–2 positive SLN in clinically node-negative women undergoing breast conservation reported equivalent survival and no difference in RNR with rates of 0.5% and 1.5% respectively.

    Article  PubMed  PubMed Central  Google Scholar 

  8. • Ling DC, Iarrobino NA, Champ CE, Soran A, Beriwal S. Regional recurrence rates with or without complete axillary dissection for breast cancer patients with node-positive disease on sentinel lymph node biopsy after neoadjuvant chemotherapy. Adv Radiat Oncol. 2019;5(2):163–70. https://doi.org/10.1016/j.adro.2019.09.006This was a retrospective review of patients with a positive sentinel lymph node biopsy after treatment with neoadjuvant chemotherapy. With a median follow-up of 28.8 months, there was no difference in regional control or overall survival comparing those that did and did not undergo axillary node dissection. Those with axillary node dissection did have a higher rate of lymphedema.

  9. Morrow M, Van Zee KJ, Patil S, Petruolo O, Mamtani A, Barrio AV, et al. Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers: a prospective validation study of 793 patients. Ann Surg. 2017;266(3):457–62. https://doi.org/10.1097/SLA.0000000000002354.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis [published correction appears in Lancet. 2019 Mar 9;393(10175):986]. Lancet. 2014;384(9938):164–72. https://doi.org/10.1016/S0140-6736(13)62422-8.

    Article  PubMed  Google Scholar 

  11. Graham PJ, Brar MS, Foster T, McCall M, Bouchard-Fortier A, Temple W, et al. Neoadjuvant chemotherapy for breast cancer, is practice changing? A population-based review of current surgical trends. Ann Surg Oncol. 2015;22(10):3376–82. https://doi.org/10.1245/s10434-015-4714-x.

    Article  PubMed  Google Scholar 

  12. Mamounas EP, Liu Q, Paik S, Baehner FL, Tang G, Jeong JH, et al. 21-gene recurrence score and locoregional recurrence in node-positive/ER-positive breast cancer treated with chemo-endocrine therapy. J Natl Cancer Inst. 2017;109(4):djw259. https://doi.org/10.1093/jnci/djw259.

    Article  CAS  PubMed Central  Google Scholar 

  13. •• Recht A, Comen EA, Fine RE, Fleming GF, Hardenbergh PH, Ho AY, et al. Postmastectomy radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Ann Surg Oncol. 2017;24(1):38–51. https://doi.org/10.1245/s10434-016-5558-8This is a consensus statement regarding the role of post-mastectomy radiation in patients with T1–2 breast cancer with 1–3 positive nodes. The panel agreed that PMRT reduces the risk of locoregional recurrence but that some subsets have a low risk of LRR resulting in a low absolute benefit. Treatment to the internal mammary nodes and supraclavicular axillary apical nodes was recommended in addition to the chest wall.

    Article  PubMed  Google Scholar 

  14. • Adra J, Lundstedt D, Killander F, Holmberg E, Haghanegi M, Kjellén E, et al. Distribution of locoregional breast cancer recurrence in relation to postoperative radiation fields and biological subtypes. Int J Radiat Oncol Biol Phys. 2019;105(2):285–95. https://doi.org/10.1016/j.ijrobp.2019.06.013This retrospective review compared locoregional recurrence locations with post-operative radiation fields. They found that most cases developed either fully or partially within post-operatively irradiated areas. Recurrences within the radiation field were more often due to an ER-negative or HER2 positive tumor.

  15. Mamounas EP, Anderson SJ, Dignam JJ, Bear HD, Julian TB, Geyer CE, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30(32):3960–6. https://doi.org/10.1200/JCO.2011.40.8369.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75. https://doi.org/10.1056/NEJMoa020128.

    Article  PubMed  Google Scholar 

  17. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41. https://doi.org/10.1056/NEJMoa022152.

    Article  PubMed  Google Scholar 

  18. Grills IS, Kestin LL, Goldstein N, Mitchell C, Martinez A, Ingold J, et al. Risk factors for regional nodal failure after breast-conserving therapy: regional nodal irradiation reduces rate of axillary failure in patients with four or more positive lymph nodes. Int J Radiat Oncol Biol Phys. 2003;56(3):658–70. https://doi.org/10.1016/s0360-3016(03)00017-8.

    Article  PubMed  Google Scholar 

  19. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Costantino JP, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33. https://doi.org/10.1016/S1470-2045(10)70207-2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. • de Boniface J, Frisell J, Bergkvist L, Andersson Y, Swedish Breast Cancer Group and the Swedish Society of Breast Surgery. Ten-year report on axillary recurrence after negative sentinel node biopsy for breast cancer from the Swedish Multicentre Cohort Study. Br J Surg. 2017;104(3):238–47. https://doi.org/10.1002/bjs.10411This study represents 10-year follow-up of a cohort of patients after negative sentinel lymph node biopsy. The rate of axillary recurrence was only 1.6% but was associated with higher risk of breast cancer death with 5-year overall survival of 51.4%.

