Natural History and Management of Isolated Local-Regional Recurrence Following Mastectomy.

The average incidence of isolated local-regional recurrence following modified radical mastectomy is 10% to 20%, but it can be as low as 5% or as high as 40%, depending on the presence or absence of various risk factors. One of the objectives of this article is to discuss how to evaluate the risk of locoregional failure. In addition, although the average overall survival rate following recurrence is approximately 40% at 5 years and 25% at 10 years, individual patient survival varies considerably and depends on a number of fairly well-documented prognostic features that are also discussed here. The unfortunate reality is that control of an isolated local-regional recurrence for the duration of life is not frequently achieved. Even with optimal irradiation, 50% of all patients will die with uncontrolled local-regional disease. The quality of life for patients with uncontrolled disease is often very poor, and some examples are shown here. For this reason, local-regional recurrence should be avoided. The way to avoid (or at least minimize) local-regional recurrence is to give postoperative irradiation to those who are at high risk for local-regional recurrence following mastectomy. This author considers the risk to be "high" when it reaches 25% to 30%.