Local recurrence of breast cancer after radical mastectomy: Biological and pathological parameters

PURPOSE To analyze different events that determine event-free survival (EFS) in a randomized trial on adjuvant radiotherapy in early breast cancer patients with more than 15 years of follow-up evaluation. PATIENTS AND METHODS The trial included 960 patients with a unilateral, operable breast cancer. Surgery consisted of a modified radical mastectomy. The trial compared three arms, as follows: preoperative radiotherapy, postoperative radiotherapy, and no adjuvant treatment. Events were analyzed by a competing-risk approach. A proportional hazards multiple regression model was used to analyze the effects of radiotherapy on the risk of distant metastasis. Similar analyses were performed separately for node-negative [N(-)] and node-positive [N(+)] patients in the two groups that did not include preoperative radiotherapy. RESULTS Radiotherapy produced a fivefold decrease of the risk of local recurrence (P < .0001). In N(+) patients, postoperative radiotherapy decreased the risk of distant dissemination (relative risk, 0.63). When local recurrence was introduced in the model as a time-dependent covariate, this factor was predictive of distant dissemination (P < .0001) and nullified the effect of postoperative radiotherapy. This finding suggests that the decrease of distant metastases was related to the prevention of local recurrence. A similar effect was found in models that used overall survival as an end point. CONCLUSION This study shows that postmastectomy radiotherapy in N(+) breast cancer patients may decrease the distant metastasis rate by preventing local recurrences and thus avoiding secondary dissemination.

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Systemic Therapy in Local Recurrence of Breast Cancer, Report of a case and Decision Making in MDT Meeting

Archives of Breast Cancer ◽

10.32768/abc.201963120-123 ◽

2019 ◽

pp. 120-123

Author(s):

Melina Deban ◽

Rami Younan ◽

Danielle Charpentier ◽

Louise Yelle ◽

Danh Tran-Thanh ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Systemic Therapy ◽

Hormone Receptor ◽

Tertiary Care ◽

Neoadjuvant Treatment ◽

Radical Mastectomy ◽

R0 Resection ◽

Hormone Receptor Positive ◽

Her 2

Background: Locoregional recurrence of breast cancer has significantly decreased over the last decades, particularly due to effective systemic therapy. While there is little controversy regarding local management of locoregional recurrences, in light of previous systemic treatment, additional chemotherapy regimens and their benefit to the patient are still subject to debate in tumors boards.Case Presentation: A 45-year-old woman was referred to our tertiary care center with a local recurrence of breast cancer 9 years after modified radical mastectomy for a ypT2N2a invasive ductal carcinoma. She received neoadjuvant treatment consisting of FEC-D (5-FU-epirubicin-cyclophosphamide, followed by docetaxel) for hormone receptor positive, HER-2-neu negative cancer in 2009, as well as adjuvant radiotherapy and tamoxifen for 9 years. After R0 resection of the hormone receptor positive, HER-2-neu negative recurrence in 2019, adjuvant therapy with ovarian suppression and an aromatase inhibitor was undertaken. A multigene assay identified a recurrence score at 37 and benefit from chemotherapy > 15%.Question: What would the ideal chemotherapy regimen consist of for this patient with an R0 resection of late recurrence of breast cancer?Conclusion: After reviewing history, imaging and pathology, members of the multidisciplinary team recommended treatment with Taxotere and cyclophosphamide (TC) x 4 for our patient.

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PROGNOSIS OF BREAST CANCER IN VERY YOUNG AGE (LESS THAN 30 YEARS)

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v2i1.53 ◽

2016 ◽

Vol 2 (1) ◽

Author(s):

Razia Bano ◽

Mariam Salim ◽

Amina Iqbal Khan ◽

Akif Zaidi

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Local Recurrence ◽

Triple Negative ◽

Locally Advanced ◽

Breast Conservation ◽

Radical Mastectomy ◽

Histopathological Diagnosis ◽

Single Patient ◽

Tumour Biology

Purpose: Breast cancer diagnosed at a younger age has aggressive biology being triple negative and high grade and is associated with poor prognosis.Materials and Methods: Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 were reviewed. Data were extracted from the cancer registry department of the institute. Demographics studied were the age at diagnosis, gender, pregnancy or lactation association, family history of breast cancer, histopathological diagnosis, and stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, and survival. Results: A total of 121 patients with age 30 years or less were included. An only a single patient was male. The age range was from 20 to 30 years; bilateral involvement was seen in a single patient. Almost half 50.4% (n = 61) patients had locally advanced disease at presentation. Pregnancy/lactation-associated breast cancer was seen in 29.8% (n = 36). The most common stage was Stage III (52.1%) and Stage II (33.9%). Invasive ductal carcinoma was the most common histology 94.2% (n = 114) of patients; triple negative was the most common molecular subtype present in 46.3% (n = 56). Chemotherapy was received by 92.6% (n = 112), 88.4% (n = 107) patients received radiation therapy. Modi ed radical mastectomy was performed in 57% (n = 69), breast conservation surgery in 35.5% (n = 43), follow- up period was 5 years, local recurrence was observed in 12.4% (n = 15) and cancer related deaths were 42.1% (n = 51). Conclusions: Breast cancer in very young has very aggressive tumour biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy. Key words: Breast cancer, pregnancy-associated aggressive tumour biology, triplenegative, young

