Breast Recurrent after Mastectomy

TREATMENT

Resectable Recurrence

  • Surgical resection for resectable disease
  • Comprehensive Post-operative radiation including IMN, SC and axilla (U. Wash)[1]
  • Systemic therapy
    • Chemotherapy
    • Hormonal therapy or ER/PR+ tumors
    • trastuzumab for HER-2+ tumors

Unresectable Recurrence and becomes resectable after neoadjuvant chemotherapy

  • Neoadjuvant chemotherapy
  • Surgical resection
  • Consolidated with comprehensive radation

Unresectable Recurrence and remains unresectable after neoadjuvant chemotherapy

  • local-regional radiation to help stabilize the diseae and avoid adverse consequences of uncontrolled local-regional disease.

OUTCOME

  • 5-yr rate of distant metastatsis after recurrence is 73% according to the Danish trials
  • The rate of distant metastasis is same whether they had MRM+XRT or MRM alone
Bibliography
1. Halverson KJ, Perez CA, Kuske RR, Garcia DM, Simpson JR, Fineberg B. Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):851-8.
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