title: Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer.
abstract: OBJECTIVE
  To review the toxicity and clinical outcomes for patients who underwent repeat chest wall or breast irradiation (RT) after local recurrence.
  
  
  METHODS
  Between 1993 and 2005, 81 patients underwent repeat RT of the breast or chest wall for locally recurrent breast cancer at eight institutions. The median dose of the first course of RT was 60 Gy and was 48 Gy for the second course. The median total radiation dose was 106 Gy (range, 74.4-137.5 Gy). At the second RT course, 20% received twice-daily RT, 54% were treated with concurrent hyperthermia, and 54% received concurrent chemotherapy.
  
  
  RESULTS
  The median follow-up from the second RT course was 12 months (range, 1-144 months). Four patients developed late Grade 3 or 4 toxicity. However, 25 patients had follow-up >20 months, and no late Grade 3 or 4 toxicities were noted. No treatment-related deaths occurred. The development of Grade 3 or 4 late toxicity was not associated with any repeat RT variables. The overall complete response rate was 57%. No repeat RT parameters were associated with an improved complete response rate, although a trend was noted for an improved complete response with the addition of hyperthermia that was close to reaching statistical significance (67% vs. 39%, p = 0.08). The 1-year local disease-free survival rate for patients with gross disease was 53% compared with 100% for those without gross disease (p < 0.0001).
  
  
  CONCLUSIONS
  The results of our study have shown that repeat RT of the chest wall for patients with locally recurrent breast cancer is feasible, because it is associated with acceptable acute and late morbidity and encouraging local response rates.
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Wahl
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Krystyna D
authors.initials: KD
authors.lastname: Kiel
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Jones
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.forename: Victoria
authors.initials: V
authors.lastname: Croog
authors.forename: Beryl M
authors.initials: BM
authors.lastname: McCormick
authors.forename: Arica
authors.initials: A
authors.lastname: Hirsch
authors.forename: Ami
authors.initials: A
authors.lastname: Karkar
authors.forename: Sabin B
authors.initials: SB
authors.lastname: Motwani
authors.forename: Welela
authors.initials: W
authors.lastname: Tereffe
authors.forename: Tse-Kuan
authors.initials: TK
authors.lastname: Yu
authors.forename: David
authors.initials: D
authors.lastname: Sher
authors.forename: Joshua
authors.initials: J
authors.lastname: Silverstein
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.forename: Christy
authors.initials: C
authors.lastname: Kesslering
authors.forename: Gary M
authors.initials: GM
authors.lastname: Freedman
authors.forename: William
authors.initials: W
authors.lastname: Small
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000628:therapy; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D019233:Retreatment; D035441:Thoracic Wall
chemical_list: D000970:Antineoplastic Agents