Treatment of Contralateral Axillary Metastases: Palliative Vs Curative Dilemma

Contralateral axillary metastasis that develops following treatment of breast cancer is a rare but challenging clinical scenario. We report the case that was discussed at the Inaugural Memorial Sloan Kettering Cancer Center and American University of Beirut Medical Center Joint Course in Oncologic Sciences catered for young oncologists. The course took place in Beirut, Lebanon between June 23 and 28, 2013. The case was presented by the trainees, discussed and built into a case report. The patient is a 63 year old woman who was treated for locally advanced breast cancer with neo-adjuvant chemotherapy followed by left Modified Radical Mastectomy (MRM), radiotherapy and hormonal therapy and who presented 4 years later with isolated contralateral axilla metastases. This was treated as stage IV disease with second-line hormonal therapy. A year later, the disease was still limited to the axilla and decision was made to approach the patient with a curative intent. She underwent right axillary dissection followed by chemotherapy and radiotherapy. Fourteen months after her last treatment, the patient has no evidence of disease. Atypical axillary metastases from contralateral breast cancer could represent a regional disease that is potentially curative. Due to the potential for long-term survival, an active and curative intent treatment of patients with similar presentation may be appropriate.