title: Clinical course of breast cancer patients with isolated sternal and full-thickness chest wall recurrences treated with and without radical surgery.
abstract: BACKGROUND
  The role and outcome of radical surgery in contemporary multidisciplinary management of breast cancer patients presenting with isolated sternal or fullthickness chest wall (SCW) recurrence are undefined compared with patients treated without surgery.
  
  
  METHODS
  Detailed analyses of all patients with isolated SCW recurrence treated from 1992 to 2011 at a large cancer institution were performed. Univariate and multivariate comparisons of clinicopathologic and treatment characteristics were analyzed. Overall and progression-free survival were compared using the Kaplan–Meier method.
  
  
  RESULTS
  Seventy-six patients were identified, 44 treated surgically and 32 nonsurgically. Overall survival at 5 years was not statistically different between patients who underwent surgery and those who did not (30.6 and 49.6 %, respectively; P = 0.52) although patients selected for surgery presented with more advanced and biologically aggressive disease. Surgically treated patients were more likely to have triple-negative breast cancer at recurrence (52 vs. 17 %; P = 0.006). Among surgical patients, 95 % received preoperative systemic therapy. Clinical response with systemic therapy was significantly different, with surgically treated patients more likely to have responsive or stable disease (54 vs. 25 %, P = 0.04). Complications related to radical surgical resection occurred in 25 % of patients. For hormone receptor–positive recurrence, 5-year progression-free survival was significantly higher among surgical patients (46.3 vs. 14.5 %; P = 0.01).
  
  
  CONCLUSIONS
  Among patients with isolated SCW recurrence, hormone receptor-positive recurrence is associated with improved survival. Systemic therapy should be the initial treatment, and clinical response can be used to help select patients who may benefit from radical resection.
authors: Michelle C
authors: MC
authors: Shen
authors: Nader N
authors: NN
authors: Massarweh
authors: Sara A
authors: SA
authors: Lari
authors: Ara A
authors: AA
authors: Vaporciyan
authors: Jesse C
authors: JC
authors: Selber
authors: Elizabeth A
authors: EA
authors: Mittendorf
authors: Mariana Chavez
authors: MC
authors: MacGregor
authors: Benjamin D
authors: BD
authors: Smith
authors: Henry M
authors: HM
authors: Kuerer
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D013249:Sternum / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D035441:Thoracic Wall / Q000473:pathology / Q000601:surgery*