Breast Cancer Chest Wall Recurrence Management

Patients with chest wall recurrence:
- Are at high risk for concurrent systemic recurrences:
  - Therefore, obtaining systemic staging and receptor information on the recurrence should be the first consideration
- Often, there may be extensive local regional involvement in several areas along the chest wall and in the nodal regions
According to National Comprehensive Cancer Network guidelines:
- Systemic staging generally consists of either a:
  - PET/ CT scan or a CT of the chest, abdomen, and pelvis, as well as a bone scan
Surgical excision with negative margins followed by comprehensive chest wall and nodal radiotherapy:
- May be indicated in the absence of widespread systemic disease
This patient should be managed by a multidisciplinary team;
- Including the surgeon, medical oncologists, radiologists, pathologists, and potentially a plastic surgeon
Patients may or may not benefit from chemotherapy:
- In the CALOR trial:
  - Chemotherapy was found to benefit patients with resected ER negative isolated locoregional recurrence, but not ER positive isolated local regional recurrence
References
- Hirsch A, Sabel MS, Hayes DF. Management of locoregional recurrence of breast cancer after mastectomy. UpToDate website 2016. http://www.uptodate.com/contents/management-of-locoregional-recurrence-of-breast-cancer-after-mastectomy. Accessed September 21, 2019
- NCCN Guidelines v.4.2018. National Comprehensive Cancer Network website. https://www.nccn.org/professionals/physician_gls/recently_updated.aspx. Accessed September 21, 2019.
- Wapnir I et al. JCO 4/10/18 vol 36 #11. P 1073-1079 Wapnir IL, Price KN, Anderson SJ, et al. Efficacy of chemotherapy for ER-negative and ER-positive isolated locoregional recurrence of breast cancer: final analysis of the CALOR Trial. J Clin Oncol. 2018;36(11):1973-1079.