Local Cancer Recurrence Research Articles

HPB SO43 - Meta-analysis of completion pancreatectomy for local recurrence of pancreatic cancer after the index pancreatectomy

Abstract Background Poor prognosis post-resection of pancreatic cancer is owed to a high rates of cancer recurrence (approximately 80%) despite complete surgical resection being achieved. The role of surgical re-resection in patients with recurrent pancreatic cancer is unclear. Several studies have reported survival benefit of repeat pancreatectomy for selected patients with local recurrence in the remnant pancreas after the index pancreatectomy. We aimed to conduct a comprehensive systematic review and meta-analysis of best available evidence to evaluate survival outcomes of completion pancreatectomy for locally recurrent pancreatic cancer following index pancreatectomy. Method A systematic search of electronic data sources and bibliographic reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data. Results Fifteen retrospective studies were included reporting a total of 250 patients who underwent completion pancreatectomy for locally recurrent pancreatic cancer following their index pancreatectomy. Completion pancreatectomy was associated with 1-year survival of 70.6% (95% CI 65.0%-76.2%), 2-year survival of 38.8% (95% CI 28.6%-49.0%), 3-year survival of 20.2% (95% CI 13.8%-26.7%), and 5-year survival of 9.2% (95% CI 5.5%-12.8%). The between-study heterogeneity was insignificant in all outcome syntheses. Conclusion Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favourable tumour size and location. Our findings may encourage conduction of better-quality studies in this context to provide stronger evidence.

Reverse resistance to immune checkpoint inhibitor in a patient with recurrent cardia cancer by intratumoral injection of recombinant human adenovirus type 5: a case report and literature review

Advanced metastatic cardia cancer is an intractable malignance with poor prognosis. It is often accompanied by upper digestive tract obstruction, which seriously affects the quality of patients. Therefore, effective relief of eating obstruction is an important goal in the treatment of cardia cancer. Immune checkpoint inhibitors (ICIs) have shown significant efficacy in cardia cancer, but only a small percentage of patients will benefit from them due to immune resistance. Oncolytic viruses have been shown to enhance the efficacy of ICIs by altering the immune microenvironment. This indicates that oncolytic virus has the potential value of overcoming the immune resistance of cardia cancer. Here, we present a case with local recurrent and multiple metastatic cardia cancer accompanied by eating obstruction. After 4 cycles of chemotherapy plus ICI therapy, the patient´s metastases were significant shrink, but the recurrent carida lesion were almost unchanged. Then we implemented exploratory local injection of recombinant human adenovirus type 5(H101) into recurrent cardia lesion by painless gastroscopy. Surprisingly, the cardia lesion shrank significantly, and the eating obstruction was greatly relieved. We also observed a significant increase of infiltrated CD4+T cells in biopsy tissues after H101 treatment. Our study not only conformed the value of oncolytic viruses to reverse ICI resistance in patients with gastric cancer, but also revealed its underlying impact on immune microenvironment.

PSOR09 Presentation Time: 12:10 PM: Initial Clinical Outcomes of a Phase II Trial of Focal Salvage LDR Brachytherapy for Local Recurrence of Prostate Cancer after External Beam Radiation Therapy

PSOR09 Presentation Time: 12:10 PM: Initial Clinical Outcomes of a Phase II Trial of Focal Salvage LDR Brachytherapy for Local Recurrence of Prostate Cancer after External Beam Radiation Therapy

Immediate Breast Reconstruction for Inflammatory Breast Carcinoma: A Scoping Review.

