Surgical Management and Its Impact on Adjuvant Treatment in Recurrent Ipsilateral Breast Cancer: A Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Statistical Analysis
3. Results
4. Discussion
4.1. Breast Surgery: Is Mastectomy Always Needed?
4.2. Axillar Surgery: SLN Detection Rate and Aberrant Drainage
4.3. Complications
4.4. Adjuvant Treatment
4.5. Recurrence and Survival
4.6. Limitations and Future Direction
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Spronk, I.; Schellevis, F.G.; Burgers, J.S.; De Bock, G.H.; Korevaar, J.C. Incidence of isolated local breast cancer recurrence and contralateral breast cancer: A systematic review. Breast 2018, 39, 70–79. [Google Scholar] [CrossRef] [PubMed]
- Arvold, N.D.; Taghian, A.G.; Niemierko, A.; Abi Raad, R.F.; Sreedhara, M.; Nguyen, P.L.; Bellon, J.R.; Wong, J.S.; Smith, B.L.; Harris, J.R. Age, Breast Cancer Subtype Approximation, and Local Recurrence after Breast-Conserving Therapy. J. Clin. Oncol. 2011, 29, 3885–3891. [Google Scholar] [CrossRef] [PubMed]
- Lannin, D.R.; Haffty, B.G. End results of salvage therapy after failure of breast conservation therapy. Oncology 2004, 18, 272–279. [Google Scholar] [PubMed]
- Lowery, A.J.; Kell, M.R.; Glynn, R.W.; Kerin, M.J.; Sweeney, K.J. Locoregional recurrence after breast cancer surgery: A systematic review by receptor phenotype. Breast Cancer Res. Treat. 2012, 133, 831–841. [Google Scholar] [CrossRef] [PubMed]
- Burger, A.E.E.; Pain, S.J.; Peley, G. Treatment of Recurrent Breast Cancer Following Breast Conserving Surgery. Breast J. 2013, 19, 310–318. [Google Scholar] [CrossRef] [PubMed]
- Fodor, J.; Major, T.; Polgár, C.; Orosz, Z.; Sulyok, Z.; Kásler, M. Prognosis of patients with local recurrence after mastectomy or conservative surgery for early-stage invasive breast cancer. Breast 2008, 17, 302–308. [Google Scholar] [CrossRef] [PubMed]
- Alpert, T.E.; Kuerer, H.M.; Arthur, D.W.; Lannin, D.R.; Haffty, B.G. Ipsilateral breast tumor recurrence after breast conservation therapy: Outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int. J. Radiat. Oncol. Biol. Phys. 2005, 63, 845–851. [Google Scholar] [CrossRef] [PubMed]
- Salvadori, B.; Marubini, E.; Miceli, R.; Conti, A.R.; Cusumano, F.; Andreola, S.; Zucali, R.; Veronesi, U. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br. J. Surg. 2003, 86, 84–87. [Google Scholar] [CrossRef] [PubMed]
- Sagona, A.; Gentile, D.; Anghelone, C.A.P.; Barbieri, E.; Marrazzo, E.; Antunovic, L.; Franceschini, D.; Tinterri, C. Ipsilateral Breast Cancer Recurrence: Characteristics, Treatment, and Long-Term Oncologic Results at a High-Volume Center. Clin. Breast Cancer 2021, 21, 329–336. [Google Scholar] [CrossRef] [PubMed]
- Arthur, D.W.; Winter, K.A.; Kuerer, H.M.; Haffty, B.; Cuttino, L.; Todor, D.A.; Anne, P.R.; Anderson, P.; Woodward, W.A.; McCormick, B.; et al. Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast: The NRG Oncology/RTOG 1014 Phase 2 Clinical Trial. JAMA Oncol. 2020, 6, 75. [Google Scholar] [CrossRef] [PubMed]
- NCCN Clinical Practice Guidelines in Oncology (NCCN. Guidelines) Version 2.2024. Available online: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1419 (accessed on 1 June 2024).
