Abstract
To report an analysis of treatment outcomes of a cohort of patients re-irradiated for locally recurrent refractory breast cancer (LRRBC). Between 2008 and 2013, 47 women (mean age = 60 years) were re-irradiated for LRRBC. Outcomes were measured using Kaplan-Meier log rank to compare curves and Cox regression for multivariate analysis. Outcomes included overall survival (OS), time to re-treatment, survival without systemic progression, and survival without local recurrence. Fifty-six instances of re-irradiation were completed and analyzed. The mean cumulative 2 Gy equivalent dose (EQD2) to the whole breast and tumour cavity (α/β = 3) was 99.8 Gy and 109.1 Gy, respectively. Most patients initially had significant symptoms before RT due to local recurrence. The median time to re-treatment and to systemic failure was 41 and 50 months, respectively. Median follow-up for OS was 17 months and OS was 0.73 (SE = 0.07) at 1 year and 0.67 (SE = 0.07) at 2 years. Local control was 0.62 (SE = 0.07) and 0.5 (0.08) at 1 and 2 years, respectively. Acute radiation dermatitis was G1-2, G3 and G4 in 45, 4 and 1 cases, respectively. One patient presented with necrosis. The most common long term toxicity was G3 fibrosis (n = 4) and telangiectatic changes (n = 3). Multivariable analysis indicated that skin involvement (Hazard Ratio = 6.6 (1.4-31), p = 0.016) and time to local recurrence <2yr (HR 3.1 (1.04-9.7) p = 0.042) predicted local recurrence. High dose re-irradiation is feasible for locally RRBC. This approach can have a significant benefit in this very high-risk group.
Highlights
Breast cancer is the most frequently diagnosed cancer in North American women
Local recurrence location was on the chest wall (n=18), breast same quadrant (n=8), breast non-specified (n=7), supraclavicular area (n=6), axilla (n=5), breast other quadrant (n=4), and sternum (n=2)
This is the first study to report the results of local re-irradiation for recurrent refractory breast cancer using external beam radiotherapy
Summary
Breast cancer is the most frequently diagnosed cancer in North American women. In 2014, in Canada it is estimated that approximately 24,400 new cases and about 5000 deaths will occur as a result of the disease [1]. Local recurrence rates are approximately 10-20% at 10 and 15 years respectively, but can be as high as 40% depending on treatment, patient age, and primary tumour size [5, 6]. Local recurrence is often a painful situation for breast cancer patients since many patients, even those with metastatic disease, may still live many months to years with appropriate treatment [7,8,9]. Uncontrolled locally recurrent breast cancer can cause many significant problems that can decrease the quality of life of patients. These problems include ulcerations, bleeding, arm edema, pain and brachial-plexus palsy. Standard treatment for local recurrence after breast-conserving surgery and radiotherapy involves total mastectomy.
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