  21. Roos MM, van Steenhoven JEC, Aalders KC, Schreuder K, Burgmans JPJ, Siesling S, et al. Regional recurrence risk following a negative sentinel node procedure does not approximate the false-negative rate of the sentinel node procedure in breast cancer patients not receiving radiotherapy or systemic treatment. Ann Surg Oncol. 2019;26(2):372–8. https://doi.org/10.1245/s10434-018-6940-5.

    Article  PubMed  Google Scholar 

  22. van Steenhoven JEC, Kuijer A, van Maaren MC, Roos M, Elias SG, van Diest PJ, et al. Quantifying the mitigating effects of whole-breast radiotherapy and systemic treatments on regional recurrence incidence among breast cancer patients. Ann Surg Oncol. 2020. https://doi.org/10.1245/s10434-020-08356-2.

  23. Donker M, van Tienhoven G, Straver ME, Meijnen P, van de Velde CJH, Mansel RE, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. https://doi.org/10.1016/S1470-2045(14)70460-7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lukens JN, Vapiwala N, Hwang WT, Solin LJ. Regional nodal recurrence after breast conservation treatment with radiotherapy for women with early-stage breast carcinoma. Int J Radiat Oncol Biol Phys. 2009;73(5):1475–81. https://doi.org/10.1016/j.ijrobp.2008.06.1955.

    Article  PubMed  Google Scholar 

  25. Pedersen AN, Møller S, Steffensen KD, Haahr V, Jensen M, Kempel MM, et al. Supraclavicular recurrence after early breast cancer: a curable condition? Breast Cancer Res Treat. 2011;125(3):815–22. https://doi.org/10.1007/s10549-010-0918-8.

    Article  PubMed  Google Scholar 

  26. de Boer R, Hillen HFP, Roumen RMH, Rutten HJT, van der Sangen MJC, Voogd AC. Detection, treatment and outcome of axillary recurrence after axillary clearance for invasive breast cancer. Br J Surg. 2001;88(1):118–22. https://doi.org/10.1046/j.1365-2168.2001.01637.x.

    Article  PubMed  Google Scholar 

  27. Kingsmore DB, Hole DJ, Gillis CR, George WD. Axillary recurrence in breast cancer. Eur J Surg Oncol. 2005;31(3):226–31. https://doi.org/10.1016/j.ejso.2004.12.003.

    Article  CAS  PubMed  Google Scholar 

  28. Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J. Loco-regional recurrence after mastectomy in high-risk breast cancer-risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol. 2006;79(2):147–55. https://doi.org/10.1016/j.radonc.2006.04.006.

    Article  PubMed  Google Scholar 

  29. Valachis A, Mamounas EP, Mittendorf EA, Hayashi N, Ishitobi M, Natoli C, et al. Risk factors for locoregional disease recurrence after breast-conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: an international collaboration and individual patient meta-analysis. Cancer. 2018;124(14):2923–30. https://doi.org/10.1002/cncr.31518.

    Article  CAS  PubMed  Google Scholar 

  30. Hortobagyi GN, Connolly JL, D’Orsi CJ, Edge SB, Mittendorf EA, Rugo HS, et al. Breast. In: Amin MB, editor. AJCC Cancer Staging Manual 8th Edition. Chicago: Springer; 2017. p. 589–628.

    Chapter  Google Scholar 

  31. Turashvili G, Chou JF, Brogi E, Morrow M, Dickler M, Norton L, et al. 21-gene recurrence score and locoregional recurrence in lymph node-negative, estrogen receptor-positive breast cancer. Breast Cancer Res Treat. 2017;166(1):69–76. https://doi.org/10.1007/s10549-017-4381-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Montagna E, Bagnardi V, Rotmensz N, Viale G, Renne G, Cancello G, et al. Breast cancer subtypes and outcome after local and regional relapse. Ann Oncol. 2012;23(2):324–31. https://doi.org/10.1093/annonc/mdr129.

    Article  CAS  PubMed  Google Scholar 

  33. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, Mc Gale P, Correa C, Taylor C, Arriagada R, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16. https://doi.org/10.1016/S0140-6736(11)61629-2.

    Article  Google Scholar 

  34. Cao L, Cai G, Xu F, Yang ZZ, Yu XL, Ma JL, et al. Trastuzumab improves locoregional control in HER2-positive breast cancer patients following adjuvant radiotherapy. Medicine (Baltimore). 2016;95(32):e4230. https://doi.org/10.1097/MD.0000000000004230.

