Regional Breast Cancer Recurrence Research Articles

Comparison of Digital Mammography with Tomosynthesis and Ultrasound to Magnetic Resonance Imaging in Assessment of Post Operative Scarring and Locoregional Recurrence of Breast Cancer

Background Breast cancer is the most common type of cancer and the second cause of cancer associated death in women. It is the most common type of cancer in women and the third cause of cancer associated death in Egypt. Aim of the Study Our study aims to evaluate the role of digital breast tomosynthesis with complementary ultrasound compared to magnetic resonance imaging in assessment of post-operative changes and loco regional recurrence of breast cancer. Patients and Methods A Cross sectional study was approved by the ethics review board of Ain Shams University Hospitals. All MR imaging were conducted at the Department of Radiology at Ain-Shams University. Thirty patients who were surgically treated by conservative breast surgery were included in our study from March2021 to September 2021 according to the regulations of the ASU ethical committee. The resultant BIRADS were subsequently correlated with the final results by histopathology. Results In our study DBT with complementary US showed greater sensitivity (100 %) than MRI (80 %), yet it revealed lower specificity(96%) than MRI (100%). DBT with complementary ultrasound show a higher NPV (100%)but lower PPV (83. 3%) than MRI (96.1%) (100%) respectively. However, both of them revealed comparable accuracy: DBT with us (96.6%) and MRI (96.6%). Conclusion MRI has a lot of technical errors that limit its results and increase its numerous pitfalls. DBT with complementary ultrasound are a powerful imaging modalities that can be used to detect any recurrence in patients who are surgically treated for breast cancer with higher sensitivity and higher NPV than MRI and both of them revealed comparable accuracy.So, the use of these modalities enhance diagnosis of surgically treated breast cancer for early detection of recurrence.

Proton therapy for isolated local regional recurrence of breast cancer after mastectomy alone.

To assess adverse events (AEs) and disease-specific outcomes after proton therapy for isolated local-regional recurrence (LRR) of breast cancer after mastectomy without prior radiotherapy (RT). Patients were identified from a multi-institutional prospective registry and included if diagnosed with invasive breast cancer, initially underwent mastectomy without adjuvant RT, experienced an LRR, and subsequently underwent salvage treatment, including proton therapy. Follow-up and cancer outcomes were measured from the date of RT completion. Nineteen patients were included. Seventeen patients were treated with proton therapy to the chest wall and comprehensive regional lymphatics (17/19, 90%). Maximum grade AE was grade 2 in 13 (69%) patients and grade 3 in 4 (21%) patients. All patients with grade 3AE received > 60 GyE (p=0.04, Spearman correlation coefficient=0.5). At the last follow-up, 90% of patients were alive with no LRR or distant recurrence. For breast cancer patients with isolated LRR after initial mastectomy without adjuvant RT, proton therapy is well-tolerated in the salvage setting with excellent loco-regional control. All grade 3 AEs occurred in patients receiving > 60 GyE.

Breast cancer recurrence after immediate and delayed postmastectomy breast reconstruction-A systematic review and meta-analysis.

BackgroundOncological safety of different types and timings of PMBR after breast cancer remains controversial. Lack of stratified risk assessment in literature makes current clinical and shared decision‐making complex. This is the first systematic review and meta‐analysis to evaluate differences in oncological outcomes after immediate versus delayed postmastectomy breast reconstruction (PMBR) for autologous and implant‐based PMBR separately.MethodsA systematic literature search was performed in MEDLINE, Cochrane Library, and Embase. The Cochrane Collaboration Handbook and Meta‐analysis Of Observational Studies in Epidemiology checklist were followed for data abstraction. Variability in point estimates attributable to heterogeneity was assessed using I 2‐statistic. (Loco)regional breast cancer recurrence rates, distant metastasis rates, and overall breast cancer recurrence rates were pooled in generalized linear mixed models using random effects.ResultsFifty‐five studies, evaluating 14,217 patients, were included. When comparing immediate versus delayed autologous PMBR, weighted average proportions were: 0.03 (95% confidence interval [CI], 0.02–0.03) versus 0.02 (95% CI, 0.01–0.04), respectively, for local recurrences, 0.02 (95% CI, 0.01–0.03) versus 0.02 (95% CI, 0.01–0.03) for regional recurrences, and 0.04 (95% CI, 0.03–0.06) versus 0.01 (95% CI, 0.00–0.03) for locoregional recurrences. No statistically significant differences in weighted average proportions for local, regional and locoregional recurrence rates were observed between immediate and delayed autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrences after autologous PMBR, and of all outcome measures after implant‐based PMBR.ConclusionsDelayed autologous PMBR leads to similar (loco)regional breast cancer recurrence rates compared to immediate autologous PMBR. This study highlights the paucity of strong evidence on breast cancer recurrence after specific types and timings of PMBR.Lay summery Oncologic safety of different types and timings of postmastectomy breast reconstruction (PMBR) remains controversial.Lack of stratified risk assessment in literature makes clinical and shared decision‐making complex.This meta‐analysis showed that delayed autologous PMBR leads to similar (loco)regional recurrence rates as immediate autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrence after autologous PMBR, and of all outcome measures after implant‐based PMBR.Based on current evidence, oncological concerns do not seem a valid reason to withhold patients from certain reconstructive timings or techniques, and patients should equally be offered all reconstructive options they technically qualify for.

