Management of Locoregional Recurrence of Breast Cancer

2019 ◽  
Author(s):  
Devon Livingston-Rosanoff ◽  
Sarah E. Tevis ◽  
Lee G. Wilke
Keyword(s):  
Breast Cancer ◽  
Metastatic Disease ◽  
Locoregional Recurrence ◽  
Previous Treatment ◽  
Close Monitoring ◽  
Curative Intent ◽  
Regional Lymph Nodes ◽  
Cancer Disease ◽  
Lymph Node Mapping ◽  
Increased Risk

Following treatment for breast cancer, disease can recur locally, regionally, or at distant sites. Locoregional recurrence is defined as recurrence in the ipsilateral breast, skin, chest wall, or regional lymph nodes. Concurrent metastatic disease is common in patients with locoregional recurrence; therefore, patients with recurrence should undergo a complete metastatic work-up. Isolated locoregional recurrence should be approached with curative intent, and patients should undergo resection and adjuvant therapy, as indicated, based on previous treatment and location of recurrence. Following treatment for locoregional recurrence, close monitoring should be performed, as patients are at an increased risk for developing metastatic disease. This review contains 5 figures, 1 table, and 50 references Key Words: breast cancer, CALOR clinical trial, locoregional recurrence, repeat radiation therapy, repeat sentinel lymph node mapping, adjuvant chemotherapy, repeat breast conserving therapy, mastectomy

Management of Locoregional Recurrence of Breast Cancer

2019 ◽  
Author(s):  
Devon Livingston-Rosanoff ◽  
Sarah E. Tevis ◽  
Lee G. Wilke
Keyword(s):  
Breast Cancer ◽  
Metastatic Disease ◽  
Locoregional Recurrence ◽  
Previous Treatment ◽  
Close Monitoring ◽  
Curative Intent ◽  
Regional Lymph Nodes ◽  
Cancer Disease ◽  
Lymph Node Mapping ◽  
Increased Risk

Following treatment for breast cancer, disease can recur locally, regionally, or at distant sites. Locoregional recurrence is defined as recurrence in the ipsilateral breast, skin, chest wall, or regional lymph nodes. Concurrent metastatic disease is common in patients with locoregional recurrence; therefore, patients with recurrence should undergo a complete metastatic work-up. Isolated locoregional recurrence should be approached with curative intent, and patients should undergo resection and adjuvant therapy, as indicated, based on previous treatment and location of recurrence. Following treatment for locoregional recurrence, close monitoring should be performed, as patients are at an increased risk for developing metastatic disease. This review contains 5 figures, 1 table, and 50 references Key Words: breast cancer, CALOR clinical trial, locoregional recurrence, repeat radiation therapy, repeat sentinel lymph node mapping, adjuvant chemotherapy, repeat breast conserving therapy, mastectomy

scholarly journals Risk of Synchronous Distant Recurrence at Time of Locoregional Recurrence in Patients With Stage II and III Breast Cancer (AFT-01)

2018 ◽  
Vol 36 (10) ◽  
pp. 975-980 ◽  
Author(s):  
Heather B. Neuman ◽  
Jessica R. Schumacher ◽  
Amanda B. Francescatti ◽  
Taiwo Adesoye ◽  
Stephen B. Edge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Chest Wall ◽  
Locoregional Recurrence ◽  
Distant Metastases ◽  
Distant Recurrence ◽  
Stage Ii ◽  
Factors Associated ◽  
Increased Risk ◽  
Synchronous Metastases

Purpose National Comprehensive Cancer Network guidelines recommend systemic staging imaging at the time of locoregional breast cancer recurrence. Limited data support this recommendation. We determined the rate of synchronous distant recurrence at the time of locoregional recurrence in high-risk patients and identified clinical factors associated with an increased risk of synchronous metastases. Methods A stage-stratified random sample of 11,046 patients with stage II to III breast cancer in 2006 to 2007 was selected from the National Cancer Database for participation in a Commission on Cancer special study. From medical record abstraction of imaging and recurrence data, we identified patients who experienced locoregional recurrence within 5 years of diagnosis. Synchronous distant metastases (within 30 days of locoregional recurrence) were determined. We used multivariable logistic regression to identify factors associated with synchronous metastases. Results Four percent experienced locoregional recurrence (n = 445). Synchronous distant metastases were identified in 27% (n = 120). Initial presenting stage ( P = .03), locoregional recurrence type ( P = .01), and insurance status ( P = .03) were associated with synchronous distant metastases. The proportion of synchronous metastases was highest for women with lymph node (35%), postmastectomy chest wall (30%), and in-breast (15%) recurrence; 54% received systemic staging imaging within 30 days of a locoregional recurrence. Conclusion These findings support current recommendations for systemic imaging in the setting of locoregional recurrence, particularly for patients with lymph node or chest wall recurrences. Because most patients with isolated locoregional recurrence will be recommended locoregional treatment, early identification of distant metastases through routine systemic imaging may spare them treatments unlikely to extend their survival.