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Trends in rates of modified radical mastectomies and bilateral mastectomies in unilateral breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.569 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 569-569

Author(s):

Ajaz Bulbul ◽

Tareq Braik ◽

Sadaf Rashad ◽

Emilio Araujo Mino ◽

Adrianna Bautista ◽

...

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Clinical Outcomes ◽

Recurrence Rate ◽

Early Stage ◽

Breast Conservation ◽

Radical Mastectomy ◽

Breast Conservation Surgery ◽

Bilateral Mastectomy ◽

Unilateral Breast Cancer

569 Background: Women with unilateral breast cancer (BC) without genetic predisposition have a low risk for local and contralateral recurrence with breast conservation surgery (BCS) and adjuvant treatment. We aimed to study the pattern of surgical care across centers in rural New Mexico and its correlation to clinical outcomes. Methods: We retrospectively evaluated 533 patients with Stage 1-3 BC diagnosed between January 1989 to October 2015. Clinical Outcomes with BCS, sentinel lymph node dissection (SLND), simple mastectomy (SM), modified radical mastectomy (MRM) and Bilateral Mastectomy (BM) were studied. Descriptive statistics were performed to describe the proportion of surgery types. Predictors of clinical outcomes were evaluated by multivariate logistic regression. Results: Out of 533 patients, 510 (82%) had early stage (0-3) resectable BC. Among these, 48% (246/510) had either MRM (209/510) or BM (37/510). MRM was performed in 3% of stage 0 (6/209), 23% (49/209) stage I, 46%(97/209) of stage II and 27% (57/209) of Stage III patients. Overall, the rate of SLND was 42% among Early stage Breast cancer. Of 41 patients treated with bilateral mastectomy, 10 were positive for BRCA mutation, 6 for family history and 3 for contralateral disease. Median age of BM was 53 +12 y. The local recurrence rate was 8.8% (45/510), and metastatic recurrence rate was 15.5% (79/510). Lymphedema rate was 9.2% (47/510). Using MRM as reference, the Odds Ratio (OR) for lymphedema after BM and BCT were 2.15 (95% CI, 0.84-5.50) and 0.58 (0.28-1.22), respectively. With 9.6 years of median follow up, the predictive probabilities of lymphedema after BCT, SM, MRM and BM were 1%, 4%, 9% and 18%. The OR for local recurrence in women with BCT were 1.46 (95th C/I: 0.72-2.95), SM 0.27 (0.03-2.13), BM 2.06 (95th C/I:0.70-6.06). Conclusions: Less BCT and more aggressive procedures are being performed, and the latter is associated with more lymphedema. No significant differences were noted in local recurrences. Presence of a genetic mutation was not the sole indicator of BM’s in our patient population. There is a need for evidence-based shared decision-making and surgical management of breast cancer, especially in a rural community setting.

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The role of postoperative radiotherapy after radical mastectomy in treatment of early breast cancer

Archive of oncology ◽

10.2298/aoo0201007m ◽

2002 ◽

Vol 10 (1) ◽

pp. 7-12

Author(s):

Jasmina Mladenovic ◽

Nenad Borojevic

Keyword(s):

Breast Cancer ◽

Survival Rate ◽

Adjuvant Chemotherapy ◽

Local Recurrence ◽

Postoperative Radiotherapy ◽

Radical Mastectomy ◽

Distant Metastases ◽

Regional Lymph Nodes ◽

Postoperative Irradiation

BACKGROUND: Radical or modified radical mastectomy was considered for many years the standard therapy for operable patients. Following radical mastectomy, postoperative irradiation of the chest wall and peripheral lymphatics is indicated in selected highrisk patients. Some studies on breast cancer patients who underwent radical mastectomy and received adjuvant chemotherapy tried to find out whether the addition of irradiation treatment to the chest wall and regional lymph nodes increases survival. The hypothesis in favor of irradiation is that chemotherapy can eliminate distant micrometastases, but is less effective against local and regional diseases, which are better controlled by radiotherapy. METHODS: In one year period, 110 patients with early stage of breast cancer were treated with radical mastectomy, and postoperative radiotherapy. Forty one patients had only postoperative radiotherapy, 27 received also adjuvant chemotherapy, 40 received adjuvant hormonal therapy and 2 patients received both adjuvant chemo and hormonotherapy. Postoperative irradiation was given on the regional lymph nodes (supra and infraclavicular, axillary and internal mammary nodes) with the tumor dose 48 Gy in 22 fractions over a period of four and a half weeks. All fields were treated with Cobalt 60. RESULTS After the median follow up of 67 months, 33 patients (30 %) had some kind of failure in form of local recurrence, distant metastases or both Locoregional relapse alone or associated with distant metastases occurred in 10 patients (9.1 %). Only 1.8 % of patients had local recurrence as the first failure. Distant metastases occurred in 32 patients (29.1%). After the end of follow up, 60 % patients are alive without evidence of disease while 16.4 % patients are alive with disease. The 5 year overall survival rate was 78.19% and 5 year disease free survival rate was 67.44%. CONCLUSION: Postoperative radiotherapy after radical mastectomy has important role in adjuvant treatment of early breast cancer in combination with adjuvant chemotherapy and hormonotherapy.

