title: Results of chest wall reirradiation using pulsed-dose-rate (PDR) brachytherapy molds for breast cancer local recurrences.
abstract: OBJECTIVE
  We report in a retrospective study on the effect and toxicity of chest wall reirradiation using pulsed-dose-rate (PDR) afterloading molds.
  
  
  METHODS
  Between 1993 and 1999, a total of 58 patients were treated. All patients presented with locally recurrent breast cancer (31 patients had concomitant distant metastases) after mastectomy and a previously completed course of radiation therapy (median, 54 Gy; range, 36-70). Indication for reirradiation was a progressive macroscopic skin recurrence in 30 cases and an incomplete surgical resection in 28 patients. Standard treatment consisted of a split course with two fractions of 20 Gy (interval, 31 days). The reference dose was prescribed to the skin surface at 5 mm distance from the source. PDR brachytherapy (37 GBq, (192)Ir) was carried out after geometric distance optimization with 0.5-1 Gy/pulse/h. The irradiated median area was 423 cm(2) (range, 100-919). The median follow-up was 18 months (range, 7-84).
  
  
  RESULTS
  The actuarial 1-, 2- and 3-year local recurrence-free survival rates in patients treated for macroscopic disease (microscopic disease in parenthesis) were 89% (96%), 81% (85%), and 75% (71%). Local control was obtained in 24/30 (22/28) patients. Twenty-nine of the 34 patients (85%) who deceased during follow-up were locally controlled. 9/58 patients experienced Grade III acute toxicity, 35/58 patients Grade III (29/58 telangiectasia, 6/58 contracture), and 4/58 Grade IV late toxicity (RTOG/EORTC).
  
  
  CONCLUSIONS
  Reirradiation of the chest wall using PDR brachytherapy molds is effective and provides a high local control rate with acceptable toxicity.
authors.affiliation: Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany. wolfgang_harms@med.uni-heidelberg.de
authors.forename: W
authors.initials: W
authors.lastname: Harms
authors.forename: R
authors.initials: R
authors.lastname: Krempien
authors.forename: F W
authors.initials: FW
authors.lastname: Hensley
authors.forename: C
authors.initials: C
authors.lastname: Berns
authors.forename: M
authors.initials: M
authors.lastname: Wannenmacher
authors.forename: P
authors.initials: P
authors.lastname: Fritz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation*; D001940:Breast; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008953:Models, Anatomic; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D055585:Physical Phenomena; D010825:Physics; D011855:Radiodermatitis / Q000209:etiology* / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D013909:Thorax