LOCAL RECURRENCE AFTER SIMPLE MASTECTOMY

A retrospective study was carried out to determine the clinical signif icance of local recurrence after simple mastectomy and node biopsy for primary operable breast cancer, without postoperative irradiation or systemic adjuvant therapy. Local recurrence was defined as a histologi cally proven lesion in or deep to the mastectomy skin flaps. A total o f 966 patients with a median follow-up of 7 years were reviewed. Of th ese, 223 (23 per cent) developed local recurrence but half the tumours were small single lesions; 70 women had multiple discrete lesions and 21 diffuse carcinomatous dermal infiltration. Local recurrence showed significant associations with tumour grade, nodal status and the pres ence of lymphovascular invasion in the primary tumour, A predictive in dex containing these three variables was constructed. Adjuvant irradia tion of the flaps is recommended for patients with high scores; such w omen would otherwise have a 39 per cent chance of developing local rec urrence by 5 years. Different types of local recurrence have different chances of responding to local therapy: 13 per cent of single local r ecurrences, 32 per cent of multiple spot recurrences and 70 per cent o f the diffuse type failed to respond to local therapy. Local recurrenc e predicts reduced patient survival.