Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3018–3024 | Cite as

Management Strategies for Locally Recurrent Breast Cancer: Redo-Lumpectomy, Redo-Sentinel Node Biopsy, Redo-Radiation

  • Zahraa Al-HilliEmail author
  • Stephen R. Grobmyer
Breast Oncology


A multidisciplinary approach to the management of locally recurrent breast cancer is essential. The complexities of the management of patients in this setting include discussions regarding the optimal surgical approach (breast, chest wall, and axillary surgery) and adjuvant treatment considerations (radiation/re-irradiation therapy and systemic therapy). Treatment has evolved to include the option of repeat breast conservation surgery, axillary staging, and radiation therapy through partial breast radiation techniques in selected patients.



Z. Al-Hilli and S. R. Grobmyer have nothing to disclose.


  1. 1.
    Van Tienhoven G, Voogd AC, Peterse JL, et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). Eur J Cancer. 1999;35:32–8. Scholar
  2. 2.
    Voogd AC, Van Oost FJ, Rutgers EJT, et al. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer. Eur J Cancer. 2005; 41:2637–44. Scholar
  3. 3.
    Francis M, Cakir B, Ung O, Gebski V, Boyages J. Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer. Br J Surg. 1999;86(12):1556–62.CrossRefPubMedGoogle Scholar
  4. 4.
    Pan H, Gray R, Braybrooke J, et al. 20-Year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377:1836–46. Scholar
  5. 5.
    Abe O, Abe R, Enomoto K, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet. 2011;378:771–84. Scholar
  6. 6.
    NCCN. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Breast Cancer [Internet]. Version 1.2019. 2019;1–215.
  7. 7.
    Fredriksson I, Liljegren G, Arnesson LG, et al. Local recurrence in the breast after conservative surgery: a study of prognosis and prognostic factors in 391 women. Eur J Cancer. 2002;38:1860–70. Scholar
  8. 8.
    Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103:478–488. Scholar
  9. 9.
    Manyam B, Shah CS, Woody NM, Juloori A, Wengler CA, Valente S, et al. Comparing 10-year outcomes with salvage mastectomy followed by immediate autologous reconstruction or tissue expander/implant based reconstruction in patients with locally recurrent breast cancer after breast conservation therapy. Int J Radiat Oncol Biol Phys. 2019;102:S44–5.CrossRefGoogle Scholar
  10. 10.
    Cordeiro PG, Snell L, Heerdt A, McCarthy C. Immediate tissue expander/implast breast reconstruction after salvage mastectomy for cancer recurrence following lumpectomy/irradiation. Plast Reconstr Surg. 2012;129:341–50. Scholar
  11. 11.
    Lam TC, Hsieh F, Salinas J, Boyages J. Can an immediate 2-stage breast reconstruction be performed after previous conservative surgery and radiotherapy? Plast Reconstr Surg Glob Open 2015. Scholar
  12. 12.
    Cagli B, Barone M, Ippolito E, et al. Ten years experience with breast reconstruction after salvage mastectomy in previously irradiated patients: Analysis of outcomes, satisfaction and well-being. Eur Rev Med Pharmacol Sci. 2016;20(22):4635–41.PubMedGoogle Scholar
  13. 13.
    Momoh AO, Ahmed R, Kelley BP, et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol. 2014;21:118–24. Scholar
  14. 14.
    Lee C, Cheng M, Wu C, Kuo W, Yu C, Huang J. Nipple-sparing mastectomy and immediate breast reconstruction after recurrence from previous breast conservation therapy. Ann Plast Surg. 2019;82(Supplement 1):S95–S102.CrossRefPubMedGoogle Scholar
  15. 15.
    Salvadori B, Marubini E, Miceli R, et al. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg. 1999;86:84–7. Scholar
  16. 16.
    Dalberg K, Mattsson A, Sandelin K, Rutqvist LE. Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Breast Cancer Res Treat. 1998;49:69–78. Scholar
  17. 17.
    Fodor J, Major T, Polgár C, Orosz Z, Sulyok Z, Kásler M. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast. 2008;17:302–08. Scholar
  18. 18.
    Alpert TE, Kuerer HM, Arthur DW, Lannin DR, Haffty BG. Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int J Radiat Oncol Biol Phys. 2005;63:845–51. Scholar
  19. 19.
    Abner AL, Recht A, Eberlein T, et al. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol. 1993;11:44–48. Scholar
  20. 20.
    Komoike Y, Akiyama F, Iino Y, et al. Analysis of ipsilateral breast tumor recurrences after breast-conserving treatment based on the classification of true recurrences and new primary tumors. Breast Cancer. 2005;12(2):104–11.CrossRefPubMedGoogle Scholar
  21. 21.
