Locoregional Recurrence in Breast Cancer: Contemporary Multimodality Management and Future Directions

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.

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).

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.

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.