Inflammatory breast carcinoma (IBC) is an aggressive form of breast cancer involving skin lymphatics. Breast reconstruction traditionally has been delayed in IBC. Immediate reconstruction has been described in select patients. Studies evaluating the reconstructive and oncologic safety of immediate breast reconstruction in this patient population are limited and retrospective. The purpose of this study is to assess the current body of literature on immediate breast reconstruction in IBC patients to identify knowledge gaps. A scoping review was conducted using PubMed, Scopus, Embase, and Cochrane databases. Original articles that evaluated patients diagnosed with IBC who underwent immediate breast reconstruction were included. The search yielded 821 articles, of which 9 articles containing 1429 IBC patients were included for analysis. Immediate implant-based reconstruction occurred in 12.2% (174/1429) of patients. Immediate autologous reconstruction occurred in 19.0% (272/1429). Immediate reconstruction with both autologous and implant-based techniques was 4.5% (64/1429). Reconstruction type was not reported for 63.0% (899/1429) of patients. Postoperative complications occurred in 1.8% (26/1429) of patients. Local cancer recurrence was 14.3% (3/21) at 18.9 months. The mortality rate was 32.4% (131/404) at 22 months. Performance of immediate breast reconstruction can be safely performed from a reconstructive standpoint in select patients.

Antiproliferative Activity of Green Process Synthesized Epipremnum Aureum Silver Nanoparticles Against Breast Cancer Mcf-7 Cells

Breast cancer (BC) is one of the most severe cancers among women globally. Local recurrence of cancer after surgery is usually seen as a poor predictor of prognosis. Cancer treatment has been significantly transformed by the progress made in nanotechnology, and nanoparticles have emerged as pivotal components in this domain. Metal nanoparticles are produced using plant extract in green synthesis or eco-friendly techniques for the stabilizing and reducing substance. The current research study synthesizes silver nanoparticles (AgNPs) from Epipremnum aureum leaf extract using the green synthesis method and its evaluations using UV-Vis, FTIR, XRD, SEM, and EDX characterization techniques. The EA-AgNPs exhibit a significant absorption peak at wavelength 420 nm, which confirms the AgNP's presence by UV-visible spectrometer. FTIR spectrum reveals the strong band at 1586.020 cm-1 confirming the O-H group presence. The stretching and bending modes of vibration of the NO32- a sharp band represented molecule at 1382.987 cm-1 and a very tiny band at 1272.241, 1077.355 cm-1. The XRD spectrum exclusively showed Ag peaks, with no additional chemical contaminants, signifying the sample's purity, and the average particle size was 12.92 nm. MTT assay result observed high cytotoxic activity of EA-AgNPs against MCF-7 cells with IC50= 0.1106 µg/ml. This research study aims to preliminary investigate the in-vitro antiproliferative activity of green process synthesized Epipremnum Aureum silver nanoparticles (EA-AgNPs) against breast cancer cell line (MCF-7).

A case of undifferentiated pleomorphic sarcoma of the thoracic wall poorly differentiated from local recurrence of lung cancer

A case of undifferentiated pleomorphic sarcoma of the thoracic wall poorly differentiated from local recurrence of lung cancer

Application of free forearm flap in reconstruction of postoperative defect of external nasal malignant tumor

Objective:To investigate the therapeutic effect of free forearm flaps in repairing the postoperative defect of external nasal malignant tumor. Methods:Six patients with nasal malignant tumor were treated with radical operation of external nasal malignant tumor and simultaneous reconstruction of external nasal defects with free forearm flap. Preoperative Allen experiment, ultrasonic Doppler blood flow meter or CT angiography confirmed that the forearm blood vessels were in good condition. Results:The free forearm flaps were obtained from six patients, and completely survived. During the follow-up period of 6-12months, all patients had good external nasal morphology, good nasal function, no nasal obstruction and anterior nostril stenosis, no obvious complications in donor hand and no local cancer recurrence. Conclusion:The free forearm flap is a reliable method to reconstruction the postoperative defect of external nasal malignant tumor, with a high success rate and good recovery of morphology and function recovery.

