Treatment of locally recurrent breast carcinoma.

Treatment of locally recurrent breast carcinoma remains a significant problem. The records of 106 patients with local chest wall recurrence were reviewed. Fifty-five percent eventually developed metastatic disease, while 45% remained free of systemic disease. Size of primary tumor (greater than 2 cm), number of recurrences (multiple), and disease-free interval from primary surgery (less than 2 years) were all highly significant for the development of metastatic disease. Negative estrogen receptors also predicted bad prognosis. Both irradiation and surgery used alone had high local failure rates of 83% and 62%, respectively, but combination radiation-surgery treatment failed only in 25%. Combination radiation-surgery treatment should be considered in patients with local recurrence, but further prospective trials with more patients will be needed to prove its effectiveness. Patients with unfavorable prognostic factors should be considered for adjuvant chemotherapy.