Isolated Recurrent Axillary Disease in Patients with a History of Breast Cancer

Isolated recurrent axillary disease:
- Is an uncommon presentation of recurrence:
  - The incidence remains rare at:
    - 1% to 2%
It is important to stage patients with locoregional recurrences:
- As approximately one-third will present with:
  - Synchronous distant metastasis
- If the staging workup is negative:
  - A complete axillary dissection should be performed if possible:
    - If surgical resection is not possible:
      - Systemic therapy should be offered:
        To potentially allow surgical resection
  - Radiation should be performed if feasible for recurrences as well:
    - Depending on the prior extent of radiation delivered
In addition, complete breast imaging should be performed:
- To ensure there is no in-breast recurrence as well
The use of systemic therapy should be offered after a multidisciplinary discussion:
- Considering:
  - Tumor phenotype and prior therapies already received by the patient
Wapnir et al:
- Demonstrated in the CALOR trial:
  - That in ER negative isolated recurrences:
    - Systemic chemotherapy improved disease-free survival:
      - However, in ER positive recurrences:
        Endocrine therapy should be the preferred therapy
References
Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg. 2016;264:(3):413-420.
Neuman HB, Schumacher JR, Francescatti AB, et al. Risk of synchronous distant recurrence at time of locoregional recurrence in patients with stage II and III breast cancer (AFT-01). J Clin Oncol. 2018;36(10):975-980.
National Comprehensive Cancer Network (NCCN) Breast CancerOnline: https://www.nccn.org/professionals/physician_gls/recently_updated.aspx. Accessed September 15, 2020
Wapnir IR, 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. N Engl J Med. 2018;36(11):1073-1079.