Isolated Loco-Regional Recurrence of Breast Cancer – Established and Innovative Therapy Concepts

Abstract

The incidence of isolated loco-regional recurrence of breast cancer is between 2–20 %. It constitutes the most common type of breast cancer recurrence. In contrast to distant metastasis, a number of curative therapies are available to treat isolated loco-regional recurrence of breast cancer. Screening for early detection and regular examinations as part of a recommended follow-up programme is important. If distant metastasis has been excluded, therapy for recurrence ideally consists of surgery with R0 resection margins. Radiotherapy is indicated after non-curative surgery (R1/R2) for local tumour control to improve the chances of curative surgery and as a palliative therapy for local control of symptoms in inoperable cancer, also in combination with hyperthermia and systemic therapy. There was previously some uncertainty concerning the benefit of systemic therapy after R0 resection and breast-conserving therapy and after previous mastectomy. If the recurrence is hormone-receptor positive, (repeat) endocrine systemic therapy is indicated for both constellations. If the hormone-receptor status is negative, the question whether repeat chemotherapy is indicated as an adjuvant therapy and whether it offers a benefit to patients was still controversially discussed. However, data from the CALOR trial presented at the San Antonio Breast Cancer Symposium in 2012 has now answered this question in favour of chemotherapy. These new findings will not merely have an impact on future therapy recommendations but also on the entire clinical management of isolated loco-regional recurrence.

Zusammenfassung

Das isolierte lokale Rezidiv und das lokoregionäre Rezidiv stellen mit einer Häufigkeit von 2–20 % die häufigsten Manifestationen bei Wiederauftreten eins Mammakarzinoms dar. Im Gegensatz zu einer Fernmetastasierung ist beim isolierten lokalen/lokoregionären Rezidiv des Mammakarzinoms ein kurativer Therapieansatz gegeben. Dieses ist der Grund für den Einsatz von Maßnahmen zur Früherkennung und der Festlegung der entsprechenden Untersuchungen in den empfohlenen Nachsorgeprogrammen. Therapeutisch ist in der Rezidivsituation eine operative Therapie mit einer R0-Resektion anzustreben, wenn eine Fernmetastasierung ausgeschlossen wurde. Indikationen zur Radiotherapie bestehen bei nicht kurativ möglicher operativer Therapie (R1/R2) zur lokalen Tumorkontrolle, zum Erhalt der Aussicht auf eine Kuration und bei Inoperabilität zur lokalen Symptomkontrolle in palliativer Intention, gegebenenfalls in Kombination mit Hyperthermie und systemischer Therapie. Unsicherheit bezüglich des Nutzens systemischer Therapien bestand bislang nach R0-Resektion nach brusterhaltender Therapie oder nach zuvor erfolgter Mastektomie. Bei Hormonrezeptorpositivität des Rezidivs ist bei beiden Konstellationen eine (erneute) endokrine Systemtherapie indiziert. Bei negativem Hormonrezeptorstatus war die Frage offen, inwieweit eine erneute Chemotherapie als adjuvante Maßnahme indiziert ist bzw. einen Benefit für die Patientin ergibt. Mit den Daten der CALOR-Studie, welche beim San Antonio Breast Cancer Symposium in 2012 vorgestellt wurde, kann diese Frage zugunsten einer Chemotherapie mittlerweile beantwortet werden. Es ist davon auszugehen, dass diese neuen Erkenntnisse nicht nur die weiteren Therapieempfehlungen beeinflussen werden, sondern auch das gesamte klinische Management des alleinigen lokalen bzw. lokoregionären Rezidivs.

Key words

breast cancer - local recurrence - chemotherapy

Schlüsselwörter

Mammakarzinom - Lokalrezidiv - Chemotherapie

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