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Management of locoregional recurrence of breast cancer after breast conserving therapy

Authors
Ariel Hirsch, MD
Lisa A Kachnic, MD
Section Editors
Daniel F Hayes, MD
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

After breast-conserving therapy (BCT), defined as breast-conserving surgery (BCS; ie, lumpectomy or partial mastectomy) followed by whole-breast radiation therapy (WBRT), breast cancer can recur locally, regionally, and/or at distant metastatic sites. A local recurrence is defined as reappearance of cancer in the ipsilateral preserved breast. In contrast, a regional recurrence denotes tumor involving the regional lymph nodes, usually ipsilateral axillary or supraclavicular, less commonly infraclavicular and/or internal mammary. The term locoregional recurrence is used to indicate a recurrence in either the breast or regional nodal basin.

The primary management of breast cancer has changed considerably over the past decade, and this may alter the incidence, presentation, and management of locoregional recurrences. With advances in systemic adjuvant therapy that have led to better survival rates [1], more isolated locoregional recurrences, sometimes delayed for several years, may become apparent. The increasing use of neoadjuvant or induction chemotherapy to allow for breast conservation, as well as the increasing popularity of partial breast irradiation, may also affect local recurrence rates. Furthermore, the use of sentinel lymph node (SLN) biopsy rather than axillary lymph node dissection (ALND) as a method of staging the axilla may not only impact on the incidence of regional recurrence, but it has also altered the approach to the patient with an isolated locoregional recurrence.

Aggressive multimodality treatment has the potential to provide long-term disease control for many patients who develop an isolated locoregional recurrence after BCT. Multidisciplinary evaluation and management of these cases appears to improve patient outcome and overall satisfaction [2].

The management of a locoregional recurrence after BCT for operable breast cancer will be reviewed here. The management of a locoregional recurrence after mastectomy, patterns of recurrence, as well as recommendations for post-treatment surveillance, are discussed in detail elsewhere. (See "Management of locoregional recurrence of breast cancer after mastectomy" and "Patterns of relapse and long-term complications of therapy in breast cancer survivors" and "Approach to the patient following treatment for breast cancer".)

INCIDENCE AND CHARACTERISTICS

The five-year locoregional recurrence rate (LRR) following breast-conserving therapy (BCT) has decreased with time. In a retrospective review of 1143 patients ≤40 years with a mean follow-up of 8.5 years after BCT, patients treated between 1988 and 1998 had a higher rate of recurrence compared with patients treated between 1999 and 2005 and 2006 and 2010 (9.8 versus 5.9 versus 3.3 percent, respectively) [3]. Based upon a meta-analysis of 17 randomized trials, patients over age 40 years at the time of BCT have a LRR <3 percent [4].

                               

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Literature review current through: Nov 2016. | This topic last updated: Wed Apr 15 00:00:00 GMT 2015.
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References
Top
  1. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353:1784.
  2. Newman EA, Guest AB, Helvie MA, et al. Changes in surgical management resulting from case review at a breast cancer multidisciplinary tumor board. Cancer 2006; 107:2346.
  3. van Laar C, van der Sangen MJ, Poortmans PM, et al. Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients. Eur J Cancer 2013; 49:3093.
  4. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378:1707.
  5. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333:1456.
  6. Wapnir IL, Anderson SJ, Mamounas EP, et al. Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in five National Surgical Adjuvant Breast and Bowel Project node-positive adjuvant breast cancer trials. J Clin Oncol 2006; 24:2028.
  7. Lee JH, Kim EK, Oh JY, et al. US screening for detection of nonpalpable locoregional recurrence after mastectomy. Eur J Radiol 2013; 82:485.
  8. van Tienhoven G, Voogd AC, Peterse JL, et al. Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer 1999; 35:32.
  9. Haffty BG, Carter D, Flynn SD, et al. Local recurrence versus new primary: clinical analysis of 82 breast relapses and potential applications for genetic fingerprinting. Int J Radiat Oncol Biol Phys 1993; 27:575.