    van der Sangen MJC, van de Poll-Franse L V., Roumen RMH, et al. The prognosis of patients with local recurrence more than five years after breast conservation therapy for invasive breast carcinoma. Eur J Surg Oncol. 2006;32:34–8. Scholar
  22. 22.
    Voogd AC, Van Tienhoven G, Peterse HL, et al. Local recurrence after breast conservation therapy for early stage breast carcinoma detection, treatment, and outcome in 266 patients. Cancer. 1999;85:437–46.;2-1.CrossRefPubMedGoogle Scholar
  23. 23.
    Yoshida A, Takahashi O, Okumura Y, et al. Prognosis after mastectomy versus repeat lumpectomy in patients with ipsilateral breast cancer recurrence: a propensity score analysis. Eur J Surg Oncol. 2016;42:474–80. Scholar
  24. 24.
    Walstra C, Schipper R, Poodt I, et al. Repeat berast-conserving therapy for ipsilateral berast cancer recurrence: a systematic review. Eur J Surg Oncol. 2019. CrossRefPubMedGoogle Scholar
  25. 25.
    Fisher B, Anderson S, Bryant J, 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;347:1233–41. Scholar
  26. 26.
    Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16:266–73. Scholar
  27. 27.
    Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: Long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382. Scholar
  28. 28.
    Jendrian S, Steffens K, Schmalfeldt B, Laakmann E, Bergelt C, Witzel I. Quality of life in patients with recurrence breat cancer after second breast-conserving therapy in comparison with mastectomy: the German experience. Breast Cancer Res Treat. 2017;163:517–26.CrossRefPubMedGoogle Scholar
  29. 29.
    Trombetta M, Julian TB, Werts DE, et al. Long-term cosmesis after lumpectomy and brachytherapy in the management of carcinoma of the previously irradiated breast. Am J Clin Oncol Cancer Clin Trials. 2009;32:314–18. Scholar
  30. 30.
    Katz A, Strom EA, Buchholz TA, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol. 2000;18:2817–27. Scholar
  31. 31.
    Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J. Study of failure pattern among high-risk breast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: Long-term results from the Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol. 2006;24:2268–2275. Scholar
  32. 32.
    Gilliland MD, Barton RM, Copeland EM. The implications of local recurrence of breast cancer as the first site of therapeutic failure. Ann Surg. 1983;197:284. Scholar
  33. 33.
    Darby S, McGale P, Correa C, 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;378:1707–1716. Scholar
  34. 34.
    Fisher B, Jeong J-H, 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;347:567–75. Scholar
  35. 35.
    Park CC, Mitsumori M, Nixon A, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol. 2000;18:1668–75. Scholar
  36. 36.
    Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014. Scholar
  37. 37.
    Taghian A, Jeong JH, Mamounas E, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: Results from five national surgical adjuvant breast and bowel project randomized c. J Clin Oncol. 2004;22:4247–54. Scholar
  38. 38.
    Wapnir IL, Anderson SJ, Mamounas EP, 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;24:2028–2037. Scholar
  39. 39.
    Wallgren A, Bonetti M, Gelber RD, et al. Risk factors for locoregional recurrence among breast cancer patients: results from International Breast Cancer Study Group Trials I through VII. J Clin Oncol. 2003;21:1205–1213. CrossRefPubMedGoogle Scholar
  40. 40.
    Recht A, Gray R, Davidson NE, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol. 1999;17(6):1689–700.CrossRefPubMedGoogle Scholar
  41. 41.
    Wakeam E, Acuna S, Keshavjee S. Chest wall resection for recurrenct breast cancer in the modern era. A systematic review and meta-analysis. Ann Surg. 2018;276(7):646–55.CrossRefGoogle Scholar
  42. 42.
    Poodt I, Vugts G, Schipper R, Nieuwenhuijzen G. Repeat sentinel lymph node biopsy for ipsilateral breast tumor recurrence: a systematic review of the results and impact on prognosis. Ann Surg Oncol. 2018;25:1329–39.CrossRefPubMedGoogle Scholar
  43. 43.
    Maaskant-Braat AJG, Voogd AC, Roumen RMH, Nieuwenhuijzen GAP. Repeat sentinel node biopsy in patients with locally recurrent breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat. 2013;138:13–20. Scholar
  44. 44.
    Maaskant-Braat AJG, Roumen RMH, Voogd AC, et al. Sentinel node and recurrent breast cancer (SNARB): results of a nationwide registration study. Ann Surg Oncol. 2013;20:620–626. Scholar
  45. 45.
    Uth C, Christensen M, Oldenbourg M, et al. Sentinel lymph node dissection in locally recurrent breast cancer. Ann Surg Oncol. 2015;22(8):2526–31.CrossRefPubMedGoogle Scholar
  46. 46.
