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:
      • 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: 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.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #CASO #Miami #CenterforAdvancedSurgicalOncology #IsolatedAxillaryRecurrence

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