A case of recurrence of breast cancer 36 years after mastectomy treated with endocrine and chemotherapy

: In 2001, a 72-year-old woman, who had undergone left mastectomy for breast carcinoma 36 years ago, was admitted because of dysphagia. Chest CT showed pleural effusion in the right side and no tumor in the breast. Chest drainage was performed. Cytology of chest effusion revealed adenocarcinoma. A high serum CA15-3 level was noted. She was diagnosed with a pleural recurrence of breast cancer, so administration of CAF agents (4 courses) was started. Pleural effusion was improved and the serum CA15-3 level was reduced. She was then clinically followed on medication with oral anastrozole (AI). After 4 years, progression of disease was noted. The serum CA15-3 level was elevated. A tumor measuring 3 cm was confirmed on the right chest wall. The tumor was removed under local anesthesia and pathological findings showed invasive ductal carcinoma expressing estrogen receptor. Chemotherapy with taxane had to be withdrawn because of its side effect. Administration of S-1 was then started. The serum CA15-3 level was gradually elevated. Thereafter, the regimen was switched to combined S-1 and toremifene citrate. The serum CA15-3 level was reduced and sustained for several months. However, she died of multiple organ metastasis in 2008.