Salvage Therapy for Isolated Local-Regional Breast Cancer Recurrence

The overall number of breast cancer patients at risk of developing local-regional disease recurrence has been increasing due to long-term survivorship from improvements in multimodality breast cancer treatment and a steady increase in breast cancer incidence. Many patients receive radiation therapy as part of definitive multidisciplinary breast cancer treatment, and to date, practitioners have approached reirradiation delivery with reticence due to concern for serious toxicities that may be incurred with high cumulative radiation doses. However, a subset of patients with breast cancer recurrence may benefit from reirradiation for improved locoregional tumor control. An emerging body of evidence has demonstrated promising efficacy and safety of breast cancer reirradiation that is gradually redefining the treatment paradigm. In addition, an increase in systemic therapy options has further optimized the opportunity for successful salvage of breast cancer recurrence. In this critical review, we review breast cancer radiation and systemic therapy salvage options, available data, ongoing studies, and treatment delivery considerations.