scholarly journals The Lymphatic System in Breast Cancer: Anatomical and Molecular Approaches

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1272
Author(s):  
Gianfranco Natale ◽  
Michael E. J. Stouthandel ◽  
Tom Van Hoof ◽  
Guido Bocci
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Molecular Mechanisms ◽  
Lymphatic System ◽  
Premature Mortality ◽  
Systemic Circulation ◽  
Physiological Control ◽  
Regional Lymph Nodes ◽  
Cancer Disease ◽  
Molecular Approaches

Breast cancer is one of the most important causes of premature mortality among women and it is one of the most frequently diagnosed tumours worldwide. For this reason, routine screening for prevention and early diagnosis is important for the quality of life of patients. Breast cancer cells can enter blood and lymphatic capillaries, then metastasizing to the regional lymph nodes in the axilla and to both visceral and non-visceral sites. Rather than at the primary site, they seem to enter the systemic circulation mainly through the sentinel lymph node and the biopsy of this indicator can influence the axillary dissection during the surgical approach to the pathology. Furthermore, secondary lymphoedema is another important issue for women following breast cancer surgical treatment or radiotherapy. Considering these fundamental aspects, the present article aims to describe new methodological approaches to assess the anatomy of the lymphatic network in the axillary region, as well as the molecular and physiological control of lymphatic vessel function, in order to understand how the lymphatic system contributes to breast cancer disease. Due to their clinical implications, the understanding of the molecular mechanisms governing lymph node metastasis in breast cancer are also examined. Beyond the investigation of breast lymphatic networks and lymphatic molecular mechanisms, the discovery of new effective anti-lymphangiogenic drugs for future clinical settings appears essential to support any future development in the treatment of breast cancer.

The clinical value of CEA and CA 15-3 in breast cancer management

1995 ◽  
Vol 10 (1) ◽  
pp. 35-41 ◽  
Author(s):  
E.C. Coveney ◽  
J.G. Geraghty ◽  
F. Sherry ◽  
E.W. McDermott ◽  
J.J. Fennelly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Disease ◽  
Lead Time ◽  
Locoregional Recurrence ◽  
Recurrent Disease ◽  
Systemic Disease ◽  
Clinical Value ◽  
Cancer Management ◽  
Breast Cancer Management

The value of tumour-associated antigens CEA and CA 15-3 was studied in patients with breast cancer over a 4-year period. A total of 252 patients with primary or recurrent disease had available and corresponding CEA and CA 15-3 values at diagnosis and during follow-up and were studied in detail. Preoperative and three-monthly serial postoperative levels were measured in each patient. Ten of 11 patients presenting with primary and concurrent metastatic disease had elevated CA 15-3 levels (> 25 I.U./ml) as compared to 6 with CEA (> 5 ng/ml). Fourty-seven patients developed locoregional recurrence of which 15 had concurrent metastatic disease. CA 15-3 was elevated in 14 cases while CEA in 11. Of 32 patients with locoregional recurrence alone, 18 later developed metastatic disease at a mean follow-up time of 17.5 months. There was a significant correlation between CA 15-3 value at locoregional recurrence and time to subsequent metastasis (r = 0. -0.57, P = 0.0133). CEA was elevated in 64%, CA 15-3 in 87% and either marker in 94% of 87 patients diagnosed with metastatic disease. Of 53 patients with serial markers and metastatic disease, 72% (38/53) had rising CA 15-3 levels prior to diagnosis with a mean lead time of 9.9 months. Use of CEA in conjunction improved lead time detection to 83%. This study demonstrates that CA 15-3 is superior to CEA at detecting metastatic disease at initial presentation and during follow-up. Use of CEA in conjunction with CA 15-3 improves the detection of systemic disease.

