Loco-regional Breast Cancer Recurrences

Abstract

• A minority of patients treated both by breast conservation and mastectomy will develop a local recurrence, which remains one of the greatest concerns of primary BC treatment. • In contrast with past studies that showed an incidence of local recurrence around 10–20 %, in the present time a very low incidence of local recurrences has been described, with a cumulative incidence of 1.1 % at 5 years. • Local recurrence can be considered a marker of tumour aggressiveness as it is linked to an increased risk of distant metastases and death. Therefore, all patients with local recurrence should undergo workup to rule out concurrent distant metastases. On the other hand, patients with isolated local or regional recurrence, without synchronous distant localisations, can be successfully treated. • Principal risk factors involved in local recurrence are tumour size, nodal status, tumour biology, age, margins and histopathological characteristics. • Mastectomy is considered the current standard of care for ipsilateral recurrence of BC; however, some retrospective analyses showed that second conservative treatments for local relapse were feasible and gave results comparable to standard mastectomy.

Future Directions. Further studies are needed to delineate optimal management of recurrences. Novel treatments, including cryotherapy, radiofrequency ablation and photodynamic and microwave therapy, will continue to be explored to move toward less aggressive but more effective local management of local recurrences. However, important impulses are expected from the potential utility of genomic profiles in estimating the usefulness of more tailored approaches to systemic therapy including recognition and use of newer biological agents.