Researchers from Memorial Sloan Kettering Cancer Center in New York, NY, suggested that for women with locoregional recurrence (LRR) of breast cancer, contralateral axillary metastases should be treated aggressively for cure after excluding distant metastases. Challenges of and best practices for managing LRR was discussed at an education session during the San Antonio Breast Cancer Symposium on Tuesday, December 5.
Managing LRR in women with breast cancer has become increasingly challenging as treatment preferences have trended toward limited surgery. The long-held treatment paradigm of treating all ipsilateral breast tumor recurrences with mastectomy if the breast was previously irradiated has also been challenged in recent years. Breast oncologists are faced with a number of questions regarding the management of LRR, because events are infrequent with modern multimodality therapy and no randomized clinical trials to date address these questions.
A number of studies were reviewed that assessed LRR management. Impact of identification of nodal disease through sentinel node (SN) biopsy on the management of LRR is controversial according to recent literature. For example, Johnson et al. reported in a 2016 Annals of Surgical Oncology article that out of 12 patients with isolated chest wall recurrence post-mastectomy, 10 patients had successful mapping and 7 patients had an axillary SN. Ugras et al. reported in 2016 that in 83 patients with breast or chest wall recurrence who were clinically node negative, 47 patients had axillary surgery and 36 did not. Interestingly, at median 4.2 years after LRR, rates of rates of axillary and nonaxillary local recurrence, distant metastases, and death did not differ significantly between groups.
Further supporting the suggestion that contralateral axillary metastases should be treated aggressively after LRR, 4%–33% of patients with local recurrence will have contralateral axillary drainage after initial axillary dissection. In a systemic review of 48 cases of contralateral nodal recurrence without other distant metastatic disease, disease-free survival was 65% and overall survival 83% after treatment that included both local and systemic therapy. Mean follow-up was 50.3 months.