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01-09-2020 | Mastectomy | Review

Spatial location of local recurrences after mastectomy: a systematic review

Authors: Orit Kaidar-Person, Philip Poortmans, Birgitte Vrou Offersen, Sabine Siesling, Miri Sklair-Levy, Icro Meattini, Dirk de Ruysscher, Thorsten Kühn, Liesbeth J. Boersma

Published in: Breast Cancer Research and Treatment | Issue 2/2020

Abstract

Purpose

We performed a systematic review to document the spatial location of local recurrences (LR) after mastectomy.

Methods

A PubMed search was conducted in August 2019 for the following terms: breast [Title/Abstract] AND cancer [Title/Abstract] AND recurrence [Title/Abstract] AND mastectomy [Title/Abstract]. The search was filtered for English language. Exclusion criteria included studies that did not specify the LR location or studies reporting LR associated with inflammatory breast cancer, or other breast cancers such as phyllodes tumours, lymphoma or associated with sarcoma/angiosarcoma.

Results

A total of 3922 titles were identified, of which 21 publications were eligible for inclusion in the final analysis. A total of 6901 mastectomy patients were included (range 25–1694). The mean LR proportion was 3.5%. Among the total of 351 LR lesions, 81.8% were in the subcutaneous tissue and the skin, while 16% were pectoral muscle recurrences.

Conclusion

Local recurrences are mostly located within the subcutaneous tissue and the skin, assumed to result from unrecognized/subclinical tumour foci left behind after mastectomy, surgical implantation of tumour cells in the wound/scar and/or tumour emboli within the subcutaneous lymphatics. Pectoral muscle recurrences are less frequent and may be attributed to residual disease along the posterior surgical margin and/or lymphatic involvement.

Freeman MD, Gopman JM, Salzberg CA (2018) The evolution of mastectomy surgical technique: from mutilation to medicine. Gland Surg 7(3):308–315PubMedPubMedCentral

Lagendijk M et al (2018) Breast conserving therapy and mastectomy revisited: breast cancer-specific survival and the influence of prognostic factors in 129,692 patients. Int J Cancer 142(1):165–175PubMed

NIH Consensus Development (1991) Conference statement on the treatment of early-stage breast cancer. Oncology 5(2):120–124

van Maaren MC et al (2016) Breast-conserving therapy versus mastectomy in T1–2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3071 patients. Breast Cancer Res Treat 160(3):511–521PubMed

Goethals A, Rose J (2019) Mastectomy. StatPearls, Treasure Island

Veronesi U et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232PubMed

Barton FE et al (1991) Glandular excision in total glandular mastectomy and modified radical mastectomy: a comparison. Plast Reconstr Surg 88(3):389–392PubMed

Griepsma M et al (2014) Residual breast tissue after mastectomy: how often and where is it located? Ann Surg Oncol 21(4):1260–1266PubMed

Kaidar-Person O, Boersma L, Poortmans P, Sklair-Levy M, Offersen BV, Cardoso MJ, De Ruysscher D (2020) Residual glandular breast tissue after mastectomy: a systematic review. Ann Surg Oncol. https://doi.org/10.1245/s10434-020-08532-4 CrossRefPubMed

10.

Kaidar-Person O, Cardoso MJ (2020) ASO author reflections: residual breast tissue after skin- and nipple-sparing mastectomies: a matter of concern or a point for improvement/action? Ann Surg Oncol. https://doi.org/10.1245/s10434-020-08532-4 CrossRefPubMed

11.

Moossdorff M et al (2014) Maastricht Delphi consensus on event definitions for classification of recurrence in breast cancer research. J Natl Cancer Inst 106(12):dju288PubMedPubMedCentral

12.

van Dongen JA et al (2000) 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 92(14):1143–1150PubMed

13.

Jacobson JA et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332(14):907–911PubMed

14.

Andry G et al (1989) Locoregional recurrences after 649 modified radical mastectomies: incidence and significance. Eur J Surg Oncol 15(6):476–485PubMed

15.

Schmoor C et al (2000) Role of isolated locoregional recurrence of breast cancer: results of four prospective studies. J Clin Oncol 18(8):1696–1708PubMed

16.

Nielsen HM et al (2006) Loco-regional recurrence after mastectomy in high-risk breast cancer—risk and prognosis. An analysis of patients from the DBCG 82 b&c randomization trials. Radiother Oncol 79(2):147–155PubMed

17.