- Vugts, G.; Maaskant-Braat, A.J.G.; Voogd, A.C.; van Riet, Y.E.A.; Luiten, E.J.T.; Rutgers, E.J.T.; Rutten, H.J.T.; Roumen, R.M.H.; Nieuwenhuijzen, G.A.P. Repeat sentinel node biopsy should be considered in patients with locally recurrent breast cancer. Breast Cancer Res. Treat. 2015, 153, 549–556. [Google Scholar] [CrossRef] [PubMed]
- Derkx, F.; Maaskant-Braat, A.J.G.; Van Der Sangen, M.J.C.; Nieuwenhuijzen, G.A.P.; Van De Poll-Franse, L.V.; Roumen, R.M.H.; Voogd, A.C. Staging and management of axillary lymph nodes in patients with local recurrence in the breast or chest wall after a previous negative sentinel node procedure. Eur. J. Surg. Oncol. (EJSO) 2010, 36, 646–651. [Google Scholar] [CrossRef] [PubMed]
- Dindo, D.; Demartines, N.; Clavien, P.-A. Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann. Surg. 2004, 240, 205–213. [Google Scholar] [CrossRef] [PubMed]
- Chen, S.L.; Martinez, S.R. The survival impact of the choice of surgical procedure after ipsilateral breast cancer recurrence. Am. J. Surg. 2008, 196, 495–499. [Google Scholar] [CrossRef] [PubMed]
- Tung, N.; Ricker, C.; Messersmith, H.; Balmaña, J.; Domchek, S.; Stoffel, E.M.; Almhanna, K.; Arun, B.; Chavarri-Guerra, Y.; Cohen, S.A.; et al. Selection of Germline Genetic Testing Panels in Patients with Cancer: ASCO Guideline. J. Clin. Oncol. 2024, 42, 2599–2615. [Google Scholar] [CrossRef] [PubMed]
- Giannakeas, V.; Lim, D.W.; Narod, S.A. Bilateral mastectomy and breast cancer mortality. JAMA Oncol. 2024; published online. [Google Scholar] [CrossRef] [PubMed]
- Ahmed, M.; Baker, R.; Rubio, I.T. Meta-analysis of aberrant lymphatic drainage in recurrent breast cancer. Br. J. Surg. 2016, 103, 1579–1588. [Google Scholar] [CrossRef] [PubMed]
- Maaskant-Braat, A.J.G.; Voogd, A.C.; Roumen, R.M.H.; Nieuwenhuijzen, G.A.P. Repeat sentinel node biopsy in patients with locally recurrent breast cancer: A systematic review and meta-analysis of the literature. Breast Cancer Res. Treat. 2013, 138, 13–20. [Google Scholar] [CrossRef] [PubMed]
- Gschwantler-Kaulich, D.; Riegler-Keil, M.; Ruecklinger, E.; Singer, C.F.; Seifert, M.; Kubista, E. Factors influencing the identification rate of the sentinel node in breast cancer: Sentinel node biopsy in breast cancer. Eur. J. Cancer Care 2011, 20, 627–631. [Google Scholar] [CrossRef] [PubMed]
- Zurrida, S.; Galimberti, V.; Orvieto, E.; Robertson, C.; Ballardini, B.; Cremonesi, M.; De Cicco, C.; Luini, A. Radioguided Sentinel Node Biopsy to Avoid Axillary Dissection in Breast Cancer. Ann. Surg. Oncol. 2000, 7, 28–31. [Google Scholar] [CrossRef] [PubMed]
- Manyam, B.; Shah, C.S.; Woody, N.M.; Juloori, A.; Wengler, C.A.; Valente, S.; Grobmyer, S.; Kundu, N.; Djohan, R.; Tendulkar, R.D. Comparing 10-Year Outcomes with Salvage Mastectomy Followed By Immediate Autologous Reconstruction or Tissue Expander/Implant Based Reconstruction in Patients with Locally Recurrent Breast Cancer after Breast Conservation Therapy. Int. J. Radiat. Oncol. Biol. Phys. 2018, 102, S44–S45. [Google Scholar] [CrossRef]
