Prognosis and treatment of locally recurrent breast cancer

Even in case of adequate curative treatment of the primary tumor, approximately 10-20% of all patients will develop a locoregional recurrence in the course of disease. At the time of diagnosis of the recurrence, one-third of patients already has distant metastases. The 5-year survival for patients without metastases is approximately 40%. Prognostic factors are the initial lymph-node status and the disease-free interval. Whether in-breast recurrences (IBTR) carry a better prognosis than chest-wall recurrences after mastectomy is not definitively clear; the better survival after IBTR might be due to a selection bias for breast preservation.

A major goal of treatment for locoregionally recurrent breast cancer is to achieve local control at the recurrent site. This includes surgery and/or radiotherapy. For local control, the patterns of local spread (scar or outside scar, multifocality, size, site) are important. In irresectable lesions, the addition of hyperthermia to radiotherapy yields improved local control. Encouraging local control rates have also been reported from some phase II studies with concurrent radiochemotherapy. In general, patients with local control at the recurrent site have a significantly better long-term prognosis as compared with patients with re-recurrence.

Local recurrence is often associated with subsequent occurrence of distant metastases. Prophylactic ('adjuvant') systemic treatment is theoretically justified, but its impact on prognosis is unclear. Hormonal treatment is recommended if the recurrence is positive for ER/PR receptors. The use of chemotherapy is currently being investigated in several multicentre studies.