  10. Voogd AC, van Oost FJ, Rutgers EJ, et al. Long-term prognosis of patients with local recurrence after conservative surgery and radiotherapy for early breast cancer. Eur J Cancer 2005; 41:2637.
  11. Francis M, Cakir B, Ung O, et al. Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer. Br J Surg 1999; 86:1556.
  12. Dalberg K, Mattsson A, Sandelin K, Rutqvist LE. Outcome of treatment for ipsilateral breast tumor recurrence in early-stage breast cancer. Breast Cancer Res Treat 1998; 49:69.
  13. Pisansky TM, Ingle JN, Schaid DJ, et al. Patterns of tumor relapse following mastectomy and adjuvant systemic therapy in patients with axillary lymph node-positive breast cancer. Impact of clinical, histopathologic, and flow cytometric factors. Cancer 1993; 72:1247.
  14. Hsi RA, Antell A, Schultz DJ, Solin LJ. Radiation therapy for chest wall recurrence of breast cancer after mastectomy in a favorable subgroup of patients. Int J Radiat Oncol Biol Phys 1998; 42:495.
  15. Chauvet B, Reynaud-Bougnoux A, Calais G, et al. Prognostic significance of breast relapse after conservative treatment in node-negative early breast cancer. Int J Radiat Oncol Biol Phys 1990; 19:1125.
  16. Fowble B, Solin LJ, Schultz DJ, et al. Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment. Int J Radiat Oncol Biol Phys 1990; 19:833.
  17. Abner AL, Recht A, Eberlein T, et al. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol 1993; 11:44.
  18. Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998; 16:441.
  19. Fredriksson I, Liljegren G, Arnesson LG, et al. Local recurrence in the breast after conservative surgery--a study of prognosis and prognostic factors in 391 women. Eur J Cancer 2002; 38:1860.
  20. Alpert TE, Kuerer HM, Arthur DW, et al. Ipsilateral breast tumor recurrence after breast conservation therapy: outcomes of salvage mastectomy vs. salvage breast-conserving surgery and prognostic factors for salvage breast preservation. Int J Radiat Oncol Biol Phys 2005; 63:845.
  21. Huang E, Buchholz TA, Meric F, et al. Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences. Cancer 2002; 95:2059.
  22. Smith TE, Lee D, Turner BC, et al. True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys 2000; 48:1281.
  23. Veronesi U, Marubini E, Del Vecchio M, et al. Local recurrences and distant metastases after conservative breast cancer treatments: partly independent events. J Natl Cancer Inst 1995; 87:19.
  24. Yi M, Buchholz TA, Meric-Bernstam F, et al. Classification of ipsilateral breast tumor recurrences after breast conservation therapy can predict patient prognosis and facilitate treatment planning. Ann Surg 2011; 253:572.
  25. Fortin A, Larochelle M, Laverdière J, et al. Local failure is responsible for the decrease in survival for patients with breast cancer treated with conservative surgery and postoperative radiotherapy. J Clin Oncol 1999; 17:101.
  26. Voogd AC, van Tienhoven G, Peterse HL, et al. Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Cancer 1999; 85:437.
  27. Kurtz JM, Spitalier JM, Amalric R, et al. The prognostic significance of late local recurrence after breast-conserving therapy. Int J Radiat Oncol Biol Phys 1990; 18:87.
  28. Meijer-van Gelder ME, Look MP, Bolt-de Vries J, et al. Breast-conserving therapy: proteases as risk factors in relation to survival after local relapse. J Clin Oncol 1999; 17:1449.
  29. Vicini FA, Antonucci JV, Goldstein N, et al. The use of molecular assays to establish definitively the clonality of ipsilateral breast tumor recurrences and patterns of in-breast failure in patients with early-stage breast cancer treated with breast-conserving therapy. Cancer 2007; 109:1264.
  30. Bollet MA, Servant N, Neuvial P, et al. High-resolution mapping of DNA breakpoints to define true recurrences among ipsilateral breast cancers. J Natl Cancer Inst 2008; 100:48.