Goldhirsch A et al (1994) Effect of systemic adjuvant treatment on first sites of breast cancer relapse. Lancet 343(8894):377–381PubMed

18.

Fisher BJ et al (1998) Long-term follow-up of axillary node-positive breast cancer patients receiving adjuvant tamoxifen alone: patterns of recurrence. Int J Radiat Oncol Biol Phys 42(1):117–123PubMed

19.

EBCTCG (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383(9935):2127–2135

20.

Kaidar-Person O et al (2019) ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer. Radiother Oncol 137:159–166PubMed

21.

Farras Roca JA et al (2016) Ipsilateral breast cancer recurrence after deep inferior epigastric perforator (DIEP) flap reconstruction: incidence and radiological presentation. Diagn Interv Imaging 97(2):203–209PubMed

22.

Noroozian M et al (2018) Use of screening mammography to detect occult malignancy in autologous breast reconstructions: a 15-year experience. Radiology 289(1):39–48PubMed

23.

Chang JS et al (2018) Mapping patterns of locoregional recurrence following contemporary treatment with radiation therapy for breast cancer: a multi-institutional validation study of the ESTRO consensus guideline on clinical target volume. Radiother Oncol 126(1):139–147PubMed

24.

Chang JS et al (2017) Three-dimensional analysis of patterns of locoregional recurrence after treatment in breast cancer patients: validation of the ESTRO consensus guideline on target volume. Radiother Oncol 122(1):24–29PubMed

25.

Cont NT et al (2017) Primary tumor location predicts the site of local relapse after nipple-areola complex (NAC) sparing mastectomy. Breast Cancer Res Treat 165(1):85–95PubMed

26.

Sood S, Elder E, French J (2015) Nipple-sparing mastectomy with implant reconstruction: the Westmead experience. ANZ J Surg 85(5):363–367PubMed

27.

Stanec Z et al (2014) Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience. Ann Plast Surg 73(5):485–491PubMed

28.

McCarthy CM et al (2008) Breast cancer recurrence following prosthetic, postmastectomy reconstruction: incidence, detection, and treatment. Plast Reconstr Surg 121(2):381–388PubMed

29.

Meretoja TJ et al (2007) Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 94(10):1220–1225PubMed

30.

Meretoja TJ et al (2007) Local recurrence of stage 1 and 2 breast cancer after skin-sparing mastectomy and immediate breast reconstruction in a 15-year series. Eur J Surg Oncol 33(10):1142–1145PubMed

31.

Caruso F et al (2006) Nipple sparing subcutaneous mastectomy: sixty-six months follow-up. Eur J Surg Oncol 32(9):937–940PubMed

32.

Uriburu JL et al (2006) Local recurrence of breast cancer after skin-sparing mastectomy following core needle biopsy: case reports and review of the literature. Breast J 12(3):194–198PubMed

33.

Gerber B et al (2003) Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg 238(1):120–127PubMedPubMedCentral

34.

Langstein HN et al (2003) Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg 111(2):712–720PubMed

35.

Newman LA et al (1998) Presentation, treatment, and outcome of local recurrence afterskin-sparing mastectomy and immediate breast reconstruction. Ann Surg Oncol 5(7):620–626PubMed

36.

Slavin SA, Love SM, Goldwyn RM (1994) Recurrent breast cancer following immediate reconstruction with myocutaneous flaps. Plast Reconstr Surg 93(6):1191–1204PubMed

37.

Johnson CH et al (1989) Oncological aspects of immediate breast reconstruction following mastectomy for malignancy. Arch Surg 124(7):819–823PubMed

38.

Howard MA et al (2006) Breast cancer local recurrence after mastectomy and TRAM flap reconstruction: incidence and treatment options. Plast Reconstr Surg 117(5):1381–1386PubMed

39.

Freyvogel M et al (2014) Screening mammography following autologous breast reconstruction: an unnecessary effort. Ann Surg Oncol 21(10):3256–3260PubMed

40.

Gilliland MD, Barton RM, Copeland EM 3rd (1983) The implications of local recurrence of breast cancer as the first site of therapeutic failure. Ann Surg 197(3):284–287PubMedPubMedCentral

41.

Noone RB et al (1994) Recurrence of breast carcinoma following immediate reconstruction: a 13-year review. Plast Reconstr Surg 93(1):96–106PubMed

42.