scholarly journals Risk of Endometrial Cancer and Frequencies of Invasive Endometrial Procedures in Young Breast Cancer Survivors Treated With Tamoxifen: A Nationwide Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Soojeong Choi ◽  
Young Jae Lee ◽  
Jae Ho Jeong ◽  
Jinhong Jung ◽  
Jong Won Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endometrial Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Proportional Hazards ◽  
Postmenopausal Breast Cancer ◽  
Cox Proportional Hazards ◽  
Close Monitoring ◽  
Increased Risk ◽  
Young Breast Cancer

BackgroundAlthough the guidelines recommend gynecological assessment and close monitoring for symptoms of endometrial cancer in postmenopausal breast cancer survivors taking tamoxifen (TAM), the risk of endometrial cancer in young breast cancer survivors has not yet been fully assessed. This study aimed to investigate the risk of developing endometrial cancer and the frequencies of gynecological examinations in young breast cancer survivors taking TAM in South Korea.MethodsA nationwide retrospective cohort study was conducted using the Health Insurance Review and Assessment Service claims data. Kaplan–Meier analyses and log-rank tests were used to assess the probability of endometrial cancer, benign endometrial conditions, and the probability of invasive endometrial procedure. To analyze the risk of endometrial cancer and benign endometrial conditions, we used a multivariable Cox proportional hazards regression model.ResultsBetween 2010 and 2015, 60,545 newly diagnosed female breast cancer survivors were included. The total person–years were 256,099 and 140 (0.23%) patients developed endometrial cancer during the study period. In breast cancer survivors aged ≥60 years [hazard ratio (HR), 5.037; 95% confidence interval (CI), 2.185–11.613], 50–59 years (HR, 4.343; 95% CI, 2.122–8.891), and 40–49 years (HR, 2.121; 95% CI, 1.068–4.213), TAM was associated with an increased risk of endometrial cancer. In subjects aged below 40 years, TAM did not significantly increase the risk of endometrial cancer. However, among the TAM subgroups, breast cancer survivors aged below 40 years [1.61 per 1,000 person–years (PY); HR, 12.460; 95% CI, 2.698–57.522] and aged 40–49 years (2.22 per 1,000 PY; HR, 9.667; 95% CI, 4.966–18.819) with TAM-related endometrial diseases showed significantly increased risks of endometrial cancer. Among the TAM subgroup with benign endometrial conditions, the ratios of the frequency of invasive diagnostic procedures to the incidence of endometrial cancer were higher in subjects under 40 than subjects aged 60 or more.ConclusionYoung breast cancer survivors with TAM-related benign endometrial diseases are at a higher risk of developing endometrial cancer. Gynecological surveillance should be tailored to the risk of endometrial cancer in young breast cancer survivors to improve the early detection of endometrial cancer and avoid unnecessary invasive procedures.

scholarly journals Current Treatment of Isolated Locoregional Breast Cancer Recurrences

Breast Care ◽  
2015 ◽  
Vol 10 (4) ◽  
pp. 265-271 ◽  
Author(s):  
Wolfgang Harms ◽  
Andreas Geretschläger ◽  
Corinne Cescato ◽  
Martin Buess ◽  
Dieter Köberle ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Survival Rates ◽  
Breast Conservation ◽  
Partial Breast Irradiation ◽  
Individual Treatment ◽  
Severe Toxicity ◽  
Curative Intent ◽  
Potential Clinical Benefit ◽  
Increased Risk

Patients with isolated locoregional breast cancer recurrences should be treated with curative intent. Mastectomy is regarded as the standard of care for patients with ipsilateral breast tumor recurrence. In a selected group of patients, partial breast irradiation after second breast-conserving surgery is a viable alternative to mastectomy. If a second breast conservation is performed, additional irradiation should be mandatory, especially in patients who had not been irradiated previously. In case of re-irradiation, the largest experience exists for multi-catheter brachytherapy. Prospective clinical trials are needed to clearly define selection criteria, long-term local control, and toxicity. In patients with resectable locoregional breast cancer recurrences after mastectomy, multi-modal therapy comprising complete resection, radiation therapy in previously unirradiated patients, and systemic therapy results in 5-year disease-free and overall survival rates of 69% and 88%, respectively. In radiation-naive patients with unresectable, isolated locoregional recurrences, radiation therapy is mandatory. In selected patients with previous irradiations and unresectable locoregional recurrences, a second irradiation as part of an individual treatment concept can be applied. The increased risk of severe toxicity should always be weighed up against the potential clinical benefit. A combination therapy with hyperthermia can further improve the treatment results.

