title: Pulsed reduced dose-rate radiotherapy: a novel locoregional retreatment strategy for breast cancer recurrence in the previously irradiated chest wall, axilla, or supraclavicular region.
abstract: OBJECTIVE
  Reirradiation of breast cancer locoregional recurrence (LRR) in the setting of prior post-mastectomy radiation poses a significant clinical challenge due to the high risk for severe toxicity. In an attempt to reduce these toxicities, we have developed pulsed reduced dose-rate radiotherapy (PRDR), a reirradiation technique in which a series of 0.2 Gy pulses separated by 3-min time intervals is delivered, creating an apparent dose rate of 0.0667 Gy/min. Here we describe our early experience with PRDR.
  
  
  METHODS
  We reirradiated 17 patients with LRR breast cancer to the chest wall, axilla, or supraclavicular region using PRDR. The median prior radiation dose was 60 Gy. We delivered a median PRDR dose of 54 Gy (range 40-66 Gy) in 1.8-2.0 Gy per fraction. Eight patients received concomitant low dose capecitabine for radiosensitization. The median treatment volume was 2,084 cm(3) (range 843-7,881 cm(3)).
  
  
  RESULTS
  At a median follow-up of 18 months (range 4-75 months) only 2 patients have had tumor failure in the treatment region. Estimated 2-year local control rate is 92%. Treatment was well tolerated with 4 patients experiencing grade 3 acute skin toxicity. Despite a median cumulative dose of 110 Gy (range 80-236 Gy), there has been only one grade 3 and one grade 4 late toxicity.
  
  
  CONCLUSIONS
  With a median follow-up of 18 months, PRDR appears to be an effective method to reirradiate large volumes of previously irradiated tissue in selected patients with locoregional chest wall, axilla, and supraclavicular recurrences.
authors.affiliation: Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Richards
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Tomé
authors.forename: H Ian
authors.initials: HI
authors.lastname: Robins
authors.forename: James A
authors.initials: JA
authors.lastname: Stewart
authors.forename: James S
authors.initials: JS
authors.lastname: Welsh
authors.forename: Peter A
authors.initials: PA
authors.lastname: Mahler
authors.forename: Steven P
authors.initials: SP
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001918:Brachytherapy; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002968:Clavicle / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011379:Prognosis; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D019233:Retreatment; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D035441:Thoracic Wall / Q000528:radiation effects*