Internal mammary node relapse following breast conservation: a case for reirradiation

Internal mammary node involvement in early breast cancer is a prognostic fa ctor of uncertain significance. This paper addresses isolated regional recu rrence at this site:following breast conservation radiotherapy. A case is p resented of a woman who developed an internal mammary recurrence after lump ectomy and breast irradiation. This recurrence was diagnosed as a bone meta stasis, a common mistake which may lead to suboptimal management. The true incidence of regional recurrences in the internal mammary nodes has been un derestimated and their clinical significance has not been appreciated. Salv age procedures for local control and long-term cure are likely to be succes sful if the diagnosis is made before distant metastases have occurred and a lengthy period has elapsed since initial treatment was given. The role of reirradiation should be considered as the tissues at this site will general ly tolerate a second course of radical radiotherapy given more than 10 year s after the first. (C) 1999 Harcourt Publishers Ltd.