Prospective results of concurrent radiation therapy and weekly paclitaxel as salvage therapy for unresectable locoregionally recurrent breast cancer

Gang Cai,Youlia M Kirova,Lu Cao,Jia-Yi Chen,Yan Feng

doi:10.1186/s13014-019-1321-1

Abstract

PurposeTo investigate the efficacy and toxicity of concurrent radiation therapy (RT) and paclitaxel in the treatment of unresectable locoregionally recurrent breast cancer (RBC) after mastectomy as primary treatment.MethodsThis was a prospective monocentric study of 51 patients (pts) diagnosed with unresectable locoregionally RBC after mastectomy and treated between 2008 and 2012. Radiotherapy (RT) was delivered at 60 Gy in 30 treatment fractions to recurrent sites. Chemotherapy was weekly paclitaxel of 50 mg/m2 for 5 weeks. All pts. underwent clinical examination, CT or PET/CT every 3 months in first 2 years and then every 6 months. Tumor response was evaluated clinically and by CT using the RECIST criteria. Toxicity was assessed weekly during RT by the NCI common toxicity criteria (version 3.0).ResultsFifty-one pts. with 61 recurrent sites were studied. The median age was 49 years. Sites of RBC were chest wall in 20 patients (32.8%), supraclavicular in 19 (31.1%), axilla in 11 (18.0%), and internal mammary lymph nodes in the remaining 11 (18.0%). RBC presented as single in 25 pts., multiple in 20 pts. and diffuse growth in 6 pts. Clinical response was observed in 47 pts. (92.2%), with 36 (70.6%) complete and 11 (21.6%) partial responses. Two patients (3.9%) presented with stable disease and 2 progressive disease. The cumulative local progression-free survival rate was 62.8% at 2 year and 53.0% at 5 years after treatment. No grade 4 toxicity was observed. Grade 3 radiation dermatitis and leukocytopenia were observed in 10 (19.6%) and 12 (23.5%) pts., respectively. One patient experienced grade 2 pneumonitis.ConclusionsConcurrent RT and weekly paclitaxel could be an effective therapeutic option for unresectable locoregionally recurrent breast cancer after mastectomy with an acceptable toxicity profile.

Highlights

Despite the increasing use of breast-conserving surgery, mastectomy with axillary lymph node dissection retains important in primary breast treatment
Patient characteristics Fifty-one patients with unresectable LRR of breast cancer after radical mastectomy were enrolled in our monocentric study from January 2008 to June 2012
The sites of recurrence were confined to chest wall (CW) in 20 patients (32.8%), to Supraclavicular nodes (SC) in 19 (31.1%), to axillary lymph node (Ax) in 11 (18.0%), and intramammary lymph node (IM) in the remaining 11 (18.0%)

Summary

Introduction

Despite the increasing use of breast-conserving surgery, mastectomy with axillary lymph node dissection retains important in primary breast treatment. This treatment must be followed by radiation therapy in cases of lymph node involvement, as well as some cases of large tumors, lymphovascular invasion (LVI) and other factors of risk [1]. The rate of second local failure after local excision alone is very high [3, 4], and some patients cannot undergo curative surgery because of locally unresectable disease, medical unfitness or an unwilling to accept the associated complications. RT is an effective method to combine with surgical excision to reduce the rate of second local failure and treat the inoperative isolated LRR with

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Conclusion