Abstract
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. 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. 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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