Loco-regional Breast Cancer Recurrences

Abstract

• A minority of patients treated both by breast conservation and mastectomy will develop a local recurrence, which remains one of the greatest concerns of primary BC treatment. • In contrast with past studies that showed an incidence of local recurrence around 10–20 %, in the present time a very low incidence of local recurrences has been described, with a cumulative incidence of 1.1 % at 5 years. • Local recurrence can be considered a marker of tumour aggressiveness as it is linked to an increased risk of distant metastases and death. Therefore, all patients with local recurrence should undergo workup to rule out concurrent distant metastases. On the other hand, patients with isolated local or regional recurrence, without synchronous distant localisations, can be successfully treated. • Principal risk factors involved in local recurrence are tumour size, nodal status, tumour biology, age, margins and histopathological characteristics. • Mastectomy is considered the current standard of care for ipsilateral recurrence of BC; however, some retrospective analyses showed that second conservative treatments for local relapse were feasible and gave results comparable to standard mastectomy.

Future Directions. Further studies are needed to delineate optimal management of recurrences. Novel treatments, including cryotherapy, radiofrequency ablation and photodynamic and microwave therapy, will continue to be explored to move toward less aggressive but more effective local management of local recurrences. However, important impulses are expected from the potential utility of genomic profiles in estimating the usefulness of more tailored approaches to systemic therapy including recognition and use of newer biological agents.

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRefPubMedGoogle Scholar
  3. 3.
    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;24:2028–37.CrossRefPubMedGoogle Scholar
  4. 4.
    Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefPubMedGoogle Scholar
  5. 5.
    Anderson SJ, Wapnir I, Dignam JJ, 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.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    van Dongen J, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy, with or without irradiation, in the treatment of breast cancer. N Engl J Med. 1995;333:1456–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Botteri E, Bagnardi V, Rotmensz N, et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol. 2010;21:723–8.CrossRefPubMedGoogle Scholar
  9. 9.
    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. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer. 1999;85:437–46.CrossRefPubMedGoogle Scholar
  10. 10.
    Weinstein SP, Orel SG, Pinnamaneni P, et al. Mammographic appearance of recurrent breast cancer after breast conservation therapy. Acad Radiol. 2008;15:240–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Moy L, Slanetz PJ, Moore R, et al. Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review. Radiology. 2002;225:176–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Lehman CD, Blume JD, Thickman D, et al. Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol. 2005;92:9–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Morris EA, Liberman L, Ballon DJ, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol. 2003;181:619–26.CrossRefPubMedGoogle Scholar
  14. 14.
    Halverson KJ, Perez CA, Kuske RR, et al. Isolated locoregional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys. 1990;19:851–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Burger AE, Pain SJ, Peley G. Treatment of recurrent breast cancer following breast conserving surgery. Breast J. 2013;19:310–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Hannoun-Levi JM, et al. Local treatments options for ipsilateral breast tumor recurrence. Cancer Treat Rev. 2013;39:737–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Kurtz JM, Jacquemier J, Amalric R, et al. Is breast conservation after local recurrence feasible? Eur J Cancer. 1991;27:240–4.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    Chen SL, Martinez SR. The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am J Surg. 2008;196:495–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Gentilini O, Botteri E, Veronesi P, et al. Repeating conservative surgery after ipsilateral breast tumor reappearance: criteria for selecting the best candidates. Ann Surg Oncol. 2012;19:3771–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Deutsch M. Repeat high-dose external beam radiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Radiat Oncol Biol Phys. 2002;53:687–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Trombetta M, Julian T, Bhandari T, et al. Breast conservation surgery and interstitial brachytherapy in the management of locally recurrent carcinoma of the breast: the Allegheny General Hospital experience. Brachytherapy. 2008;7:29–36.CrossRefPubMedGoogle Scholar
  23. 23.
    Hannoun-Levi JM, Resch A, Gal J, and on behalf of the GEC-ESTRO Breast Cancer Working Group. 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.Google Scholar
  24. 24.
    Cardoso F, Harbeck N, Fallowfield L, Kyriakides S, Senkus E, and on behalf of the ESMO Guidelines Working Group. Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii11–vii19.Google Scholar
  25. 25.
    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.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Panet-Raymond V, Truong PT, Alexander C, Lesperance M, McDonald RE, Watson PH. Clinicopathologic factors of the recurrent tumor predict outcome in patients with ipsilateral breast tumor recurrence. Cancer. 2011;117:20135–43.CrossRefGoogle Scholar

Further Reading

  1. 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.CrossRefPubMedCentralPubMedGoogle Scholar
  2. Freedman GM, Fowble BL. Local recurrence after mastectomy or breast-conserving surgery and radiation. Oncology. 2000;14:1561–81.PubMedGoogle Scholar
  3. Taras AR, Thorpe JD, Morris AD, et al. Irradiation effect after mastectomy on breast cancer recurrence in patients presenting with locally advanced disease. Am J Surg. 2011;201:605–10.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Breast SurgeryEuropean Institute of Oncology (IEO)MilanoItaly

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