Analysis of local recurrences after breast conserving therapy using postoperative radiotherapy

One hundred and ninety-one breast cancer patients had breast conserving therapy (lumpectomy and postoperative radiotherapy) at the Shikoku Cancer Center Hospital between July 1989 and December 1994. Seven patients developed recurrence, two of them experienced recurrence in the treated breast after a median follow-up of 27 months. One of the two patients with the local recurrence had an inflammatory cancer-like change in the treated breast which consisted of a diffuse induration in the breast and thick overlying skin with redness. It was very difficult to distinguish local recurrence from the local change due to radiation. Her primary tumor showed prominent lymphatic vessel involvement, although the surgical margins were negative histologically. We believe that the possible lymphatic retention after axillary dissection facilitated this type of progression of the residual tumor cells within the lymphatic vessels. Although this type of local recurrence is quite rare, it could cause distant metastases. Reanalysis of surgical treatment and postoperative adjuvant therapy for the patients with breast cancer showing prominent lymphatic vessel involvement is required.