Even after standard combination therapy, 5% to 15% of patients experience a local recurrence within 10 years of breast-conserving surgery. How are recurrences treated after they occur?
- Re-conservation: There is no international consensus or standardization on whether to re-conserve the breast after recurrence. If the patient’s desire for breast conservation is very strong and the tumor is solitary and small, secondary breast conservation is theoretically feasible. However, in addition to surgery, advice from a radiation therapist on the method of radiotherapy is needed, and in hospitals where it is available, receiving intraoperative or local radiotherapy may be a more appropriate approach.
- Supplemental total mastectomy: Most doctors will perform a supplemental total mastectomy for recurrence in the breast after breast-conserving surgery. The need for radiation therapy is determined by the extent of tumor recurrence.
- Surgery and/or radiotherapy after systemic treatment: If the recurrence is extensive or involves the skin, or even presents with inflammatory breast cancer manifestations, systemic treatment is usually performed before considering local surgery and/or radiotherapy. After remedial mastectomy, physicians generally do not consider chest wall radiotherapy, but if there are metastases in the axillary lymph nodes and no prior regional lymph node irradiation, supplemental supra/inferior clavicular lymph node irradiation is usually required.