Abstract P2-18-05: Isolated loco-regional recurrence in the breast: Re-quadrantectomy and systemic treatment
Authors: Costanzo Victoria , Fabiano Veronica , Maino Mercedes , Colo Federico , Chacon Reinaldo , Nervo Adrian , Nadal Jorge , Loza Martin , Loza Jose , Mysler Daniel , Amat Mora 
Published: May 2015

Background: Local or regional recurrence in breast cancer is associated with poor prognosis. Mastectomy is the classic indication in these situations. However, second attempts of breast conservation in previously radiated patients with small, histologically favorable local relapse have been reported. Also, prospective data (The CALOR Trial) suggest that adjuvant chemotherapy should be recommended in patients with isolated loco-regional recurrence, especially if the recurrence is HR negative. The purpose of our study was to determine the frequency of use of re-quadrantectomy and systemic treatment in isolated loco-regional recurrence (ILR) in breast cancer.

Methods: Retrospective review of the database of our institution. Inclusion criteria: ILR in surgical bed, breast or lymph nodes with complete resection (mastectomy, re-quadrantectomy or axillary resection) with or without systemic treatment and radiotherapy.

Findings: 4695 patients were analyzed from april 2000 to april 2014. 78 patients had a ILR, 66 were analyzed. Median age 49,5 years (27-86). 54,5% of the patients were postmenopausal and 16,6% had bilateral involvement at diagnosis. Characteristics of the primary tumor: Mean tumor size 2 cm, 66,6% were HR positive, 6% HER2 positive, 13,6% TN and 14% unknown. Initial treatment: breast conserving surgery 62 p (sentinel node 25, axillary node disection 36); mastectomy 4 patients. 42 patients underwent adjuvant chemotherapy, 57 patients radiotherapy and 62 patients hormonotherapy. Time to recurrence: 94,3 months.

Characteristics of the ILR: Mean tumor size 1.8 cm. 65% were HR positive, 12% triple negative, 6% HER positive and 17% unknown. Treatment at relapse was as follows: 27 re-quadrantectomy, 34 mastectomy, 1 lymph node dissection; all these patients had previous quadrantectomy. The other patients underwent to mastectomy (1) and complete resection of the lesion (3). 29 patients received chemotherapy (43.9%), : 70% anthracyclines and taxanes, 6% trastuzumab, 30% other and 65% received hormonotherapy. Local progression free survival 30,7 months; distance progression free survival 100 months. Local relapse was evidenced in 30% of patients who had a re-quadrantectomy procedure.

Conclusions: Second attemp of breast conservation in previously radiated patients with small, histologically favorable ILR and long recurrence free interval disease is feasible as described. The target population is of good prognosis as evidenced the long free disease interval at recurrence (94,3 m), the mean size of tumor at recurrence (1.8 cm) and the high proportion of HR positive disease. The percentage of local recurrence after re quadrantectomy is as described in some reports, 30% (20-35%). The indication of chemotherapy was mostly in HR negative or HER 2 positive tumors, but the low number of patients does not permit a valid comparaison.

Citation Format: Victoria Costanzo, Veronica Fabiano, Mercedes Maino, Federico Colo, Reinaldo Chacon, Adrian Nervo, Jorge Nadal, Martin Loza, Jose Loza, Daniel Mysler, Mora Amat. Isolated loco-regional recurrence in the breast: Re-quadrantectomy and systemic treatment [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-18-05.