National United Kingdom study of the management of breast cancer locoregional recurrence (MARECA) study: Analysis of disease presentation and patient management.

BACKGROUND

Despite improvements in primary breast cancer treatment, 10-year cumulative locoregional recurrence (LRR) incidence is around 8%. This study aimed to examine the management of patients diagnosed with LRR.

METHODS

Patients previously treated for breast cancer and diagnosed with LRR were prospectively identified at breast MDT meetings and clinics. Data collection included tumour pathology, imaging results, surgical treatment, and adjunct therapy for the original and recurrent cancer.

RESULTS

Data were analysed for 742 patients recruited from 50 UK hospitals (2022-2023). Median ages at original cancer (OC) and LRR diagnosis were 53 and 67 years old respectively; median disease-free interval (DFI) 8.9 years. For the OC and LRR, ER + PR + HER2-receptor profile was most prevalent. Breast conserving surgery (BCS) was predominantly performed for the OC (75.3%; 559/742). Concomitant distant metastases (DM) rate was 9.3% (69/742) with higher incidence seen in node positive LRR, HER2+ LRR, and shorter DFI (<5 years). Of 622 patients receiving LRR resection, commonest procedures were mastectomy (62.9%; 391/622), wide excision of chest wall/skin flap LRR (20.6%; 128/622), and repeat BCS (10.9%; 68/622). For patients receiving axillary surgery, node positivity rate was 25.3% (140/554) for OC and 21.3% (86/403) for LRR. Radiotherapy (67.8% OC vs. 18.8% LRR) and chemotherapy (33.1% OC vs. 23.9% LRR) utilisation rates were lower for LRR. Endocrine therapy utilisation rate was higher for LRR (63.5% OC and 70.5% LRR).

CONCLUSION

Routine radiological staging investigation is advocated for invasive LRR. Majority of LRR were resectable, with nodal positivity rate comparable to the original cancer.