Local recurrence of breast cancer after mastectomy and modern multidisciplinary treatment.

BACKGROUND: To study the incidence of local recurrence (LR) of early breast cancer in the ipsilateral thoracic wall after mastectomy and outcome of patients with LR. MATERIAL AND METHODS: A retrospective cohort study based on 2220 consecutive breast cancer patients treated at the Helsinki University Central Hospital, Finland, in 2000 to 2003. A subset of 755 (34.0%) patients had mastectomy which was usually followed by postoperative radiotherapy (51.2%) and/or systemic adjuvant therapy (79.2%). RESULTS: During a median follow-up of 89 months, 22 (2.9%) patients treated with mastectomy had LR. The median time to LR was 27 months. None of the 12 patient- or tumour-related standard risk factors studied were independently associated with LR-free survival in a multivariate model. Six (27.3%) of the 22 patients with LR had distant metastases diagnosed either prior to or simultaneously with LR. The subset of 16 patients who were diagnosed with LR without concomitant distant recurrence had five-year breast cancer-specific survival of 77.5% as calculated from the date of LR detection, and overall survival of 59.2%. CONCLUSIONS: LR after mastectomy has become a rare event. Most women with isolated LR survive for five years after LR.

Effect of delayed autologous breast reconstruction on breast cancer recurrence and survival.

BACKGROUND: The goal of the present study was to evaluate the impact of delayed autologous breast reconstruction on disease relapse in breast cancer patients treated with mastectomy. MATERIAL AND METHODS: The study was based on 503 consecutive patients younger than 70 years of age who underwent mastectomy between January 2000 and December 2003. Overall, 391 (78 %) received mastectomy alone and 112 (22 %) underwent a delayed breast reconstruction. The median time from mastectomy to delayed breast reconstruction was 34 months. The median duration of follow-up was 102 months. RESULTS: There were no locoregional recurrences (LRR) in patients who underwent delayed reconstruction (0.0 %); 21 LRR developed in patients treated with mastectomy only (5.4 %), P = 0.011. Distant metastases occurred less frequently in the reconstruction group (12.5 %) than in the patients who underwent mastectomy alone (21.5 %); P = 0.0343. The 8-year breast cancer specific survival in the reconstruction group was 98.2 and 85.7 % for the mastectomy only group, P = 0.000. CONCLUSIONS: Delayed autologous breast reconstruction does not appear to adversely influence disease progression when compared to patients treated with mastectomy only.

Axillary and supraclavicular recurrences are rare after axillary lymph node dissection in breast cancer.

BACKGROUND: This study was designed to evaluate the incidence of and risk factors for axillary recurrence (AR) and supraclavicular recurrence (SR) in breast cancer patients with axillary lymph node dissection. METHODS: The study was based on 1,180 patients with unilateral invasive breast cancer operated between January 2000 and December 2003. The median duration of follow-up was 78 months. RESULTS: The 7-year AR incidence was 0.7% and SR incidence was 1.3%. Twelve of the 14 SR patients and 4 of the 8 AR patients had concomitant distant recurrences. No risk factors for AR were identified. Histological tumor grade III as well as estrogen and progesterone negativity were risk factors for SR. SR, but not AR, was an independent risk factor for poor breast cancer-specific survival [hazard ratio, 10.116; P < 0.0001]. Among N1 patients, the extent of radiotherapy (RT) had no influence on regional recurrences. Among N2-N3 patients, the 7-year regional recurrence rates were 34.3% in patients without RT, 0% in patients with local RT, and 1.2% in patients with locoregional RT (P < 0.0001). CONCLUSIONS: AR and SR are rare events that often are detected concomitantly with distant metastases. SRs are associated with aggressive disease and poor survival. Our results also suggest that regional RT reduces regional recurrences in N2-N3 patients but not in N1 patients, but the retrospective, nonrandomized study setting renders this conclusion as uncertain.