Current Strategies for the Management of Locoregional Breast Cancer Recurrence

Advances in the treatment of breast cancer have decreased the rate of isolated locoregional recurrences (ILRRs) over time. Surgery, radiation therapy, and systemic therapies are used to manage these failure events and their associated poor prognosis. Operable ipsilateral breast tumor recurrences (IBTRs) are treated by either salvage mastectomy or, in select cases, repeat lumpectomy. Axillary nodal recurrences and postmastectomy chest wall relapses are commonly amenable to surgical resection, too. Repeat sentinel node mapping may be undertaken after IBTRs and chest wall recurrences. Aberrant lymphatic drainage, especially after previous mastectomy, is frequently observed. Adjuvant radiation is recommended for most ILRR cases; the dose and volume must be adjusted for prior to receipt of therapy. Implementation of adjuvant systemic therapies after ILRR should be based on the expression of molecular markers in the recurrent tumor. Administration of chemotherapy for estrogen receptor-negative ILRR is indicated, since it significantly decreases the rate of distant metastases.