Riccardo Ponzone, M.D.
Strategies for breast cancer loco-regional control
The prevention and early detection of local-regional relapses requires a better understanding of the complex relationship between the primary tumor and its metastatic dissemination. For optimal breast cancer care new advancements in surgery and radiotherapy must be integrated in to the complex and rapidly evolving armamentarium of targeted systemic therapies.
The influence of several treatment-related (accelerated partial radiotherapy, width of surgical margins, endocrine therapy with aromatase inhibitors), tumor-related (lobular histology, miR148b expression) and host-related parameters (body mass index, polymorphisms at the CYP19A1 locus) on the likelihood of breast cancer relapse have been examined. The available data and the new hypotheses on the relationship between loco-regional control and survival have been reviewed from a breast surgeon’s standpoint.
Conclusions and perspectives:
The current understanding of breast cancer natural history points towards the existence of a complex interplay between loco-regional and systemic processes. Loco-regional recurrences are associated with decreased overall survival and this may be related to a complex relationship between circulating tumor cells, re-seeding of the primary tumor site and several metabolic effects linked to the act of surgery. A re-definition of local-regional breast cancer treatment according to the risk of relapse based on improved bio-molecular characterization of the tumor is required to tailor the adoption of diagnostic tools, loco-regional and systemic treatments.