title: Reirradiation of recurrent breast cancer with and without concurrent chemotherapy.
abstract: BACKGROUND
  Treatment options for loco-regional recurrent breast cancer after previous irradiation are limited. The efficacy of chemotherapy might be hampered because of impaired tissue perfusion in preirradiated tissue. Thus, mastectomy or local excision and reconstructive surgery are the preferred treatments. However, in recent years evidence accumulates that a second breast conserving approach with reirradiation as part of the treatment might be feasible and safe and, furthermore, reirradiation might be an option for palliation. Here we report on the experience of a single community centre in reirradiation of recurrent breast cancer.
  
  
  METHODS
  The report is based on 29 patients treated with reirradiation. All data were prospectively collected. The median age was 63 years (range 35 to 82 yrs). The interval between initial diagnosis and diagnosis before start of reirradiation was 11.6 months to 295.5 months. The mean total dose (initial dose and reirradiation dose) was 106.2 Gy (range 80.4 to 126 Gy) and the mean BED3 Gy 168,5 Gy (range 130,6 to 201,6). The mean interval between initial radiotherapy and reirradiation was 92.9 months (range 8.7 to 290.1). Inoperable or incompletely resected patients were offered concurrent chemotherapy with either 5-FU or capecitabine. All patients received 3D-conformal radiotherapy with 1.6 to 2.5 Gy/fraction five times weekly. The treatment volume comprised all visible lesions or lesions detectable on CT/MRI/FDG-PET/CT or the tumour bed or recurrent tumour.
  
  
  RESULTS
  The local progression-free survival of all patients at one and two years was 81% and 63%. Patients who had no surgery of the recurrence (16/29) had local progression-free survival at one and two years of 72% and 25% with a median progression-free survival time of 17 months. Partial remission and good symptom relief was achieved in 56% (9/16) or complete response of symptoms and/or tumour in 44% (7/16). Patients who had no distant metastases and had at least an R1-resection had a local progression-free survival of 90% after 2 years. The disease-free survival after 2 years was 43% and the median disease-free survival time was 24 months. In four patients a second breast conserving operation was performed and the cosmetic results in all four patients are good to excellent. Acute side effects were mild to moderate with no grade 3 or 4 toxicity. Accordingly, no grade 3 or 4 late effects were observed so far. No grade 3 or 4 plexopathy was observed.
  
  
  CONCLUSIONS
  In this heterogeneous group of patients reirradiation of locoregional recurrences of breast cancer showed low to moderate acute toxicity. In our experience, local control rates are high and palliation is good.
authors.affiliation: GMP Radiologie & Radioonkologie im Struensee-Haus, Hamburg, Germany. wuerschmidt@ramoe.de
authors.forename: Florian
authors.initials: F
authors.lastname: Würschmidt
authors.forename: Jörg
authors.initials: J
authors.lastname: Dahle
authors.forename: Cordula
authors.initials: C
authors.lastname: Petersen
authors.forename: Claudia
authors.initials: C
authors.lastname: Wenzel
authors.forename: Matthias
authors.initials: M
authors.lastname: Kretschmer
authors.forename: Christoph
authors.initials: C
authors.lastname: Bastian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy; D010166:Palliative Care; D011878:Radiotherapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
references.citation: Strahlenther Onkol. 2002 Nov;178(11):633-6
references.pmid: 12426674
references.citation: Semin Radiat Oncol. 2007 Apr;17(2):99-107
references.pmid: 17395040
references.citation: Int J Radiat Oncol Biol Phys. 2002 Jul 1;53(3):687-91
references.pmid: 12062613
references.citation: N Engl J Med. 1989 Mar 30;320(13):822-8
references.pmid: 2927449
references.citation: Semin Radiat Oncol. 1994 Oct;4(4):260-269
references.pmid: 10717115
references.citation: Clin Cancer Res. 2002 Feb;8(2):374-82
references.pmid: 11839652
references.citation: Radiother Oncol. 1987 Jan;8(1):1-9
references.pmid: 3809596
references.citation: Strahlenther Onkol. 1991 Feb;167(2):93-7
references.pmid: 2000551
references.citation: Radiology. 2002 Dec;225(3):713-8
references.pmid: 12461250
references.citation: Int J Radiat Oncol Biol Phys. 1988 Dec;15(6):1407-13
references.pmid: 2461920
references.citation: Cancer Treat Rev. 2003 Feb;29(1):21-30
references.pmid: 12633577
references.citation: BMC Cancer. 2007;7:178
references.pmid: 17854511
references.citation: Br J Cancer. 1999 Feb;79(3-4):483-90
references.pmid: 10027317
references.citation: Cancer. 1989 May 15;63(10):1912-7
references.pmid: 2702564
references.citation: Int J Radiat Oncol Biol Phys. 1981 May;7(5):581-5
references.pmid: 6792170
references.citation: Int J Radiat Oncol Biol Phys. 1992;24(2):261-77
references.pmid: 1526865
references.citation: Cancer. 1995 May 1;75(9):2328-36
references.pmid: 7712444
references.citation: Int J Radiat Oncol Biol Phys. 2001 Jan 1;49(1):205-10
references.pmid: 11163516