Locoregional recurrence (LRR) after breastconserving therapy (BCT): diagnosis, treatment and impact on survival

Abstract

The great revolution which has drastically changed the treatment of breast cancer in the last 20 years is likely to continue in the next decade along the following lines: 1) Genetics: The identification of women at high risk of developing breast cancer will stimulate the introduction of preventive measures; the genetic studies on the ‘progression’ of breast cancer, as a multistep process, will reveal the various mutations involved in the dedifferentiation of the disease; specific biomolecular alterations will be more clearly correlated with prognosis. 2) Chemoprevention: The chemoprevention trials in progress with tamoxifen and retinoids will soon produce their long term results while new agents will be tested. 3) Breast cancer detection through mass screening programs will become a routine procedure in many countries leading to an increased rate of early non palpable lesions. 4) Local treatment policies will be influenced by the increasing number of small occult tumors, leading to new radiosurgical procedures which minimize the unfavorable cosmetic outcome. 5) Axillary dissection in clinically node negative patients might gradually be abandoned in most subgroups of patients. 6) Chemotherapy may slowly switch from ‘adjuvant’ to ‘preoperative’ utilization, while ‘high dose treatments’ is likely to become a routine procedure for more aggressive types of tumors. 7) Radiotherapy will be used in many cases as a preoperative treatment in association with chemotherapy. 8) The classic TNM classification based on the anatomic extent of the disease will be replaced by a more biological one. 9) Reconstructive surgery will be developed to become fully integrated with other therapeutic procedure.