Prognosis after regional lymph node recurrence in patients with Stage I-II breast carcinoma treated with breast conservation therapy

BACKGROUND. The authors evaluated the risk factors for regional lymph node recurrence and the prognosis of patients with regional nodal recurrence after breast conservation therapy for Stage I-II breast carcinoma. METHODS. Between 1977 and 1995, 1293 women with pathologic Stage I and It (T1-2, N0-1) breast carcinoma were treated with breast-conserving therapy including lumpectomy, axillary lymph node dissection, and definitive breast irradiation. A total of 39 women (3%) had any regional lymph node recurrence. The median follow-up was 8.5 years (range, 1.5-24 years). RESULTS. Among 39 patients with a regional lymph node recurrence, 10 women had regional recurrence only, 16 had simultaneous locoregional recurrence, and 13 had simultaneous regional and distant recurrence. Regional recurrence occurred in the axillary lymph nodes only (n = 21; 51%), supraclavicular lymph nodes only n = 8; 23%), internal mammary lymph nodes only ( n = 3; 8%), infraclavicular lvmph nodes only (n = 3; 8%), or multiple lymph node sites ( n 4; 10%). The median time to regional lymph node recurrence was 3.1 years (range, 0.2-20.9 years). Overall survival after regional-only disease recurrence was 44%, locoregional disease recurrence was 26%, and regional with distant disease recurrence was 12%. Cause-specific survival rates at 10 years for the 3 groups were 44%, 40%, and 12%, respectively. For patients who presented with simultaneous regional and distant metastases, the median Survival period was 1.1 years, compared with 5.2 years for women who developed distant disease subsequent to regional recurrence. CONCLUSIONS. Regional lymph node recurrence after breast conservation therapy may be salvaged, but is associated with a high rate of either simultaneous or subsequent distant metastatic dissemination and poor overall prognosis. (C) 2003 American Cancer Society.