Donegan WL, Perez-Mesa CM, Watson FR (1966) A biostatistical study of locally recurrent breast carcinoma. Surg Gynecol Obstet 122(3):529–540PubMed

43.

Johnson J et al (2016) Sentinel lymph node mapping in post-mastectomy chest wall recurrences: influence on radiation treatment fields and outcome. Ann Surg Oncol 23(3):715–721PubMed

44.

Holland R et al (1985) Histologic multifocality of tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990PubMed

45.

Kaidar-Person O, Kühn K, Poortmans P (2020) Should we worry about residual disease after mastectomy? Lancet Oncol (accepted)

46.

Mota BS et al (2016) Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev 11:8932

47.

Vargo JA, Beriwal S (2015) RTOG chest wall contouring guidelines for post-mastectomy radiation therapy: is it evidence-based? Int J Radiat Oncol Biol Phys 93(2):266–267PubMed

48.

Pifer PM et al (2019) The lack of consensus of international contouring guidelines for the dorsal border of the chest wall clinical target volume: what is the impact on organs at risk and relationships to patterns of recurrence in the modern era? Adv Radiat Oncol 4(1):35–42PubMed

49.

Salas AP et al (1998) Is mammography useful in screening for local recurrences in patients with TRAM flap breast reconstruction after mastectomy for multifocal DCIS? Ann Surg Oncol 5(5):456–463PubMed

50.

Franchelli S et al (2002) Local recurrence of breast cancer around a prosthesis dome. Br J Plast Surg 55(8):685–686PubMed

51.

Slavin SA et al (1998) Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 102(1):49–62PubMed

52.

Ottesen G et al (1988) Frequency and types of chest wall recurrences among node negative breast cancer patients. Acta Oncol 27(6A):601–604PubMed

53.

Kaidar-Person O, Offersen BV, Poortmans P (2019) Should risk-adapted delineation considered de-escalation of therapy? The ESTRO-ACROP radiation therapy guidelines after implant-based immediate reconstruction for early stage breast cancer. Radiother Oncol 141:327–328PubMed

54.

Komenaka IK et al (2004) Interpectoral nodes as the initial site of recurrence in breast cancer. Arch Surg 139(2):175–178PubMed

55.

Rowell NP (2010) Are mastectomy resection margins of clinical relevance? A systematic review. Breast 19(1):14–22PubMed

56.

Kummerow KL et al (2015) Nationwide trends in mastectomy for early-stage breast cancer. JAMA Surg 150(1):9–16PubMed

57.

Li L et al (2019) Comparison of prepectoral and subpectoral breast reconstruction after mastectomies: a systematic review and meta analysis. Eur J Surg Oncol 45(9):1542–1550PubMed

58.

Tasoulis MK et al (2017) Subcutaneous implant breast reconstruction: time to reconsider? Eur J Surg Oncol 43(9):1636–1646PubMed

59.

Offersen BV et al (2016) ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1. Radiother Oncol 118(1):205–208PubMed

60.

Dillekas H et al (2016) The recurrence pattern following delayed breast reconstruction after mastectomy for breast cancer suggests a systemic effect of surgery on occult dormant micrometastases. Breast Cancer Res Treat 158(1):169–178PubMedPubMedCentral

61.

Zippel D et al (2015) Magnetic resonance imaging (MRI) evaluation of residual breast tissue following mastectomy and reconstruction with silicone implants. Clin Imaging 39(3):408–411PubMed

62.

Buchanan CL et al (2006) Locoregional recurrence after mastectomy: incidence and outcomes. J Am Coll Surg 203(4):469–474PubMed

63.

Sakamoto N et al (2016) Local recurrence following treatment for breast cancer with an endoscopic nipple-sparing mastectomy. Breast Cancer 23(4):552–560PubMed

Title: Spatial location of local recurrences after mastectomy: a systematic review
Authors: Orit Kaidar-Person
Philip Poortmans
Birgitte Vrou Offersen
Sabine Siesling
Miri Sklair-Levy
Icro Meattini
Dirk de Ruysscher
Thorsten Kühn
Liesbeth J. Boersma
Publication date: 01-09-2020
Publisher: Springer US
Keywords: Mastectomy
Breast Cancer
Breast Cancer
Published in: Breast Cancer Research and Treatment / Issue 2/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05774-4

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