Management of Isolated Locoregional Recurrences in Breast Cancer: A Review of Local and Systemic Modalities

Abstract

Locoregional recurrence (LRR) after adequate treatment of primary breast cancer poses a therapeutic challenge. Advances in the management of breast cancer have led to significant improvements in survival. With this advantage, it is observed that the incidence of LRR has relatively decreased. Systemic involvement should be ruled out in patients presenting with locoregionally recurrent disease, as isolated LRR requires a treatment with curative intent. Salvage mastectomy following ipsilateral breast tumor recurrence is a time-tested treatment option and widely accepted. Second-time breast conservation surgery with or without radiotherapy is an emerging alternative. Following a second breast conservation, partial breast irradiation has been seen to improve local control. Five-year overall survival with second breast conservation and radiotherapy is in the range of 76% to 100% with acceptable toxicities. Isolated chest wall recurrences after mastectomy are difficult to manage. Multimodality treatment has been adopted to treat chest wall recurrences, following which the 5-year overall survival was observed to be in the range of 45% to 60%. Use of hyperthermia and photodynamic therapy in combination with conventional treatment options has been associated with better clinical outcomes. Systemic therapy, in the form of chemotherapy and/or hormonal therapy in addition to adequate locoregional treatment, has shown to improve survival. Multimodality treatment for isolated regional recurrences has been associated with better outcomes, and the 5-year survival rates are around 50%. All patients with LRR should be evaluated by a multi-disciplinary tumor board to individualize treatment based on the expected risk-benefit ratio of retreatment.

Keywords: Breast conservation surgery; Chest wall recurrence; Hyperthermia; Ipsilateral breast tumor recurrence; Photo dynamic therapy.