  31. Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer 1995; 76:259.
  32. Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer 2010; 46:3219.
  33. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys 2014; 88:553.
  34. Botteri E, Bagnardi V, Rotmensz N, et al. Analysis of local and regional recurrences in breast cancer after conservative surgery. Ann Oncol 2010; 21:723.
  35. Lupe K, Truong PT, Alexander C, et al. Subsets of women with close or positive margins after breast-conserving surgery with high local recurrence risk despite breast plus boost radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:e561.
  36. de Bock GH, van der Hage JA, Putter H, et al. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies. Eur J Cancer 2006; 42:351.
  37. Hattangadi-Gluth JA, Wo JY, Nguyen PL, et al. Basal subtype of invasive breast cancer is associated with a higher risk of true recurrence after conventional breast-conserving therapy. Int J Radiat Oncol Biol Phys 2012; 82:1185.
  38. Gonzalez-Angulo AM, Litton JK, Broglio KR, et al. High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller. J Clin Oncol 2009; 27:5700.
  39. Dershaw DD, McCormick B, Osborne MP. Detection of local recurrence after conservative therapy for breast carcinoma. Cancer 1992; 70:493.
  40. Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local recurrence after breast-conserving surgery and radiation as initial treatment for mammographically detected ductal carcinoma in situ of the breast. Cancer 2001; 91:1090.
  41. Weng EY, Juillard GJ, Parker RG, et al. Outcomes and factors impacting local recurrence of ductal carcinoma in situ. Cancer 2000; 88:1643.
  42. Montgomery DA, Krupa K, Jack WJ, et al. Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience. Br J Cancer 2007; 96:1802.
  43. Montgomery DA, Krupa K, Cooke TG. Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature. Br J Cancer 2007; 97:1632.
  44. Mumtaz H, Davidson T, Hall-Craggs MA, et al. Comparison of magnetic resonance imaging and conventional triple assessment in locally recurrent breast cancer. Br J Surg 1997; 84:1147.
  45. Dao TH, Rahmouni A, Campana F, et al. Tumor recurrence versus fibrosis in the irradiated breast: differentiation with dynamic gadolinium-enhanced MR imaging. Radiology 1993; 187:751.
  46. Belli P, Costantini M, Romani M, et al. Magnetic resonance imaging in breast cancer recurrence. Breast Cancer Res Treat 2002; 73:223.
  47. Rieber A, Schramm K, Helms G, et al. Breast-conserving surgery and autogenous tissue reconstruction in patients with breast cancer: efficacy of MRI of the breast in the detection of recurrent disease. Eur Radiol 2003; 13:780.
  48. Krämer S, Schulz-Wendtland R, Hagedorn K, et al. Magnetic resonance imaging in the diagnosis of local recurrences in breast cancer. Anticancer Res 1998; 18:2159.
  49. Muüller RD, Barkhausen J, Sauerwein W, Langer R. Assessment of local recurrence after breast-conserving therapy with MRI. J Comput Assist Tomogr 1998; 22:408.
  50. Teifke A, Lehr HA, Vomweg TW, et al. Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast. AJR Am J Roentgenol 2003; 181:655.
  51. Drew PJ, Kerin MJ, Turnbull LW, et al. Routine screening for local recurrence following breast-conserving therapy for cancer with dynamic contrast-enhanced magnetic resonance imaging of the breast. Ann Surg Oncol 1998; 5:265.
  52. Heywang-Köbrunner SH, Schlegel A, Beck R, et al. Contrast-enhanced MRI of the breast after limited surgery and radiation therapy. J Comput Assist Tomogr 1993; 17:891.
  53. Nomura M, Inoue Y, Fujita S, et al. Pathological complete response to trastuzumab and paclitaxel in a patient with inflammatory local recurrence following breast conserving surgery. Breast Cancer 2005; 12:226.
  54. Kurtz JM, Jacquemier J, Brandone H, et al. Inoperable recurrence after breast-conserving surgical treatment and radiotherapy. Surg Gynecol Obstet 1991; 172:357.
