WIDE LOCAL EXCISION OF RECURRENT BREAST-CANCER IN THE THORACIC WALL

Background. Local recurrence is one of the major problems in treatment of breast cancer. Approximately 20% of patients who have radical or m odified radical mastectomy have a local recurrence. Methods. The recor ds of 98 women with locally recurrent breast cancer treated with wide local excision, in the years 1983-1987, were reviewed. The median age at excision was 62 years (range, 32-84 years). All patients were obser ved until death or December 31, 1989. The median follow-up period was 36 months (range, 2-79 months). Results. At follow-up, 44 of 98 patien ts (45%) had had a new local relapse and 47 of 98 (48%) were dead. The median duration of local control for all patients was 21 months (rang e, 1-79 months). The diameter of the local recurrence seemed to influe nce the duration of local disease control but not total survival. Pati ents admitted directly for surgery had a longer period of local contro l compared with patients admitted after unsuccessful oncologic treatme nt of the local recurrence. The 5-year local control rates were 50% an d 24%, respectively (P > 0.92). No statistically significant differenc e in local control could be shown whether or not the patient received additional oncologic therapy in continuity with the wide local excisio n. The 5-year local control rate in patients treated only by surgery w as 33% compared with 42% in patients also receiving additional oncolog ic treatment (P > 0.63). Conclusions. Wide local excision of recurrent breast cancer seems to provide as good or even better local control t han other treatment modalities. Surgery should not be postponed in cas es of ineffective medical treatment or radiation therapy.