Regional Chemotherapy for Thoracic Wall Recurrence and Metastasized Breast Cancer

Abstract

With breast cancer the treatment strategy has fundamentally changed over the last three decades. While in the past local radical surgical interventions were indicated, such as mastectomy and inclusion of the pectoralis major muscle, the treatment standards have changed increasingly from initially mastectomy alone toward breast-conserving measures. Radical surgical interventions are considered local overtreatment. Similarly, the primary axillary dissection was abandoned in favor of the initial diagnostic removal of the sentinel lymph node. After the breast cancer is potentially capable of metastasizing early and is thus considered a systemic disease, the endeavor in treatment protocols is primarily breast-conserving local tumor excision with removal of the sentinel lymph node rather than invasive procedures. Radiation therapy, however, is an integral part of combination treatments to destroy any microscopic axillary lymph node metastases or prevention of local recurrences on the thoracic wall. The range of indications of anti-hormonal therapy is clearly defined, as is induction and adjuvant chemotherapy. Nevertheless, breast cancer remains a tumor, in which local recurrences or distant metastases may occur at any given time – 2 months or 15 years and more after a guideline-based therapy. The patient’s prognosis at the stage of metastasis is bleak in the medium to long term. For this reason quality of life must be assigned special significance under any therapeutic measures. For the treatment of tumor masses that are mainly localized at a defined region such as the thoracic wall, lung, or liver, which mainly or exclusively cause discomfort there or are life-threatening, regional treatment measures can be used. Their advantage is a faster onset of action with fewer side effects and better quality of life.