Microbiota of Breast Tissue and Its Potential Association with Regional Recurrence of Breast Cancer in Korean Women.

Recent studies have reported dysbiosis of the microbiome in breast tissue collected from patients with breast cancer and the association between the microbiota and disease progression. However, the role of the microbiota in breast tissue remains unclear, possibly due to the complexity of breast cancer and various factors, including racial and geographical differences, influencing microbiota in breast tissue. Here, to determine the potential role of microbiota in breast tumor tissue, we analyzed 141 tissue samples based on three different tissue types (tumor, adjacent normal, and lymph node tissues) from the same patients with breast cancer in Korea. The microbiota was not simply distinguishable based on tissue types. However, the microbiota could be divided into two cluster types, even within the same tissue type, and the clinicopathologic factors were differently correlated in the two cluster types. Risk of regional recurrence was also significantly different between the microbiota cluster types (p = 0.014). In predicted function analysis, the pentose and glucuronate interconversions were significantly different between the cluster types (q < 0.001), and Enterococcus was the main genus contributing to these differences (q < 0.01). Results showed that the microbiota of breast tissue could interact with the host and influence the risk of regional recurrence. Although further studies would be recommended to validate our results, this study could expand our understanding on the breast tissue microbiota, and the results might be applied to develop novel prediction methods and treatments for patients with breast cancer.

Abstract B040: Electrospun implantable anticancer device comprising immune adjuvant photo-responsive nanoparticles with checkpoint blockade for effective cancer therapy

Abstract An implantable anticancer device (IAD) that can eradicate local regional breast cancer recurrence (LRR), inhibit metastasis as well as to enhance the breast reconstruction during/after therapy is proposed. The IAD is developed by combining nanofiber-based chemo-photothermal therapy platform with check point blockade immunotherapy. Here we developed a coreshell electrospun nanofiber encapsulated with drug conjugated MoS2 as chemo-photothermal agent along with imiquimod as an immune response modifier. The near-infrared laser exposure to IADs can generate tumor-associated antigens from primary tumors, which in the presence of released imiquimod from IADs can show vaccine-like functions. Moreover, the nanofiber matrix will enable the sustained and tumor-specific anticancer drug release with a minimum initial burst release and the repeated photothermal capability to ensure the synergistic inhibition of tumor recurrence. In addition to that, the checkpoint-blockade using anti-cytotoxic T-lymphocyte antigen-4 (CTLA4) in combination with the generated immunologic responses will be able to attack remaining tumor cells causing metastasis inhibition with strong immunologic memory effect, which can shield against the tumor recurrence after the post elimination of initial tumors. The IAD nanofiber morphology resembles the extra cellular matrix (ECM) enrich the reconstruction of poor breast cosmesis resulted from the surgical treatment, by supporting the lipofilling of the surgical residual cavity to induce the adipogenic process. So, in this work we propose that the tumor associated antigens created in situ after photothermal therapy by the immune adjuvant nanofiber IAD could show vaccine-like functions, which in combination with checkpoint blockade show strong antitumor immune responses for effective cancer immunotherapy as a potential platform for synergistic inhibition of LRR and a great promise for the in situ breast reconstruction ability for better breast cosmesis. Citation Format: Afeesh Rajan Unnithan, Arathyram Ramachandra Kururp Sasikala, Chan Hee Park, Cheol Sang Kim. Electrospun implantable anticancer device comprising immune adjuvant photo-responsive nanoparticles with checkpoint blockade for effective cancer therapy [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B040.

