Survival and pattern of failure following locoregional recurrence of breast cancer

This study analyzed prognostic factors at primary diagnosis and at first re currence for impact on survival after isolated locoregional failure. The ai ms were: (1) assessment of prognostic factors for time to second locoregion al failure, distant failure, and survival in isolated locoregional recurren ce of breast cancer after mastectomy; and (2) investigation of the impact o f a second locoregional failure on dissemination and survival. Between 1983 and 1985, 99 patients who had undergone mastectomy and then developed isol ated local and/or regional recurrences, were treated with radical excision and radiotherapy; none of these patients had distant metastases. Survival a nd the times to second local failure and distant metastasis were analyzed a ccording to potential prognostic factors. The median follow-up was 123 months; 38 patients were still alive. Median s urvival was 89 months and the 10-year survival rate was 38%, with no differ ence between local and regional recurrences. A total of 43 patients develop ed a second locoregional recurrence after a median of 73 months; primary tu mour size and initial node status were significant independent prognostic f actors. The annual hazard rates for recurrence were similar for patients de veloping local failure or systemic recurrence. The 10-year rate of dissemin ation was 49% for patients with locoregional control, compared with 51% for patients who had a second locoregional recurrence. The prognostic factors for survival were node status at mastectomy and haemoglobin level at first recurrence. The development of a second locoregional recurrence was not associated with an increased risk of dissemination or reduced survival. Differences in pro gnostic factors for locoregional control and distant metastases suggest tha t these recurrences represent different biological entities that require di fferent treatment strategies. However, as the achievement of locoregional c ontrol had no influence on prognosis, the use of systemic adjuvant therapy may be warranted in a subset of these patients.