General principles of conduct in loco-regional recurrences after mastectomy

Abstract

Introduction. Breast cancer is the most commonly diagnosed life-threatening cancer in women and one of the leading causes of cancer death among women. Mastectomy is one of methods of treating breast cancer, but after performing it there is a risk of local and general recurrences. Approximately 10 - 15% of patients with stage I/II invasive breast cancer will develop a local recurrence. In case of relapses there are treatment tactics that allow us to apply it individually depending on the type of recurrence. Aim of study. Studying specialized literature in order to present the general principles of conduct in locoregional recurrences after mastectomy and to emphasize the importance of individualizing treatment strategies in patients with loco-regional recurrences. The treatment of loco-regional recurrences after mastectomy remains a clinical challenge. Methods and materials. The “PubMed MEDLINE” database and the last European and American guidelines were used to select relevant full-text original articles published from 2016 till 2021, using a search formula “Recurrences after Mastectomy”, review articles, as well as non-human studies were excluded. According to research criteria, there were retrieved full-text, clinical trial articles. Results. In case of local recurrence if initial treatment with mastectomy and level I / II axillary lymph nodes dissection and prior local radiotherapy (RT), will be performed surgical resection if it is possible. In initial treatment with mastectomy and no prior RT, the same will be done surgical resection if it is possible and RT. In the event if it is present regional only or local and regional recurrence, the method of treatment will depend on it. Axillary recurrence will be treated through surgical resection and RT if possible. Supraclavicular and internal mammary node recurrences will heal with RT if possible. Also in all cases of local and regional relapses will resort to systemic therapy with preoperative or adjuvant chemotherapy, adjuvant endocrine therapy and biologic therapy. Conclusion. The general principles of breast cancer treatment includes the treatment of local disease with surgery, radiation therapy, or both, and systemic treatment with chemotherapy, biologic therapy, endocrine therapy or combinations of these. The need for and selection of diverse local or systemic therapies are based on several prognostic and predictive factors.