Internal mammary node relapse following breast conservation: a case for reirradiation

Internal mammary node involvement in early breast cancer is a prognostic factor of uncertain significance. This paper addresses isolated regional recurrence at this site following breast conservation radiotherapy. A case is presented of a woman who developed an internal mammary recurrence after lumpectomy and breast irradiation. This recurrence was diagnosed as a bone metastasis, a common mistake which may lead to suboptimal management. The true incidence of regional recurrences in the internal mammary nodes has been underestimated and their clinical significance has not been appreciated. Salvage procedures for local control and long-term cure are likely to be successful if the diagnosis is made before distant metastases have occurred and a lengthy period has elapsed since initial treatment was given. The role of reirradiation should be considered as the tissues at this site will generally tolerate a second course of radical radiotherapy given more than 10 years after the first.