    Article  CAS  Google Scholar 

  35. Lanning RM, Morrow M, Riaz N, McArthur HL, Dang C, Moo TA, et al. The effect of adjuvant trastuzumab on locoregional recurrence of human epidermal growth factor receptor 2-positive breast cancer treated with mastectomy. Ann Surg Oncol. 2015;22(8):2517–25. https://doi.org/10.1245/s10434-014-4321-2.

    Article  PubMed  Google Scholar 

  36. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis [published correction appears in Lancet. 2019 Mar 9;393(10175):986]. Lancet. 2014;384(9938):164–72. https://doi.org/10.1016/S0140-6736(13)62422-8.

    Article  PubMed  Google Scholar 

  37. Konkin D, Tyldesley S, Kennecke H, Speers C, Olivotto I, Davis N. Management and outcomes of isolated axillary node recurrence in breast cancer. Arch Surg. 2006;141(9):867–74. https://doi.org/10.1001/archsurg.141.9.867.

    Article  PubMed  Google Scholar 

  38. van der Sangen MJC, Coebergh JW, Roumen RMH, Rutten HJT, Vreugdenhil G, Voogd AC. Detection, treatment, and outcome of isolated supraclavicular recurrence in 42 patients with invasive breast carcinoma. Cancer. 2003;98:11–7. https://doi.org/10.1002/cncr.11469.

    Article  PubMed  Google Scholar 

  39. National Comprehensive Cancer Network. Breast Cancer (Version 5.2050). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed July 23, 2020.

  40. • Elfgen C, Schmid SM, Tausch CJ, Montagna G, Guth U. Radiologic staging for distant metastases in breast cancer patients with confirmed local and/or locoregional recurrence: How useful are current guideline recommendations? Ann Surg Oncol. 2019;26:3455–61. https://doi.org/10.1245/s10434-019-07629-9Data from a prospective database was used to determine the frequency of concurrent distant metastases with locoregional recurrence. Concurrent distant disease was more commonly associated with lymph node recurrence compared to breast/chest wall recurrence. The authors recommend routine systemic staging at the time of locoregional recurrence.

    Article  PubMed  Google Scholar 

  41. •• Wapnir IL, Price KN, Anderson SJ, Robidoux A, Martín M, JWR N, et al. Efficacy of Chemotherapy for ER-Negative and ER-Positive Isolated Locoregional Recurrence of Breast Cancer: Final Analysis of the CALOR Trial. J Clin Oncol. 2018;36(11):1073–9. https://doi.org/10.1200/JCO.2017.76.5719This represents the final results of the CALOR trial which evaluated the effectiveness of chemotherapy after resection of isolated locoregional breast cancer recurrence. After a median 9 years of follow-up, chemotherapy showed a benefit in disease-free survival in ER-negative patients but not in ER-positive patients.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Poodt IGM, Vugts G, Schipper RJ, Nieuwenhuijzen GAP. Repeat sentinel lymph node biopsy for ipsilateral breast tumor recurrence: a systematic review of the results and impact on prognosis. Ann Surg Oncol. 2018;25(5):1329–39. https://doi.org/10.1245/s10434-018-6358-0.

    Article  PubMed  Google Scholar 

  43. Sávolt Á, Cserni G, Lázár G, Maráz R, Kelemen P, Kovács E, et al. Sentinel lymph node biopsy following previous axillary surgery in recurrent breast cancer. Eur J Surg Oncol. 2019;45(10):1835–8. https://doi.org/10.1016/j.ejso.2019.05.016.

    Article  PubMed  Google Scholar 

  44. Chen SC, Chang HK, Lin YC, Leung WM, Tsai CS, Cheung YC, et al. Prognosis of breast cancer after supraclavicular lymph node metastasis: not a distant metastasis. Ann Surg Oncol. 2006;13(11):1457–65. https://doi.org/10.1245/s10434-006-9012-1.

    Article  PubMed  Google Scholar 

  45. Reddy JP, Levy L, Oh JL, Strom EA, Perkins GH, Buchholz TA, et al. Long-term outcomes in patients with isolated supraclavicular nodal recurrence after mastectomy and doxorubicin-based chemotherapy for breast cancer. Int J Radiat Oncol Biol Phys. 2011;80(5):1453–7. https://doi.org/10.1016/j.ijrobp.2010.04.015.

    Article  PubMed  Google Scholar 

  46. DeSelm C, Yang TJ, Cahlon O, Tisnado J, Khan A, Gillespie E, et al. A 3-dimensional mapping analysis of regional nodal recurrences in breast cancer. Int J Radiat Oncol Biol Phys. 2019;103(3):583–91. https://doi.org/10.1016/j.ijrobp.2018.10.021.