Multifaceted Implantable Anticancer Device for Potential Postsurgical Breast Cancer Treatment: A Single Platform for Synergistic Inhibition of Local Regional Breast Cancer Recurrence, Surveillance, and Healthy Breast Reconstruction

Adv. Funct. Mater. 2018, 28, 1704793 In the initial publication, a project number was mistakenly omitted from the acknowledgements section. The updated acknowledgements are: A.R.K.S. and A.R.U. contributed equally to this work. This work was supported by the grants from the Basic Science Research Program (Project no. 2016R1A2A2A07005160 and NRF 2016R1D1A1B03934124) and the Korea Research Fellowship Program (KRF 2016H1D3A1938077) through National Research Foundation of Korea (NRF) by Ministry of Education, Science and Technology. The authors thank Shalom Sara Thomas for technical assistance with adipogenesis. The authors apologize for any inconvenience or misunderstanding that this omission may have caused.

Local and Regional Breast Cancer Recurrences: Salvage Therapy Options in the New Era of Molecular Subtypes.

Isolated local or regional recurrence of breast cancer (BC) leads to an increased risk of metastases and decreased survival. Ipsilateral breast recurrence can occur at the initial tumor bed or in another quadrant of the breast. Depending on tumor patterns and molecular subtypes, the risk and time to onset of metastatic recurrence differs. HER2-positive and triple-negative (TNG) BC have a risk of locoregional relapse between six and eight times than luminal A. Thus, the management of local and locoregional relapses must take into account the prognostic factors for metastatic disease development. It is important to personalize the overall management, including or not systemic treatment according to the metastatic risk. All isolated recurrence cases should be treated with curative intent. Complete surgical resection is recommended whenever possible. Patients who did not receive postoperative irradiation during their initial management should receive full-dose radiotherapy to the chest wall and to the regional lymph nodes if appropriate. Overall, total mastectomy is the “gold standard” among patients who were previously treated by conservative surgery followed by radiation therapy. In terms of systemic therapy, the benefits of additional treatments are not conclusively proven in cases of isolated recurrence. The beneficial role of chemotherapy has been reported in at least one randomized trial, while endocrine therapy and anti-HER2 are common practice. This review will discuss salvage treatment options of local and locoregional recurrences in the new era of BC molecular subtypes.

Multifaceted Implantable Anticancer Device for Potential Postsurgical Breast Cancer Treatment: A Single Platform for Synergistic Inhibition of Local Regional Breast Cancer Recurrence, Surveillance, and Healthy Breast Reconstruction

AbstractAn implantable anticancer device (IAD) amenable to eradicate local regional recurrence (LRR) of breast cancer as well as to enhance the breast reconstruction during/after therapy is proposed for the first time. The IAD is fabricated by incorporating the superparamagnetic graphene oxide doxorubicin nanocomposite of size ≈200 nm in a nanofiber matrix to enable the sustained and tumor specific anticancer drug release over 60 d in vitro with a minimum initial burst release and the repeated hyperthermic capability in an alternating magnetic field to ensure the synergistic inhibition of LRR. The IAD also enriches the reconstruction of poor breast cosmesis that resulted from the surgical treatment by supporting the lipofilling of the surgical residual cavity to induce the adipogenic process. Moreover, the noninvasive monitoring capability of IAD through magnetic resonance imaging augments to the effective patient care. Thus, this work reports a new and reliable concept by introducing the multifunctional IAD possessing enhanced specificity with a real‐time monitoring capability and long‐term anticancer efficacy as a potential platform for synergistic inhibition of LRR and a great promise for the in situ breast reconstruction ability for better breast cosmesis.

18FDG-PET/CT versus Contrast Enhanced CT in Detection of Loco-Regional Breast Cancer Recurrence.

