Jennifer R. Bellon, MD

Current data challenge the statement that recommendations for postmastectomy radiotherapy should be based on the highest clinical or pathologic stage. Instead, data suggest that in a majority of patients, the pathologic stage after neoadjuvant chemotherapy carries more prognostic value.

Management recommendations for breast cancer local-regional recurrence (LRR), including patient scenarios, are reviewed, and represent evidence-based data and expert opinion of the American College of Radiology Appropriateness Criteria Expert Panel on LRR.

Drs. Lannin and Haffty’s comprehensiveand thoughtful reviewof breast cancer recurrencefollowing breast-conservingtherapy details the risk factors forlocal recurrence, factors predictive ofoutcome at the time of a breast recurrence,and prognosis after recurrence.The complex interaction betweenlocal and distant recurrence is alsoexplored; the authors argue thatlocally recurrent disease is both amarker of a more aggressive primarycancer, as well as a potential sourcefor seeding distant sites. Strategiesfor managing local recurrences arealso discussed. We are in agreementwith this excellent review and willtake this opportunity to expand on afew points.