  55. Gage I, Schnitt SJ, Recht A, et al. Skin recurrences after breast-conserving therapy for early-stage breast cancer. J Clin Oncol 1998; 16:480.
  56. Huston TL, Simmons RM. Inflammatory local recurrence after breast-conservation therapy for noninflammatory breast cancer. Am J Clin Oncol 2005; 28:431.
  57. National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
  58. Lindfors KK, Meyer JE, Busse PM, et al. CT evaluation of local and regional breast cancer recurrence. AJR Am J Roentgenol 1985; 145:833.
  59. Rosenman J, Churchill CA, Mauro MA, et al. The role of computed tomography in the evaluation of post-mastectomy locally recurrent breast cancer. Int J Radiat Oncol Biol Phys 1988; 14:57.
  60. Lingawi SS, Bilbey JH, Munk PL, et al. MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence. Skeletal Radiol 1999; 28:318.
  61. Radan L, Ben-Haim S, Bar-Shalom R, et al. The role of FDG-PET/CT in suspected recurrence of breast cancer. Cancer 2006; 107:2545.
  62. Eubank WB, Mankoff D, Bhattacharya M, et al. Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer. AJR Am J Roentgenol 2004; 183:479.
  63. Gallowitsch HJ, Kresnik E, Gasser J, et al. F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging. Invest Radiol 2003; 38:250.
  64. Eubank WB, Mankoff DA, Takasugi J, et al. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 2001; 19:3516.
  65. Bender H, Kirst J, Palmedo H, et al. Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma. Anticancer Res 1997; 17:1687.
  66. Constantinidou A, Martin A, Sharma B, Johnston SR. Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital. Ann Oncol 2011; 22:307.
  67. Isasi CR, Moadel RM, Blaufox MD. A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Res Treat 2005; 90:105.
  68. Leung S, Otmezguine Y, Calitchi E, et al. Locoregional recurrences following radical external beam irradiation and interstitial implantation for operable breast cancer--a twenty three year experience. Radiother Oncol 1986; 5:1.
  69. Recht A, Schnitt SJ, Connolly JL, et al. Prognosis following local or regional recurrence after conservative surgery and radiotherapy for early stage breast carcinoma. Int J Radiat Oncol Biol Phys 1989; 16:3.
  70. Easson AM, McCready DR. Management of local recurrence of breast cancer. Expert Rev Anticancer Ther 2004; 4:219.
  71. Osborne MP, Borgen PI, Wong GY, et al. Salvage mastectomy for local and regional recurrence after breast-conserving operation and radiation therapy. Surg Gynecol Obstet 1992; 174:189.
  72. Haffty BG, Fischer D, Beinfield M, McKhann C. Prognosis following local recurrence in the conservatively treated breast cancer patient. Int J Radiat Oncol Biol Phys 1991; 21:293.
  73. Orel SG, Fowble BL, Solin LJ, et al. Breast cancer recurrence after lumpectomy and radiation therapy for early-stage disease: prognostic significance of detection method. Radiology 1993; 188:189.
  74. Galper S, Blood E, Gelman R, et al. Prognosis after local recurrence after conservative surgery and radiation for early-stage breast cancer. Int J Radiat Oncol Biol Phys 2005; 61:348.
  75. Doyle T, Schultz DJ, Peters C, et al. Long-term results of local recurrence after breast conservation treatment for invasive breast cancer. Int J Radiat Oncol Biol Phys 2001; 51:74.
  76. Shen J, Hunt KK, Mirza NQ, et al. Predictors of systemic recurrence and disease-specific survival after ipsilateral breast tumor recurrence. Cancer 2005; 104:479.
  77. Salvadori B, Marubini E, Miceli R, et al. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg 1999; 86:84.
  78. Kuerer HM, Arthur DW, Haffty BG. Repeat breast-conserving surgery for in-breast local breast carcinoma recurrence: the potential role of partial breast irradiation. Cancer 2004; 100:2269.