Background: Among women cancer, cancer breast represents the most common type and the second cause of death related to malignancy. During the first 2 to 3 years after treatment the loco-regional recurrence rate is highest and then it decreases gradually. FDG PET/CT has high sensitivity and specificity in detection of breast cancer recurrence. Aim: Evaluation of the role of PET/CT compared to CECT in detection of loco regional recurrence in breast cancer patients during restaging and follows up. Material and Methods: Fifty seven female patients with treated breast cancer were included in this study. All patients underwent estimation of breast tumor markers levels, whole body FDG PET–CTand contrast enhanced CT (CECT). Correlation with the histopathological examination of the loco regional lesions was done. Results: Fourteen patients 14/57 (24.56%) had loco-regional recurrences most of them were hormone receptor positive and had high levels of tumor markers out of them, 2/14 patients (14.28 %) had regional recurrence, 2/14 patients (14.28%) had local recurrence (LR) with distant metastases (DM) and 10/14 patients (71.42%) had both local and regional recurrence. PET-CT detected loco-regional recurrence in 13/14 patients versus 6/14 patients for CECT. The sensitivity, specificity, PPV, NPV of both PET-CT and CECT were 92.9%, 93.0%, 81.25%, and 97.5% versus 42.9%, 100%,100% and 84.3% respectively. PET-CT had higher sensitivity than CECT with statistically significant difference (P value 0.00001), while CECT had higher specificity with no statistically significantdifference (P value 0.61). Conclusion: FDG-PET/CT is very sensitive compared to CECT in the detection of loco- regional recurrence of breast cancer. It has higher detection rate of metastatic lymph nodes.

Regional recurrence in the era of sentinel lymph node biopsy

BackgroundThe incidence of all-location regional recurrence after sentinel lymph node biopsy is not well documented. This study attempts to identify risk factors. MethodsA prospectively maintained database was queried to identify patients with a regional recurrence of breast cancer after a first operation for invasive unilateral breast cancer. Patients with regional recurrence were compared with those alive and disease free at 5 years. ResultsTwenty-one of 1,060 patients (2%) experienced a regional recurrence. Most patients (95%) underwent sentinel lymph node biopsy as their axillary staging. Those with regional recurrences had larger tumors (P < .001), higher stage disease (P < .001), more estrogen receptor– and triple-negative breast cancers (P < .001), and more positive lymph nodes (P = .007). Mastectomy (P = .001) and receipt of neoadjuvant and/or chemotherapy (P < .001) were more common among those with regional recurrences. ConclusionsRegional recurrence of breast cancer occurs infrequently. Risk factors include high-risk cancers, higher stage at presentation, nodal involvement, and need for therapies reflecting higher risk biology.

P047. Outcomes in loco regional breast cancer recurrence

P047. Outcomes in loco regional breast cancer recurrence

PCN124 - Individual Risk Profiling For Breast Cancer Recurrence: Towards Tailored Follow-Up Schemes

Current international guidelines for breast cancer follow-up are not specific to individual risk of local regional recurrences. Instead, for personalised follow-up it is required to have more precise estimates of local regional recurrence probability as a function of time. The objective of this study is to identify prognostic factors, and to quantify individualized and time dependent local regional recurrence risk rates. Prognostic factors for local regional recurrence of breast cancer were identified due to a three-step funnel approach, including: scoping literature review, expert consultation and stepwise multivariate regression analysis. Quantification of the prognostic value of each risk factor was performed with a regression model based on a five-year dataset of women diagnosed with breast cancer in the Netherlands in 2005 or 2006 (n=17762). Six-month interval risk probabilities were derived from regression estimates by calculating coefficients of the prognostic factors. Eight prognostic factors were identified, including: age, tumour size, multifocality, gradation, adjuvant chemo-, adjuvant radiation-, hormonal therapy and triple negative status. Expected inter-patient variability was elucidated by average, and high risk example patient types with local regional, non-uniform distributed, recurrence risks of 5.2% and 12% over a five-year period. It is concluded that local regional recurrence risks are not distributed uniformly, and time depended, over the five-year follow-up period. The calculated prognostic value of the factors enables quantification of risks for local regional recurrences on six-month time intervals for the individual patient. Implicating improved allocation of hospital capacities and resources, local regional recurrence risk profiling is a first step towards tailored follow-up in breast cancer care.