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Cutaneous Metastasis vs. Isolated Skin Recurrence of Invasive Breast Carcinoma after Modified Radical Mastectomy

Case Reports in Dermatological Medicine ◽

10.1155/2021/6673289 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Reza Hosseinpour ◽

Mohammad Javad Yavari Barhaghtalab

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Radical Mastectomy ◽

Treatment Decision ◽

Skin Metastasis ◽

Axillary Lymph ◽

Modified Radical Mastectomy ◽

Breast Clinic ◽

Chest Wall Recurrence ◽

Disease Case

Background. Five to ten percent of the patients with operable breast cancer develop a chest wall recurrence within 10 years following the mastectomy. One of the most distressing presentations of locally recurrent breast cancer is the appearance of cutaneous metastases. To the best of authors’ knowledge, there is no study distinguishing skin metastasis from local recurrence, so the main aim of this report was to elucidate if these two features are important in the prognosis and management of the disease. Case Presentation. A 51-year-old woman referred to the breast clinic due to a painful mass in the left breast. The patient underwent the modified radical mastectomy (MRM) and left axillary lymph node dissection followed by 30 sessions of radiotherapy and 8 sessions of chemotherapy (T3N1M0, ER−, and HER2+). About 15 months after the surgery, she presented with redness and eruptive lesions over the mastectomy scar that increased in size within a three-month follow-up. Conclusion. Mastectomy is not an absolute cure in the treatment of an invasive breast cancer because almost always, there is a recurrence risk and possibility of metastasis. It is vital to differentiate between local recurrence and skin metastasis because it would alter the overall treatment decision, prognosis, and patient outcomes.

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Comparison of overall survival, local recurrence and distant metastasis of breast-conserving therapy with modified radical mastectomy in Iranian women with stage I and II breast cancer

Chinese Journal of Medical Research ◽

10.37515/cjmr.091x.3206 ◽

2020 ◽

Vol 3 (2) ◽

pp. 62-69

Author(s):

Alireza Mozafari ◽

◽

Fariba Binesh ◽

Ali Akhavan ◽

Zeynab Eshaghie ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Local Recurrence ◽

Distant Metastasis ◽

Radical Mastectomy ◽

Stage I ◽

Iranian Women ◽

Historical Cohort ◽

Surgical Methods ◽

Significant Difference

Introduction: Breast cancer effects on younger patients and how it behaves more severely in Iran. This matter may influence the efficacy of breast conservation surgery (BCT) and radical mastectomy (MRM) as common treatments. The aim of this study was to compare the overall survival, local recurrence and distant metastasis of these two surgical methods in Iranian women with stage I and II of breast cancer. Material and methods :This historical cohort study was performed on women with stage I&II of breast cancer who had undergone MRM and BCT and had referred to Shahid Ramezanzadeh Radiotherapy Center, Yazd, Iran, from 2005 to 2012.Patient’s characteristics, tumor information, treatment modalities, local recurrence, distant metastasis and overall survival were collected. Data were analyzed by SPSS software using chisquare, t-test, log-rank and Kaplan-Meier tests. The study code of ethics is IR.SSU.MEDICINE.REC.1394.318. Results: 506 patients were included in this study, 285 (56.3%) in the MRM group and 221 (43.7%) in the BCT group. The mean age of the patients was 47.69 ± 10.62 years. Most of the patients (408 patients or 80.6%) were in stageII and the rest (98 patients or 19.4%) were in stage Iof the disease. Distant metastasis occurred in 23.94% (17 cases) of the patients in the BCT group and in 76.05% (54 cases) of the patients in the MRM group. The MRM group was indicative of more distant metastasis (p = 0.001). There was no significant difference between the two groups regarding local recurrence (p = 0.83). Overall survival in the BCT group was 105.43 ± 2.06 months and in the MRM group it was 96.26 ± 2.16 months, indicating a higher overall survival in the BCT group (p = 0.002). Conclusion: The findings of the study showed that women with MRM had higher metastasis and lower overall survival. Also, local recurrence was not significantly different between the two groups. Considering the results, it is possible to recommend BCT as the treatment of choice for Iranian women.

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