Frequency, anatomical distribution and management of local recurrences after definitive therapy for breast cancer

Abstract

From January 1948 through August 1962, 1243 patients with cancer of the breast received definitive therapy. Seven hundred and eighty-eight patients were treated with radical mastectomy alone or with pre- or postoperative irradiation. One hundred and sixty-seven patients were treated with simple mastectomy followed by radiation therapy and 288 were treated by radiation therapy alone. Analysis was made of the distribution of 203 local recurrences (16.3%) within the regional areas. Local recurrences occurred primarily on the chest wall with a correlation between size and skin disturbance of the primary lesion and histological findings in the axillary nodes. Local recurrences in the radical mastectomy alone group were 4.7%, in the radical mastectomy with post-operative therapy, 15.6%, and in the preoperative therapy followed by radical mastectomy, 4.7%. In 90% of the patients who developed local recurrences, chest wall recurrences were the first manifestations of the disease. Axillary recurrences in the radical mastectomy group were less than 1% and supraclavicular recurrences were 2%. Chest wall nodules are best managed by comprehensive irradiation of the whole chest wall.