Salvage radiotherapy for local failures of lumpectomy and breast irradiation

Abstract

Background and Purpose: In-breast tumor recurrence (IBTR) following lumpectomy and breast irradiation is usually managed by mastectomy. For women who refused mastectomy at the time of an IBTR, a repeat course of radiotherapy following repeat lumpectomy was offered. Materials and methods: Sixteen women with an IBTR following lumpectomy, axillary node dissection and breast irradiation were treated with repeat lumpectomy and radiotherapy to the operative area. Fifteen patients received 5000 cGy/25 fractions. One patient discontinued radiotherapy for non-medical reasons after having received only 3200 cGy/16 fractions. The interval from completion of the initial course of radiotherapy to documentation of IBTR varied from 10–130 months (median 31 months). Results: Four patients (20%) have had further local failure. Ten of sixteen patients (62.5%) are alive and free or disease at 42–119 months from completion of the repeat course of radiotherapy. Of these latter patients, one had another in-breast tumor recurrence treated by excision alone and another had an in-breast tumor recurrence in the contra lateral breast post-lumpectomy and irradiation. Four patients died with distant metastasis, one is currently alive with contralateral breast cancer and distant metastasis, and one is alive with an extensive recurrence in the re-irradiated breast. Two of the patients with distant metastasis had abnormal bone scans at the time they received the repeat course of radiotherapy. There have been no severe late sequelae from the repeat course of radiotherapy. Conclusions: For selected patients, a repeat course of radiotherapy for an IBTR following lumpectomy and radiotherapy is well tolerated and may provide long-term local control.