Regionally Recurrent Breast Cancer – Management

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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 taking into account tumor phenotype and prior therapies already received by the patient
  • Wapnir et al:
    • Demonstrated in the CALOR trial that in ER negative (ER-) isolated recurrences:
      • Systemic chemotherapy improved disease-free survival:
        • However, in ER+ 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.
      3. 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.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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