Management and outcomes of isolated axillary node recurrence in breast cancer.
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.
Konkin
David E
DE
Division of Surgical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
Tyldesley
Scott
S
Kennecke
Hagen
H
Speers
Caroline H
CH
Olivotto
Ivo A
IA
Davis
Noelle
N
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