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Management and Outcomes of Isolated Axillary Node Recurrence in Breast Cancer
David E. Konkin, MD;
Scott Tyldesley, MD, FRCPC;
Hagen Kennecke, MD, MHA, FRCPC;
Caroline H. Speers, BA;
Ivo A. Olivotto, MD, FRCPC;
Noelle Davis, MD, FRCSC
Arch Surg. 2006;141:867-874.
Hypothesis Management strategies affect the outcome of axillary recurrence in breast cancer.
Design Population-based analysis.
Setting Cancer agency breast cancer database.
Patients Two hundred twenty women diagnosed with stage 0 through III breast cancer between 1989 and 2003 who subsequently developed an isolated axillary relapse.
Main Outcome Measures 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.
Author Affiliations: Divisions of Surgical Oncology (Drs Konkin and Davis), Radiation Therapy (Drs Tyldesley and Olivotto), and Medical Oncology (Dr Kennecke) and Breast Cancer Outcomes Unit, British Columbia Cancer Agency (Drs Tyldesley, Kennecke, and Olivotto and Ms Speers); and University of British Columbia (Drs Konkin, Tyldesley, Kennecke, Olivotto, and Davis), Vancouver (Drs Konkin, Tyldesley, Kennecke, and Davis and Ms Spears) and Victoria (Dr Olivotto), British Columbia.
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