Exeresis and brachytherapy as salvage treatment for local recurrence after conservative treatment for breast cancer: results of a ten-year pilot study.
OBJECTIVE
To analyze the long-term results of a pilot study assessing excision and brachytherapy as salvage treatment for local recurrence after conservative treatment of breast cancer.


METHODS
Between December 1990 and March 2001, 36 patients with breast-only recurrence less than 3 cm in diameter after conservative treatment for Stage I or II breast carcinoma were treated with local excision followed by high-dose rate brachytherapy implants (30 Gy in 12 fractions over a period of 5 days). No patient was lost to follow-up. Special attention was paid to local, regional, or distant recurrences; survival; cosmesis; and early and late side effects.


RESULTS
All patients completed treatment. During follow-up (range, 1-13 years), 8 patients presented metastases (2 regional and 6 distant) as their first site of failure, 1 had a differed local recurrence, and 1 died of the disease. Actuarial results at 10 years were as follows: local control, 89.4%; disease-free survival, 64.4%; and survival, 96.7%. Cosmetic results were satisfactory in 90.4%. No patient had Grade 3 or 4 early or late complications. Of the 11 patients followed up for at least 10 years, all but 1 still had their breast in place at the 10-year stage.


CONCLUSIONS
High-dose rate brachytherapy is a safe, effective treatment for small-size, low-risk local recurrence after local excision in conservatively treated patients. The dose of 30 Gy of high-dose rate brachytherapy (12 fractions over a period of 5 days twice daily) was well tolerated. The excellent results support the use of breast preservation as salvage treatment in selected patients with local recurrence after conservative treatment for breast cancer.
Guix
Benjamín
B
IMOR Foundation, Medical Institute for Radiotherapy and Oncology, Barcelona, Spain. bguix@imor.org
Lejárcegui
José Antonio
JA
Tello
José Ignacio
JI
Zanón
Gabriel
G
Henríquez
Iván
I
Finestres
Fernando
F
Martínez
Antonio
A
Fernandez-Ibiza
Jaume
J
Quinzaños
Luis
L
Palombo
Pau
P
Encinas
Xavier
X
Guix
Inés
I
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D010865:Pilot Projects; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000379:methods*; D013030:Spain; D013997:Time Factors; D047368:Tumor Burden