    Boughey JC, Ross MI, Babiera GV, et al. Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer. 2006;7:248–253. Scholar
  47. 47.
    Karam A, Stempel M, Cody HS, Port ER. Reoperative sentinel lymph node biopsy after previous mastectomy. J Am Coll Surg. 2008;207:543–48. Scholar
  48. 48.
    Intra M, Veronesi P, Gentilini OD, et al. Sentinel lymph node biopsy is feasible even after total mastectomy. J Surg Oncol. 2007;95:175–9. Scholar
  49. 49.
    Poodt I, Walstra CJEF, Vugts G, et al. Low risk of development of a regional recurrnce after an unsuccessful repeat sentinel lymph node biopsy in patietns with ipsilateral breast tumor recurrence. Ann Surg Oncol. 2019. Scholar
  50. 50.
    Vugts G, Maaskant-Braat AJG, Voogd AC, et al. Improving the success rate of repeat sentinel node biopsy in recurrent breast cancer. Ann Surg Oncol. 2015; 22:529–35. Scholar
  51. 51.
    Shah C, Wilkinson JB, Jawad M, et al. Outcome after ipsilateral breast tumor recurrence in patients with early-stage breast cancer treated with accelerated partial breast irradiation. Clin Breast Cancer. 2012;12(6):392–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Maulard C, Housset M, Brunel P, Delanian S, Taurelle R, Baillet F. Use of perioperative or split-course interstitial brachytherapy techniques for salvage irradiation of isolated local recurrences after conservative management of breast cancer. Am J Clin Oncol Cancer Clin Trials. 1995;18:348–52. Scholar
  53. 53.
    Deutsch M. Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Radiat Oncol Biol Phys. 2002;53:687–91. CrossRefPubMedGoogle Scholar
  54. 54.
    Chadha M, Trombetta M, Boolbol S, et al. Managing a small recurrence in the previously irradiated breast: Is there a second chance for breast conservation? Oncology. 2009;23(11):933–40.PubMedGoogle Scholar
  55. 55.
    Trombetta M, Julian TB, Werts ED, et al. Comparison of conservative management techniques in the re-treatment of ipsilateral breast tumor recurrence. Brachytherapy. 2011; 10:74–80. Scholar
  56. 56.
    Hannoun-Levi JM, Resch A, Gal J, et al. Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumour recurrence: Multicentric study of the GEC-ESTRO Breast Cancer Working Group. Radiother Oncol. 2013;108:226–31. CrossRefPubMedGoogle Scholar
  57. 57.
    Guix B, Lejárcegui JA, Tello JI, et al. Exeresis and brachytherapy as salvage treatment for local recurrence after conservative treatment for breast cancer: results of a ten-year pilot study. Int J Radiat Oncol Biol Phys. 2010;78:804–10. Scholar
  58. 58.
    Adkison JB, Kuske RR, Patel RR. Breast conserving surgery and accelerated partial breast irradiation after prior breast radiation therapy. Am J Clin Oncol Cancer Clin Trials. 2010;33:427–31. Scholar
  59. 59.
    Arthur DW, Winter KA, Kuerer HM, et al. NRG oncology–radiation therapy oncology group study 1014: 1-year toxicity report from a phase 2 study of repeat breast-preserving surgery and 3-dimensional conformal partial-breast re-irradiation for in-breast recurrence. Int J Radiat Oncol Biol Phys. 2017;98:1028–35. Scholar
  60. 60.
    Datta NR, Puric E, Klingbiel D, Gomez S, Bodis S. Hyperthermia and radiation therapy in locoregional recurrent breast cancers: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2016; 94:1073–87. Scholar
  61. 61.
    Wahl AO, Rademaker A, Kiel KD, et al. Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys. 2008; 70:477–84. Scholar
  62. 62.
    Woodward WA, Fang P, Arriaga L, et al. A Phase 2 study of preoperative capecitabine and concomitant radiation in women with advanced breast cancer. Int J Radiat Oncol Biol Phys. 2017;99:777–83. Scholar
  63. 63.
    Olson CE, Ansfield F, Richards MS, Ramirez G, Davis HL. Review of local soft tissue recurrence of breast cancer irradiated with and without actinomycin-D. Cancer. 1977;39:1981–83.;2-1.CrossRefPubMedGoogle Scholar
  64. 64.
    Fentiman IS, Balkwill FR, Cuzick J, Hayward JL, Rubens RD. A trial of human alpha interferon as an adjuvant agent in breast cancer after loco-regional recurrence. Eur J Surg Oncol. 1987;13:425–8.PubMedGoogle Scholar
  65. 65.
    Aebi S, Gelber S, Anderson SJ, et al. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol. 2014;15:156–63. Scholar
  66. 66.
    Wapnir IL, Price KN, Anderson SJ, 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;36:1073–79. Scholar
  67. 67.
    Waeber M, Castiglione-Gertsch M, Dietrich D, 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;14:1215–21. Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Section of Breast Surgery, Department of General Surgery, Digestive Diseases and Surgery InstituteCleveland ClinicClevelandUSA

Personalised recommendations