Which of the following statement(s) is/are true concerning local recurrence of breast cancer?

a. The percentage of patients with chest wall recurrence as their initial site of failure following mastectomy is similar for node-negative and node-positive patients

b. Most patients with local-regional recurrence of their disease will eventually die of metastatic disease

c. The treatment of local recurrence following mastectomy includes local radiation therapy and systemic chemotherapy

e. Regional lymph node recurrence following axillary node dissection is rare

Recurrence in the chest wall after mastectomy is ominous. In a large series of patients treated with mastectomy, 6.5% of node-negative and 8.8% of node-positive women had chest wall recurrence as their initial site of failure. By ten years after local-regional recurrence, about 60% of initially node-negative and almost all (> 90%) of initially node-positive patients had evidence of metastatic disease. Patients with local recurrence, who have not had prior chest wall radiation, should receive radiation therapy. A full course of at least 4500 to 5000 cGy should be delivered to the entire chest wall, with consideration given to a boost dose at any sites of gross tumor. Because post-mastectomy recurrence is often rapidly followed by metastatic disease, it is logical to postulate a role for adjuvant systemic therapy once local measures have achieved control of chest wall disease.

Recent data suggests that in-breast recurrence following breast conservation is a prognostic factor. Women who develop an in-breast recurrence have a higher likelihood of developing systemic disease than do women who remain diseasefree in their breast. Fewer than 3% of patients develop recurrence of disease in the axilla after axillary node dissection.