Re-surgery and chest wall re-irradiation for recurrent breast cancer: a second curative approach

Abstract

Background: 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.

Methods: Forty-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.

Results: After 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).

Conclusions: Repeat 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.

Figure 1

Local control and survival parameters. Local control (a), distant disease-free survival (b), disease-free survival (c) and overall survival were estimated using the Kaplan-Meier-method after a median follow-up of 41 months. The parameters were calculated from time of re-irradiation for recurrence.

Figure 2

Impact of treatment- and tumour-related parameters on overall survival. Overall survival was significantly influenced by surgery of recurrence (a) and resection margin (b). R0-resection led to prolonged overall survival in contrast to patients with gross residual disease (80% vs. 29%, p = 0.04). Furthermore, time to first recurrence less than two years was associated with a significant detrimental effect on overall survival (c). A trend to prolonged overall survival was detected in patients without nodal involvement at initial diagnosis of breast cancer (d). All parameters were calculated from time of re-irradiation for recurrence.