Coronary artery disease associated with radiation therapy

Open Medicine ◽  
2010 ◽  
Vol 5 (2) ◽  
pp. 180-183
Author(s):  
Turgay Celık ◽  
Cagdas Yuksel ◽  
Sait Demırkol ◽  
Atila Iyısoy ◽  
Cuneyt Ulutın
Keyword(s):  
Breast Cancer ◽  
Coronary Artery Disease ◽  
Radiation Therapy ◽  
Coronary Artery ◽  
Cardiac Complications ◽  
Curative Intent ◽  
Increased Risk ◽  
Cancer Specific Mortality ◽  
Artery Disease ◽  
Effects Of Radiation

AbstractRecent advancements in curative-intent therapies have led to dramatic improvements in breast cancer-specific mortality but at the direct expense of increased risk of cardiovascular-related mortality. The use of radiation therapy has led to significant improvements in survival for patients treated for breast cancer. However, as patients live longer, the potentially serious adverse effects of radiation on the heart have raised concerns. Coronary artery disease following irradiation is encountered rarely but is one of the most devastating treatable complications.In this article we review the cardiac complications associated with radiation therapy.

scholarly journals Increased Risk of Locoregional Recurrence for Women With T1-2N0 Triple-Negative Breast Cancer Treated With Modified Radical Mastectomy Without Adjuvant Radiation Therapy Compared With Breast-Conserving Therapy

2011 ◽  
Vol 29 (21) ◽  
pp. 2852-2858 ◽  
Author(s):  
Bassam S. Abdulkarim ◽  
Julie Cuartero ◽  
John Hanson ◽  
Jean Deschênes ◽  
David Lesniak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Locoregional Recurrence ◽  
Triple Negative ◽  
Radical Mastectomy ◽  
Breast Conserving Therapy ◽  
Adjuvant Radiation ◽  
Modified Radical Mastectomy ◽  
Free Survival ◽  
Adjuvant Radiation Therapy ◽  
Increased Risk

Purpose To evaluate the risk of locoregional recurrence (LRR) associated with locoregional treatment of women with primary breast cancer tumors negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (triple-negative breast cancer [TNBC]). Patients and Methods Patients diagnosed with TNBC were identified from a cancer registry in a single institution (n=768). LRR-free survival was estimated using Kaplan-Meier analysis. The Cox proportional hazards regression model was used to determine risk of LRR on the basis of locoregional management: breast-conserving therapy (BCT; ie, lumpectomy and adjuvant radiation therapy [RT]) and modified radical mastectomy (MRM) in the TNBC population and T1-2N0 subgroup. Results At a median follow-up of 7.2 years, 77 patients (10%) with TNBC developed LRR. Five-year LRR-free survival was 94%, 85%, and 87% in the BCT, MRM, and MRM + RT groups, respectively (P < .001). In multivariate analysis, MRM (compared with BCT), lymphovascular invasion and lymph node positivity were associated with increased LRR. Conversely, adjuvant chemotherapy was associated with decreased risk of LRR. For patients with T1-2N0 tumors, 5-year LRR-free survival was 96% and 90% in the BCT and MRM groups, respectively (P =.027), and MRM was the only independent prognostic factor associated with increased LRR compared with BCT (hazard ratio, 2.53; 95% CI, 1.12 to 5.75; P= .0264). Conclusion Women with T1-2N0 TNBC treated with MRM without RT have a significant increased risk of LRR compared with those treated with BCT. Prospective studies are warranted to investigate the benefit of adjuvant RT after MRM in TNBC.

