title: Management and outcomes of isolated axillary node recurrence in breast cancer.
abstract: OBJECTIVE
  Management strategies affect the outcome of axillary recurrence in breast cancer.
  
  
  METHODS
  Population-based analysis.
  
  
  METHODS
  Cancer agency breast cancer database.
  
  
  METHODS
  Two hundred twenty women diagnosed with stage 0 through III breast cancer between 1989 and 2003 who subsequently developed an isolated axillary relapse.
  
  
  METHODS
  Overall survival rate and disease-free survival rate according to treatment strategy of the axillary recurrence.
  
  
  RESULTS
  Among 19 789 women diagnosed with stage 0 through III breast cancer during the study era, 220 had an isolated axillary recurrence (Kaplan-Meier 5-year isolated axillary relapse rate, 1.0%). The median interval between primary breast cancer diagnosis and axillary recurrence was 2.2 years (range,1.8 months to 11.9 years). Median follow-up time after axillary recurrence was 5.4 years. Treatment for the axillary recurrence included lymph node biopsy (47.3%), complete axillary dissection (25.9%), axillary radiation (65.0%), chemotherapy (24.1%), and hormonal therapy (68.2%). The 5-year Kaplan-Meier overall survival rate estimate after axillary recurrence was 49.3% (95% confidence interval, 42.0-56.3). Median survival time from the isolated axillary recurrence was 4.9 years (range, 2.0 months to 15.1 years). Overall (P < .001) and disease-free (P = .006) survival times were highest in those treated with a combination of surgery and radiation. Other factors associated with improved overall survival rate were an interval from diagnosis to relapse greater than 2.5 years (P = .003), no initial axillary radiation (P < .001), asymptomatic presentation of the recurrence (P = .05), and subsequent systemic treatment (P = .02).
  
  
  CONCLUSIONS
  The 5-year isolated axillary recurrence rate of women treated for breast cancer was 1.0%. Multimodality management at the time of recurrence, including axillary surgery, radiation, and systemic therapy, significantly improved overall and disease-free survival.
authors.affiliation: Division of Surgical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: David E
authors.initials: DE
authors.lastname: Konkin
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.forename: Hagen
authors.initials: H
authors.lastname: Kennecke
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Speers
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Olivotto
authors.forename: Noelle
authors.initials: N
authors.lastname: Davis
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome