Radiotherapeutic Management For Breast Cancer Patients With Loco-regional Recurrence After Modified Radical Mastectomy

Purpose:The aim of this study is to evaluate the impact of radiotherapy on local control and survival for patients with loco-regional recurrence(LRR)following modified radical mastectomy and investigate the prognostic factors.Patients and Methods:A total of 214 patients from Cancer Hospital Chinese Academy of Medical Science were retrospectively reviewed.Patients were all diagnosed with isolated loco-regional recurrence(ILRR)following modified radical mastectomy from 2000 to 2014.The entire cohort comprised 109 patients with chest wall recurrence only,84 with regional lymph nodes only and 21 with both.133 patients were treated with radiotherapy.Results:The median follow-up time was 50.4 months.5-year rLRR,PFS,DMFS and OS were 40,3%,28.5%,33.9%,and 60.7%,respectively.Multivariate analysis showed that whether being treated with systemic therapy(yes vs.no)was the independent prognostic factor of rLRR,PFS,DMFS,OS.Type of local treatment(surgery+radiotherapy vs.radiotherapy only vs.surgery only vs.none)was the prognostic factors of rLRR,PFS and DMFS,and with a tendency to affect OS(p=0.053).Whether with a vascular tumor thrombus(yes vs.no),whether initial treatment included anti-Her2 therapy(yes vs.no),disease-free interval(? 12 months vs.>12 months),LRR site distribution(only local/region vs.local+region)were the prognostic factors of rLRR;disease-free interval ?12 months vs.>12 months)was the prognostic factor of DMFS;LRR site distribution(only local/region vs.local+region)was the prognostic factor of OS.For patients with recurrence in regional lymph nodes only,prophylactic irradiation to chest wall can reduce the recurrent recurrence of chest wall,from 5/20(25.0%)to 4/41(9.8%).Conclusions:The overall outcome of patients with LRR after modified radical mastectomy is poor.The comprehensive local treatment(surgery+radiotherapy)and systemic therapy can improve both local control and survival.Prophylactic irradiation to chest wall has a tendency to reduce recurrence of it,but the optimal radiotherapy target volume is not clear.