Chemotherapy Prolongs Survival for Isolated Local or Regional Recurrence of Breast Cancer: The CALOR Trial

Chemotherapy Prolongs Survival for Isolated Local or Regional Recurrence of Breast Cancer: The CALOR Trial

Abstract S3-2: Chemotherapy prolongs survival for isolated local or regional recurrence of breast cancer: The CALOR trial (Chemotherapy as Adjuvant for Locally Recurrent breast cancer; IBCSG 27-02, NSABP B-37, BIG 1-02)

Abstract Introduction Patients with isolated local and regional recurrences (ILRR) of breast cancer (BC) have a high risk of developing distant metastasis and dying from BC. We investigated the impact of chemotherapy (C) on disease-free survival (DFS) and overall survival (OS) after ILRR. Methods Patients with resected ILRR were stratified according to prior chemotherapy (yes vs. no), ER and/or PgR status of the recurrent tumor (both negative vs. either positive), and location of recurrence (breast vs. scar/chest wall vs. lymph nodes). Radiation, hormone and HER2 directed therapies were delineated in the protocol. Participants were randomly assigned to receive C or none. Multidrug C for at least 4 courses was recommended. Drug selection was at the discretion of the investigator. Slow accrual led to premature closure of the trial before achieving the planned sample size of 265. Results The trial accrued 162 patients (C, 85; control, 77) from 2002–2010. The groups were balanced in regard to the characteristics listed in the table below. At a median follow up of 4.9 years, there were 24 (28%) DFS events and 9 (11%) deaths in the C group compared with 34 (44%) DFS events and 21 (27%) deaths in the control group, corresponding to a 5-year DFS of 69% vs. 57%, [DFS HR (C/control) = 0.59, 95% CI (0.35, 0.99)], p =0.046] and a 5-year OS of 88% vs. 76%, [OS HR (C/control) = 0.41, 95% CI (0.19, 0.89)], p =0.02]. The results remained significant for both DFS and OS in multivariable Cox proportional hazards modeling controlling for ILRR location, disease-free interval, ER status and prior adjuvant chemotherapy. Adjuvant C was particularly effective for women with ER-negative ILRR: 5-year DFS 67% vs. 35%, [DFS HR (C/control) = 0.32, 95% CI (0.14, 0.73)], p =0.007] and OS 79% vs. 69%, [OS HR (C/control) = 0.43, 95% CI (0.15, 1.24)], p =0.12]. Results for the ER-positive ILRR cohort were: 5-year DFS 70% vs. 69%, [DFS HR (C/control) = 0.94, 95% CI (0.47, 1.89)], p =0.87] and OS 94% vs. 80%, [OS HR (C/control) = 0.40, 95% CI (0.12, 1.28)], p =0.12]. Conclusion Adjuvant chemotherapy should be recommended for patients with completely resected isolated loco-regional recurrences of breast cancer, in particular, if the recurrence is not sensitive to endocrine therapy. Funding NCI PHS grants U10-CA-37377, -69974, -12027, -69651, CA-75362. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S3-2.

Abstract CN08-02: Psychological stress and disease progression

Abstract A randomized clinical trial was designed to test the hypothesis that cancer patients coping with a cancer diagnosis but receiving a psychological intervention would have reduced risk for disease progression (1994). Patients (N=227) surgically treated for regional breast cancer participated. Before beginning adjuvant cancer therapies, patients were assessed with psychological and behavioral measures, had a health evaluation, and a 60 mL blood sample was drawn. Patients were randomized to Psychological Intervention or Assessment only arms. The intervention was psychologist led, conducted in small groups, and included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment. Earlier papers (2004, 2007) showed that, compared to the Assessment arm, the Intervention arm improved across all of the latter secondary outcomes. T cell blastogenesis was also enhanced. An interim paper (2007) clarified treatment mechanisms in the Intervention arm. First, patients were satisfied with the intervention, but it was group cohesion that related to better outcomes. Second, offering patients a stress conceptualization (Selye) and teaching them multiple coping strategies related to better health. Third, three relationships between treatment utilization and outcomes are noted: 1) Relaxation training was associated with both distress reduction and symptom lowering. 2) Patients' use of assertive communication with health care providers was associated with better health outcomes. 3) Intervention strategy use was also associated with fewer signs/symptoms and cancer treatment toxicities. After a median of 11 years follow-up, recurrence occurred for 62 of 212 (29%) women and death for 54 of 227 (24%). Intent to treat hazard analyses showed, as predicted, Intervention arm patients had a reduced risk of recurrence [Hazard Ratio (HR)=0.55, P=.034] and breast cancer death (HR=0.44, P=.016). Follow up papers (2009) have examined the covariation of inflammation and distress during the period of intervention delivery (2009) and in the months prior to recurrence diagnosis (2008). Learning Objective 1: Show that a randomized clinical trial has produced evidence that a behavioral intervention can reduce fatal and nonfatal regional breast cancer recurrence. Learning Objective 2: Demonstrate that patients' use of assertive communication with health care providers was associated with better health outcomes. Citation Information: Cancer Prev Res 2011;4(10 Suppl):CN08-02.