- Lam, T.C.; Hsieh, F.; Salinas, J.; Boyages, J. Can an Immediate 2-stage Breast Reconstruction Be Performed After Previous Conservative Surgery and Radiotherapy? Plast. Reconstr. Surg.—Glob. Open 2015, 3, e473. [Google Scholar] [CrossRef] [PubMed]
- Cordeiro, P.G.; Snell, L.; Heerdt, A.; McCarthy, C. Immediate Tissue Expander/Implast Breast Reconstruction after Salvage Mastectomy for Cancer Recurrence following Lumpectomy/Irradiation. Plast. Reconstr. Surg. 2012, 129, 341–350. [Google Scholar] [CrossRef] [PubMed]
- Cagli, B.; Barone, M.; Ippolito, E.; Cogliandro, A.; Silipigni, S.; Ramella, S.; Persichetti, P. Ten years experience with breast reconstruction after salvage mastectomy in previously irradiated patients: Analysis of outcomes, satisfaction and well-being. Eur. Rev. Med. Pharmacol. Sci. 2016, 20, 4635–4641. [Google Scholar] [PubMed]
- Khavanin, N.; Gart, M.S.; Berry, T.; Thornton, B.; Saha, S.; Kim, J.Y.S. Sentinel Lymph Node Biopsy Versus Axillary Lymphadenectomy in Patients Treated with Lumpectomy: An Analysis of Short-Term Outcomes. Ann. Surg. Oncol. 2014, 21, 74–80. [Google Scholar] [CrossRef] [PubMed]
- Farrús, B.; Vidal-Sicart, S.; Velasco, M.; Zanón, G.; Fernández, P.L.; Muñoz, M.; Santamaría, G.; Albanell, J.; Biete, A. Incidence of internal mammary node metastases after a sentinel lymph node technique in breast cancer and its implication in the radiotherapy plan. Int. J. Radiat. Oncol. Biol. Phys. 2004, 60, 715–721. [Google Scholar] [CrossRef] [PubMed]
- Hannoun-Levi, J.-M.; Gal, J.; Polgar, C.; Strnad, V.; Loessl, K.; Polat, B.; Kauer-Domer, D.; Schiappa, R.; Gutierrez, C. Second Conservative Treatment for Local Recurrence Breast Cancer: A GEC-ESTRO Oncological Outcome and Prognostic Factor Analysis. Int. J. Radiat. Oncol. Biol. Phys. 2023, 117, 1200–1210. [Google Scholar] [CrossRef] [PubMed]
- Wapnir, I.L.; Price, K.N.; Anderson, S.J.; Robidoux, A.; Martín, M.; Nortier, J.W.R.; Paterson, A.H.G.; Rimawi, M.F.; Láng, I.; Baena-Cañada, J.M.; 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, 1073–1079. [Google Scholar] [CrossRef] [PubMed]
- Veronesi, U.; Marubini, E.; Vecchio, M.D.; Manzari, A.; Andreola, S.; Greco, M.; Luini, A.; Merson, M.; Saccozzi, R.; Rilke, F.; et al. Local Recurrences and Distant Metastases After Conservative Breast Cancer Treatments: Partly Independent Events. JNCI J. Natl. Cancer Inst. 1995, 87, 19–27. [Google Scholar] [CrossRef] [PubMed]
- ElSherif, A.; Shah, C.; Downs-Kelly, E.; Alhareb, A.; Valente, S.A.; Tu, C.; Al-Hilli, Z. Outcomes of ipsilateral breast tumor recurrence after breast conserving surgery: Repeat lumpectomy as an alternative to salvage mastectomy. Surgery 2022, 171, 673–681. [Google Scholar] [CrossRef] [PubMed]
- Matsumoto, A.; Jinno, H.; Nakamura, T.; Saito, J.; Takahashi, M.; Hayashida, T.; Kameyama, K.; Kitagawa, Y. Technical feasibility of sentinel lymph node biopsy in patients with ipsilateral breast tumor recurrence and previous axillary surgery. Int. J. Surg. 2015, 22, 28–31. [Google Scholar] [CrossRef] [PubMed]
