[Reirradiation of chest wall local recurrences from breast cancer].
OBJECTIVE
The aim of this article was to describe the radio-therapeutic treatment options in previously irradiated patients suffering from breast cancer local recurrences and to review the literature.


METHODS
Reirradiation of the chest wall can be performed using electron beams or alternatively CLDR/PDR (continuous/pulsed low dose rate) brachytherapy techniques with large skin moulds. With both techniques high doses can be applied to the chest wall while deeper-seated organs (lung, heart) can be spared to a large extent. Electron-beam therapy is readily available and the depth of treatment can be easily controlled by selecting the appropriate energy. The protracted irradiation schedule of CLDR/PDR brachytherapy results due to radiobiological reasons in a broad therapeutic ratio and safe treatment time.


RESULTS
In the literature, more than 250 cases being reirradiated for chest wall local recurrences have been published. After retreatment using electron beams complete remissions were obtained in 41-74 % of the patients (brachytherapy 79-82 %). Severe grade IV complications (RTOG/EORTC) occurred in less than 10 % of the patients.


CONCLUSIONS
With regard to the limited treatment options reirradiation of chest wall local recurrences resulted in high local control rates while toxicity remained acceptable. These data weaken the radio-therapeutic dogma that reirradiation of the chest wall may not be possible.
Harms
W
W
Universität Heidelberg, Radiologische Klinik, Abteilung für Klinische Radiologie, INF 400, 69190 Heidelberg. wolfgang_harms@med.uni-heidelberg.de
Krempien
R
R
Grehn
C
C
Hensley
F
F
Berns
C
C
Wannenmacher
M
M
Debus
J
J
D001918:Brachytherapy; D001943:Breast Neoplasms / Q000532:radiotherapy*; D004583:Electrons; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D035441:Thoracic Wall / Q000528:radiation effects; D016896:Treatment Outcome