Early breast cancer can be removed by surgery, and for most women the chance of the cancer returning (recurrence) is small. In some women however, the cancer returns in the same area. Chemotherapy (anti-cancer drugs) can be used together with other treatments, such as surgery or radiation therapy, to try to treat recurring cancer and improve survival. The review found that few trials have been performed to investigate its effectiveness. There is currently not enough evidence that adding chemotherapy to other treatments helps to treat the recurring cancer or to improve survival. However, chemotherapy may be an option, and further trials are underway.
This systematic review of randomised trials provides insufficient evidence to support systemic treatment in women with loco-regional recurrence of breast cancer. Participation in randomised trials of systemic treatment versus observation is appropriate.
Between 10% and 35% of women with operable breast cancer will experience an isolated locoregional recurrence following their primary treatment. There is currently no good evidence that adjuvant systemic treatment is effective in this situation and there is no standard treatment for women who have such a recurrence.
To investigate whether additional systemic treatment will improve the result of local therapy in regard to relapse-free and overall survival in women with potentially curatively resected locoregional recurrence following breast cancer and who have not had a previous or synchronous distant metastases.
The specialised register of the Cochrane Breast Cancer Collaborative Review Group, The Cochrane Library, MEDLINE and EMBASE and records of the Early Breast Cancer Trialists´ Collaborative Group were searched for the initial review in 2001. A subsequent search of the Cochrane Breast Cancer Specialised Register was conducted (19th May 2008).
Randomised controlled trials or trials in which women were allocated to active treatment or observation by a quasi-randomised process (such as alternation or date of birth) were eligible. Our aim was to consider separately women with a first incidence of isolated loco-regional recurrence in the treated breast, the chest wall or the regional lymphnode areas (except clavicular nodes) which can be resected without (R0) or with (R1) microscopically demonstrable residual disease. Women with previous or synchronous distant metastases were to be excluded from this part of the review. The second part of the review was to consider women with inoperable loco-regional recurrence and/or clavicular lymphnode involvement, regardless of previous or synchronous metastases.
We identified three completed studies in which there were a total of four randomised comparisons of systemic therapy versus observation for women who have received radiotherapy for loco-regional recurrence of breast cancer. One trial from the 1960's assessed actinomycin-D and randomised 32 patients and another from the early 1980's randomised the same number of women to alpha-interferon versus observation. The Swiss SAKK trial assessed the use of tamoxifen for 'good risk' patients and combination chemotherapy (vincristine, doxorubicin and cyclophosphamide) for 'poor risk' patients by randomising 178 and 50 women respectively, from 1982-1991. Where possible, data on relapse-free and overall survival were extracted for these trials and analysed using RevMan. No attempt was made to pool the results of the studies because of clinical heterogeneity and the small number of randomised patients. Three ongoing trials of chemotherapy versus observation have been identified.
The trial of 32 women who received either radiotherapy alone or in combination with systemic administration of actinomycin-D found that chemotherapy improved the local control rate but had no apparent effect on overall survival. The interferon trial, which also included a total of only 32 patients, showed that the addition of alpha-interferon to local treatment of locoregional recurrent breast cancer had no apparent effect on the further course of the disease. The Swiss SAKK trial of tamoxifen (178 women randomised) found an improvement in disease-free survival but not in overall survival. No results were available for the 50 women randomised into the concurrent trial of chemotherapy. The three ongoing trials of chemotherapy have a total target accrual of nearly 2000 patients.