The feasibility of a second lumpectomy and breast brachytherapy for localized cancer in a breast previously treated with lumpectomy and radiation therapy for breast cancer.
OBJECTIVE
With accumulating evidence supporting partial-breast irradiation, we conducted a Phase I/II study to evaluate the role of a second conservative surgery and brachytherapy for patients presenting with a local recurrence/new primary in a breast who has previously undergone a lumpectomy and external radiation therapy for breast cancer.


METHODS
Fifteen patients with a localized lesion in the breast have undergone a second lumpectomy and received low-dose-rate brachytherapy on protocol. The first 6 patients received a dose of 30Gy. With no unacceptable acute toxicity observed, the brachytherapy dose was increased to 45Gy. Three patients received adjuvant chemotherapy and 8 patients are on antiestrogen therapy.


RESULTS
The median time interval between the primary breast cancer diagnosis and the second cancer event in the ipsilateral breast is 94 months (range, 28-211). With a median followup of 36 months after brachytherapy, the 3-year Kaplan-Meier overall survival, local disease-free survival and mastectomy-free survival are 100% and 89%, respectively. There was no Grade 3/4 fibrosis or necrosis observed. All patients had baseline asymmetry due to the breast volume deficit from the second lumpectomy. With breast asymmetry as a given, the cosmetic result observed in all patients has been good to excellent.


CONCLUSIONS
Early results suggest low-complication rates, high rate of local control and freedom from mastectomy. Additional studies are needed to establish whether a second lumpectomy and breast brachytherapy are an acceptable alternative to mastectomy for patients presenting with a localized cancer in a previously irradiated breast.
Chadha
Manjeet
M
Department of Surgery, Beth Israel Medical Center, New York, NY 10003, USA. mchadha@chpnet.org
Feldman
Sheldon
S
Boolbol
Susan
S
Wang
Lin
L
Harrison
Louis B
LB
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy* / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D012086:Reoperation
D007496:Iridium Radioisotopes