  79. Cajucom CC, Tsangaris TN, Nemoto T, et al. Results of salvage mastectomy for local recurrence after breast-conserving surgery without radiation therapy. Cancer 1993; 71:1774.
  80. Meric F, Mirza NQ, Vlastos G, et al. Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast-conserving therapy. Cancer 2003; 97:926.
  81. Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ. Eur J Cancer 2005; 41:1715.
  82. Weksberg DC, Allen PK, Hoffman KE, et al. Outcomes and predictive factors for salvage therapy after local--regional recurrence following neoadjuvant chemotherapy and breast conserving therapy. Ann Surg Oncol 2013; 20:3430.
  83. Halverson KJ, Perez CA, Kuske RR, et al. Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1992; 23:285.
  84. Whelan T, Clark R, Roberts R, et al. Ipsilateral breast tumor recurrence postlumpectomy is predictive of subsequent mortality: results from a randomized trial. Investigators of the Ontario Clinical Oncology Group. Int J Radiat Oncol Biol Phys 1994; 30:11.
  85. Haffty BG, Reiss M, Beinfield M, et al. Ipsilateral breast tumor recurrence as a predictor of distant disease: implications for systemic therapy at the time of local relapse. J Clin Oncol 1996; 14:52.
  86. Panet-Raymond V, Truong PT, Alexander C, et al. Clinicopathologic factors of the recurrent tumor predict outcome in patients with ipsilateral breast tumor recurrence. Cancer 2011; 117:2035.
  87. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000; 92:1143.
  88. Komoike Y, Motomura K, Inaji H, et al. Repeat lumpectomy for patients with ipsilateral breast tumor recurrence after breast-conserving surgery. Preliminary results. Oncology 2003; 64:1.
  89. Gentilini O, Botteri E, Veronesi P, et al. Repeating conservative surgery after ipsilateral breast tumor reappearance: criteria for selecting the best candidates. Ann Surg Oncol 2012; 19:3771.
  90. McCready DR, Fish EB, Hiraki GY, et al. Total mastectomy is not always mandatory for the treatment of recurrent breast cancer after lumpectomy alone. Can J Surg 1992; 35:485.
  91. Kauer-Dorner D, Pötter R, Resch A, et al. Partial breast irradiation for locally recurrent breast cancer within a second breast conserving treatment: alternative to mastectomy? Results from a prospective trial. Radiother Oncol 2012; 102:96.
  92. Gentilini O, Botteri E, Rotmensz N, et al. When can a second conservative approach be considered for ipsilateral breast tumour recurrence? Ann Oncol 2007; 18:468.
  93. Resch A, Fellner C, Mock U, et al. Locally recurrent breast cancer: pulse dose rate brachytherapy for repeat irradiation following lumpectomy-- a second chance to preserve the breast. Radiology 2002; 225:713.
  94. Deutsch M. Repeat high-dose external beam irradiation for in-breast tumor recurrence after previous lumpectomy and whole breast irradiation. Int J Radiat Oncol Biol Phys 2002; 53:687.
  95. Maulard C, Housset M, Brunel P, et al. Use of perioperative or split-course interstitial brachytherapy techniques for salvage irradiation of isolated local recurrences after conservative management of breast cancer. Am J Clin Oncol 1995; 18:348.
  96. Wahl AO, Rademaker A, Kiel KD, et al. Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer. Int J Radiat Oncol Biol Phys 2008; 70:477.
  97. Guix B, Lejárcegui JA, Tello JI, et al. Exeresis and brachytherapy as salvage treatment for local recurrence after conservative treatment for breast cancer: results of a ten-year pilot study. Int J Radiat Oncol Biol Phys 2010; 78:804.
  98. Hannoun-Levi JM, Houvenaeghel G, Ellis S, et al. Partial breast irradiation as second conservative treatment for local breast cancer recurrence. Int J Radiat Oncol Biol Phys 2004; 60:1385.