Five-year experience with titanium mesh for rigid chest wall reconstruction

ObjectiveTo characterize the performance of titanium mesh (TM) (off-label) for rigid chest wall reconstruction at a single institution over a 5-year period. MethodsBetween January 1, 2019, and May 15, 2023, 22 patients (median age, 61 years) underwent chest wall resection with TM reconstruction at Cleveland Clinic. Indications for resection included sarcoma (n = 15), breast cancer (n = 2), lung cancer (n = 2), chondroblastoma (n = 1), and benign neoplasm (n = 2). Patients were followed every 6 months with computed tomography scans for cancer recurrence. Continuous variables are summarized as median (interquartile range [IQR]); categorical variables, as frequency and percentage. Time to mesh fracture was assessed nonparametrically using Kaplan-Meier analysis. ResultsAmong the 22 patients over 21,870 patient-days of TM implantation, 21 (95%) had an R0 resection. The mean area of mesh coverage was 108 cm2 (IQR, 97-180 cm2). No patient experienced respiratory complications or mesh failure postoperatively. Of the 3 reoperations (13.6%), 2 were for delayed regional infection (at 7 and 12 months postoperatively), necessitating localized mesh removal, and the third was for local cancer recurrence. Fifteen implants developed visible fractures on imaging at a median time of 9 months after implantation. There were no adverse sequelae, including migration/erosion or clinical decline in respiratory function. ConclusionsChest wall resections, particularly those for sarcomas, require large margins for optimal oncologic outcomes. Rigid reconstruction of large defects is desirable, yet options are limited. TM reconstruction provides a promising alternative because of its biocompatibility, rigidity, robust incorporation into surrounding structures, and resistance to infection.

Residual breast tissue after mastectomy and reconstruction: A substudy of the Spatial location of breast cancer local rECurRence aftEr masTectomy (SECRET) project

The current project is part of the Spatial location of breast cancer local rECurRence aftEr masTectomy (SECRET) study (NCT06130111). Herein we compared the chest wall thickness after non-skin sparing mastectomy (non-SSM) with the chest wall thickness after SSM, as a surrogate for residual breast tissue after mastectomy. MethodsThe study was approved by the ethics committee of relevant institutions. Data of patients with a local recurrence (LR) after non-SSM was collected from the Netherlands Cancer Registry (NCR); data of patients undergoing SSM were collected from Sheba Medical Center. Student's t-test was used to evaluate the difference between the cohorts. Chest wall thickness was measured on postoperative images. ResultsOut of 4949 patients who underwent mastectomy from the NCR cohort, a total of 173 (3.5 %) had a LR at 5 years, of these a total of 153 patients included in the non-SSM cohort. The median age was 59 years (age 33–92), LR occurred at a median of 23.6 months (2.5–60 months). The SSM cohort included 84 patients, with a median age of 38.4 years (28–63.5), overall, 5 LRs occurred at a median of 15 months (5–46 months). The SSM cohort had significantly thicker chest walls compared to non-SSM (p < 0.001). Most LRs in both groups occurred in the subcutis. ConclusionThe chest wall thickness differed according to mastectomy procedures. Most of the LR occurred at the subcutis. The role of residual breast tissue and residual cancer in relation to type of mastectomy should be further investigated.

Current State of Evidence-Based Long-Term Monitoring Protocols for Breast Plastic Surgery Patients

BackgroundRecommendations for breast surveillance following breast plastic surgery are frequently changing. Establishing guidelines for long-term monitoring protocols may help identify treatable conditions and prevent untoward sequelae. We sought to evaluate the current state of evidence-based long-term monitoring protocols for patients following breast augmentation, reduction, and breast reconstruction.MethodsOfficial guidelines from various American societies and international societies were analyzed for alignment in evidence-based recommendations regarding breast surveillance.ResultsThe most recent US FDA update recommends magnetic resonance imaging or ultrasound starting 5–6 years after surgery and every 2–3 years thereafter. Discrepancies exist among professional societies: the American Society of Plastic Surgeons (ASPS) aligns with the FDA, while the American Society of Breast Surgeons and American College of Radiology (ACR) find no role for imaging for asymptomatic cases. Ultrasound is first-line for any implant concerns, with MRI if necessary. European societies oppose routine breast implant imaging. Breast reduction patients lack unique screening protocols; monitoring aligns with age and cancer risk factors. Following mastectomy and breast reconstruction, most organizations advocate for annual clinical examinations, with more frequent examinations initially. Evidence suggests that physical examination is sufficient to detect local cancer recurrence, with imaging only indicated if there is concern for recurrence. No surveillance imaging is recommended by the American Society of Clinical Oncology, National Comprehensive Cancer Network, or ASPS; however, ACR recommends mammography for autologous reconstruction only.ConclusionMultispecialty and regulatory body alignment may promote provider and patient adherence. Ongoing studies of long-term outcomes are needed to strengthen the level of evidence for monitoring guidelines.

