Lymphatic relapse in women with early breast cancer: a difficult management problem

The aim of this study was to review the ability to control symptoms of regi onal lymphatic relapse in women with early breast cancer. A retrospective s tudy was made of 759 consecutive women presenting with stage 1 or 2 breast cancer treated by breast conserving surgery and radiotherapy between June 1 984 and December 1994, 291 (38.3%) of whom were managed by a policy of obse rvation on the lymphatic pathways. Patterns of lymphatic relapse, relapse m anagement and morbidity caused by recurrent malignancy were reviewed from t he case notes. The overall rate of relapse in the ipsilateral axilla and/or supraclavicular fossa was 76/759 (10%) at any time prior to death or last follow-up. 34 of 65 patients who relapsed in the axilla did so despite prio r axillary surgery and/or radiotherapy. 41 of 76 patients with regional rec urrence presented with symptoms, including lymphoedema, arm pain or sensory motor changes. These symptoms were poorly controlled by palliative surgery , radiotherapy or systemic therapy in 23 cases, including 12 who progressed to arm paralysis. Symptomatic control of patients with regional lymphatic relapse can be very difficult, even in women under regular surveillance in a multidisciplinary breast cancer clinic. (C) 1999 Elsevier Science Ltd. Al l rights reserved.