612 poster CLINICAL RESULTS OF THE COMBINED TREATMENT INCLUDING INTRALUMINAL CF-252 BRACHYTHERAPY FOR BREAST CANCER

Abstract

Purpose: The aim of this study was to evaluate the impact the preoperative radiotherapy including intraluminal Cf-252 brachytherapy on risk of locoregional recurrence and long-term survival in breast cancer patients treated with mastectomy in 1987-1997. Materials: Weretrospectively reviewed records for 155 patientswith invasive medial and central breast cancer (T1-T3, N0-2) who received preoperative irradiation of the chest wall, axillary, and supraclavicular, and parasternal regions and underwentmastectomy.Median age was 55 years, 56.5 % of the patients were lymph node negative. Patients received of conventional 36-45 Gy radiation dose in 2-Gy fractions and intraluminal Cf-252 neutron brachytherapy to parasternal lymph nodes. During surgery catheters were placed in the arteria thoracica interna and on the first or second post-operative day, flexible Cf-252 sources were inserted into catheters. Their active length was 10-12 cm, irradiation dose at a distance of 1 cm from the centre of source was 4045 Gyeq. There was no Tamoxifen given. The five-year actuarial and 10-year of loco-regional recurrence and survival probabilities were estimated by the Kaplan-Meier method and differences between patient subgroups were compared by the log-rank test. Results: Overall survival was 73.8, 72.2 and 44.0% at 3, 5 and 10 years. The 5-yer acturial overall survival was 38% for patients with chest wall, axillary, supraclavicular or internal mammary lymph node (one case) recurrence. Recurrence was observed in 31 of 154 (20 %) patients at the end of this study. Loco-regional recurrence rate was 7.4, 13.9 and 20.4% at 3, 5 and 10 years. The recurrence rate was 1.96% in patients without lymphovascular permeation, and it increased to 21.36 % in patients with in patients with lymphovascular permeation (p=0.03). Patients younger than 50 years at primary diagnosis had statistically significantly higher rates of 10 year recurrence [16 of 53 (30.2%)] than older patients [15 of 101 (15 %)], p=0.03. The side effects included of pneumonitis (3 cases, 1.9%), lung fibrosis (26 cases, 16.8 %) and oedema of the arm (37 cases, 23.9%). Conclusions: The long-term data show that the preoperative radiotherapy including intraluminal Cf-252 brachytherapy has positive impact on time of loco-regional recurrence and survival in patients after mastectomy.