Breast Cancer Recurrences: Management

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • In general, local chest wall or nodal recurrences should be excised if feasible, and then possibly treated with systemic therapy
  • The role of chemotherapy following complete excision of isolated locoregional recurrence:
    • Was examined in the CALOR trial with the final analyses of this trial:
      • Demonstrating a 10-year disease-free survival benefit:
        • For patients with the addition of chemotherapy in ER negative recurrences:
          • But no statistically significant benefit for ER positive recurrences
  • Re-irradiation with or without hyperthermia has also been examined:
    • Vernon et al. included multiple prospective randomized trials comparing radiation alone (RT) versus hyperthermia (HT):
      • The local complete response was:
        • 59% in the combined group and 41% in the RT alone group
    • A large meta-analysis by Datta et al. combined 34 studies (8 two-arm, and 26 single-arm):
      • The complete response (CR) rate reported for the combined RT + HT for the two-arm studies was 60% vs. 38% for RT alone
  • Concurrent chemotherapy with radiation therapy has also been evaluated, in particular with chemosensitizers such as capecitabine:
    • Zagar et al. report that a combination of mild hyperthermia with a thermally sensitive doxorubicin containing liposome was safe when treating for patients with chest wall recurrences of breast cancer
  • References
    • 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;36:1073-9.
    • Vernon CC, Hand JW, Field SB, et al. Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: results from five randomized controlled trials. International Collaborative Hyperthermia Group. Int J Radiat Oncol Biol Phys. 1996;35(4):731-744.
    • Datta NR, Puric E, Klingbiel D, Gomez S, Bodis S. Hyperthermia and radiation therapy in locoregional recurrent breast cancers: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys. 2016;94(5):1073-1087.
    • Zagar TM, Higgins KA, Miles EF, et al. Durable palliation of breast cancer chest wall recurrence with radiation therapy, hyperthermia, and chemotherapy. Radiother Oncol. 2010;97(3):535-540.
    • Zagar TM, Oleson JR, Vujaskovic Z, et al. Hyperthermia combined with radiation therapy for superficial breast cancer and chest wall recurrence: a review of the randomised data. Int J Hyperthermia. 2010; 26(7): 612-617.
    • Zagar TM, Vujaskovic Z, Formenti S, et al. Two phase I dose-escalation/pharmacokinetics studies of low temperature liposomal doxorubicin (LTLD) and mild local hyperthermia in heavily pretreated patients with local regionally recurrent breast cancer. Int J Hyperthermia. 2014 Aug; 30(5): 285-294.
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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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