Evaluation of predictive factors for local tumour control after electron-beam-rotation irradiation of the chest wall in locally advanced breast cancer.
OBJECTIVE
Different radiotherapy techniques are being used for chest wall irradiation after mastectomy. We review our results with the electron-beam-rotation technique in a series of 130 high risk breast cancer patients. The main end point of the study was local tumour control; secondary end points were disease free survival, and overall survival, as well as acute and late side effects.


METHODS
From January 1990 to June 1995, 89 patients underwent electron-beam-rotation irradiation of the chest wall after primary mastectomy and axillary lymph node dissection (group I) and 41 patients after excision of local recurrent breast cancer (group II) with 4 x 2.5 Gy/week to 50 Gy total dose (4-12 MeV electrons depending on the thickness of the chest wall). In addition, irradiation of local-regional lymph nodes and/or a local boost of 10 Gy were applied dependent on the resection and node status.


RESULTS
After a median follow up of 29 months (65% stadium III/IV) the 3 year local tumour control, disease free survival, and overall survival were 73%, 47%, and 75%, respectively. Local control in group I was 78% versus 60% in group II. Significant predictors for local tumour control, disease free survival, and overall survival were resection status (R0 versus R1/2) and estrogen receptor status (positive versus negative). In group I, tumour grading (GI-IIa versus GIIb-III) and estrogen receptor status were found to be additional significant prognostic factors for complete resected tumours. Five patients developed symptomatic pneumonitis (< 4%) and one patient developed a chronic fistula at the resection. A significant correlation between the degree of acute skin reaction and persistent pigmentation was observed.


CONCLUSIONS
In high risk breast cancer patients postoperative irradiation with the electron-beam-rotation technique of the chest wall is an effective therapy resulting in 78% local tumour control at 3 years for locally advanced breast cancer and 60% for recurrent disease. The rate of acute and late toxicity is low. The degree of acute skin reaction correlates with the degree of persistent pigmentation.
Department of Radiotherapy and Oncology, CRONA, Tübingen, Germany.
T
T
Hehr
W
W
Budach
F
F
Paulsen
C
C
Gromoll
G
G
Christ
M
M
Bamberg
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017577:Cutaneous Fistula / Q000209:etiology; D018572:Disease-Free Survival; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000528:radiation effects; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control* / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D010859:Pigmentation Disorders / Q000209:etiology; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology; D017564:Radiation Pneumonitis / Q000209:etiology; D011879:Radiotherapy Dosage; D011960:Receptors, Estrogen / Q000032:analysis; D012307:Risk Factors; D015996:Survival Rate; D013909:Thorax / Q000528:radiation effects*
D011960:Receptors, Estrogen