- Karanlik, H.; Ozgur, I.; Kilic, B.; Fathalizadeh, A.; Sanli, Y.; Onder, S.; Saip, P.; Sen, F.; Gulluoglu, B.M. Sentinel lymph node biopsy and aberrant lymphatic drainage in recurrent breast cancer: Findings likely to change treatment decisions: Aberrant Lymphatic Drainage in Recurrent Breast Cancer. J. Surg. Oncol. 2016, 114, 796–802. [Google Scholar] [CrossRef] [PubMed]
- Kaur, P.; Kiluk, J.V.; Meade, T.; Ramos, D.; Koeppel, W.; Jara, J.; King, J.; Cox, C.E. Sentinel Lymph Node Biopsy in Patients with Previous Ipsilateral Complete Axillary Lymph Node Dissection. Ann. Surg. Oncol. 2011, 18, 727–732. [Google Scholar] [CrossRef] [PubMed]
- Tokmak, H.; Kaban, K.; Muslumanoglu, M.; Demirel, M.; Aktan, S. Management of sentinel node re-mapping in patients who have second or recurrent breast cancer and had previous axillary procedures. World J. Surg. Oncol. 2014, 12, 205. [Google Scholar] [CrossRef] [PubMed]
- Lu, X.; He, M.; Yu, L.; Gou, Z. Is repeat sentinel lymph node biopsy possible for surgical axillary staging among patients with ipsilateral breast tumor recurrence? Cancer 2023, 129, 1492–1501. [Google Scholar] [CrossRef] [PubMed]
- Hartup, S.M.; Morgan, J.L.; Cheng, V.W.; Barry, P.A.; Copson, E.; Cutress, R.I.; Dave, R.; Elsberger, B.; Fairbrother, P.; Hogan, B.; et al. The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: Protocol for a prospective, multicentre cohort study. Int. J. Surg. Protoc. 2024, 28, 20–26. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
Oncological Characteristics | Initial Diagnosis | Local Recurrence |
---|---|---|
Size of tumor | 17.3 mm (range 2–66) | 18.7 mm (range 4–77) |
Focality | ||
Unifocal | 52 (92.8%) | 47 (83.9%) |
Multifocal | 4 (7.2%) | 6 (10.7%) |
Multicentric | 0 (0%) | 3 (5.4%) |
Histological subtype | ||
DCIS | 14 (25%) | 6 (10.7%) |
IDC | 39 (69.7%) | 43 (76.8%) |
ILC | 3 (5.3%) | 4 (7.1%) |
Other | 0 (0%) | 3 (5.4%) |
IHQ subtype (only infiltrating) | ||
Luminal (HR+/Her2 negative) | 34 (83.3%) | 39 (76.5%) |
HR+/Her2 positive | 0 (0%) | 2 (3.9%) |
HER2 positive | 2 (4.8%) | 3 (5.9%) |
TN | 5 (11.9%) | 6 (11.7%) |
Initial TNM staging (T) | ||
Tx | 6 (10.7%) | 0 (0%) |
Tis | 14 (25%) | 5 (8.9%) |
T1mi | 0 | 3 (5.4%) |
T1a | 0 | 5 (8.9%) |
T1b | 8 (14.3%) | 10 (17.9%) |
T1c | 14 (25%) | 23 (41%) |
T2 | 12 (21.4%) | 8 (14.2%) |
T3 | 2 (3.6%) | 2 (3.6%) |
Initial TNM staging (N) | ||
Nx | 12 (21.4%) | 7 (12.5%) |
N0 | 26 (46.4%) | 43 (7.7%) |
N0 (itc) | 3 (5.4%) | 1 (1.7%) |
N1 | 15 (26.8%) | 5 (8.9%) |
Neoadjuvant therapy | 8 (14.3%) | 11 (19.6%) |
Adjuvant therapy | ||
Radiotherapy | 49 (87.5%) | 21 (37.5%) |
Endocrine therapy | 31 (55.4%) | 43 (76.8%) |
Chemotherapy | 19 (33.9%) | 12 (21.4%) |
Targeted therapy | 2 (3.6%) | 5 (8.9%) |
Surgical Techniques | Initial Diagnosis | Local Recurrence |
---|---|---|
Breast surgery | ||
BCS | 50 (89.3%) | 15 (26.8%) |
Mastectomy | 4 (7.1%) | 23 (41.1%) |
Mastectomy with reconstruction | 2 (3.6%) | 12 (21.4%) |
Excision over previous mastectomy | 0 (0%) | 6 (10.7%) |
Type of reconstruction | ||