Thoracoscopic approach in the treatment of breast cancer relapse in the internal mammary lymph node

Regional recurrence of breast cancer may involve the surgical site of mastectomy, axillary lymph nodes and the internal mammary lymphatic chain. Treatment of regional recurrent mammary cancer rarely requires thoracic surgery intervention, except in some selected cases of recurrence in the chest wall. Concerning lymphatic recurrence in breast cancer, the therapeutic choice rarely includes surgical lymph node excision. Exclusive videothoracoscopic (VTS) resection of recurrence in internal mammary lymph nodes has not as yet been reported in the literature. Due to the rare surgical exploration of this lymphatic chain, the thoracoscopic approach is described only in three published studies involving humans, furthermore, in these three descriptions, the operation was performed only for mere staging but not for the whole resection of the recurrent lymphatic structure. We present a case of recurrence of breast cancer in lymph nodes of the internal mammary chain that was treated with complete resection by pure VTS surgery.

Determining the Oncological Risk of Autologous Lipoaspirate Grafting for Post-Mastectomy Breast Reconstruction

This study compares the incidence of local and regional recurrence of breast cancer between two contiguous time windows in a homogeneous population of 137 patients who underwent fat tissue transplant after modified radical mastectomy. Median follow-up time was 7.6 years and the follow-up period was divided into two contiguous time windows, the first starting at the date of the radical mastectomy and ending at the first lipoaspirate grafting session and the second beginning at the time of the first lipoaspirate grafting session and ending at the end of the total follow-up time. Although this study did not employ an independent control group, the incidence of local recurrence of breast cancer was found to be comparable between the two periods and in line with data from similar patient populations enrolled in large multicenter clinical trials and who did not undergo postsurgical fat tissue grafting. Statistical comparison of disease-free survival curves revealed no significant differences in relapse rate between the two patient subgroups before fat grafting and after fat grafting. Although further confirmation is needed from multicenter randomized clinical trials, our results support the hypothesis that autologous lipoaspirate transplant combines striking regenerative properties with no or marginal effects on the probability of post-mastectomy locoregional recurrence of breast cancer.

Genetic Assay Predicts Risk of Local, Regional Breast Cancer Recurrence

Genetic Assay Predicts Risk of Local, Regional Breast Cancer Recurrence

Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients

Purpose: Long-term outcome after radiation therapy for local–regional recurrence of breast cancer after mastectomy is generally poor. This study was performed to evaluate the long-term outcome for a potentially favorable subgroup of patients with chest wall recurrence. Methods and Materials: Of 71 patients with an isolated local–regional recurrence of breast cancer after mastectomy, 18 were identified who met the following favorable selection criteria: 1) a disease-free interval after mastectomy of 2 years or more, 2) an isolated chest wall recurrence, and 3) tumor size < 3 cm or complete excision of the recurrent disease. All 18 patients were treated with local–regional irradiation between 1967 and 1988. Radiotherapy (RT) was delivered to the chest wall to a median total dose of 60 Gy (range 30–66 Gy). Four patients received adjuvant chemotherapy and six patients received adjuvant hormonal therapy. Results: With a median follow-up of 8.4 years, nine of 18 patients were alive and free of disease. The 10-year actuarial overall and cause-specific survivals were 72% and 77%, respectively. The 10-year actuarial relapse-free survival and local control were 42% and 86%, respectively. Conclusion: Treatment for a local–regional recurrence of breast cancer after mastectomy in a favorable subgroup of patients results in a high rate of long-term survival as well as excellent local control. Aggressive treatment is warranted in this favorable subgroup of patients. 1998 Elsevier Science Inc.

Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer

The study evaluated prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983-85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen. If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5-11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.