72321 - Validation of the reporting of local recurrence of rectal cancer in the Swedish ColoRectal Cancer Registry (SCRCR)

72321 - Validation of the reporting of local recurrence of rectal cancer in the Swedish ColoRectal Cancer Registry (SCRCR)

Actinomycosis masquerading recurrent carcinoma after hemicolectomy - A rare case report

Abdominal actinomycosis is a chronic suppurative infection caused by anaerobic bacteria, Actinomyces species. The ileocecal region is most commonly affected, while the left side of the colon is more rarely involved. The presentation may vary from non-specific symptoms and signs to an acute abdomen. We present the case of colonic actinomycosis in a 74-year-old woman who had undergone left hemicolectomy due to carcinoma of the sigmoid colon and became infected with actinomycosis at the anastomotic site, which mimicked local recurrence of cancer. The patient presented with intermittent colicky left-sided abdominal pain for 3 months’ duration. Computed tomography of the abdomen showed a circumferential thickening of the wall of the sigmoid colon surrounded by inflammation. The patient underwent resection of the bowel including the anastomotic site. The macroscopic evaluation revealed mucosal irregularities with abscesses attached to the sigmoid colon and histopathological examination of the specimen revealed actinomycosis of the sigmoid colon with no evidence of malignancy. We are presenting this case to illustrate the preoperative diagnostic difficulties of this rare disease and its ability to mimic malignancy.

Clinical features and prognosis of conjunctival melanoma in Japanese patients.

To evaluate the clinical features and prognosis of conjunctival melanoma in Japanese patients. Retrospective observational case series. Twenty patients (8 men and 12 women) diagnosed with conjunctival melanoma at a singlehospital between 2003 and 2017 were analyzed. Data on clinical presentation, sex, age, the affected eye, tumor location, tumor origin, tumor stage according to the American Joint Committee on Cancer staging system (eighth edition), treatment, outcomes, local recurrence, metastasis, and survival were extracted from the patients' medical records and reviewed. The mean age at diagnosis was 64.2 ± 14.8 years. Tumor locations at the first examination included the bulbar conjunctiva (n = 19), plica (n = 13), and fornix (n = 12). The tumor stage was T1 in 5 cases (25%), T2 in 12 cases (60%), T3 in 3 cases (15%), and T4 in none. The mean follow-up duration was 91.7 ± 46.0 months. The local recurrence rates at 1, 5, and 10 years were 5.0%, 18.8%, and 31.5%, respectively, whilst the metastasis rates were 5.0%, 25.6%, and 32.4%, respectively. Four of the 6 patients who experienced metastasis died; duration from metastasis to death was 17.5 months (range, 7-25). The 5-year survival rate for conjunctival melanoma was 78.8%. Tumor thickness was significantly associated with survival duration on univariate Cox regression analyses. The mortality rate for conjunctival melanoma in the Japanese population was lower and higher than that reported in the Chinese and United States populations, respectively. Tumor thickness was a prognostic factor for survival in patients with conjunctival melanoma.

