In a patient with local recurrence of breast cancer after mastectomy, how would you sequence adjuvant treatment after wide local resection?

Endocrine therapy can be given simultaneously with RT without increasing toxicity or decreasing effectiveness, as shown in a randomized French-Swiss trial (Azria et al., PMID 20138810). Toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when given after RT instead of before (Recht et al., PMID 8614420; Bellon et al., PMID 15774786). Hence, I would give this patient endocrine therapy simultaneously with RT and chemotherapy before RT if she is going to receive systemic therapy. However, there are only limited data from randomized trials on whether either endocrine therapy or chemotherapy is beneficial for patients having local-regional recurrence.

The only such trial on the role of endoc...