ISOLATED AXILLARY RECURRENCES AFTER CONSERVATIVE TREATMENT OF BREAST-CANCER

This retrospective study presents the diagnostic, prognostic and thera peutic problems raised by axillary recurrences (AR). 1589 cases of bre ast cancer measuring less than 3 cm, treated at the Institut Curie bet ween 1981 and 1987, were studied by a combination of surgery and radio therapy. Treatment of the breast always included wide local excision a ssociated with irradiation. The axilla was treated either by dissectio n (865 cases) or by irradiation (724 cases) and 159 patients received chemotherapy. 26 patients (2%) developed AR, confirmed by fine needle aspiration cytology in 92% of cases. None of these 26 patients had ini tially received chemotherapy. The treatment of the AR was variable, ad apted to the initial treatment. 22 patients retained their breast duri ng treatment of the AR and none subsequently developed a local recurre nce. 4 mastectomies were performed and histological examination reveal ed a subclinical local recurrence in 2 cases. The TNM classification, menopausal status, size of the tumour and hormonal receptor status wer e not risk factors for AR. Young age (P = 0.01) and high histological grade (P = 0.03) were Significant risk factors for AR. The AR rate was similar whether axillary dissection or axillary irradiation had been performed. The overall 5-year survival after initial treatment was 85% for AR and 95% for the reference population. The overall 4-year survi val after recurrence was 69% and the incidence of metastasis was marke dly increased (P = 0.002). 2 of the 26 patients developed lymphoedema of the arm after treatment of AR. We confirm that AR worsens the progn osis, but not significantly more than local recurrence. Young age and the modified histological grading of Scarff Bloom and Richardson were risk factors for AR. Although excision of the AR is necessary to ensur e local control, mastectomy is unnecessary when clinical examination a nd mammography are normal. (C) 1996 Elsevier Science Ltd