Electrospun amygdalin and Inula helenium extract-loaded polylactic acid (PLA)/Polyvinylpyrrolidone (PVP) nanofibrous patches for colon cancer treatment: Fabrication, characterization and antitumour effect results

In this study, 75PLA/25PVP nanofibrous loaded with amygdalin (AMG) and Inula helenium (I.H) extract were produced by electrospinning method in order to prevent local colon cancer recurrence, and the effect of the produced nanofibrous on the HCT-116 cell line was examined in vitro. When the scanning electron microscopy (SEM) images were examined, the fiber diameter of the 75PLA/25PVP group was measured as 443.74 ± 79 nm, but the addition of I.H and AMG caused a thickening effect on the fiber diameters. Drug release results show the controlled release period of 75PLA/25PVP/I.H and 75PLA/25PVP/AMG loaded nanofibrous patches within 180 h. Slowly degrading nanofibrous remained durable for up to 25 days. When the in vitro cytotoxicity results were analyzed, all nanofibrous were found to be effective in inducing cytotoxicity against HCT-116 colon cancer cells. The most effective group is the group in which I.H extract and AMG drug are loaded onto the nanofibrous together. AMG drug and I.H plant extract showed effects on the colon cancer cell line in in vitro experiments. Considering all the results I.H and AMG loaded nanofibrous can be implanted into solid tumor cells in order to reduce the risk of local recurrence of cancer after surgery in colon cancer.

1211 Patterns of Recurrences After Mastectomy for Invasive Breast Cancer and DCIS Followed by Immediate Breast Reconstruction: 13-Year Follow-Up from a Single institution

Abstract Aim A retrospective review was conducted at a single centre to analyse the patterns of recurrence in IBR. Method Between January 2009 and December 2021, 347 patients who had IBR for either invasive (244) or DCIS (125), were analysed retrospectively. The study included patients who received implants without ADM (10.8%), ADM with +implant (69%), Latissimus Dorsi flap +/- implant (18.1%), and deep inferior epigastric perforator-free flaps (2.5%). Results During the study period, 29 patients developed recurrence over a median period of 74 months (ranging from 24 to 125 months). Two patients had local cancer recurrence only (0.5%), 5 patients had local recurrence associated with distant or regional metastasis, (1.4%) and 19 cases with distal metastasis were identified (8.3%). The study found an overall survival rate of 96.4% and a disease-free survival rate of 91.7%. The most familiar sites of recurrence in breast cancer are distal recurrence, (Bone being the most common site), followed by local recurrence. Discussion This rate is in line with the expected range, assuming a standard of recurrence of 1% per year. Nevertheless, it is crucial to acknowledge the possibility of selection bias, as patients with advanced diseases and significant comorbidities may not have been offered IBR. Conclusions Based on the findings of the study, it can be inferred that mastectomy with (IBR) is a safe option for mastectomy.

Hypofractionated Partial Breast Reirradiation in the Conservative Retreatment of Breast Cancer Local Recurrence

Aimto evaluate the outcome of partial breast re-irradiation (re-PBI) with intensity modulated RT (IMRT), using a hypofractionated scheme for breast cancer (BC) local recurrence (LR) operated on with repeat breast-conserving surgery (re-BCS). MethodsIMRT-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence (CumI) of 2ndLR, toxicity, disease-free (DFS), BC specific (BCSS), and overall (OS) survival were evaluated. ResultsBetween 5/2012 and 5/2021, 70 patients had re-PBI. Median follow-up (FU) was 6.3 years (Q1-Q3, 4.0-8.1.). Median age at 1stLR was 62. The median primary BC-1stLR interval was 12.4 years (range: 1.6-26.7). Luminal A-like 1stLR accounted for 41% of the cases and median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: three 2snLRs (corresponding to 8-y Cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BCSS and OS were 76%, 90%, and 90%, respectively. At multivariate analysis, Grade 3 and extensive intraductal component were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis and cosmesis was deemed good/excellent in just over 60% of the cases. ConclusionRe-PBI after re-BCS represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice

Pharyngeal Constrictor-Sparing Salvage Stereotactic Body Radiation Therapy With Tongue-Out for In-Field Recurrence After Definitive Radiation Therapy for Head and Neck Cancer: Guide to Tongue-Out Radiation Therapy

This report details a pharyngeal constrictor muscle (PCM)–sparing stereotactic body radiation therapy (SBRT) using our institutional technique of “tongue-out” radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTVuvula) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients’ reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTVuvula abutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-to-GTVuvula was increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving ≥ 60% prescription dose (V60%Rx), V80%Rx, and V100%Rx to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (Dmax) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTVuvula were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully finished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment.

