Chest Wall Reconstruction and Chemotherapy for Infectious Costochondritis Associated with Recurrent Breast Cancer.

introductionManagement of chest wall recurrence after mastectomy remains debated. While surgery is invasive, both Japanese and international guidelines allow resection in selected patients and complete excision can provide durable control. With advances in systemic therapy, the value of aggressive local treatment for isolated recurrence requires reevaluation. Tumor biology and changes in receptor status after prior therapy also affect prognosis. However, infectious ribs or cartilage ulcers following chemotherapy and chest wall reconstruction are rarely reported. We describe a case of chest wall recurrence treated with multimodal therapy, including resection and reconstruction, complicated by infectious costochondritis. CASE PRESENTATION: A 55-year-old woman, first diagnosed 20 years ago with stage I breast cancer, underwent partial mastectomy and received adjuvant therapies. Sixteen years later, a new right breast mass was identified as stage IIA cancer. After chemotherapy, a total mastectomy and lymph node dissection were done. Five months of post-surgery recurrence in the right chest wall led to further chemotherapy and brachytherapy. Despite managing initial metastasis, new metastases occurred in the opposite breast and lymph nodes. During paclitaxel and bevacizumab treatment, she developed an ulcer from costochondritis, requiring surgery. Liver metastasis was later treated, maintaining an infection-free status for 6 months until her death. Effective local control allowed continuation of various chemotherapy regimens, enhancing her survival and QOL.

conclusionsIn patients with chest wall recurrence complicated by refractory infection including costochondritis, surgical resection with appropriate reconstruction should be actively considered. Timely aggressive management of infection can enable further systemic therapy and may prolong survival and preserve QOL.