Implant based reconstruction | 1 (50%) | 4 (33.3%) |
Autologous reconstruction | 1 (50%) | 8 (66.7%) |
SLN biopsy | ||
Yes | 34 (60.7%) | 44 (78.6%) |
No | 22 (39.3%) | 12 (21.4%) |
Number SLN | 1.9 (range 1–5) | Mean 1.7 (range 1–5) |
SLN positive | ||
Yes | 10 (29.4%) | 6 (13.6%) |
No | 24 (70.6%) | 38 (86.3%) |
ALND | ||
Yes | 19 (33.9%) | 7 (12.5%) |
No | 35 (62.5%) | 49 (87.5%) |
Total positive nodes | 2 (range 1–7) | 1 (range 1–1) |
Total nodes | 7.4 (range 1–26) | 2.95 (range 1–11) |
SLN Harvesting Rate | ||
---|---|---|
Previous breast surgery | ||
Breast conserving surgery | 37 (75.5%) | |
Mastectomy | 4 (100%) | |
Mastectomy with reconstruction | 2 (100%) | p = 0.25 |
Previous SLN biopsy | ||
Yes | 26 (76.5%) | |
No | 16 (80%) | p = 0.5 |
Previous ALND | ||
Yes | 12 (63.2%) | |
No | 30 (85.7%) | p = 0.06 |
Aberrant Drainage | ||
---|---|---|
Breast surgery | ||
Breast-conserving surgery | 12 (24.5%) | |
Mastectomy | 2 (50%) | |
Mastectomy with reconstruction | 1 (50%) | p = 0.2 |
Previous SLN biopsy | ||
Yes | 8 (53.3%) | |
No | 7 (46.7%) | p = 0.5 |
Previous ALND | ||
Yes | 8 (44.4%) | |
No | 7 (20%) | p = 0.06 |
Oncological Characteristics | Previous Surgery | Time to Recurrence | Recurrence |
---|---|---|---|
pT1c pN1mi Luminal B-like | Mastectomy + SLN biopsy | 28 months | Distance recurrence (hepatic metastasis) |
pT1c pNx Luminal B-like | Mastectomy (no SLN biopsy, previous ALND) | 3 months | Distance recurrence (pulmonary metastasis) |
pT2 pN0 Luminal B-like VUS BRIP1 | Mastectomy + SLN biopsy | 3 months | Distance recurrence (bone metastasis) |
pT1c pN0 Luminal B-like (secretor) | Excision over previous mastectomy + SLN biopsy | 14.9 months | Axillary recurrence |
pT1c pN0 Luminal A-like | Excision over previous mastectomy + SLN biopsy | 24 months | Local recurrence |
pT1c pN0 Luminal B like Refused chemotherapy | BCS + SLN biopsy | 63 months | Local recurrence |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Torras, I.; Cebrecos, I.; Castillo, H.; Rodríguez, L.; Zaragoza-Ballester, P.; Sitges, C.; Loinaz, I.; Garcia, M.; Molla, M.; Vidal-Sicart, S.; et al. Surgical Management and Its Impact on Adjuvant Treatment in Recurrent Ipsilateral Breast Cancer: A Retrospective Cohort Study. J. Clin. Med. 2024, 13, 5142. https://doi.org/10.3390/jcm13175142
Torras I, Cebrecos I, Castillo H, Rodríguez L, Zaragoza-Ballester P, Sitges C, Loinaz I, Garcia M, Molla M, Vidal-Sicart S, et al. Surgical Management and Its Impact on Adjuvant Treatment in Recurrent Ipsilateral Breast Cancer: A Retrospective Cohort Study. Journal of Clinical Medicine. 2024; 13(17):5142. https://doi.org/10.3390/jcm13175142
Chicago/Turabian StyleTorras, Ines, Isaac Cebrecos, Helena Castillo, Laura Rodríguez, Pablo Zaragoza-Ballester, Carla Sitges, Ignacio Loinaz, Marta Garcia, Meritxell Molla, Sergi Vidal-Sicart, and et al. 2024. "Surgical Management and Its Impact on Adjuvant Treatment in Recurrent Ipsilateral Breast Cancer: A Retrospective Cohort Study" Journal of Clinical Medicine 13, no. 17: 5142. https://doi.org/10.3390/jcm13175142