    Article  PubMed  Google Scholar 

  47. Müller AC, Eckert F, Heinrich V, Bamberg M, Brucker S, Hehr T. Re-surgery and chest wall re-irradiation for recurrent breast cancer - a second curative approach. BMC Cancer. 2011;11:197. Published 2011 May 25. https://doi.org/10.1186/1471-2407-11-197.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Oldenborg S, Griesdoorn V, Van Os R, Kusumanto YH, Oei BS, Venselaar JL, et al. Reirradiation and hyperthermia for irresectable locoregional recurrent breast cancer in previously irradiated area: size matters. Radiother Oncol. 2015;117(2):223–8. https://doi.org/10.1016/j.radonc.2015.10.017.

    Article  PubMed  Google Scholar 

  49. Wahl AO, Rademaker A, Kiel KD, Jones EL, Marks LB, Croog V, et al. Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys. 2008;70(2):477–84. https://doi.org/10.1016/j.ijrobp.2007.06.035.

    Article  PubMed  Google Scholar 

  50. Thorpe CS, Niska JR, Girardo ME, Kosiorek HE, McGee LA, Hartsell WF, et al. Proton beam therapy reirradiation for breast cancer: multi-institutional prospective PCG registry analysis. Breast J. 2019;25(6):1160–70. https://doi.org/10.1111/tbj.13423.

    Article  PubMed  Google Scholar 

  51. Gabani P, Patel H, Thomas MA, Bottani B, Goddu SM, Straube W, et al. Clinical outcomes and toxicity of proton beam radiation therapy for re-irradiation of locally recurrent breast cancer. Clin Transl Radiat Oncol. 2019;19:116–22. https://doi.org/10.1016/j.ctro.2019.09.005.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Refaat T, Sachdev S, Sathiaseelan V, Helenowski I, Abdelmoneim S, Pierce MC, et al. Hyperthermia and radiation therapy for locally advanced or recurrent breast cancer. Breast. 2015;24(4):418–25. https://doi.org/10.1016/j.breast.2015.03.008.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Waeber M, Castiglione-Gertsch M, Dietrich D, Thürlimann B, Goldhirsch A, Brunner KW, et al. Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: definitive results of phase III randomized trial (SAKK 23/83) comparing tamoxifen with observation. Ann Oncol. 2003;14(8):1215–21. https://doi.org/10.1093/annonc/mdg347.

    Article  CAS  PubMed  Google Scholar 

  54. Cuzick J, Sestak I, Baum M, Buzdar A, Howell A, Dowsett M, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol. 2010;11(12):1135–41. https://doi.org/10.1016/S1470-2045(10)70257-6.

    Article  CAS  PubMed  Google Scholar 

  55. Baselga J, Campone M, Piccart M, Burris HA, Rugo HS, et al. Everolimus in postmenopausal hormone-receptor-positive advanced breast cancer. N Engl J Med. 2012;366(6):520–9. https://doi.org/10.1056/NEJMoa1109653.

    Article  CAS  PubMed  Google Scholar 

  56. Im SA, Lu YS, Bardia A, Harbeck N, Colleoni M, Franke F, et al. Overall survival with ribociclib plus endocrine therapy in breast cancer. N Engl J Med. 2019;381(4):307–16. https://doi.org/10.1056/NEJMoa1903765.

    Article  CAS  PubMed  Google Scholar 

  57. Slamon DJ, Neven P, Chia S, Fasching PA, de Laurentiis M, Im SA, et al. Phase III randomized study of ribociclib and fulvestrant in hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer: MONALEESA-3. J Clin Oncol. 2018;36(24):2465–72. https://doi.org/10.1200/JCO.2018.78.9909.

    Article  CAS  PubMed  Google Scholar 

  58. Tesch H, Stoetzer O, Decker T, Kurbacher CM, Marmé F, Schneeweiss A, et al. Efficacy and safety of everolimus plus exemestane in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative locally advanced or metastatic breast cancer: results of the single-arm, phase IIIB 4EVER trial. Int J Cancer. 2019;144(4):877–85. https://doi.org/10.1002/ijc.31738.

    Article  CAS  PubMed  Google Scholar 

  59. Wapnir IL, Gelber S, Anderson SJ, Mamounas EP, Robidoux A, Martín M, et al. Poor prognosis after second Locoregional recurrences in the CALOR trial. Ann Surg Oncol. 2017;24(2):398–406.

    Article  Google Scholar 

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Albright, E.L., Lizarraga, I.M. Regional Nodal Recurrence after Treatment for Breast Cancer. Curr Breast Cancer Rep 12, 336–343 (2020). https://doi.org/10.1007/s12609-020-00392-x

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