Abstract
BackgroundRepeat radiation is a rarely used treatment strategy that must be performed with caution. The efficacy and toxicity of a second curative radiotherapy series was investigated in cases of recurrent breast cancer.MethodsForty-two patients treated from 1993 to 2003 with resection (n = 30) and postoperative re-irradiation or definitive re-irradiation (n = 12) for recurrent breast cancer were enrolled in the study. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy.ResultsAfter a median follow-up of 41 months (range 3-92 months) higher graded late toxicity > G3 according to CTC 3.0 and LENT-SOMA was not observed. The estimated 5-year local control rate reached 62%. The estimated 5-year overall survival rate was 59%. Significantly inferior survival was associated with recurrence within two years (40 vs. 71%, p < ([0-9]).01) and presence of macroscopic tumour load (24 vs. 75%, p = 0.03).ConclusionsRepeat radiotherapy for recurrent breast cancer with total radiation doses of 60 Gy and the addition of hyperthermia in the majority of patients was feasible, with acceptable late morbidity and improved prognosis, particularly in patients with previous resection of recurrent tumours.
Highlights
Repeat radiation is a rarely used treatment strategy that must be performed with caution
The routine addition of a second radiotherapy series is accompanied by major concerns regarding side effects, as cumulative radiation doses reach or exceed 100 Gy, which may lead to an increased rate of late complications
Between 1993 and 2003, 42 women with locoregional recurrent breast cancer were treated with a macroscopically complete resection plus subsequent re-irradiation of the chest wall (n = 30) or definitive radiotherapy (n = 12) at the University of Tübingen. For inclusion in this retrospective analysis, patients had to fulfill the following criteria: All patients had been initially treated for invasive breast cancer using mastectomy or breast conserving surgery, both combined with adjuvant radiotherapy of the whole breast or the chest wall including regional lymphatics, or a radiation boost if indicated
Summary
Repeat radiation is a rarely used treatment strategy that must be performed with caution. The efficacy and toxicity of a second curative radiotherapy series was investigated in cases of recurrent breast cancer. Treating chest wall recurrences after mastectomy with re-surgery alone provides limited local control for onethird of patients [6]. Combined treatment of chest wall recurrences i.e. excision plus irradiation revealed superior local control of 48 vs 34% after five years in single institution series [7]. Re-irradiation combined with additional hyperthermia enhanced efficacy i.e. local control compared to radiotherapy alone by approximately 20% [8,9]. On the basis of the results from these prospective trials, thermoradiotherapy has become a standard treatment for patients with irresectable recurrent lesions those in previously irradiated areas
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