  99. Trombetta M, Julian T, Bhandari T, et al. Breast conservation surgery and interstitial brachytherapy in the management of locally recurrent carcinoma of the breast: the Allegheny General Hospital experience. Brachytherapy 2008; 7:29.
  100. Chadha M, Feldman S, Boolbol S, et al. The feasibility of a second lumpectomy and breast brachytherapy for localized cancer in a breast previously treated with lumpectomy and radiation therapy for breast cancer. Brachytherapy 2008; 7:22.
  101. Intra M, Trifirò G, Viale G, et al. Second biopsy of axillary sentinel lymph node for reappearing breast cancer after previous sentinel lymph node biopsy. Ann Surg Oncol 2005; 12:895.
  102. Taback B, Nguyen P, Hansen N, et al. Sentinel lymph node biopsy for local recurrence of breast cancer after breast-conserving therapy. Ann Surg Oncol 2006; 13:1099.
  103. Newman EA, Cimmino VM, Sabel MS, et al. Lymphatic mapping and sentinel lymph node biopsy for patients with local recurrence after breast-conservation therapy. Ann Surg Oncol 2006; 13:52.
  104. Boughey JC, Ross MI, Babiera GV, et al. Sentinel lymph node surgery in locally recurrent breast cancer. Clin Breast Cancer 2006; 7:248.
  105. Port ER, Garcia-Etienne CA, Park J, et al. Reoperative sentinel lymph node biopsy: a new frontier in the management of ipsilateral breast tumor recurrence. Ann Surg Oncol 2007; 14:2209.
  106. Cox CE, Furman BT, Kiluk JV, et al. Use of reoperative sentinel lymph node biopsy in breast cancer patients. J Am Coll Surg 2008; 207:57.
  107. Newman LA. Lymphatic mapping and sentinel lymph node biopsy for locally recurrent breast cancer: new clues to understanding the biology of chest wall relapse. Ann Surg Oncol 2007; 14:2182.
  108. Harris EE, Hwang WT, Seyednejad F, Solin LJ. Prognosis after regional lymph node recurrence in patients with stage I-II breast carcinoma treated with breast conservation therapy. Cancer 2003; 98:2144.
  109. Galper S, Blood E, Gelman R, et al. Prognosis after isolated axillary nodal recurrence following conservative surgery and radiotherapy for early-stage breast carcinoma (abstract). Int J Radiat Oncol Biol Phys 2002; 54(2 suppl):56s.
  110. Newman LA, Hunt KK, Buchholz T, et al. Presentation, management and outcome of axillary recurrence from breast cancer. Am J Surg 2000; 180:252.
  111. Fodor J, Toth J, Major T, et al. Incidence and time of occurrence of regional recurrence in stage I-II breast cancer: value of adjuvant irradiation. Int J Radiat Oncol Biol Phys 1999; 44:281.
  112. Halverson KJ, Perez CA, Kuske RR, et al. Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Radiat Oncol Biol Phys 1990; 19:851.
  113. Fowble B, Solin LJ, Schultz DJ, Goodman RL. Frequency, sites of relapse, and outcome of regional node failures following conservative surgery and radiation for early breast cancer. Int J Radiat Oncol Biol Phys 1989; 17:703.
  114. Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure. Breast J 2002; 8:81.
  115. Vicini FA, Horwitz EM, Lacerna MD, et al. The role of regional nodal irradiation in the management of patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 1997; 39:1069.
  116. Recht A, Pierce SM, Abner A, et al. Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1991; 9:988.
  117. de Boer R, Hillen HF, Roumen RM, et al. Detection, treatment and outcome of axillary recurrence after axillary clearance for invasive breast cancer. Br J Surg 2001; 88:118.
  118. Jagsi R. Breast cancer in the supraclavicular region: is the horse out of the barn? Breast Cancer Res Treat 2011; 125:823.
  119. Willner J, Kiricuta IC, Kölbl O. Locoregional recurrence of breast cancer following mastectomy: always a fatal event? Results of univariate and multivariate analysis. Int J Radiat Oncol Biol Phys 1997; 37:853.