Combined Pubic Arch and Ischial Bone Resection for Metachronous and Frequent Local Recurrences of Rectal Cancer.

Complete surgical resection with negative margins remains the cornerstone for curative treatment of rectal cancer; however, local recurrence can pose a significant challenge. Herein, we aimed to introduce a novel surgical technique for combined resection of the pubic arch and ischial bone in the context of treating recurrent rectal cancer. We present a case of a patient with a fourth local recurrence of rectal cancer, with no evidence of distant metastasis. The tumor directly invaded the posterior wall of the pubic arch. To achieve complete tumor resection, an osteotomy was performed using a thread wire saw at the bilateral pubic rami and ischial bones. Intraoperative frozen section analysis (rapid tissue examination) was conducted on tissue samples from the lateral margins of the planned osteotomy line. Samples were negative for adenocarcinoma (cancerous cells). The combined resection of the pubic arch and ischial bone was successfully performed with negative margins for adenocarcinoma, as confirmed by frozen section analysis. Mastery of the surgical technique for combined resection of the pubic arch and ischial bone may be clinically significant for achieving complete resection in cases of multiple resections for locally recurrent rectal cancer.

Local Recurrence of Postoperative Prostate Cancer, Treatment and Toxicity with Stereotactic Body Radiotherapy (SBRT): A Case Report

Background: Prostate cancer remains a major health concern worldwide, and postoperative recurrences are a significant challenge in its treatment. Various treatment modalities have been studied, but consensus on optimal strategies has not yet been established. This case report examines the feasibility and toxicity of stereotactic body radiation therapy (SBRT) as a therapeutic option for postoperative recurrences of prostate cancer. Case presentation: A 68-year-old man with a history of prostate cancer, initially treated with radical prostatectomy, who presented biochemical recurrence. Diagnostic imaging revealed a 9 mm nodule in the prostate bed, which was treated by SBRT guided by ultrasound visualization. The patient tolerated the treatment well, experiencing minimal genitourinary and gastrointestinal discomfort. Discussion: Multiple treatment alternatives exist for post-prostatectomy recurrence. Retrospective studies have suggested the efficacy of SBRT, although they lack robust empirical evidence. Recent investigations have highlighted the safety profile of SBRT, emphasizing the need for further exploration, particularly in image-guided radiotherapy. Conclusion: SBRT guided by ultrasound visualization emerges as a promising option for ablative treatment of postprostatectomy recurrence, offering a favorable safety profile and encouraging oncologic outcomes. Further research is needed to further clarify its role in salvage radiotherapy for localized recurrences.

Incidence of local breast cancer recurrence with delayed radiation therapy.

The purpose of this research was to examine the probability of ipsilateral breast cancer recurrence in individuals whose RT was delayed after the first chemotherapy and surgery. To analyze the effect of delaying RT for breast cancer patients (by more than 6weeks after treatment). A retrospective analysis comprised 136 female breast cancer patients treated at the Baghdad Centre for Radiation Oncology and Nuclear Medicine from 2021 to May 2022. External beam radiation was started more than 6weeks after chemotherapy was finished for all patients who also had surgery. Clinical examination and ultrasound were part of the follow-up process. Patients' ages varied from 28 to 71, and the majority (83%) had a mastectomy. The majority of cases (95.5%) were diagnosed as invasive ductal carcinoma on histopathology, with 49.6% being at stage 2 and 42.6% being at stage 3. Seventy-six percent of patients tested positive for hormones. Although 10 patients (7.35%) acquired distant metastases within 5years, only 2 (1.47%) had local recurrence because of the delay in RT. Specifically, 91.1% had complete local control with no evidence of disease spread. Delaying RT by more than 6weeks in patients with breast cancer did not substantially affect local control, according to the results of a new research, the first of its type in Iraq.