Isolated Loco-Regional Recurrence of Breast Cancer - Established and Innovative Therapy Concepts

Abstract

The incidence of isolated loco-regional recurrence of breast cancer isbetween 2-20%. It constitutes the most common type of breast cancerrecurrence. In contrast to distant metastasis, a number of curativetherapies are available to treat isolated loco-regional recurrence ofbreast cancer. Screening for early detection and regular examinations aspart of a recommended follow-up programme is important. If distantmetastasis has been excluded, therapy for recurrence ideally consists ofsurgery with R0 resectionmargins. Radiotherapy is indicated afternon-curative surgery (R1/R2) for local tumour control to improve thechances of curative surgery and as a palliative therapy for localcontrol of symptoms in inoperable cancer, also in combination withhyperthermia and systemic therapy. There was previously some uncertaintyconcerning the benefit of systemic therapy after R0 resection andbreast-conserving therapy and after previous mastectomy. If therecurrence is hormone-receptor positive, (repeat) endocrine systemictherapy is indicated for both constellations. If the hormone-receptorstatus is negative, the question whether repeat chemotherapy isindicated as an adjuvant therapy and whether it offers a benefit topatients was still controversially discussed. However, data from theCALOR trial presented at the San Antonio Breast Cancer Symposium in 2012has now answered this question in favour of chemotherapy. These newfindings will not merely have an impact on future therapyrecommendations but also on the entire clinical management of isolatedloco-regional recurrence.