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Spatial location of local recurrences after mastectomy: a systematic review

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Abstract

Purpose

We performed a systematic review to document the spatial location of local recurrences (LR) after mastectomy.

Methods

A PubMed search was conducted in August 2019 for the following terms: breast [Title/Abstract] AND cancer [Title/Abstract] AND recurrence [Title/Abstract] AND mastectomy [Title/Abstract]. The search was filtered for English language. Exclusion criteria included studies that did not specify the LR location or studies reporting LR associated with inflammatory breast cancer, or other breast cancers such as phyllodes tumours, lymphoma or associated with sarcoma/angiosarcoma.

Results

A total of 3922 titles were identified, of which 21 publications were eligible for inclusion in the final analysis. A total of 6901 mastectomy patients were included (range 25–1694). The mean LR proportion was 3.5%. Among the total of 351 LR lesions, 81.8% were in the subcutaneous tissue and the skin, while 16% were pectoral muscle recurrences.

Conclusion

Local recurrences are mostly located within the subcutaneous tissue and the skin, assumed to result from unrecognized/subclinical tumour foci left behind after mastectomy, surgical implantation of tumour cells in the wound/scar and/or tumour emboli within the subcutaneous lymphatics. Pectoral muscle recurrences are less frequent and may be attributed to residual disease along the posterior surgical margin and/or lymphatic involvement.

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Acknowledgements

We thank Alina Markinzon, a medical librarian from Sheba Tel H’ashomer, for her assistance. All figures and illustrations are original. Illustrations were done by Alon Person, via Adobe Illustrator cc 2019. The authors thank Alon Person for his contribution.

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Authors and Affiliations

  1. Breast Radiation Therapy Unit, Sheba Medical Center, Sheba Tel Ha’shomer, Ramat Gan, Israel

    Orit Kaidar-Person

  2. GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, The Netherlands

    Orit Kaidar-Person

  3. Iridium Kankernetwerk, Wilrijk, 2610, Antwerp, Belgium

    Philip Poortmans

  4. Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Wilrijk-Antwerp, Belgium

    Philip Poortmans

  5. Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark

    Birgitte Vrou Offersen

  6. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Sabine Siesling

  7. Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands

    Sabine Siesling

  8. Meirav Breast Center, Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel

    Miri Sklair-Levy

  9. Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Miri Sklair-Levy

  10. Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy

    Icro Meattini

  11. Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands

    Dirk de Ruysscher & Liesbeth J. Boersma

  12. Department of Gynaecology and Obstetrics, Interdisciplinary Breast Center, Klinikum Esslingen, Esslingen, Germany

    Thorsten Kühn

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  1. Orit Kaidar-Person
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  2. Philip Poortmans
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  9. Liesbeth J. Boersma
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Contributions

All authors: conceptualization, methodology. O.K.P.: data curation, writing—original draft preparation. P.P., L.B., B.V.O. and D.d.R.: supervision. All authors: writing—reviewing and editing.

Corresponding author

Correspondence to Orit Kaidar-Person.

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Research involving human participants and/or animals: This article does not contain any studies with animals performed by any of the authors.

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Kaidar-Person, O., Poortmans, P., Offersen, B.V. et al. Spatial location of local recurrences after mastectomy: a systematic review. Breast Cancer Res Treat 183, 263–273 (2020). https://doi.org/10.1007/s10549-020-05774-4

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  • DOI: https://doi.org/10.1007/s10549-020-05774-4

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