Sickness absence and disability pension among Swedish women before breast cancer relapse.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14121-e14121
Author(s):  
Hedayati Elham ◽  
Sofie a.m. Gernaat ◽  
Aina Johnsson ◽  
Ulla m Wilking ◽  
Renske Altena
Keyword(s):  
Breast Cancer ◽  
Sickness Absence ◽  
Metastatic Disease ◽  
Primary Breast Cancer ◽  
Disability Pension ◽  
Smooth Transition ◽  
Regional Recurrence ◽  
Disease Relapse ◽  
Annual Prevalence ◽  
Increased Risk

e14121 Background: Sickness absence (SA) and disability pension (DP) from diagnosis of primary breast cancer (BC) among patients who in a later stage will develop a recurrence or metastatic disease is unknown. This study explores the prevalence and risk factors of SA and DP in this study population before and after primary breast cancer diagnosis. Methods: Longitudinal register data on 1,310 female patients living in Sweden (age 20 to 63 years) diagnosed with primary BC between 1996 to 2011, were analyzed for annual prevalence of SA days and DP starting 2 years pre- to 5 years postdiagnosis. Logistic regressions were used to explore associations between primary BC characteristics and future SA. Results: 579 (44.2%) had loco-regional recurrence after a median of 2.5 years (interquartile range (IQR) = 1.3-4.3) and 731 (55.8%) had a metastatic disease after a median of 2.3 years (IQR = 1.3-4.1). 320 (24.4%) of 1,310 were still relapse-free 5 years postdiagnosis. SA was high during year 1 postdiagnosis but decreased steadily through year 5 (67.9%, 40.3%, 29.0%, 23.9%, 19.4%, respectively), while DP steadily increased during this time period (16.4%, 17.5%, 19.7%, 24.9%, 28.7%, respectively). The annual prevalence of SA over 180 days among patients who later were diagnosed with metastatic disease was constantly higher compared to patients who later were diagnosis of loco-regional recurrence. Pre-diagnosis SA, age < 50 years at the time of diagnosis, higher tumor stage, chemotherapy and future metastatic disease were associated with higher odds ratios for SA (odds ratio range, 1.56 to 4.42) Conclusions: In conclusion, longitudinal rates of SA and DP in a cohort of women with early BC, of whom a part developed disease relapse during follow-up were higher compared to previous studies. These are unique findings as previously published studies excluded patients with disease relapse. Patients at increased risk for SA, should be assessed and triaged to optimize chances for a smooth transition to return to work after oncological treatment.

scholarly journals Factors Predicting Locoregional Recurrence After Neoadjuvant Chemotherapy and Nipple-Sparing/Skin-Sparing Mastectomy With Immediate Breast Reconstruction

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhen-Yu Wu ◽  
Hee Jeong Kim ◽  
Jong Won Lee ◽  
Il Yong Chung ◽  
Jisun Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Neoadjuvant Chemotherapy ◽  
Breast Reconstruction ◽  
Locoregional Recurrence ◽  
Tumor Grade ◽  
Immediate Breast Reconstruction ◽  
Breast Cancer Patients ◽  
Increased Risk ◽  
Associated Risk Factors

BackgroundFew data are available on the risk factors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NACT) and immediate breast reconstruction (IBR) in breast cancer. Herein, we evaluated the factors predicting LRR in a large series of patients who underwent either nipple- (NSM) or skin-sparing mastectomy (SSM) with IBR after NACT.MethodsWe retrospectively analyzed 609 breast cancer patients who underwent NACT and NSM/SSM with IBR between February 2010 and June 2017. Factors associated with an increased risk of LRR were analyzed by univariate (chi-square or Fisher’s exact test) and multivariate (Cox proportional hazard regression model) analyses.ResultsDuring a median follow-up of 63 months, LRR as the first event occurred in 73 patients, and the 5-year cumulative LRR rate was 10.8%. Multivariate analysis revealed post-NACT Ki67 ≥ 10% [hazard ratio (HR), 2.208; 95% confidence interval (CI), 1.295-3.765; P = 0.004], high tumor grade (HR, 1.738; 95% CI, 1.038-2.908; P = 0.035), and presence of lymphovascular invasion (LVI) (HR, 1.725; 95% CI, 1.039-2.864; P = 0.035) as independently associated with increased LRR risk. The 10-year LRR rate was 8.5% for patients with none of the three associated risk factors, 11.6% with one factor, 25.1% with two factors, and 33.7% with all three factors (P &lt; 0.001).ConclusionsPost-NACT Ki67 ≥ 10%, high tumor grade, and presence of LVI are independently associated with an increased risk of developing LRR after NACT and NSM/SSM with IBR. Future prospective trials are warranted to decrease the risk of LRR in patients with associated risk factors.

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