A study on pattern of locoregional recurrence and its relation to the irradiated volume in patients with carcinoma breast receiving adjuvant radiotherapy

Abstract

Author(s): Greeshma KE, Geetha Muttath*, Nabeel Yahia, Suja CA, Resmi K Bharathan and Arun Kumar

Aims and objectives: Loco Regional Recurrences (LRR) can occur in up to 5%- 15% of patients with breast cancer despite appropriate treatment and this can potentially be a harbinger for subsequent systemic relapse. We analysed the incidence and patterns of LRR in breast cancer patients who received adjuvant radiotherapy from January 2015 to December 2018 at our centre.

Methodology: The planning CT scans and the imaging done at the time of recurrences were superimposed to find out if the recurrences are inside or outside the irradiated volume.

Results: After a median follow up of 37.5 months (18 m-52 m), 12 out of the 517 patients irradiated had LRR (2.3%). Median disease free interval was 14.5 m (1 m-52 m). 58.3% of patients had N2 or above nodal stage. 66.7% had Invasive carcinoma Gr2. Lympho vascular emboli was noted in 58.3%, perineural invasion in 33.3% and extra capsular extension in 58.3% of patients. Most common site of LRR was SCF (n=7) followed by CW (n=5). 91.7% of patients had Infield recurrence. Outside field recurrence occurred in 5 patients (41.7%), all of which occurred in the Internal Mammary Nodes (IMN). 50% of patients (6/12) had associated systemic relapse.

Conclusions: The rate of LRR among patients with breast cancer after adjuvant radiotherapy is low in our experience. 41.7% of all LRR involved IMN either in isolation or along with other sites. This highlights the importance of IMN as a site of LRR and hence the need to address the ipsilateral IMN in all patients receiving adjuvant radiotherapy for advanced breast cancer.

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