Locoregional Treatment Advances Are Outpacing Evidence
Treatment advances over recent years render much of the previously used evidence base outdated, noted Monica Morrow, MD, chief of the breast surgery service and Anne Burnett Windfohr chair of clinical oncology at Memorial Sloan Kettering Cancer Center in New York, New York.
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“Most of the data come from patients who were treated with modified radical mastectomy or lumpectomy, axillary lymph node dissection [ALND], and radiotherapy,” Dr Morrow noted. “Evidence to guide practice is limited.”
Changing standards of treatment raise new questions about the potential benefits of repeat lumpectomy and the management of axillary nodes after initial sentinel node (SN) biopsy, Dr Morrow added. Repeat lumpectomy without radiotherapy is a treatment option for locoregional recurrence.
“Metastatic workup is essential prior to any local therapy for locoregional recurrence,” she said. “Historically, about 50% of locoregional recurrences were accompanied by distant metastasis.”
Isolated axillary recurrence after sentinel node biopsy is now very uncommon, she said: less than 1% after SN biopsy and about 1.1% after positive SN biopsy and whole-body radiotherapy.
ALND remains appropriate for axilla management in patients with nodal recurrence after a SN biopsy, and radiotherapy should be considered in light of ALND findings, Dr Morrow said.
References
- Wapnir I. Management controversies in locoregional recurrence. Oral presentation at: 2017 San Antonio Breast Cancer Symposium; December 5-9, 2017; San Antonio, TX.
- Pan H, Gray R, Braybrooke J, et al. 20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years. New Engl J Med. 2017;377:1836-46. doi: 10.1056/NEJMoa1701830
- Morrow M. Challenges in the surgical management of locoregional recurrence. Oral presentation at: 2017 San Antonio Breast Cancer Symposium; December 5-9, 2017; San Antonio, TX.
