Locoregional Recurrence in Breast Cancer: Contemporary Multimodality Management and Future Directions
In brief
Surgical removal offers best chance of cure for breast cancer recurrences
A review of evidence from 2010-2025 shows that patients with locoregional breast cancer recurrence who can undergo complete surgical excision have the highest likelihood of long-term control and survival, while unresectable disease is managed like metastatic cancer with systemic therapy tailored to subtype. The authors stress the need for biopsy-confirmed biomarker reassessment and note that data guiding adjuvant chemo- or radiation after surgery remain limited.
- Journal
- Clinical oncology (Royal College of Radiologists (Great Britain)) (Q1)
- Published
- 11 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- T Elumalai, M Ismail, N Thummalapenta, H Martin, M Sabar, J Wardropper, et al.
- PMID
- 42727309
- DOI
- 10.1016/j.clon.2026.104317
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 13 September 2026): Review of multimodality management of breast cancer locoregional recurrence
- Picked for Oncology and Radiation Oncology (top studies of the week, 13 September 2026): Review of multimodality management of breast LRR
Abstract
AIMS: Locoregional recurrence (LRR) of breast cancer, comprising ipsilateral breast tumour recurrence (IBTR), chest wall recurrence after mastectomy (CWR), and regional nodal recurrence including axillary nodal recurrence (ANR), internal mammary node (IMN) recurrence, and supraclavicular (SCV) recurrence, is a significant challenge for patients previously cured of breast cancer. LRR may be surgically resectable or present as locally advanced unresectable disease. There is limited evidence to guide the management of LRR in breast cancer and it requires a multidisciplinary approach. The aim of this review is to synthesise the current evidence and identify gaps in the literature. MATERIALS AND METHODS: MEDLINE/PubMed, JAMA Network, Annals of Oncology/ESMO, NCCN educational materials, ASTRO/Advances in Radiation Oncology, Clinical Oncology, and key oncology journals were searched (Jan 2010-Oct 2025) for guidelines, randomised controlled trials, prospective trials, large retrospective series, and meta-analyses focused on LRR after prior curative treatment. Outcomes of interest included local control (LC), disease-free survival (DFS), distant metastasis-free survival (DMFS), overall survival (OS), toxicity, and quality of life (QoL). Preference was given to randomised and prospective evidence where available (eg, Chemotherapy as Adjuvant for Locally Recurrent Breast Cancer (CALOR); NRG Oncology/Radiation Therapy Oncology Group (RTOG) 1014). RESULTS: The management of LRR depends on the resectability of the disease. If a negative margin can be achieved, then curative surgical options should be considered. Following surgery, adjuvant systemic therapy (chemotherapy, anti-HER2 therapy, endocrine therapy) may be considered, although evidence specific to LRR is limited. Radiotherapy can also help with LC as well as symptom management. If LRR is unresectable, it should be treated similarly to metastatic disease with the treatment tailored to the molecular subtype. CONCLUSION: There is limited evidence guiding the management of LRR in breast cancer. Surgical resectability remains the best prognostic factor and offers a potential cure. Systemic therapy and radiotherapy depend on disease biology, and careful examination of the recurrence allows optimal management. Biopsy confirmation and biomarker reassessment are essential because discordance is common.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.