First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research.

Borner, Markus; Bacchi, M.; Goldhirsch, Aron; Greiner, R; Harder, F.; Castiglione, M.; Jungi, W. F.; Thürlimann, Beat; Cavalli, F.; Obrecht, J.P.

doi:10.1200/jco.1994.12.10.2071

Cited by 158 publications

(113 citation statements)

References 24 publications

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“…However, this hypothesis was addressed in 167 patients with a first isolated local and regional recurrence after mastectomy for breast carcinoma in a Swiss Phase III multicenter study comparing tamoxifen with observation after local therapy. 63,64 Although a local recurrence of breast carcinoma after mastectomy appears to confer a worse prognosis in general than local recurrence after breast conservation, the results of this multicenter study have implications for the latter clinical scenario. 23,65,66 At a median follow-up of 11.6 years in surviving patients, tamoxifen was associated with improved disease-free survival (61% vs. 33%; P ϭ 0.006).…”

Section: Impact Of Systemic Therapy Given At the Time Of Inbreast Locmentioning

confidence: 91%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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Mastectomy is the current standard of care for in-breast local recurrence of breast carcinoma. The objective of the current study was to critically review the rationale for and the theoretic and actual risks and benefits of repeat breast-conserving surgery followed by partial breast irradiation (PBI) for in-breast local recurrence of breast carcinoma. The main outcomes of interest were local control and survival after in-breast local recurrence and side effects, complications, and cosmesis after reirradiation of the breast. The risk of local recurrence was not found to be eliminated with mastectomy; approximately 2-32% of patients treated with mastectomy develop a chest wall recurrence. The interpretation of local control rates in evaluating repeat breast-conserving surgery studies is difficult because of the lack of information regarding preoperative diagnostic mammography to rule out concurrent multicentric disease and microscopic margin status after surgery. Rates of subsequent local recurrence in these studies appeared to be between 19 -50%, similar to reported rates of in-breast local recurrence in patients with a first diagnosis of breast carcinoma who were treated with conservative surgery without irradiation. Early follow-up studies of breast reirradiation suggest that catheterbased interstitial brachytherapy and standard external beam radiation therapy can be delivered to the breast more than once without significant side effects in most patients and with acceptable cosmesis in some patients. Mastectomy may not be necessary in all patients with an in-breast local recurrence of breast carcinoma. KEYWORDS: recurrent breast carcinoma, breast surgery, radiation therapy, accelerated partial breast irradiation, three-dimensional conformal radiation therapy, brachytherapy.A t present, the standard surgical approach for the treatment of in-breast local recurrence of breast carcinoma is mastectomy. The rationale for the general consensus for this recommendation is threefold. First, a third local recurrence after repeat conservative surgery is reported in approximately 35% of patients. Second, a second lumpectomy would yield a cosmetically unacceptable outcome. Third, reirradiation of the whole breast after breast-conserving surgery is considered inappropriate because of the likelihood of serious tissue damage. Recently, novel brachytherapy devices and three-dimensional conformal radiation therapy techniques have brought accelerated partial breast irradiation (APBI) to the forefront as a potential treatment approach in women with in-breast local recurrence of 2269

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Section: Impact Of Systemic Therapy Given At the Time Of Inbreast Locmentioning

confidence: 91%

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Kuerer

Arthur

Haffty

2004

Cancer

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“…30 Such beneficial effects have been demonstrated by tamoxifen use in patients with isolated LRR after mastectomy. 40 It has been demonstrated by several groups of authors that the method by which a local recurrence is detected is a predictor of outcome in patients with IBTR after BCT. 28,31 Patients who have local recurrences detected by mammography or by a combination of mammography and physical examination have a better prognosis than patients who have recurrences detected by physical examination alone.…”

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confidence: 99%

Predictors of systemic recurrence and disease‐specific survival after ipsilateral breast tumor recurrence

Shen

Hunt

Mirza

et al. 2005

Cancer

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BACKGROUNDIn patients with breast carcinoma, ipsilateral breast tumor recurrence (IBTR) after breast‐conserving therapy (BCT) is an independent predictor of systemic recurrence and disease‐specific survival (DSS). However, only a subgroup of patients with IBTR develop systemic recurrences. Therefore, the management of isolated IBTR remains controversial. The objective of the current study was to identify determinants of systemic recurrence and DSS after IBTR.METHODSThe medical records of 120 women who underwent BCT for Stage 0–III breast carcinoma between 1971 and 1996 and who subsequently developed isolated IBTR were reviewed. Clinicopathologic factors were studied using univariate and multivariate analyses for their association with DSS and the development of systemic recurrence after IBTR.RESULTSThe median time to IBTR was 59 months. At a median follow‐up of 80 months after IBTR, 45 patients (37.5%) had a systemic recurrence. Initial lymph node status was the strongest predictor of systemic recurrence according to the a univariate analysis (P = 0.001). Other significant factors included lymphovascular invasion (LVI) in the primary tumor, time to IBTR ≤ 48 months, clinical and pathologic IBTR tumor size > 1 cm, LVI in the recurrent tumor, and skin involvement at IBTR. In a multivariate logistic regression analysis, initially positive lymph node status (relative risk [RR], 5.3; 95% confidence interval [95% CI], 1.4–20.1; P = 0.015) and skin involvement at IBTR (RR, 15.1; 95% CI, 1.5–153.8; P = 0.022) remained independent predictors of systemic recurrence. The 5‐year and 10‐year DSS rates after IBTR were 78% and 68%, respectively. In a multivariate Cox proportional hazards model analysis, only LVI in the recurrent tumor was found to be an independent predictor of DSS (RR, 4.6; 95% CI, 1.5–14.1; P = 0.008).CONCLUSIONSPatients who initially had lymph node‐positive disease or skin involvement or LVI at IBTR represented especially high‐risk groups that warranted consideration for aggressive, systemic treatment and novel, targeted therapies after IBTR. Determinants of prognosis after IBTR should be taken into account when evaluating the need for further systemic therapy and designing risk‐stratified clinical trials. Cancer 2005. © 2005 American Cancer Society.

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“…In case of a positive oestrogen and/or progesterone receptor status however, patients with local recurrence are candidates for hormonal treatment anyway, irrespective of their axillary nodal status. This decision is supported by results from a randomized controlled trial, which showed an increase of 5-year disease-free survival for patients with local recurrence treated with tamoxifen compared to observation alone (Borner 1994). 11 Until now, the effectiveness of chemotherapy in patients with local recurrence has remained unclear, 12,13 and a randomized study is ongoing to determine the value of chemotherapy in this setting.…”

Section: Reasons To Stage the Axillamentioning

confidence: 48%

Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure

Derkx

Maaskant‐Braat

Sangen

et al. 2010

European Journal of Surgical Oncology (EJSO)

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First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research.

Cited by 158 publications

References 24 publications

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Repeat breast‐conserving surgery for in‐breast local breast carcinoma recurrence

Predictors of systemic recurrence and disease‐specific survival after ipsilateral breast tumor recurrence

Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure

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