Abstract
BackgroundRadiation is a standard component of treatment for patients with locoregional recurrence (LRR) of breast cancer following mastectomy. The current study reports the results of a 10% radiation dose escalation in these patients.Methods159 patients treated at MD Anderson Cancer Center between 1994-2006 with isolated LRR after mastectomy alone were reviewed. Patients in the standard treatment group (65 pts, 40.9%) were treated to 50 Gy comprehensively plus a boost of 10 Gy. The dose escalated group (94 pts, 59.1%) was treated to 54 Gy comprehensively and a minimum 12 Gy boost. Median dose in the standard dose and dose escalated group was 60 Gy (±1 Gy, 95% CI) and 66 Gy (±0.5 Gy, 95% CI) respectively. Median follow up for living patients was 94 months from time of recurrence.ResultsThe actuarial five year locoregional control (LRC) rate was 77% for the entire study population. The five year overall survival and disease-free survival was 55% and 41%, respectively. On multivariate analysis, initial tumor size (p = 0.03), time to initial LRR (p = 0.03), absence of gross tumor at the time of radiation (p = 0.001) and Her2 status (p = 0.03) were associated with improved LRC. Five year LRC rates were similar in patients with a complete response to chemotherapy without surgery and patients with a complete surgical excision (77% vs 83%, p = NS), compared to a 63% LRC rate in patients with gross disease at the time of radiation (p = 0.024). LRC rates were 80% in the standard dose group and 75% in the dose escalated group (p = NS).ConclusionsWhile LRR following mastectomy is potentially curable, distant metastasis and local control rates remain suboptimal. Radiation dose escalation did not appear to improve LRC. Given significant local failure rates, these patients are good candidates for additional strategies to improve their outcomes.
Highlights
Radiation is a standard component of treatment for patients with locoregional recurrence (LRR) of breast cancer following mastectomy
After obtaining MD Anderson Cancer Center Institutional Review Board (IRB) approval for a retrospective chart analysis, a total of 292 charts was reviewed, representing all patients identified has having received radiotherapy for loco-regionally recurrent breast cancer after mastectomy between 1994 - 2006 at MDACC. 133 patients were excluded from this study because they had visceral or bony metastases at time of recurrence, previous radiation to the breast or chest wall, or pathology other than breast cancer, leaving a total of 159 patients who were treated with curative intent
In this study of 159 patients we achieved 77% locoregional control and 55% overall survival at five years for the entire study group
Summary
Radiation is a standard component of treatment for patients with locoregional recurrence (LRR) of breast cancer following mastectomy. The therapeutic approaches for isolated locoregional recurrence (LRR) of breast cancer vary widely from palliation to aggressive multimodality salvage therapy. In those patients with isolated LRR after mastectomy treated with curative intent, long-term survival ranges from as low as 25% [1] to a more typical 50% [2,3,4,5,6]. We have seen improved local control in inflammatory breast cancer with the use of radiation dose escalation [12] These findings led us to implement a systematic 10% radiation dose escalation in patients treated for isolated locoregionally recurrent breast cancer to improve on our previously reported results. This study compares patient outcomes using our previous standard dose (typically 60 Gy) versus our current escalated dose (66 Gy)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
