title: Locally recurrent breast cancer: pulse dose rate brachytherapy for repeat irradiation following lumpectomy-- a second chance to preserve the breast.
abstract: OBJECTIVE
  To perform and assess the effectiveness of local excision of recurrent tumor followed by postoperative pulse dose rate (PDR) brachytherapy.
  
  
  METHODS
  From 1994 to 2000, 17 patients who had small recurrent breast carcinomas after initially undergoing breast-conserving therapy (BCT), which included postoperative radiation therapy, were treated with local tumor excision and PDR brachytherapy. Recurrences occurred at a median time of 50 months (range, 11-208 months) after primary treatment. Eight patients underwent a combination of PDR brachytherapy (total dose range, 12.5-28.0 Gy) and external-beam radiation therapy (EBT) (total dose range, 12-30 Gy). Nine patients underwent radiation therapy with 40.2-50.0-Gy PDR brachytherapy only. The prescribed radiation dose was 0.5-1.0 Gy per pulse. Patients were examined for local tumor control and treatment-related side effects.
  
  
  RESULTS
  Twelve of 17 patients had no local tumor at a median follow-up time of 59 months (range, 20-84 months); two of these patients showed signs of having distant disease. One patient died after a cerebral stroke without evidence of tumor. Four women treated with combined EBT and brachytherapy had secondary local tumor recurrences 4, 8, 8, and 11 months after therapy and had to undergo mastectomy. Despite having undergone radiation therapy previously, patients had side effects limited to moderate (grade 1-2) fibrosis.
  
  
  CONCLUSIONS
  Local tumor excision combined with PDR brachytherapy for small local-regional tumor recurrences after primary BCT is feasible and well tolerated and might obviate mastectomy. Preliminary experiences are encouraging. Further studies are required for appropriate patient selection.
authors.affiliation: Department of Radiotherapy and Radiology, Vienna University, Währinger Gürtel 18-20, 1090 Vienna, Austria. alexandra.resch@univie.ac.at
authors.forename: Alexandra
authors.initials: A
authors.lastname: Resch
authors.forename: Claudia
authors.initials: C
authors.lastname: Fellner
authors.forename: Ulrike
authors.initials: U
authors.lastname: Mock
authors.forename: Leonore
authors.initials: L
authors.lastname: Handl-Zeller
authors.forename: Eva
authors.initials: E
authors.lastname: Biber
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Seitz
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013997:Time Factors